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Calcific tendonitis is the name given to a shoulder condition in which there is a slow accumulation of calcium, usually in the body of the supraspinatus tendon. As the calcification builds up over time, it becomes chalk-like.

 There may not be symptoms, since there are no vascular or cellular reactions taking place in this stage. This disease goes through a chronic period before it ever reaches an acute stage. Some of the symptoms in this chronic stage may be localized tenderness at the anterior portion of the shoulder near the anterior acromion, pain while sleeping on the side of the pain, and a painful arc between 70 and 110 degrees of abduction. Patients may feel a catching upon shoulder elevation and an impingement between the calcium deposit and the coracoacromial ligament. Sometimes, a painful arc may be the only finding.

If spontaneous resorption of the calcium occurs, the condition progresses to the acute stage, and the calcium will be removed by macrophages and giant cells. During this phase, there is extremely acute pain, and the calcific deposit develops a thick, white, toothpaste-like consistency.There is vascular proliferation and an increase in cells, which raises the intratendinous pressure, causing pain as the tendon impinges on the surrounding bursa. Interestingly, during the chronic stage, the presence of calcium is usually painless, and as it dissipates, the pain increases. Excruciating pain may last from one to 14 days, but the condition is self-limited. If the deposit ruptures spontaneously, the patient will experience immediate relief. However, if the excruciating, acute pain persists, the patient may have to be referred for needling or aspiration.

Treatment in the acute stage may require an arm sling, ice and various modalities. Techniques such as ART, Graston Technique and friction massage are contraindicated. The calcium deposit will be tender under direct pressure. In the chronic stage, the above techniques may be useful if there is not severe tenderness over the area.