Calcific tendonitis and reflex sympathetic dystrophy in a patient with bilateral frozen shoulder syndrome

Abstract

Calcific tendonitis is a common painful syndrome of the shoulder region that affects mainly women of 40 to 60 years of age. It usually remains asympatomatic at the early stages and in some patients, but produces severe and sometimes protracted pain during the resolution phase. Complex regional pain syndrome (CRPS) and the “frozen shoulder” syndrome are the main entities that need to be considered in the differential diagnosis of the syndrome.  Although there are specific criteria to diagnose any of these painful syndromes but occasionally some of these may co-exist and make diagnosis and appropriate treatment quite a challenging task.
We present a case with bilateral calcific tendonitis of the shoulders, complicated with causalgia and reflex sympathetic dystrophy (RSD) syndrome that make the two arms of the CRPS. After failure of the conservative treatment (e.g., non-steroidal anti-inflammatory medications, opioids, physiotherapy, intra-articular steroids) to treat both pain and causalgia, we applied repetitive trials of electroacupuncture together with auricular acupuncture and one trial of intravenous regional anesthesia. The patient gradually responded to treatment and regained normal, painless mobility of the shoulders. She returned to normal life activities after five years of debilitating pain in both of her shoulders.
We believe that electroacupuncture deserves further clinical research in painful musculoskeletal disorders like calcific tendonitis.