Ultrasound-Guided Cortisone Injections for Calcific Tendinopathy

 

Introduction

Calcific tendinopathy is a condition characterised by the deposition of calcium within tendons, most commonly in the shoulder's rotator cuff. This condition can cause pain, stiffness, and restricted movement, impacting daily activities. While the exact cause of calcium deposits remains unclear, they can lead to inflammation and mechanical irritation of surrounding structures.

At Alton Pain Clinic, we offer a range of treatment options for calcific tendinopathy, including ultrasound-guided cortisone injections, which are selectively used to help manage pain and inflammation. This blog provides a comprehensive overview of calcific tendinopathy, from its anatomy and pathology to its symptoms, diagnosis, treatment options, and the role of cortisone injections in its management.



Anatomy of the Affected Tendons

Tendons are strong, fibrous tissues that connect muscles to bones, enabling movement and stability. Calcific tendinopathy most commonly affects the rotator cuff tendons in the shoulder, particularly the supraspinatus tendon. However, it can also occur in other tendons, such as those in the hip, elbow, and Achilles region.

Key Structures Involved in the Shoulder

  • Rotator Cuff Muscles and Tendons – Provide stability and facilitate shoulder movements.
  • Supraspinatus Tendon – The most commonly affected tendon in calcific tendinopathy.
  • Subacromial Bursa – A fluid-filled sac that reduces friction between the tendons and bones, which may also become inflamed due to calcium deposits.
  • Acromion – The bony projection of the scapula that forms the highest point of the shoulder.

When calcium deposits form within a tendon, they can cause irritation, inflammation, and increased pressure, leading to pain and restricted movement.


Pathology of Calcific Tendinopathy

Calcific tendinopathy occurs in distinct phases, each contributing to the symptoms and progression of the condition.

1. Pre-Calcific Stage

  • The tendon undergoes cellular changes, making it more susceptible to calcium deposition.
  • No symptoms are typically present during this phase.

2. Calcific Stage

This stage is divided into three sub-phases:

  • Formative Phase – Calcium deposits begin to accumulate within the tendon.
  • Resting Phase – The deposits remain stable, sometimes without causing symptoms.
  • Resorptive Phase – The body initiates an inflammatory response to break down the calcium, often causing significant pain.

3. Post-Calcific Stage

  • The calcium deposits are gradually absorbed, and the tendon begins to heal.
  • Pain and inflammation subside over time.

The resorptive phase is usually the most painful, as inflammation peaks and can lead to significant discomfort and restricted movement.

Causes and Risk Factors

The exact cause of calcific tendinopathy remains unclear, but several factors may contribute to its development.

Intrinsic Factors

  • Ageing – Most commonly affects individuals between 30 and 60 years old.
  • Reduced Tendon Blood Supply – Leads to metabolic changes that may trigger calcium deposition.
  • Degenerative Changes – Structural wear and tear in tendons.

Extrinsic Factors

  • Repetitive Overuse – Common in athletes and individuals with physically demanding jobs.
  • Mechanical Stress – Poor posture or repetitive overhead movements may contribute to the condition.
  • Hormonal Influences – Some studies suggest a link between calcific tendinopathy and hormonal imbalances.

Symptoms of Calcific Tendinopathy

Symptoms can vary depending on the stage of the condition, with the resorptive phase often being the most painful.

  • Pain – Ranges from mild discomfort to severe, sharp pain, particularly during the resorptive phase.
  • Shoulder Stiffness – Reduced range of motion, making it difficult to lift the arm.
  • Night Pain – Increased discomfort when lying on the affected side.
  • Weakness – Reduced strength due to pain and inflammation.
  • Swelling and Tenderness – Localised inflammation may be present.

Pain may develop suddenly or gradually, depending on the progression of calcium deposits.

Diagnosis of Calcific Tendinopathy

A thorough assessment is necessary to confirm the diagnosis and determine the severity of the condition.

Diagnostic Methods

  1. Medical History – Evaluating symptoms, onset, and any previous injuries.
  2. Physical Examination – Assessing range of motion, tenderness, and functional limitations.
  3. Ultrasound Imaging – Provides real-time visualisation of calcium deposits and inflammation.

At Alton Pain Clinic, ultrasound imaging plays a crucial role in diagnosing calcific tendinopathy and guiding treatment options.

Management of Calcific Tendinopathy

Treatment aims to reduce pain, inflammation, and improve tendon function.

Conservative Management

  • Activity Modification – Avoiding movements that aggravate symptoms.
  • Cold Therapy – Applying ice packs to reduce swelling.

Interventional Management

  • Ultrasound-Guided Cortisone Injections – Used selectively for pain and inflammation management.

Ultrasound-Guided Cortisone Injections for Calcific Tendinopathy

Cortisone injections are a form of corticosteroid treatment used selectively to help manage pain and inflammation associated with calcific tendinopathy. These injections are administered under ultrasound guidance to ensure precision.

Mechanism of Action

Cortisone injections work by:

  • Reducing Inflammation – Corticosteroids inhibit inflammatory mediators, reducing pain and swelling.
  • Suppressing Immune Response – Minimising excessive immune activity that contributes to tendon irritation.
  • Modulating Pain Signals – Temporary reduction in pain transmission from affected tissues.

Ultrasound guidance ensures that the injection is delivered precisely into the inflamed area, improving accuracy and effectiveness.

Benefits of Ultrasound-Guided Cortisone Injections

  • Accurate Targeting – Ensures precise delivery into the affected tendon or bursa.
  • Minimised Risk – Reduces the likelihood of unnecessary tissue damage.
  • Real-Time Visualisation – Enhances safety and effectiveness.

At Alton Pain Clinic, we use ultrasound imaging to optimise the accuracy of cortisone injections for calcific tendinopathy.

Considerations and Precautions

While cortisone injections may provide temporary relief, they are used selectively. Excessive use of corticosteroids may lead to potential side effects, including tendon weakening. Therefore, these injections are typically reserved for cases where pain significantly impacts daily activities and conservative treatments have not provided sufficient relief.

Conclusion

Calcific tendinopathy can cause significant pain and movement limitations, particularly during the resorptive phase. While conservative treatments often help manage symptoms, interventional options such as ultrasound-guided cortisone injections may be considered in specific cases.

At Alton Pain Clinic, we offer advanced, precision-guided treatments to help manage calcific tendinopathy effectively. If you are experiencing persistent shoulder pain, a thorough assessment can help determine the most suitable course of action.

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