Tendon Calcification Therapy

Calcium can often build up in tendons and tissues near a joint, which causes pain and makes movement difficult. Treating this calcium can help permanently reduce pain. We use ultrasound to localize the deposit and remove the calcium with a needle.

After the treatment, a local steroid is injected to reduce inflammation. We arrange a follow-up ultrasound six months after your treatment for re-assessment, and to plan additional procedures, if required. Calcium deposits must meet specific size criteria to be amenable to this procedure. We advise a diagnostic bursal steroid injection before this procedure is considered.

During your procedure, we have treated your calcium and encouraged your body to resorb any residual calcium causing your pain. This may take 2-4 weeks to take full effect.

HOW DO I PREPARE FOR MY PROCEDURE?

• If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin etc.) you may need to have an international normalized ratio (INR) test and stop your medication prior to the procedure. Please inform our booking coordinators of any blood thinners you may be taking, so that they can discuss further instructions with you.
• If you take insulin to manage your diabetes, please let your booking coordinator know. You may have some juice and a small snack after taking your insulin.
• If you are currently taking antibiotics, you will need to wait two days after your last dose to be able to have your injection done.
• Take all prescribed medications as directed.
• Please arrive 15 minutes before your appointment to allow enough time to check in with reception.
• Bring photo identification and your provincial health card.
• Wear comfortable clothes.
• Please do not bring children who require supervision.

WHAT HAPPENS DURING MY PROCEDURE?

• We may provide you with a comfortable clinic gown to change into (depending on the area being treated).
• A team member will go over the consent form, explain procedure details, and answer any questions.
• We will then escort you to our treatment suite where you will meet the radiologist who will clean the skin and inject a local anesthetic, similar to the freezing you get at the dentist.
• Ultrasound will be used to guide the needle into the area of interest. Once in position the radiologist will attempt to extract or aspirate the calcium deposit from the affected tendon and an anti-inflammatory may then be injected.
• Any remaining calcium deposits will be gradually re-absorbed by your body.
• You will be assessed post-injection by our team and, if there are no concerns, you will be free to leave.

POST-PROCEDURE INSTRUCTIONS

• First 24 hours: Keep the treatment area clean. Leave the Band-Aid on. Do not shower.
• First 48 hours: Avoid bathtubs, hot tubs, and pools. Avoid strenuous activities and lifting. The pain may temporarily worsen due to inflammation during the first 24-48 hours. Take Tylenol, aspirin, ibuprofen, and apply heat or cold as needed.
• After one week: You may gradually return to activity and resume physiotherapy. Be mindful of your pain and stop if it hurts too much. Notify your physiotherapist that you have had this injection so they can modify your exercises if necessary.
• Watch for infection: If you develop worsening pain, skin redness at the site of injection, or a temperature greater than 38.5°C, please proceed to an urgent care or emergency centre.
• If you have pain or other symptoms beyond 48 hours after your injection, this is a normal reaction. You may apply heat and ice to the treatment area. If you have any questions, please email us at paintherapy@radiology.ca during business hours.
• Diabetics: Note that cortisone can cause a temporary increase in blood sugar. Please monitor your blood sugar closely and if you have any concerns, consult with your doctor.
• Anti-coagulant therapy: You will be directed when to resume any anti-coagulant (blood thinners) medication.

WHEN WILL I SEE RESULTS?

• During your procedure, we have treated your calcium and encouraged your body to resorb any residual calcium causing your pain. This may take 2-4 weeks to take full effect.
• We will arrange a follow-up ultrasound in six months to assess your response to this treatment. At that time, you will be asked about your level of activity, range of motion, and pain score to determine the effectiveness of the treatment and guide further management.
• If your symptoms recur before your follow-up ultrasound, a bursal steroid injection may be considered.
• If an injection does not help relieve your symptoms, then you may need further evaluation by your referring doctor for another cause of your symptoms.
• Please consult with your doctor regarding your results and any follow up exams or questions.

HOW MUCH WILL IT COST?

This exam is covered under your Alberta Health Care Plan. It is not currently offered at our Saskatchewan clinics.