Tendonitis Treatment Singapore
MBBS (SINGAPORE) MMED (ORTHO) FRCS ED (ORTH)
Calcific tendinitis is a condition where the body “over-reacts” and deposits calcium in the rotator cuff tendon. There are two (2) distinct variants of this problem; acute calcific tendinitis and chronic calcific tendinitis.
The treatment for each is slightly different, hence it is important to distinguish between the two.
What Is a Tendonitis?
Tendonitis is the inflammation of the tendon, the thick fibrous cords that attach muscle to bone. Tendonitis typically affects the shoulders, wrists, heels and elbow.
It is crucial to understand your symptoms and seek medical treatment as soon as possible, as early diagnosis and treatment can reduce the complications of tendonitis.
What Causes Tendonitis?
- Overuse of the muscle tendons
- Improper exercise or sports technique
- Injury
What symptoms might I experience?
The main symptom that patients experience is pain. The pain that patients with acute calcific tendinitis feel is quite different from that of chronic calcific tendinitis.
Acute Calcific Tendinitis
The pain is usually very severe and comes on very quickly. Most patients will report that they were feeling absolutely normal, went to sleep then woke up in the next middle of the night or the next morning with such severe pain in their shoulder that they are unable to move it at all.
The pain is often severe enough with the arm held completely still, but any small movements are excruciating. Many patients come in hunched over, cradling their arms trying to minimize movements at the shoulder joint while they walk.
Chronic Calcific Tendinitis
The onset of pain is usually much more gradual. Many patients will report that they have been having discomfort and pain in their shoulders with certain movements. But because the pain is typically milder in nature, they had simply ignored it until either it gradually became worse, or the patients finally decided that they had put it off for too long and were seeking answers.
There is often little to no pain at rest, though some patients may have a mild background aching sensation. But movements, especially overhead movements, will cause pain. The pain is often not unbearable, but annoying enough to make patients avoid overhead movements.
As a result, they often develop stiffness as well. The stiffness is not severe but apparent when compared to the other unaffected side.
What Tests Can Be Done To Confirm The Diagnosis?
X-rays will usually reveal the problem. Often times, I will also order an MRI scan in order to assess the condition of the rotator cuff.
I generally shy away from ultrasound scans because it does not give me much additional information. In addition, the calcium deposit often casts a shadow (acoustic shadow) hence obscuring details about the tendon.
Please refer to the section on Investigations to learn more about the various forms of investigations.
Dr. Tan will assess your symptoms in detail before recommending the right surgical option for your specific injury.
How Is Tendonitis Treated?
Treatment of frozen shoulders depend on the phase at which the patients present. Generally, treatment comprises pain relief and physiotherapy.
Most frozen shoulders will resolve with time and noninvasive treatment modalities as described above. However, not all do. For cases that fail to improve, invasive treatment options may be required.
Common treatment methods include:
- Rest
- Ice compression to minimise swelling and pain
- Anti-inflammatory medications such as ibuprofen, diclofenac, etoricoxib and aspirin
- Physiotherapy
- Cortisone injection
Surgery may be recommended if non-surgical treatments fail to alleviate the symptoms, or if the trendonitis progresses to a more serious condition like a tendon tear. Surgical treatments may include:
- Dry needling. This procedure involves making small holes in the tendon with a fine needle to stimulate and promote tendon healing.
- Ultrasonic treatment. This minimally invasive procedure creates a small incision to insert a special device that removes tendon scar tissue with ultrasonic sound waves.
- Radiofrequency treatment. A radiofrequency probe is inserted into the tendon at various sites to remove unhealthy tendon tissue and allow it’s replacement by heathy tissues as the tendon heals.
- Surgery. Depending on the severity of the tendon injury, surgical repair may be needed, especially if the tendon has torn away from the bone.
Treatment of Acute Calcific Tendinitis
The first line of treatment is pain relief. A course of anti-inflammatory medications is usually given. This will usually help to dull the pain. Other pain medications can also be prescribed in addition to the anti-inflammatory medications.
In many cases, the pain does start to recede in a week or two. While this may be a preferred option for some patients, others may be in too much pain to tolerate.
This procedure involves locating the calcium deposit using an ultrasound scan, using a needle to physically break up the calcium deposit and usually giving a dose of steroids in the area to reduce the inflammation.
