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Providing physiotherapy services for patients in East Anglia

Calcific bursitis of the shoulder

Inflammation of the bursa can lead to calcium deposition most commonly seen within the sub-acromial bursa of the shoulder.

Calcifying bursitis. (a) The image shows hyperechoic material within the subacromial subdeltoid bursa compatible with calcific deposits, most commonly calcium hydroxyapatite crystal, distension of the bursa (small arrows) by the extensive bursal calcification (b) Wide posterior acoustic shadow in calcific bursitis. The finding was correlated with shoulder radiography (not shown).

Assessment
Treatment

Subjective History

Often pain felt at the acromion
Pain may radiate to upper arm
Pain may be felt at rest and often worse at night
Patient may report a history of, gradual onset, repetitive upper limb activity; history of rotator cuff trauma
Often aggravated by shoulder abduction

Objective Examination

Positive painful arc – pain between 60 and 120 degrees
It is important to note that calcific bursitis and a rotator cuff pathology can co-exist
Limited active range secondary to pain
Full passive range of motion
Ultrasound/ X-ray or MRI can be used to confirm diagnosis

Treatment

0-48 hours NSAID’s, ice , rest
Physiotherapists may apply tape in the acute stage to help with a patients perception of pain and provide symptom relief
After 48 hours encourage active or active assisted shoulder range of movement within pain-free range
Once pain has subsided a rotator cuff strengthening programme can be implemented
For chronic persistent symptoms a corticosteroid injection under ultrasound guidance may be considered