From the Guidelines
Calcific tendinitis should be treated with a combination of conservative measures, including rest, ice therapy, and physical therapy exercises, as well as medical interventions such as pain medications and corticosteroid injections, with surgery considered only if conservative treatments fail after 6 months. The treatment approach should prioritize reducing inflammation and promoting healing, while also addressing the underlying calcium deposits that cause irritation and inflammation in the tendon.
Treatment Options
- Rest and ice therapy: applying ice to the affected area for 15-20 minutes several times daily to reduce inflammation 1
- Pain medications: taking over-the-counter pain medications like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily) for pain relief and to reduce inflammation 1
- Physical therapy exercises: focusing on gentle stretching and strengthening to restore function and prevent recurrence, performed daily for 10-15 minutes 1
- Corticosteroid injections: directly into the affected area for persistent pain 1
- Ultrasound-guided needling (barbotage): to break up calcium deposits 1
- Extracorporeal shock wave therapy (ESWT): for stubborn cases, typically requiring 3-5 sessions 1
- Surgery: rarely needed, but may be considered if conservative treatments fail after 6 months 1
Key Considerations
- The goal of treatment is to reduce inflammation, promote healing, and address the underlying calcium deposits that cause irritation and inflammation in the tendon
- Conservative measures should be tried for at least 6 months before considering surgery
- Treatment should be individualized based on the severity of symptoms and the patient's overall health status
- Regular follow-up with a healthcare provider is necessary to monitor progress and adjust treatment as needed 1
From the FDA Drug Label
Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. Naproxen may also be used The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
The recommended treatment for calcific tendinitis is not explicitly stated in the provided drug labels. However, for acute tendonitis, the recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required 2.
- Key points:
- Naproxen may be used for the management of acute painful conditions.
- The recommended starting dose is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
- Naproxen sodium is recommended for prompt onset of pain relief. However, since the question is about calcific tendinitis, which is not explicitly addressed in the labels, the information provided for acute tendonitis may not be directly applicable. 2
From the Research
Treatment Options for Calcific Tenditis
- Conservative management is the initial treatment approach for calcific tenditis, including rest, physical therapy, nonsteroidal anti-inflammatory drugs, and subacromial infiltration with corticosteroids 3
- A conservative management protocol involving phonophoresis with Movelat cream, cross-friction massage, and range of motion exercises has been shown to be effective in resolving calcific deposits and symptoms in some cases 4
- Therapeutic exercise and rehabilitation alone can also be an effective management approach for calcific tendinopathy, improving pain and function and facilitating a decrease in the size or presence of calcium deposits 5
- Nonsteroidal anti-inflammatory drugs, physical therapy, and ultrasound-guided needle aspiration and lavage techniques are commonly used to manage pain and inflammation in rotator cuff calcific tendinopathy 6
- Nonsurgical management options, including oral anti-inflammatory medication, physical therapy, and corticosteroid injections, are the mainstay of treatment for calcific tendinitis of the rotator cuff tendons 7
Surgical Management
- Surgery is recommended when conservative treatment fails 3
- Arthroscopic procedures to remove calcific deposits and subacromial decompression are surgical management options, although the role of subacromial decompression and repair of rotator cuff defects remains controversial 7
Alternative Therapies
- Extracorporeal shock wave therapy and ultrasound-guided needle lavage are alternative treatment options that have demonstrated success in alleviating pain by eliminating the calcific deposit 7