resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
AAAOM – Making Promises They Can't Keep
When the AAAOM first formed in 2007, their mission was clear: to support the profession through education, resources and legislative advocacy. The first years of the organization were filled with promise and hope.
Resilience is the New Longevity
Sometimes we must enter a room through one door and not another, even though they both lead into the same space. I am talking now of the recent cachet with the concept of "resilience" regarding health, chronic pain and longevity.
Steven Rosenblatt: Birthing A Cross-Cultural Acupuncture Profession
The existence of a cross-cultural acupuncture profession in the United States, one that is legalized, licensed, supported by formalized, academic training and inclusive of non-Asian practitioners, is an important part of the medical landscape in this country and is responsible for improving the lives of hundreds of thousands of Americans.
Creating Child-Friendly Clinics with ABT
The Zurich Dojo was scattered with toy ducks, dolls, trains, exercise balls and teddy bears during my recent pediatric workshop.
Green Tea Catechins Lower PSA, Other Biomarkers in Men With Localized Prostate Cancer
A 2006 study (Cancer Research) was the first human investigation to show that green tea catechins (GTC) are highly effective in reversing premalignant prostate lesions (high-grade prostate intra-epithelial neoplasia), an established precursor to prostate cancer.
Risk Factors for Heel Problems
Heel pain and gait disability are common occurrences in adults, often the result of thinning heel pads and a lifetime of exposure to heel-strike shock. One condition experienced by many people is plantar fasciitis.
Why DCs Need to Understand the Principles of "Inclusive Design"
In the past few columns, I've written about the negative effects of prolonged sitting at work. I've attempted to make the point that prolonged sitting (or prolonged standing) takes a toll on workers. Now let's discuss a related issue: the concept of "inclusive design."
AAAOM – The Beginning of the End (Part II)
In 2012, the AAAOM board members met in Chicago for their annual meeting. The goal was to come to a consensus on a long list of issues the AAAOM needed to work on including a functional board and budget.
The Healing Properties of Light: An Interview With Researcher Anna Cocliovo
This interview is with Anna Cocliovo, a light researcher and Acupuncturist in Arizona. During my own research in light, I came across the article she published for the American Journal of Acupuncture and sought her out as a result.
Stress in the Modern Age: Impact on Homeostasis and What You Can Do (Part 1)
In 1926, Hans Selye first used the word stress in a biological context, referring to the nonspecific response of the body to any demand placed upon it.
Flexion-Intolerant Lower Back Pain (Pt. 3): Mobilization & Soft-Tissue Treatment
What is the biggest challenge to the chiropractor in treating discogenic pain? You have to completely reframe the purpose of your manipulation. It is rarely about unlocking a stuck segment at the disc involvement level; it is not about putting a joint back in alignment.
Get That Shoulder to Move: Restoring Internal Rotation
How many times have you mobilized, performed ART, Graston, FAKTR and PIR, and stripped a patient's posterior capsule, yet on re-exam, discovered it was still blocked?
Chiropractic Prevents ADHD? Research Shows...
Now that I have your attention, let me tell you what the latest study actually states. As you may have noticed, research over the past few years has begun to reveal that acetaminophen (the primary ingredient in Tylenol) is not as safe as once thought.
Leaving a Lasting Legacy: Donna Liewer
For the past 31 years, Donna Liewer has been on a personal mission "to comfort the afflicted and afflict the comfortable." In her role as executive director of the Federation of Chiropractic Licensing Boards, Liewer has accomplished that and much, much more.
What is a Discipline in Medicine?
In my now prolonged dialogue with physicians, one question emerges with enough regularity to deserve mention and naming: what is a discipline?
One and Done: Keeping Patients From Vanishing After Just One Appointment
What happened to my 3:30 p.m. ROF? They may have rescheduled, but there are two common answers no one wants to hear: 1) "She called to cancel. I tried to get her to reschedule, but she refused." 2) "She no-showed.
