From the Guidelines
Calcific tendinopathy occurs due to a complex interplay of factors, including age-related tendon degeneration, repetitive microtrauma, and decreased local blood supply to tendons, leading to the formation of calcium hydroxyapatite crystal deposits within tendons. The exact cause of calcific tendinopathy remains unclear, but several factors contribute to its development, such as genetic predisposition, metabolic disorders affecting calcium regulation, and hormonal factors 1. The condition is more common in women, particularly during pre-menopausal years, and typically affects the rotator cuff tendons of the shoulder.
Key Factors Contributing to Calcific Tendinopathy
- Age-related tendon degeneration
- Repetitive microtrauma from overuse
- Decreased local blood supply to tendons
- Genetic predisposition
- Metabolic disorders affecting calcium regulation
- Hormonal factors
The calcium deposits in calcific tendinopathy form through a cycle of formation and resorption phases, with symptoms often being most severe during the resorptive phase when the body attempts to remove the deposits 1. Understanding these mechanisms helps explain why treatments focus on managing inflammation, promoting natural resorption of deposits, and addressing underlying factors like biomechanical issues that contribute to tendon stress.
Diagnostic Approaches
Diagnostic approaches for calcific tendinopathy may include plain radiography, ultrasonography, and magnetic resonance imaging (MRI) to detect calcium deposits and assess tendon damage 1. These imaging studies can help guide treatment decisions and monitor the progression of the condition.
Treatment Considerations
Treatment for calcific tendinopathy typically involves a combination of rest, icing, and eccentric strengthening exercises to promote tendon healing and reduce pain 1. Nonsteroidal anti-inflammatory drugs (NSAIDs) and topical NSAIDs may also be used to relieve pain and inflammation. In some cases, injected corticosteroids or surgery may be necessary to address underlying tendon damage or promote healing.
From the Research
Causes of Calcific Tendinopathy
- Calcific tendinopathy (CT) is a self-limiting condition that affects otherwise-healthy tendon with deposition of calcium hydroxyapatite crystals between healthy tenocytes 2
- The aetiopathogenesis of CT is still controversial, but seems to be the result of an active cell-mediated process and a localized attempt of the tendon to compensate the original decreased stiffness 3
- Current theories indicate that CT may be the result of a cell-mediated process in which, after a stage of calcium deposition, calcifications are spontaneously resorbed 4
- Genetic factors may also play a significant role in the aetiopathogenesis of tendinopathy, with genes such as ABO, COL5A1, and tenascin-C implicated 5
Pathogenesis of Calcific Tendinopathy
- Tendon healing includes many sequential processes, and disturbances at different stages of healing may lead to different combinations of histopathological changes, diverting the normal healing processes to an abnormal pathway 3
- The presence of calcific deposits may worsen the clinical manifestations of tendinopathy with an increase in rupture rate, slower recovery times and a higher frequency of post-operative complications 3
- Recent literature shows an emerging role of biological and genetic factors underlying CT, which may explain why the majority of the therapies currently in use are only able to provide partially satisfactory outcomes 4
Factors Contributing to Calcific Tendinopathy
- Intrinsic and extrinsic factors, as well as genetic make-up, may increase the likelihood of one individual developing tendinopathy over another 5
- An interaction between the various intrinsic and extrinsic factors with the genetic make-up of an individual may contribute to the development of tendinopathy 5