In calcific tendonitis, deposits of calcium form within the rotator cuff tendons. The deposits irritate the tendon and the surrounding tissue, which can cause intense shoulder pain, particularly when the deposit is inflamed.
Excision of calcium is a keyhole (arthroscopic) operation that removes those deposits. It is often performed together with another procedure, such as an acromioplasty, where that is also required.
The procedure
The deposit is usually found by looking for the inflamed area on the surface of the tendon. Its exact position is then confirmed by probing with a needle until calcium appears at the needle tip.
A small incision is made in the tendon running lengthwise, in line with the direction of the tendon fibres, so that as little of the tendon as possible is disturbed. The calcium is then removed using an arthroscopic shaver and a curette.
Occasionally the gap left behind after the calcium is removed is large enough that a rotator cuff repair is needed. Where that happens, the sling and rehabilitation requirements change, and this is explained to you afterwards.
Risks and complications
All surgery carries risk. The risks below are the ones that matter most for this operation, and the ones that apply to you are discussed with you in consultation before any decision is made.
General surgical risks
-
Bruising and haematoma. The amount of bruising varies from patient to patient. Bruising is a normal consequence of surgery and usually settles within a short time. A haematoma is a collection of blood that occasionally needs to be drained in theatre.
-
Infection. Infection is rare but possible, and is usually treated with antibiotics.
-
Deep vein thrombosis and pulmonary embolism. Blood clots can form in the veins of the leg and can travel to the lung. The risk of serious harm is significantly reduced when a clot is recognised and treated promptly.
-
Anaesthetic risks. These are discussed with your anaesthetist before surgery. The risk of death from a general anaesthetic in Australia is approximately 1 in 100,000.
-
Wound problems. Superficial wound problems can occur. Most need only a small intervention.
Risks specific to this procedure
-
Recurrent calcium deposits. Calcium can form again in the tendon after it has been removed.
-
Shoulder bursitis. Inflammation of the bursa can develop. See subacromial bursitis.
-
Shoulder impingement. See shoulder impingement.
-
Frozen shoulder. This occurs in approximately 3% of patients after this operation. It resolves with time. Where it is severe it makes rehabilitation longer and harder, and most people still recover good function, although it takes longer to get there. See frozen shoulder.
Before surgery
- Confirm with your health fund that the hospital fee is covered.
- Confirm the anaesthetist’s fees.
- Register your details with the hospital.
- Read, complete and return the paperwork to the office.
- Plan your transport to and from hospital. You cannot drive yourself home.
- Attend any recommended pre-operative physiotherapy.
- Complete any requested pre-operative pathology, such as blood tests.
- Confirm your admission details with the office one to two business days before surgery.
Skin preparation
Use a benzoyl peroxide 5% wash on the operative shoulder, five applications in total: twice daily for two days, then once more on the morning of surgery. This reduces the risk of infection from Cutibacterium acnes, a bacterium that lives in the skin around the shoulder.
Packing and medications
- Pack your regular medications in their original packaging, a loose button-up shirt, nightwear and toiletries. Bring your CPAP machine if you have sleep apnoea.
-
Blood thinners. Call the office to confirm when to stop these before surgery.
-
Diabetes tablets. Call your anaesthetist to confirm whether to stop these.
The day of surgery
Your admission details are confirmed with the office one to two business days beforehand. Note both your admission time and your fasting time. Admission can be as early as 6am, so patients who live outside Brisbane are usually advised to stay in Brisbane the night before. See accommodation for options near the hospital.
After the admissions process you wait in the surgical waiting area. You have a short consultation with your anaesthetist before your general anaesthetic, and Dr Cutbush greets you in the anaesthetic bay and marks the operation site.
The hospital stay is usually one night, with discharge around 10am. You are reviewed before discharge and given a folder containing a letter describing the findings and the operation performed, together with your rehabilitation and post-operative care information. You will need someone to take you home.
Recovery and healing
In most cases nothing is repaired during this operation, so there is no repair to protect and movement can start straight away. Physiotherapy begins immediately after surgery.
A sling is not required. You may choose to wear one during the first week for comfort, with the aim of stopping within that week. Do not drive during the first week.
Most people take approximately 6 weeks to recover, although symptoms can persist for up to 12 weeks. Your post-operative review is normally at 6 weeks.
Rehabilitation
The aims of rehabilitation are to regain your range of motion, to build strength, and to be able to use the shoulder with little to no pain.
Day one
The goal on day one is gentle function and restoring both passive and active range of motion.
An important point of understanding before you leave hospital: in most cases no surgical repair was performed, so it is safe to start moving the shoulder and you will not pull anything apart by using it gently.
The sling is for comfort only, with the aim of stopping it within one week. The physiotherapist checks that it fits and practises showering and dressing with you.
For everyday activities, light use of the arm for dressing and eating is fine within the limits of your pain. Avoid repetitive or loaded work above chest height. Pain is managed with ice, positioning, attention to posture, and the pain medication you have been prescribed.
Exercises and precautions
There is no range of motion limitation after this operation. Active-assisted range of motion exercises begin on day one, concentrating initially on forward flexion and external rotation:
- Circular pendulum.
- Active-assisted external rotation at neutral.
- Supine flexion.
- Forward lean on a bench.
- Horizontal flexion.
- Supine hand to head.
- Internal rotation, hand to hip, with the shoulder blade in neutral.
Video demonstrations of these exercises are included with your rehabilitation information.
Follow-up
-
Week 2. See your local physiotherapist, who checks that both your active and your passive range of motion are improving.
-
Week 6. Review with Dr Cutbush and the shoulder physiotherapist.
Results after surgery
Most people experience a substantial reduction in pain and an improvement in shoulder function after this operation. Individual results vary.
It is worth knowing that rehabilitation is often slower than people expect, and frequently takes at least four months. Some aching in the shoulder for a period after surgery is not uncommon.
Next steps
This page is general information about a surgical procedure and is not a recommendation that you have it. Whether surgery is appropriate for you can only be determined after assessment. All surgery carries risk; the risks relevant to you are discussed in consultation before any decision is made.
