Tendon calcification

Any tendon in the body can “calcify”, but tendons in the shoulder, elbow, knee or Achilles tendon are particularly often affected. Tendon calcification is usually manifested by pain in the affected area. It can be treated well, for example with painkillers, physiotherapy, injections or extracorporeal (outside the body) shock wave therapy.

What is tendon calcification?

In the case of tendon calcification, fine calcium crystals are deposited on the tendons or tendon attachments. In principle, all tendons in the body can be affected. However, tendon calcification is particularly common in the shoulder. This clinical picture is called “calcific shoulder” or medically “tendinosis calcarea”. But the patellar, Achilles or elbow tendons can also calcify. In this case, experts speak of patellar tendinitis, Achillodynia and tennis or golfer’s elbow.

The causes of tendon calcification can vary. They range from overloading and incorrect loading, circulatory disorders due to ageing and wear and tear processes to injuries caused by accidents or falls. Some sports in particular can put a strain on the tendons, such as golf, tennis, throwing, running or jumping sports.

The main symptoms of tendon calcification are pain in the affected area of the body, for example the shoulder, knee, elbow or Achilles heel. They can occur during physical exertion and later also at rest.

We treat tendon calcification with the help of various therapies, such as physiotherapy, painkillers, injections or high-energy, focused extracorporeal shock wave therapy (ESWT). Then the chances are good that the tendon calcification will improve again.

Tendon calcification – frequency and age

The frequency of tendon calcification is not exactly known. In principle, any tendon in the body can become calcified and the disease can affect people of any age. There is a risk for athletes who practise throwing, jumping or running sports. You can overload or misload the tendons during sport. However, people who work in certain manual occupations can also suffer from tendon calcification. Degradation processes and signs of wear and tear, on the other hand, play a greater role with sporting activity, but also with increasing age.

Tendon calcification: causes and risk factors

In the case of tendon calcification, the tendon tissue is remodeled and calcium crystals accumulate on the tendon or at the tendon insertion. However, the disease does not develop overnight, but usually develops gradually. There are various causes and risk factors for tendon calcification, for example:

• Overloading or incorrect loading, for example during sport or overhead work at work,
• degenerative breakdown processes and signs of wear and tear – sporting activities are also a common cause here,
• Injuries to the tendon, for example due to an accident.

Experts suspect that reduced blood circulation and metabolic disorders in the tissue promote tendon calcification. The tendon tissue is converted into cartilage tissue. Subsequently, calcium is deposited there and replaces the original tendon tissue. Larger calcium deposits of a few millimeters can be seen very well on ultrasound and X-ray images. The tendon structure can also be assessed in the ultrasound examination.

Clinical pictures depending on the location of the tendon calcification

Depending on the tendon affected, we distinguish between different clinical pictures. Some examples:

• Calcified shoulder (tendinosis calcarea): Calcified shoulder usually affects the tendons of the rotator cuff. This comprises four muscles that stabilize the shoulder joint and hold the humeral head in the socket, but also ensure its mobility. The tendons of these four muscles all attach to the humeral head. The tendon of the supraspinatus muscle is particularly often affected. Calcified shoulder affects, for example, throwing athletes or people who work a lot above their head.
• Tennis elbow (Epicondylopathia radialis): The tendons and the bone-tendon junction on the hand and finger extensor muscles on the outer elbow are diseased (epicondylus humeri radialis), whereby calcification does not always have to occur for this diagnosis, it is often just an irritation of the tendon.
• Golfer’s elbow (ulnar epicondylopathy): The tendons and the bone-tendon junction on the inner elbow (ulnar humeral epicondyle) are affected.
• Patella tip syndrome (“jumpers knee”): The bone-tendon junction at the kneecap (patella) is damaged. Overloading of the kneecap particularly often affects people who do jumping and ball sports (e.g. high jump, long jump, volleyball, basketball) as well as weightlifters or joggers who run on hard surfaces.
• Achillodynia: The damage affects the Achilles tendon, which connects the calf muscle to the heel bone.