Relief from the pain takes about a week or two. The problem with this procedure is that it is often very painful for the patient. In addition, due to the viscous nature of the calcium deposit, it is not easy to suck it up, even with a large bore needle.
In addition, a lot of calcium is liberated into the bursa which often transiently worsens the inflammation. The thought of having to endure a painful procedure, followed by the prospect of having even more pain for a few days after the procedure is often unthinkable for a patient who is already in distress from the pain.
This is a keyhole surgery which is performed under anaesthesia. Under direct vision, the calcium deposit is located, liberated and removed. Most, if not all, of the calcium deposit can be removed.
In addition, the inflamed and occasionally fibrous bursa is removed. I usually finish off with a small dose of steroids which helps to further suppress any remaining inflamed tissue. The pain relief from this procedure is usually dramatic.
This arthroscopic procedure has the added benefit of allowing me to repair any defects in the tendon left after the calcium deposit has been removed. Please refer to the page on Keyhole Surgery to learn more.
Treatment of Chronic Calcific Tendinitis
Anti-inflammatory medications are useful to dull the pain, but are not the answer in the long term. I often prescribe anti-inflammatory medications as an adjunct to other non-invasive treatment like physiotherapy.
Physiotherapy, together with other treatments directed at pain, are useful for pain control. Although physiotherapy is not likely to help resolve a chronic calcific deposit, it may help to improve the pain but improving the way the patient moves the shoulder.
Some physiotherapists and sports physicians may use shockwave therapy to disrupt the calcium deposit in order to encourage the body to absorb the calcium deposit. The drawback of this is that it is often painful and may aggravate the inflammation due to irritation and disruption of the deposit.
Steroid injections delivered into the subacromial bursa can help to reduce the pain from the presence of the calcific deposit. It, alone, is not likely to make the deposit disappear. The pain often may also recur after a few months.
For stubborn chronic calcific tendinitis, removal of the deposit surgically is a very reliable and gratifying procedure. Not only can the calcium deposit be removed, defects left in the tendon by the presence of the calcium deposit can also be repaired at the same sitting.
Anatomy of the Shoulder Joint
The shoulder joint is made up of 3 bones: the shoulder blade (scapula), the humeral head and the collar-bone (clavicle).
Movements around the shoulder involve 3 separate articulations: the glenohumeral joint, the acromioclavicular joint and the scapulothoracic articulation. When the arm is raised, the majority of movement occur at the glenohumeral joint and the scapulothoracic articulation.
Four (4) muscles are attached to the scapula and send their respective tendons across the glenohumeral joint and attach to the humerus just beyond the humeral head.
These 4 tendons are collectively known as the rotator cuff. You can think of the muscles as motors and their tendons as pulleys. Contractions of the muscles will hence bring about movement at the joint that their tendons cross.
A part of the scapula, known as the acromion, forms a roof over the humeral head and rotator cuff (see picture of bony anatomy of the shoulder).
To reduce friction between the acromion and the underlying rotator cuff during shoulder movements, a thin sac containing a sliver of fluid sits on the superior surface of the rotator cuff. This sac is known as the bursa.
Frequently Asked Questions
Is tendonitis serious? When should I visit a doctor?
What will the doctor do?
How to prevent tendonitis?
Billing & Payment
Medisave & Insurance Claims
The following are accredited For Singaporeans, Singapore Permanent Residents and Foreigners. If your insurance is not listed, you will still be able to make claims for eligible procedures! We have experience processing claims from many other various insurance providers. Please contact us if you have any queries.
WHAT’S THE FIRST STEP?
Embark on Your Road to Recovery With Dr Bryan Tan
Book An Appointment
With Dr. Bryan
Our friendly clinic staff will assist you with your registration, ensuring an efficient and hassle-free process for you. Fill up this form to schedule an appointment with Dr. Bryan.
Initial Consultation & Diagnosis of your Condition
During your consultation, Dr. Bryan will evaluate your medical history and the pain you are experiencing. You may also ask Dr. Bryan any questions you may have about your condition.
Treatment & Follow Up Visits With Dr. Bryan
After your consultation with Dr. Bryan, our friendly clinic staff will assist you with your follow-up appointment, and provide you with instructions/information for any prescribed treatment plans from Dr. Bryan.
Take the First Step
Book An Appointment
Leave us a few details and Dr. Bryan will get back to you shortly.
Visit our Clinic
Feel free to visit our clinic and get to meet our specialist.
Dr Bryan Tan