Calcium deposits, or calcification, are the accumulation of calcium salts in soft tissues or organs where they do not belong. While calcium is essential for bones and teeth, its unwanted deposition can stiffen arteries, obstruct organs, or cause pain in tendons. Treatment is highly specific, depending on the deposit’s location, size, and the underlying cause of the mineral imbalance. Addressing calcification requires a phased approach, ranging from non-invasive pain management to targeted procedural interventions.
Identifying the Location and Type of Deposit
A precise diagnosis is the necessary first step before establishing any treatment plan. Physicians rely on various imaging modalities to locate and characterize the deposits. X-rays easily detect the dense mineral clusters, while Computed Tomography (CT) scans offer detailed, cross-sectional views useful for assessing complex areas like the coronary arteries or brain. Ultrasound is frequently used to visualize soft tissue calcifications, such as those in tendons, and to guide subsequent minimally invasive procedures.
Blood tests are performed to determine the type and cause of calcification. The two main types are dystrophic and metastatic calcification, which differ in origin. Dystrophic calcification occurs in damaged tissue despite normal blood calcium levels, often seen in injured tendons or atherosclerotic plaques. Conversely, metastatic calcification occurs in otherwise normal tissue and is caused by systemic metabolic disorders resulting in elevated blood calcium levels (hypercalcemia).
Conservative Management Strategies
For localized soft tissue deposits, such as calcific tendonitis, initial treatment begins with conservative management aimed at reducing pain and inflammation. This approach is the first line of defense, often employed for several months before considering more aggressive interventions. The goal is to alleviate symptoms while allowing the body’s natural processes to resorb the calcium over time.
Resting the affected joint or limb is recommended, but complete immobilization is avoided to prevent muscle atrophy and stiffness. A program of relative rest limits painful activities while encouraging gentle range-of-motion exercises. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) control acute pain, sometimes supplemented by topical NSAID preparations to reduce systemic side effects.
Physical therapy helps maintain or restore function. Specific exercises, such as eccentric strengthening, manage underlying tendinosis and improve the tissue environment. For acute flare-ups, the application of ice (cryotherapy) reduces localized inflammation and discomfort. If pain persists despite these measures, corticosteroid injections may provide short-term relief. These are injected carefully around the tendon, not directly into the deposit itself.
Minimally Invasive Medical Procedures
When conservative methods fail to provide sufficient relief for localized deposits, minimally invasive procedures are the next step. These techniques aim to disrupt or remove the calcium without open surgery. Extracorporeal Shock Wave Therapy (ESWT) utilizes high-energy acoustic waves, similar to those used to break up kidney stones.
The focused shockwaves penetrate the tissue and create mechanical stress that fragments the crystalline calcium structures, breaking the deposit into smaller pieces. This disruption stimulates a biological response, promoting local blood vessel formation and engaging the body’s metabolism to resorb the fragments. ESWT is a non-invasive option that often improves pain and mobility over several sessions.
Ultrasound-guided needle aspiration and lavage, known as barbotage, is often used for shoulder calcifications. This technique uses ultrasound imaging to guide fine needles directly into the deposit. A mixture of saline and anesthetic is injected and repeatedly aspirated to mechanically break up and wash out the calcium material. After removing the substance, a small amount of corticosteroid is often injected into the surrounding bursa to reduce inflammation.
Surgical Removal and Systemic Treatments
For large, obstructive calcifications or those related to a systemic disorder, more aggressive interventions, including surgery or long-term medication, are necessary. Surgery is reserved for severe cases where less invasive treatments have failed or when the deposit poses an immediate health risk, such as in the cardiovascular system. For calcified tendons, arthroscopic surgery uses small instruments and a camera to manually debride, or surgically remove, the hardened deposit.
In arteries, where calcified plaque restricts blood flow, atherectomy removes the obstruction. Specialized catheters with rotating blades or lasers are guided into the artery to shave or vaporize the calcium-rich plaque, restoring the vessel’s inner diameter. For extensive coronary artery calcification, Coronary Artery Bypass Grafting (CABG) may be performed to reroute blood flow around blocked sections.
Systemic treatments manage the underlying metabolic conditions that cause metastatic calcification, especially in patients with chronic kidney disease or hyperparathyroidism. Medications like calcimimetics (e.g., Cinacalcet) control overactive parathyroid glands and reduce high blood calcium levels. Bisphosphonates or Denosumab can also be administered to quickly lower high calcium levels, particularly those linked to cancer. For kidney patients, switching from calcium-containing phosphate binders to non-calcium alternatives is a dietary adjustment to control mineral balance and prevent progressive calcification.
Reducing Recurrence Through Lifestyle
Reducing the risk of future calcification requires long-term lifestyle and dietary adjustments, particularly for systemic conditions like kidney stone disease. Adequate hydration is an effective preventative measure, as high fluid intake dilutes mineral concentrations in the urine, making crystal formation less likely. A target of roughly 64 ounces of water per day is often recommended, with more needed for active individuals.
Dietary changes impact recurrence, especially for calcium-based kidney stones. Maintaining a normal intake of dietary calcium is recommended, as it binds to oxalate in the gut, countering the misconception that a low-calcium diet is helpful. Conversely, limiting sodium and animal protein intake is advisable, as high amounts increase calcium excretion in the urine, raising the risk of stone formation. Managing chronic diseases like diabetes and hypertension is also important, as these conditions are linked to an increased risk of arterial calcification.