Symptoms: tendon calcification is usually painful

The main symptoms of tendon calcification are pain in the affected area of the body. The intensity of the pain varies from person to person. The intensity of the pain also depends on the stage of the disease and the respective stress situation. The pain may occur:

• during physical exertion,
• before, during and after physical activity,
• at rest – without strain,
• when pressure, stretching or traction is applied to the calcified tendon.

In addition, tendon calcification can be associated with inflammatory symptoms such as swelling, overheating or redness as well as swelling due to calcification. In most cases, the function, mobility and range of motion of the affected extremity are restricted.

Tendon calcification: diagnosis at the USZ

The first indication of the diagnosis of “tendon calcification” is provided by a discussion of your medical history, the anamnesis. For example, we ask you the following questions:

• What symptoms do you experience exactly?
• Where are the symptoms localized? For example, shoulder, elbow, knee, foot?
• Can you show exactly where the pain is located?
• How intense are your symptoms?
• How long have the symptoms been present?
• Are there situations in which the symptoms worsen or improve? For example, under stress, at rest?
• Do you play sport? If yes: Which sport? Since when? Competitive or amateur sport?
• Is there anything you no longer do because of your complaints?
• Do you have any known illnesses or injuries?
• What is your profession?

Based on your answers, we can already make an initial assessment of what could be the cause of your complaints. This is followed by a physical examination. We

• carefully and thoroughly palpate the muscles, tendons and joints in the affected body region,
• check whether pain can be felt when moving, pulling, pressing or stretching,
• look for swelling or redness,
• test whether the body area feels overheated,
• check how well the joints can move and whether the function or range of movement is restricted,
• pay attention to any misalignments, incorrect weight-bearing and poor posture
• observe the movement pattern during spontaneous everyday movements.

Imaging procedures are then usually used to visualize damage, inflammatory processes and calcifications in the tendon. Examples of examination methods for tendon calcification are

• Ultrasound examination (sonography): This method uses ultrasound waves, which can make changes to the tendon visible.
• X-ray examinationCalcium deposits on the tendons or tendon insertions are usually clearly visible on the X-ray.
• Magnetic resonance imaging (MRI = magnetic resonance imaging): A method that works with strong magnetic fields and images the body slice by slice. The radiologist obtains detailed cross-sectional images of soft tissues such as tendons, muscles and tissue.

Tendon calcification: prevention, early detection, prognosis

The causes of tendon calcification are usually overloading and incorrect loading of the affected tendon, for example during sport or at work. You may be able to prevent tendon calcification if you:

• practise gentle and correct movement sequences. Learn running, throwing, jumping and striking techniques from professional trainers and not on your own. The right technique is also important in weightlifting to avoid putting incorrect or excessive strain on muscles and tendons.
• change incorrect movement patterns quickly,
• warm up well before the sporting activity,
• pay attention to gentle movement sequences and patterns at work. Sometimes aids can help to support the musculoskeletal system and thus prevent overloading and incorrect loading.

Special measures for the early detection of incipient tendon calcification are not known. See your doctor if you have prolonged pain in your shoulder, elbow, knee or Achilles tendon. It is also a case for the doctor if the pain increases continuously or even occurs at rest. Tendon calcification can be treated well. We can help to alleviate the symptoms and reduce the calcification.

Progression and prognosis of tendon calcification

The course and prognosis of tendon calcification cannot be predicted. Sometimes the body dissolves the calcifications itself. In general, the prognosis is good. However, it can take a few weeks or months for the symptoms to improve as a result of the therapy. And you must actively participate in the treatment yourself: Try to correct unfavorable movement sequences with the help of physiotherapy and avoid overloading and incorrect loading. This benefits not only your tendons, but your entire musculoskeletal system.

Tendon calcification: treatment with several options

In principle, the body is able to break down the calcium deposits and remove them itself. The tendon calcification will then heal on its own and you will not need therapy. However, this does not always happen.

We can support the body with suitable therapies. However, some treatments take some time. You should expect to wait several weeks or months for the treatment to be successful. It is also important that you do not put too much strain on the affected limb, but do not rest it completely either. You should definitely keep moving. You will find the most important therapies in the treatment details.