Collaboration for a Cause
The Patient Protection and Affordable Care Act strongly encourages the formation of multidisciplinary practitioner teams called Patient Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs).
Monoculture of the Mind: Part II
Cases are built within boundaries. Such bounds may be a program, event, activity or individuals. In this instance, a medical case has boundaries that include clinical interactions that are comprised of history, signs, symptoms, diagnoses, treatment plans and treatments.
News in Brief
Hamm Elected New President of the ACA; WFC / ACC 2014 Education Conference: Call for Papers; F4CP Recognizes Standard Process as $1 Million Supporter; Texas Chiro. College Begins Search for New President; League of Chiropractic Women Hosts Women's Success Summit.
Successful Strategies in Integrating Acupuncture and Shiatsu in a Hospital Oncology Program
Colleagues from the Network of Researchers in Public Health in CAM recently published an article of interest to our Traditional Asian Medicine community.
Are You Guilty of Paternalism in Your Approach to Patient Care?
Einstein is purported to have said, "When a man sits with a pretty girl for an hour, it seems like a minute. But let him sit on a hot stove for a minute and it's longer than any hour. That's relativity." In some way, everything is relative to one's point of view.
September, 2010, Vol. 10, Issue 09
Soft Tissue Pain: Calcific Tendinitis
By Whitney Lowe, LMT
Calcific tendinitis in the shoulder is a soft-tissue pain complaint that may be acute but is usually chronic, and affects the rotator cuff tendons. Its symptoms somewhat mimic other conditions such as adhesive capsulitis, rotator cuff disorders, shoulder impingement syndrome, or traditional tendinitis characterized by tendon fiber inflammation.Because of these similar symptoms, knowing the evaluation procedures that will distinguish this condition from others is a priority for treatment. Treatment strategies also differ so attention to the particular treatment protocols for this condition is necessary for pain resolution or management.
Calcium deposits can accumulate in any tendon, but occur most often in the supraspinatus, but also the infraspinatus, teres minor, and subscapularis tendons (in that order) (Fig. 1). Calcium deposits develop for no apparent reason (idiopathically), and may disappear and reabsorb without intervention.
Sometimes the tendon tissue gradually returns to normal and the calcium deposits reabsorb. In chronic calcific tendinitis, the healing process is interrupted and the condition becomes exacerbated, prolonged, and deposits may continue to develop. In some cases, there may be compression of the supraspinatus tendon fibers against the underside of the acromion process. However, there is controversy about whether the impingement process contributes to tendon pathology.
Some cases of calcific tendinitis have an active inflammatory process, but research has yet to provide a cause. It may be that it is the inflammatory process that produces the calcium deposits, but inflammation may also result from their development. In either case, inflammation may not be apparent as it may reside under the acromion process. Anti-inflammatory medications, both oral and injected, are often successfully used to provide pain relief, so this would indicate some inflammatory process.
Calcific tendinitis can be mistaken for other shoulder pathologies including adhesive capsulitis, shoulder impingement, bursitis, rotator cuff tears, or other disorders. Evaluating for calcium deposits is usually done through the history and physical exam because they may not show up in X-rays. However, both X-ray and ultrasound are sometimes used for diagnosis.
The relationship between calcium deposits and pain is unpredictable, as there are people who have deposits yet no symptoms of pain or limitation in movement. Nor does there seem to be a direct correlation between the size of the calcium deposit and the amount of pain it produces. For those who do have symptoms, pain can present rapidly - frequently within 24-48 hours - and be severe. Pain is usually described as deep or throbbing in nature (similar to a toothache).
This presentation is in sharp contrast to overuse conditions in the shoulder where symptoms emerge gradually and are more clearly a result of repetitive overuse. Calcific tendinitis pain usually increases in a short period of time, and motion of the shoulder may aggravate the pain. In addition, resting the affected joint often resolves the pain of classic impingement and tendinitis complaints. With calcific tendinitis pain may persist even with a significant period of rest from activities that are painful.
