Lime shoulder

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A calcified tendon (Tendinosis calcarea / Tendinitis calcarea) in the shoulder joint is called calcified shoulder, which is often very painful. It occurs mainly between the ages of 30 and 50. The calcareous shoulder runs very differently. In most cases, pain therapy and physiotherapy alleviate the symptoms, and surgery is rarely necessary. Read more about causes, symptoms and treatment here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. M75

Brief overview

Description: Calcification of tendons (Tendinosis calcarea / Tendinitis calcarea) in the shoulder joint
Treatment: Can be treated well with painkillers and physiotherapy exercises, surgery is rarely necessary
Prevention / treatment: exercises to strengthen the shoulder muscles
Symptoms: pain, restricted mobility, nocturnal rest pain, concomitant diseases: bursitis (bursitis), impingement syndrome
Causes: Not yet clarified, presumably insufficient blood supply to the tendons
Prognosis: In 80 percent of cases, therapy without surgery is successful.
Diagnostics: Using symptoms, ultrasound, X-rays, magnetic resonance imaging (MRI)

What is a lime shoulder?

The calcareous shoulder is a disease of the shoulder in which there is calcification of the tendons (Tendinosis calcarea / Tendinitis calcarea) in the shoulder joint. It often causes pain. The calcareous shoulder occurs on both sides and may severely restrict the movement of the shoulder joint.

Basically, tendons connect the corresponding muscle with a certain bone and thus ensure a specific movement. The calcareous shoulder affects different tendons:

Supraspinatus tendon: most frequently affected, the associated muscle (musculus supraspinatus) enables the arm to be spread apart
Infraspinatus tendon: often affected, the associated muscle (infraspinatus muscle) is responsible for the external rotation of the arm
Subscapularis tendon: less often affected, the corresponding muscle (subscapularis muscle) is used for internal rotation of the arm

Who is affected by a calcified shoulder?

The calcareous shoulder occurs predominantly in people between the ages of 30 and 50 years. It is not a disease of wear and tear like osteoarthritis - which was assumed for a long time - which is why older people are less affected by the calcified shoulder. People with diabetes mellitus, especially type 1 diabetes, where the hormone insulin is lacking, have an increased risk of developing a calcareous shoulder.

So far, no concrete connections have been found between diet with calcified shoulder and possible causes, but in women, elevated blood lipid levels seem to increase the risk of developing a calcified shoulder. We speak of elevated blood lipid levels (hyperlipidemia) when the normal levels of cholesterol, triglycerides and lipoproteins are exceeded.

A calcified shoulder often occurs together with a so-called rotator cuff defect. The rotator cuff is the muscle-tendon cap around the shoulder joint, which also enables the healthy shoulder to move 360 degrees.

Around two to three percent of the population will develop a calcareous shoulder in their lifetime, although symptoms do not necessarily have to occur.

How can complaints be alleviated?

If a calcareous shoulder causes discomfort, a doctor is advisable. Depending on the extent and location of the calcification of the tendons, the doctor initiates appropriate treatment to alleviate the pain and discomfort. When treating the calcareous shoulder, a distinction is made between conservative (without surgery) and surgical treatment.

Conservative treatment

Therapy of the calcareous shoulder is usually started conservatively, that means without surgery, but with pain medication. Sufferers are given so-called non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac to relieve the pain. Depending on the severity, the doctor may also prescribe the very powerful opioids for severe pain for a certain period of time.

In some cases, cortisone injections help relieve the pain and inflammation in the joint. In the case of very severe pain, the doctor uses injections for local anesthesia for short-term bridging.

Furthermore, rest or the immobilization of the shoulder joint alleviates the symptoms in the acute pain phase. To do this, the affected shoulder is relieved for a short time by an arm sling. In order to ensure that those affected allow the painful calcified shoulder to rest, the doctor usually issues a sick note or certifies that they are unable to work.

After the acute painful phase of the calcareous shoulder, in most cases the doctor prescribes physiotherapy (physiotherapy) to promote the mobility of the shoulder and to strengthen the muscles.

