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20-September-2008 10:21:21 - Calcific tendinitis Calcific tendinitis Classification and external resources ICD-10 M65.2 ICD-9 727.82 Calcific Tendinitis also calcific/calcifying/calcified/calcareous tenonitis/tendonitis/tendinopathy, and tendinosis calcarea is a disorder characterized by deposits of hydroxyapatite a crystalline calcium phosphate in any tendon of the body, but most commonly in the tendons of the rotator cuff shoulder, causing pain and inflammation. Pain is often aggravated by elevation of the arm above shoulder level or by lying on the shoulder. Pain may waken the patient from sleep. Other complaints may be stiffness, snapping, catching, or weakness of the shoulder. The condition is related to and may cause frozen shoulder. The calcific deposits are visible on X-ray as discrete lumps or cloudy areas. The deposits look cloudy on X-ray if they are in the process of re-absorption, and this is also when they cause the most pain. The deposits are crystalline when in their resting phase and like toothpaste in the re-absorptive phase. However, poor correlation exists between the appearance of a calcific deposit on plain x-rays and its consistency on needling. Contents 1 Treatment 1.1 Dietary calcium restriction 1.2 Magnesium supplementation 1.3 Extracorporeal shock wave therapy ECSW 1.4 Medications 1.5 Physical therapy 1.6 Iontophoresis 1.7 Injections, needling, and lavage 1.8 Corticosteroid injections 1.9 Surgery 2 See also 3 References 4 External links Treatment Dietary calcium restriction A controversial topic, this conservative treatment can be very effective for some patients, and reports of pain cessation with strict dietary calcium restriction have been documented. Dietary restriction applies to all milk products, nuts that have a high calcium content, calcium-fortified products and high calcium vegetables and snacks. Food nutritional labels are helpful in determining foods to restrict. If no improvement is noted after three months, other treatment modalities should be tried. It is assumed the body scavenges the pathological calcium deposits when dietary calcium is restricted. Studies are required in this area. Magnesium supplementation Low magnesium levels can result in calcium deposition in soft tissues. Therefore magnesium supplementation may prevent the formation of calcifications.1 Extracorporeal shock wave therapy ECSW ECSW uses sound waves focused onto the deposit. It works by an unknown mechanism in this disorder. In some German studies, 30-70% of patients obtained pain relief, and, in 20-77% of cases, the calcific deposit disappeared or disintegrated. Medications Analgesics and non-steroidal anti-inflammatory drugs NSAID are useful to a limited extent. Physical therapy Electroanalgesia, ice therapy, and heat offer symptomatic relief. The benefit of ultrasound in calcific tendinitis is debated; most studies are negative but a study by Ebenbichler et al 1999 showed resolution of deposits and clinical improvement. Iontophoresis In studies, acetic acid iontophoresis combined with ultrasound provided no better clinical results or shrinkage of the calcific deposits than did no treatment. Injections, needling, and lavage Under local anesthetic, the calcific deposits can be mechanically broken up by puncturing them repeatedly with a needle and then aspirating the calcific material with the help of a sluice of saline. About 75% of patients are helped by this procedure. Ultrasound can be used to help localize the deposit and to visualize the needle entering the deposit in real time. Corticosteroid injections These may be useful when the shoulder is acutely inflammed but otherwise are not generally useful. Surgery Removing the deposit/s either with open shoulder surgery or arthroscopic surgery are both difficult operations, but with a high success rates around 90%. About 10% require re-operation. If the deposit is large then frequently the patient will require a rotator cuff repair to fix the defect left in the tendon when the deposit is removed or to reattach