With classic supraspinatus tendinitis, pain is most likely to be exaggerated with abduction of the shoulder, either with active motion or resisted abduction. In calcific tendinitis, pain is not as dependent on activity or movement; though movement can increase the pain, it can also occur when the arm is motionless at the client's side.
Particularly notable with calcific tendinitis is pain with palpation over the greater tuberosity of the humerus (Fig. 2). Pain is not predominant at the greater tuberosity of the humerus with other types of rotator cuff problems. For example, with shoulder impingement syndrome pain may be felt under the acromion process with the arm abducted. But if the greater tuberosity is palpated with the shoulder in a neutral position, there won't be as much discomfort if shoulder impingement is the problem. In contrast, palpation of this area is likely to be very painful with calcific tendinitis.
Calcific tendinitis can be distinguished from adhesive capsulitis or frozen shoulder as there is no capsular pattern with this condition. The capsular pattern of restriction (greatest motion limitations in lateral rotation and then abduction) is a primary criteria for evaluation in the frozen shoulder. Shoulder bursitis can produce pain with various motions, but is usually not aggravated with resisted shoulder abduction. The resisted abduction usually increases discomfort in calcific tendinitis.
Treatment for calcific tendinitis differs from treatment of other shoulder disorders. A predictable pathological process has not been identified, and natural resolution of the condition can take years (3 to more than 10, with sometimes no improvement). It is generally dealt with conservatively, using non-operative modalities and with many cases responding positively to some of these approaches. Anti-inflammatories and steroid injections are usually recommended, along with transcutaneous electrical nerve stimulation and physical therapy, but these have limited benefit for this condition. Rest from offending activities also doesn't result in much improvement.
Ultrasound has shown the most positive results, but recent research indicates higher levels of ultrasound are required for improvement and that little to no improvement results from lower levels. Another recent study resulted in complete dissolution of the calcium deposits in 86.6 percent of treatment subjects with application of radial shock wave therapy, which is an application of a low- to medium-energy shock wave to the affected tissues.1 These modalities both aim to break up the calcium deposits.
A role for massage for calcific tendinitis has not been determined at this point. A study from 1999 found deep friction massage treatment combined with phonophoresis to be beneficial.2 Phonophoresis uses ultrasound to drive medication (usually anti-inflammatory medication) into the skin. More research is needed to evaluate the two treatments individually. Even if deep friction massage could possibly function to break up calcification in the tissue, it would likely be uncomfortable for the client.
Further, massage could aggravate the client's condition. For this reason, applying direct massage on tendons with calcifications is not recommended. If calcific tendinitis is suspected, the massage practitioner should refer the client to a physician. However massage could be used for general pain relief in associated tissues and general relaxation, unless it produces pain. Because calcific tendinitis can lead to frozen shoulder from restricted mobility, massage (in the non-calcified tissues) and passive range of motion may be used as prevention by keeping the shoulder mobile.
Finally, complicated cases may be treated by a physician with a needling technique if conservative treatments have provided no pain relief or benefit. This is a technique in which a hypodermic needle is inserted into the calcium deposit. The needle is then used like a probe to break up the calcified deposits in the tendon tissue. A local anesthetic or corticosteroids are used in conjunction.
An individual with calcific tendinitis may seek the help of a massage practitioner believing they have some other type of pain condition in the shoulder. If the pain pattern for that individual is similar to that described above, calcific tendinitis should be considered. Thorough assessment and evaluation will be helpful to discriminate between calcific tendinitis and other soft-tissue disorders such as rotator cuff pathology, impingement, or adhesive capsulitis. Making these distinctions is important for this condition. Clients suspected to have calcific tendinitis should be referred to a physician, even if the client chooses to continue massage for mild pain relief.
Click here for more information about Whitney Lowe, LMT.
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