The calcareous shoulder sometimes causes very severe pain. Movement exercises are not recommended at this stage as they may cause more pain.

Extracorporeal shock wave therapy for calcified shoulder

If the pain therapy in the calcareous shoulder shows little relief from the symptoms, the doctor will consider what is known as extracorporeal shock wave therapy (ESWT). The effect of this therapy has now been well researched and proven. The ESWT uses high-energy pressure waves to dissolve the calcium build-up.

During the treatment, the head of the device is held against the shoulder and the procedure in the joint is checked radiologically or by ultrasound. Depending on the severity of the pain, the doctor may administer pain medication.

The extracorporeal shock wave therapy (ESWT) is not yet a health insurance benefit. It is one of the individual health services (IGeL), the costs of which you have to bear yourself.

Operative treatment

Conservative therapy of the calcareous shoulder is unsuccessful in around ten percent of those affected. The doctor usually suggests an operation. For this purpose, certain conditions must be present, these are:

The complaints increase.
There are permanent restrictions in everyday life.
Conservative therapy is unsuccessful after three to six months.

Arthroscopic clearance

Surgical treatment of the calcareous shoulder usually means removing calcium deposits using arthroscopy. Arthroscopy is a joint endoscopy and is now a firmly established surgical procedure with which joints such as the shoulder, knee or ankle can be treated through a small incision. The arthroscopic removal of the calcified shoulder is successful in 80 percent of cases. Most patients feel an immediate improvement after the operation, and mild discomfort can persist for up to a year after the operation.

Because the arthroscopic removal of the calcareous shoulder is a relatively small, tissue-sparing procedure that causes little surgical pain, the operation is usually carried out on an outpatient basis. This means that after a certain time in the recovery room, you can go home with someone on the same day.

Which exercises for calcareous shoulder?

There are exercises that prevent or relieve shoulder pain in a calcareous shoulder. Ideally, a physiotherapist will show you individual movement exercises, for example with a fitness band. Basically, you should avoid pain-inducing movements - often overhead movements - as well as joint-stressing shoulder activities for the time being.

If the pain is currently very severe, if you have been injured or you have recently had an operation, it is best to consult your doctor before starting any exercise.

To move your shoulder gently, do the following exercises several times a day:

Stand in front of a chair or table and rest your good arm on it. Let your sore arm hang down and relax. Then slowly swing your arm back and forth in an arc. This exercise should be painless, if not, make the arch smaller. Having a small weight in hand (such as a can) will help reduce the pain. Do ten repetitions.

Regularly stretch your sore shoulder by standing upright with your shoulders pointing back and down. Position the arm of the sore shoulder behind your back, then grab the wrist of the affected side with the other hand and gently pull. Hold the stretch for a few seconds, then let the arm return to the starting position. Do ten repetitions.

Prevent the lime shoulder

Gentle exercises help to keep the shoulder joint flexible, stretch it and strengthen the muscles. Strong shoulder muscles ensure an upright posture and problem-free mobility. This is particularly important if you perform monotonous movements in your everyday work, such as sitting down, doing overhead work that puts stress on the joints or sports such as swimming. The exercises help to prevent a calcified shoulder and other shoulder problems.

What are the symptoms of a calcareous shoulder?

The symptoms of the calcified shoulder differ depending on the extent of the calcification and where exactly it is. In addition, the symptoms of the calcified shoulder depend on the phase in which the calcification of the tendons is. Depending on the phase, pain occurs or not.

In the beginning, the calcification of the tendons usually goes unnoticed. At a certain stage of the disease, you may experience sudden, severe pain that increases with movement. Depending on where the calcification is located, it is painful to lift the arm, to turn inwards or to turn outwards.

Acute, severe pain in the shoulder joint, which often occurs in the morning hours, is typical. In addition, movement is severely restricted and those affected feel stiff. Because of the pain, they often take a relieving posture.

If the disease leads to inflammation of the bursa (bursitis) or impingement syndrome, the symptoms that are typical of these diseases are the main ones. The pain then radiates to the upper arm. Nocturnal pain at rest is also possible, especially if the patient lies on the affected side. In bursitis, reddening and overheating of the joint also indicate bursitis.

