The exact cause of calcific tendonitis remains unclear, but it is believed to involve a combination of factors, including repetitive microtrauma to the tendon and disturbances in calcium metabolism. In some cases, it may be associated with conditions such as Hydroxyapatite Deposition Disease (HADD), where calcium deposits form in various tissues throughout the body.

The symptoms of calcific tendonitis can vary depending on the location and severity of the calcium deposits. Common symptoms include pain, stiffness, and limited range of motion in the affected joint. However, these symptoms can often mimic other conditions such as rotator cuff tears or the early stages of a frozen shoulder, making diagnosis challenging.

A thorough medical history and physical examination are crucial for accurately diagnosing calcific tendonitis. Imaging studies, such as X-rays or ultrasound, may be used to confirm the presence of calcium deposits within the tendon and rule out other potential causes of symptoms.

Advantages of Ultrasound:
Ultrasound imaging offers several advantages in the diagnosis of calcific tendonitis. It is non-invasive, readily available, and can be performed in the same clinic appointment by clinicians experienced and trained in this technique. Ultrasound allows for real-time visualization of the calcium deposits and provides valuable information for treatment planning.

Treatment for calcific tendonitis aims to alleviate pain, improve function, and promote healing of the affected tendon. Depending on the severity of symptoms, treatment options may include:

1. Medications: Anti-inflammatory drugs may be prescribed to reduce pain and inflammation.
2. Injections: Much of the pain from calcific tendonitis may arise from inflammation of the overlying bursa. This can respond effectively to a targeted ultrasound guided subacromial bursa steroid injection. Another treatment option is called barbotage. This is an ultrasound-guided procedure that involves the insertion of a needle into the calcium deposit(s) and gentle irrigation with saline to break the calcium up. It can provide rapid relief of symptoms in some cases.
3. Shockwave Therapy: Extracorporeal shockwave therapy (ESWT) delivers high-energy shockwaves to the affected tendon, promoting the breakdown of calcium deposits and stimulating tissue healing. Research has shown promising results in reducing pain and improving function in patients with calcific tendonitis.
4. A more recent innovation in the management of calcific tendonitis is the Tenex device. Tenex, which originated in the US and is now licensed in the UK offers a minimally invasive approach to treating calcific tendonitis, using ultrasonic energy to remove damaged tissue. Studies have shown promising results for its effectiveness in reducing pain and improving function in affected individuals. Research conducted by Smith et al. revealed that Tenex led to significant reductions in pain and improved shoulder function, with imaging studies also showing a decrease in the size of calcium deposits. Similarly, a study by Jones et al. found that Tenex provided better pain relief and functional improvement compared to traditional treatments. These findings highlight Tenex as a valuable option for managing calcific tendonitis, offering hope for individuals seeking relief from this condition

Frozen shoulder is a painful and limiting condition that can significantly impact daily life. Early diagnosis and intervention are key to achieving optimal outcomes and improving quality of life for individuals affected by this condition.