the tendon to the bone if the deposit was at the tendon insertion into the bone. See also Tendinitis References ^ Planells E, Llopis J, Perán F, Aranda P. 1995. Changes in tissue calcium and phosphorus content and plasma concentrations of parathyroid hormone and calcitonin after long-term magnesium deficiency in rats.. J Am Coll Nutr. 14 3: 292-8. PMID 8586780. Ebenbichler GR, Erdogmus CB, Resch KL, et al May 1999. Ultrasound therapy for calcific tendinitis of the shoulder. N. Engl. J. Med. 340 20: 1533-8. PMID 10332014. External links Orthogate Calcific Tendonitis of the Shoulder Calcific tendonitis causes treatment page Management of calcifying tendonitis of the shoulder. eMedicine on Calcific Tendonitis Extracorporeal shock wave therapy v d e Diseases of the musculoskeletal system and connective tissue M, 710-739 Arthropathies Arthritis Septic arthritis - Reactive arthritis - Rheumatoid arthritis - Psoriatic arthritis - Felty syndrome - Juvenile idiopathic arthritis - Still's disease - crystal Gout, Chondrocalcinosis - Osteoarthritis Heberden's node, Bouchard's nodes - Monoarthritis/Polyarthritis Specific joints shoulder Winged scapula - elbow Cubitus valgus, Cubitus varus - hand Wrist drop, Boutonniere deformity, Swan neck deformity hip Protrusio acetabuli, Coxa valga, Coxa vara - leg Foot drop, Flat feet, Club foot, Unequal leg length - patella Luxating patella, Chondromalacia patellae - foot Bunion/hallux valgus, Hallux varus, Hallux rigidus, Hammer toe general terms Valgus deformity, Varus deformity Other Hemarthrosis - Arthralgia - Osteophyte - Hypermobility Systemic CT disorders vasculitis: Arteritis Polyarteritis nodosa, Takayasu's arteritis, Temporal arteritis - arterioles/capillaries Wegener's granulomatosis, Kawasaki disease, Churg-Strauss syndrome, Microscopic polyangiitis hypersensitivity/autoimmune: Hypersensitivity vasculitis - Goodpasture's syndrome - Systemic lupus erythematosus Drug-induced - Dermatomyositis Juvenile dermatomyositis - Polymyositis - Scleroderma - Sjögren's syndrome - Behçet's disease - Polymyalgia rheumatica - Eosinophilic fasciitis Dorsopathies spinal curvature Kyphosis, Lordosis, Scoliosis - Scheuermann's disease - Spondylolysis - Torticollis - Spondylolisthesis Spondylopathies Ankylosing spondylitis, Spondylosis, Spinal stenosis - Schmorl's nodes - Degenerative disc disease - Coccydynia - Back pain Radiculopathy, Neck pain, Sciatica, Low back pain Soft tissue disorders Muscle Myositis Pyomyositis - Myositis ossificans Fibrodysplasia ossificans progressiva Synovium and tendon Synovitis/Tenosynovitis Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome - Irritable hip - Ganglion cyst Bursa Bursitis Olecranon, Prepatellar, Trochanteric - Baker's cyst Fascia/fibroblastic Fasciitis Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis - Dupuytren's contracture - Fibromatosis Shoulder lesions Adhesive capsulitis - Rotator cuff tear - Subacromial bursitis Enthesis Enthesopathies Iliotibial band syndrome, Achilles tendinitis, Patellar tendinitis, Golfer's elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis Other, NEC Muscle weakness - Rheumatism - Myalgia - Neuralgia - Neuritis - Panniculitis - Fibromyalgia Osteopathies disorders of bone density and structure: Osteoporosis - Osteomalacia - continuity of bone Pseudarthrosis, Stress fracture - Monostotic fibrous dysplasia - Skeletal fluorosis - Aneurysmal bone cyst - Hyperostosis - Osteosclerosis Osteomyelitis - Avascular necrosis - Paget's disease of bone - Algoneurodystrophy - Osteolysis - Infantile cortical hyperostosis Chondropathies Juvenile osteochondrosis Legg-Calvé-Perthes syndrome, Osgood-Schlatter disease, Köhler disease, Sever's disease - Osteochondritis - Tietze's syndrome - Relapsing polychondritis See also congenital Retrieved from http://en..org/wiki/Calcific_tendinitis Categories: Diseases involving the fasciae | Pathology | Orthopedics Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Hrvatski Italiano Nederlands This page was last modified on 31 July 2008, at 03:26
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