Shoulder Surgery

Arthroscopic Excision of Calcium

Arthroscopic Excision of Calcium

Arthroscopic excision of calcium is a minimally invasive keyhole procedure to treat calcific tendonitis. It is often done as a part of other keyhole procedures in the shoulder, such as a subacromial decompression, biceps tenodesis and/or rotator cuff repair. After an isolated arthroscopic excision of calcium a sling is worn for 1-2 weeks; and JPL therapy commences immediately after surgery. Strengthening is allowed at 4-6 weeks; and full unrestricted activity is possible at 6-12 weeks after surgery. This pathway is modified if other procedures are carried out at the same time.

This is a keyhole procedure that uses cameras and small instruments inside the shoulder to remove the calcium deposit in the rotator cuff tendon (usually the supraspinatus tendon). There may also be a supraspinatus tendon tear which can be treated if needed at the same time. In some cases the biceps tendon and or the AC joint may also need treatment. 

Physiotherapy is commenced 2 weeks after surgery and the procedure can be done as a day stay or with an overnight admission. 

Although most patients improve with cortisone injection into the bursa and ultrasound guided needling, symptoms may persist in some patients. 

Surgery is suitable for those patients who are not responding to non-surgical treatments and find that:

  • Their range of motion is not improving or even going backwards resulting in worsening shoulder stiffness
  • Unrelenting pain despite cortisone injections and regular analgesia
  • Associated rotator cuff tear or biceps tendon dislocation necessitating more urgent repair (whilst removing the calcium deposit at the same time)

If your symptoms have persisted for six months and your condition is deteriorating then surgery is a good option (particularly for the younger patient). 

  • The procedure is under a General Anaesthetic where you will be positioned on your side  and the affected arm is secured in a special arm holder.
  • Small key-hole incisions (about 1cm) are made and the camera and surgical instruments are placed inside the shoulder. 
    • Usually 2-3 small  incisions are enough (depending on what else needs to be repaired)
  • A thorough 15-point examination of the shoulder joint, capsule, labrum, biceps, and bursa is made via the arthroscopic camera and pictures are taken to document findings. 
  • The location of the calcium deposit is noted on the pre-surgery MRI and then found at surgery using a probe/needle with direct visualisation (via the keyhole camera) 
  • The bursitis and bone spur are removed to allow better visualisation of the rotator cuff tendon and location of the tendonitis and calcium deposit .
  • Once the calcium deposit is confirmed, it is removed using an arthroscopic shaver
  • Any other unexpected injuries/tears are noted and repaired via key-hole at the same time if needed (such as the biceps tendon, rotator cuff tears, shoulder spurs, and AC joint arthritis) 
  • The key-hole incisions are closed with sutures, dressings applied and a sling used to position the arm correctly.
  • Dr Pant will then organise close follow up at regular intervals and liaise with your Physiotherapist to maximise recovery.

There are three essential components to a good outcome from surgery

  •   Your surgeon
  •   You as a patient
  •   Your physiotherapist. 

Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery. 

The JPL pathway allows for self-directed, early passive shoulder range of movement: 

  •   Passive = assisted with your other arm
  •   Active = you move the affected arm independently

A sling may be worn for up to 6 weeks after surgery. However, after isolated arthroscopic excision of calcium surgery, Dr Pant will encourage you to come out of the sling as much as possible – to commence early physiotherapy immediately after surgery. 

Driving after shoulder surgery

  •  After shoulder surgery you will be in a sling and you may be unable to drive for at 1-2 weeks
  • This does vary depending on the complexity of your surgery and the patient. Some patients may be able to drive 2 weeks; and some may not be able to drive for the full 6 weeks. This will be individualised to your situation. 

Showering and getting dressed

  •  You may take the sling off to shower
  •  Lean forward and allow your arm to “dangle” to wash under your arms
  •  The dressings applied are waterproof and you may shower with them on
  •  Usually before you are discharged from Hospital, your dressings are changed after your morning shower.
  •  These “new” dressings are then kept intact until your review at 10-14 days
  •  When getting dressed, you may use your good arm to move your affected (operated arm) to place your arms through the sleeves carefully


Sleeping after Shoulder Surgery

  • Most patients find it difficult to lie flat after shoulder surgery.
  • Consider using a few pillows to prop yourself up and sleep at a slight incline; this may be necessary for 2-4 weeks after surgery.

Elbow and hand movement

  • Keep your elbow and hands joints moving and supple for the duration of time you are in the sling. The best time to move your elbow (into full extension and flexion) is when you are in the shower, just out of the shower and about to get dressed.

Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications. 

The risk of complications after isolated arthroscopic excision of calcium surgery are less than 1% in the Sydney Shoulder Unit experience. 

General risks: 

  • Infection
  • Bleeding
  • Wound healing problems
  • Damage to blood vessels or nerves
  • Sensory changes around the surgical scar

Specific risks relating to Arthroscopic excision of calcium surgery: 

  • Recurrent of calcium deposit
  • Frozen shoulder 

Patients who smoke, use tobacco products, have diabetes, or elderly are at higher risk of complications both during and after surgery. They are also more likely to have problems with wound healing. 

With careful patient selection, surgical removal of the calcium deposit and early physiotherapy patients report improved range of motion and less pain.

Patient results

Calcific Tendonitis

This 59 year old gentleman presented with unrelenting shoulder pain which was progressively getting worse.  He reported no prior trauma and was finding it difficult to undertake activities of daily living and unable to jog. He required pain killers and elected to proceed with key-hole surgery given his lack of improvement with non-surgical treatment.

He underwent an Arthroscopy (Key-hole) of the left shoulder and the calcium deposit in the Supraspinatus Tendon was removed entirely. The tendon was stable at the end of surgery and did not require treatment. He used a sling for 2 weeks and commenced immediate range of motion as tolerated using the JPL protocol.



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