Tendon calcification is a tendinopathy; it is a degenerative process that affects the tendons of the striated muscles (especially the larger ones) and which consists in the sedimentation of bone mineral on the surface of the tendon connective tissues.
The primary cause of calcification is chronic inflammation.
On the other hand, not all tendinitis causes tendon calcification, but the so-called calcific tendonitis is mainly involved.
The latter is caused by the chronic repetition of minor microtraumas; more rarely it is triggered by acute and close traumatic events (which on the other hand can begin degeneration).
Tendon calcification is responsible for pain, reduced elasticity, impaired mobility and increased risk of rupture.
The body areas most affected by tendon calcifications are: shoulder (supraspinatus muscle tendon), Achilles tendon (triceps sural tendon), knee (quadriceps hamstring tendon), elbow (extensors of the forearm), etc.
Risk factors are mainly behavioral, but individual susceptibility also plays a decisive role.
- Pain in specific movements.
- Pain on palpation.
- Sometimes swelling and redness, but they are not indispensable in calcific tendonitis (sometimes they are not even detectable).
- Joint stiffness.
- Movement restriction.
- Sometimes a sensation of joint instability (especially in the shoulder, related to a primary and complex pathological picture).
- Loss of strength.
- Thinning, elongation and fragility of tendons: these are clinical signs rather than symptoms.
- Ultrasound.
- Radiography and MRI: to exclude other diseases with similar symptoms.
- ATTENTION! There are generic diseases (eg lupus erythematosus) that predispose to the generic onset of tendinopathies. This increases the risk of evolution into calcifications.
- Rest.
- Support with aids that reduce mobility or improve load (braces, splints, canes or crutches, orthotics, etc.).
- Physiotherapy, preventive-rehabilitative gymnastics and stretching: founders of conservative therapy, they are necessary for the recovery of muscle trophism and possibly joint stability.
- Cryotherapy (cold therapy): reduces inflammation and pain.
- Drug therapy: non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids (more rarely).
- Technological medical treatments (see below): useful for the destruction of calcification and / or the fight against inflammation.
- Physiotherapy and rehabilitation.
- Consume an adequate amount of calories, which is 70% of normal calories.
- Choose foods with a suitable metabolic impact (whole foods and foods without refined carbohydrates) by preventing spikes in blood sugar and insulin.
- Get a good amount of dietary fiber. It helps to keep blood sugar under control, modulates fat absorption and positively affects estrogen levels.
- Keep the fraction of simple carbohydrates no more than 10-16% of total calories (it is sufficient to eliminate all sweet foods by keeping 4-6 servings of fruit and vegetables, as well as 1-3 servings of milk and yogurt).
- Keep the fat fraction no more than 25-30% of total calories, preferring the "good" ones (raw vegetable oils and medium-fat blue fish) over the "bad" ones (saturated, hydrogenated, bi-fractionated, etc.).
- Omega 3: they are eicosapentaenoic acid (EPA), docosahexaenoic (DHA) and alpha linolenic (ALA). They have an anti-inflammatory role. The first two are biologically very active and are mainly found in: sardines, mackerel, bonito, sardinella, herring , alletterato, belly of tuna, garfish, seaweed, krill etc. The third is less active, but constitutes a precursor of EPA; it is mainly contained in the fat fraction of certain foods of plant origin and in the oils of: soy, linseed, kiwi seeds, grape seeds etc.
- Vitamins: the antioxidant vitamins are carotenoids (provitamin A), vitamin C and vitamin E. Carotenoids are contained in vegetables and red or orange fruits (apricots, peppers, melons, peaches, carrots, squash, tomatoes, etc.); they are also present in crustaceans and milk. Vitamin C is typical of sour fruit and some vegetables (lemons, oranges, mandarins, grapefruits, kiwis, peppers, parsley, chicory, lettuce, tomatoes, cabbage, etc.). Vitamin E can be found in the lipid portion of many seeds and related oils (wheat germ, corn germ, sesame, kiwi, grape seeds, etc.).
- Minerals: zinc and selenium. The first is mainly contained in: liver, meat, milk and derivatives, some bivalve molluscs (especially oysters). The second is mainly contained in: meat, fish products, egg yolk, milk and derivatives, enriched foods (potatoes, etc.).
- Polyphenols: simple phenols, flavonoids, tannins. They are very rich: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and relative seeds (pomegranate, grapes, berries, etc.), wine, oil seeds, coffee, tea, cocoa, legumes and whole grains, etc.
- It is advisable to eliminate junk foods and drinks, especially fast food and sweet or savory snacks.
- It is also necessary to reduce the frequency of consumption and the portions of: pasta, bread, pizza, potatoes, derivatives, fatty cheeses, fatty meats and fish, cured meats, sausages and sweets.
- Analgesics: generally also with anti-inflammatory action, they are used orally especially in the fight against pain:
- Paracetamol: for example Tachipirina ®, Efferalgan ® and Panadol ®.
- Non-steroidal anti-inflammatory drugs (NSAIDs):
- Systemic for oral use: they are more used than topical ones, as the tendon structures can be difficult to reach through skin application (useless for example in the rotator cuff). They are also more powerful than ointments and gels. require the use of a gastro protector. People with liver or kidney disorders are not always able to take them.
- Ibuprofen: e.g. Brufen ®, Moment ®, Spidifen ®, Nurofen ®, Arfen ®, Actigrip fever and pain ® and Vicks fever and pain ®).
- Ketoprofen: for example Arthrosilene ®, Orudis ®, Oki ®, Fastum gel ®, Flexen "Retard" ® and Ketodol ®.
- Diclofenac: for example Dicloreum ®, Deflamat ®, and Flector ®.
- Naproxen: for example Momendol ®, Synflex ® and Xenar ®.
- For topical use: they are mainly ointments or gels. They have the advantage of acting locally (useful for example on the Achilles tendon) without excessively straining the stomach and liver; however they are less effective. It must be specified that this is not the most suitable pharmacological category and persisting with their use (albeit in the initial stages) could favor the worsening of the inflammation.
- Ibuprofen 10% lysine salt or 2.5% Ketoprofen (for example Dolorfast ®, Lasonil ®, Fastum gel ® etc.).
- Corticosteroids:
- they are used only if oral NSAIDs are not well tolerated for: allergy, gastric ulcer, diabetes, etc. If used for long periods they exert many side effects on connective tissues, especially tendons. They constitute the most drastic pharmacological solution but also the most effective one.
- Avoid slippery, too hard (asphalt) or too soft (sand) soils.
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