From the Guidelines
For an 80-year-old male with right shoulder pain and X-ray findings suggesting calcific infraspinatus tendinitis without acute findings, I recommend a conservative treatment approach. This approach is based on the evidence that most patients with overuse tendinopathies, including calcific tendinitis, can recover within three to six months with relative rest, icing, and eccentric strengthening exercises 1. The patient should start with over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 3000mg daily) or NSAIDs such as ibuprofen (400-600mg three times daily with food) if there are no contraindications like kidney disease or bleeding risk.
Key Components of Treatment
- Apply ice for 15-20 minutes several times daily to reduce inflammation, followed by gentle heat after 48 hours
- Rest the shoulder initially, avoiding activities that worsen pain, then gradually introduce gentle range-of-motion exercises
- Physical therapy would be beneficial to improve shoulder function and prevent stiffness
Considerations for Treatment
- If pain persists after 2-3 weeks of conservative treatment, consider referral for corticosteroid injection
- Calcific tendinitis occurs when calcium deposits form in the rotator cuff tendons, particularly the infraspinatus in this case, causing inflammation and pain
- This condition often resolves with conservative management, though recovery may take longer in elderly patients due to decreased tissue healing capacity 1.
Additional Recommendations
- Ultrasonography, shock wave therapy, orthotics, massage, and technique modification are treatment options, but few data exist to support their use at this time 1
- Surgery is an effective treatment that should be reserved for patients who have failed conservative therapy 1
From the Research
Clinical Correlation of Calcific Infraspinatus Tendinitis
The patient's X-ray findings suggesting calcific infraspinatus tendinitis can be correlated clinically with the presence of shoulder pain. The studies suggest that calcific tendinitis is a common cause of shoulder pain, with 35%-45% of patients whose calcific deposits are inadvertently discovered developing shoulder pain 2.
Treatment Options
The treatment options for calcific tendinitis include:
- Ultrasound-guided needling with subacromial corticosteroid injection, which has been shown to be more effective than extracorporeal shock wave therapy (ESWT) for function restoration and pain relief in patients with calcific tendinitis of the shoulder 3
- Extracorporeal shock wave therapy (ESWT), which has been shown to improve clinical outcomes and eliminate calcium deposits, although it may not be as effective as ultrasound-guided needling in the short term 3, 4
- Ultrasound-guided percutaneous lavage (UGPL) or barbotage, which has been shown to be effective in improving clinical outcomes and decreasing the size of calcium deposits, especially when combined with subacromial corticosteroid injection 4
- Acetic acid iontophoresis, which has been shown to be effective in treating calcific tendinopathy of the rotator cuff, with marked resorption of the calcific deposit observed after treatment 5
Key Findings
The key findings from the studies include:
- Calcific tendinitis is a common cause of shoulder pain, and treatment options should aim to minimize complications such as decreased range of motion of the shoulder joint while managing pain 2
- Ultrasound-guided needling with subacromial corticosteroid injection is a effective treatment option for calcific tendinitis, with significant improvements in clinical outcomes and elimination of calcium deposits 3
- Combined treatment modalities, such as UGPL and subacromial corticosteroid injection, may be more effective than single treatment modalities in improving clinical outcomes and decreasing the size of calcium deposits 4