X-ray shows calcium buildup in shoulder may be cause of pain. What is this from?

Q: My shoulder has been hurting so my doctor ordered an X-ray. This showed calcium buildup, and she said that was causing the pain. What is this from?

A: It seems you are describing calcific tendonitis of your shoulder, and that is what I will focus on today. Double check with your doctor to make sure that is what she said you have.

Calcium is the most abundant mineral in the human body, stored in and helping make up/give strength to our bones and teeth. It is also critical in the biochemistry that helps our muscles move, nerve signals to be carried from the brain, our blood to clot, many hormones/other chemicals to be released from various organs, and to keep our heart beating normally, among other functions.

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With calcium performing so many vital functions, it should not be surprising that it can sometimes also cause problems. The blood levels of calcium are tightly regulated by the parathyroid glands, but despite this issues with calcium blood levels can occur, whether due to problems with the parathyroid gland, due to vitamin D abnormalities (vitamin D, which can come from food intake or be made by the body when our skin is exposed to sunlight, is needed for the body to absorb calcium from food, so abnormal vitamin D levels can cause abnormal calcium regulation) or for other reasons.

Abnormal blood levels of calcium can affect many body functions. For example, high calcium levels (hypercalcemia) can cause gastrointestinal issues (constipation, others), kidney issues, problems with bones, muscles issues, heart issues (including arrythmias), brain issues, and other problems. Low levels of blood calcium (called hypocalcemia) can cause muscle problems, brain issues (ranging from confusion to seizures to other symptoms), bone/teeth issues, eye cataracts and many other issues.

Even with normal blood levels of calcium, calcium can build up in many places in the body, although the cause(s) of this is often not well understood. In many cases this buildup can be benign and cause no problems (and may even clear on its own over time), but it can sometimes cause complications, whether due to an inflammatory response to this calcium buildup or for other reasons. For example, calcification of the coronary arteries is a known risk factor for heart disease, buildup of calcium on the heart’s valves can cause valvular dysfunction, calcium oxalate kidney stones are the most common type of kidney stone, calcium buildup in the gallbladder can lead to "porcelain gallbladder," brain calcification can cause neurological issues, calcium buildup in joints/tendons/muscle/other soft tissue can cause problems (including calcific tendonitis, discussed further below), and many others.

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Calcium buildup in the tendons of the shoulder is not uncommon, affecting up to 3% to 8% of people. In a third to half of these people it does not seem to cause any symptoms and is an "incidental" finding noted on an imaging exam done for some other reason. However, it may be associated with an inflammatory response (although whether the calcium buildup causes the inflammation or the inflammation causes the calcium buildup is not certain). This most commonly occurs in people between the ages of 40 to 60, and it is more common in women than men. Symptoms include pain (often worse in the mornings) which is typically exacerbated by movement, and potentially some limitation of range of motion.

The diagnosis of calcific tendonitis is suspected based on the history and physical exam, and may be confirmed by an imaging exam (commonly X-ray, but ultrasound has been shown to be very useful to see the abnormal calcification, and in uncommon cases MRI may be indicated).

Calcific tendonitis of the shoulder is most often a self-limited condition whose symptoms resolve on their own over weeks to months, although in some cases symptoms it may persist for years. Initial treatment over the first three to six months is aimed at relieving symptoms and may include nonsteroidal anti-inflammatory drugs (NSAIDs), heat and/or ice therapy, physical therapy, and in some cases steroid injections. More severe/more persistent cases may benefit from ultrasound treatments (different kinds of ultrasound waves are used in treatment than are used for diagnostic ultrasounds), transcutaneous electrical nerve stimulation (TENS), shock wave therapy (similar to that used for kidney stones), other treatments (for example I saw some case reports of platelet-rich plasma injections being utilized), and even surgical treatments (the most common is a minimally invasive arthroscopy to ‘clean out’ the inflammation and calcification).

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Although I have noted lots of potential issues from calcium buildup and/or abnormal calcium blood levels above, with the exception of calcium oxalate kidney stones (where about a third of patients may develop calcific tendonitis), calcific tendonitis does not seem to have a strong association with these other conditions, and hence a workup for these other conditions is not typically indicated.

Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.

This article originally appeared on MetroWest Daily News: sore shoulder caused by calcium build-up is common ailment