What causes a lime shoulder?

Exactly why people get a calcified shoulder has not yet been fully clarified. There are various theories about the causes of the calcareous shoulder, which assume a reduced blood supply to the tendons or a connection with the impingement syndrome. Doctors also suspect that tissue disorders, metabolic diseases (e.g. diabetes mellitus) or a certain genetic predisposition may play a role in the formation of calcium deposits in the shoulder joint.

Phases of the calcareous shoulder

The reason for the sudden and massive pain in the calcareous shoulder is its phased course. Doctors make a distinction

the precalcification,
the calcification
and the post-calcification stage.

While more cartilage tissue forms in the precalcification stage, small calcium deposits are deposited in the tissue in the calcification stage. In the last stage, the post-calcification stage, the calcium deposit liquefies into a toothpaste-like mass and is dissolved. The emerging mass takes up a certain space, which in turn increases the pressure in the shoulder joint, which leads to irritation and inflammatory reactions - and above all causes massive pain.

At the same time, there are also cases in which spontaneous healing occurs and the calcium deposit completely recedes by itself.

How long do you have a calcareous shoulder?

The calcareous shoulder is very individual. Depending on the size and location of the calcium deposits and whether the disease is chronic - i.e. keeps recurring - or spontaneously regresses, the disease lasts for several weeks or even years. The symptoms also vary from severe to mild. The prognosis of the calcareous shoulder is therefore difficult to predict.

For physiotherapeutic measures to strengthen the shoulder muscles and prevent or counteract pain, those affected should expect a duration of two to four months.

How is a calcareous shoulder determined?

In the beginning, the doctor diagnoses a calcareous shoulder primarily based on the symptoms. He can also do an ultrasound scan and an X-ray of the shoulder. This diagnosis is especially useful before an operative treatment. With both examination methods it is possible to determine where the calcification is located and in which consistency or phase the calcification is present in the tendon. Magnetic resonance imaging (MRI) of the shoulder is less common.

Which home remedies for lime shoulder?

Warmth or cold: what helps with lime shoulder?

Basically: Cold helps with inflammatory diseases, warmth with chronic ailments such as muscle tension or joint wear.

If you have acute symptoms that indicate inflammation, such as redness, swelling, overheating or pain, it is advisable to cool your shoulder. If you tend to feel muscular tension or a certain stiffness, warmth will help in most cases to alleviate the discomfort of the calcareous shoulder somewhat.

Warm wraps on lime shoulder

If there are no signs of inflammation (redness, swelling, pain, overheating) with the complaints of the calcareous shoulder, a warm compress with vinegar or salt could also provide some remedy, according to natural medicine. There are different options here:

Warm vinegar wrap for lime shoulder: Heat 100 ml of water and 200 ml of vinegar and soak a cotton cloth in it. Place the squeezed out cotton towel on your shoulder and cover it with a towel. Once it cools down, you can renew it.
Warm salt pack for Kalkschulter: Fill a bowl with 200 g of sea salt and heat it in the oven at 80 degrees Celsius. Spread the mass about 5 mm thick on a cotton cloth and place it on the affected shoulder for about 20 minutes. When the salt wrap has cooled, wipe the shoulder dry.

If you have open skin on your shoulder, neither the vinegar nor the salt wraps are recommended!

Homeopathy / Schüßler salts for calcareous shoulder

For the treatment of the shoulder-arm syndrome, which can be triggered by the calcareous shoulder, homeopathy recommends, among other things, Schüßler salts. The salts should, among other things, dissolve metabolic blockages and activate the body's self-healing powers.

Apple cider vinegar against lime shoulder

As an additional alternative therapy for calcareous shoulder, apple cider vinegar should be able to support the treatment. Apple cider vinegar is recommended for internal use. So that the calcification in the shoulder is reduced and no new one develops, those affected drink diluted apple cider vinegar every morning and evening.

Home remedies and homeopathic remedies are not a substitute for medical treatment by a doctor. It is always advisable to consult a doctor, especially if symptoms occur over a longer period of time.

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