From the Guidelines
The recommended treatment for calcific tendinopathy of the supraspinatus tendon with reactive bursitis typically follows a stepwise approach, starting with conservative measures such as rest, activity modification, and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce pain and inflammation, as supported by 1 and 1.
Initial Management
Initial management includes:
- Rest and activity modification to reduce stress on the affected tendon
- NSAIDs to reduce pain and inflammation
- Physical therapy focusing on gentle stretching and strengthening exercises for the rotator cuff, which should be implemented for 6-8 weeks, as recommended by 1 and 1
Further Treatment
If symptoms persist, further treatment options may include:
- A subacromial corticosteroid injection (such as 40mg methylprednisolone mixed with local anesthetic) to provide significant relief, as suggested by 1 and 1
- Ultrasound-guided needling (barbotage) or extracorporeal shock wave therapy (ESWT) to break up the calcium deposit, as mentioned in 1, 1, and 1
Surgery
Surgery (arthroscopic removal of the calcium deposit and subacromial decompression) is typically reserved for cases that fail to respond to conservative management after 6 months, as stated in 1, 1, and 1.
Lifestyle Modifications
Throughout treatment, patients should avoid overhead activities and heavy lifting to prevent exacerbation of symptoms, as advised by 1 and 1. It's worth noting that while other treatments like ultrasonography, iontophoresis, and phonophoresis are mentioned in the literature 1, the evidence for their effectiveness is limited, and they should not be considered as first-line treatments. The most recent and highest quality study 1 provides general recommendations for the treatment of chronic non-bacterial osteitis, which can be applied to the treatment of calcific tendinopathy, emphasizing the importance of patient education, lifestyle recommendations, and physiotherapy.
From the FDA Drug Label
In the treatment of conditions such as tendinitis or tenosynovitis, care should be taken following application of a suitable antiseptic to the overlying skin to inject the suspension into the tendon sheath rather than into the substance of the tendon. The dose in the treatment of the various conditions of the tendinous or bursal structures listed above varies with the condition being treated and ranges from 4 mg to 30 mg. 2. Bursitis. The area around the injection site is prepared in a sterile way and a wheal at the site made with 1 percent procaine hydrochloride solution A 20 to 24 gauge needle attached to a dry syringe is inserted into the bursa and the fluid aspirated.
The recommended treatment for calcific tendinopathy involving the supraspinatus tendon and reactive bursitis is an injection of methylprednisolone acetate into the tendon sheath or bursa. The dose may range from 4 mg to 30 mg, depending on the condition being treated. It is essential to follow proper sterile technique and inject the suspension into the correct space to avoid surrounding tissue and ensure the full anti-inflammatory effect. 2
From the Research
Treatment Options for Calcific Tendinopathy
The recommended treatment for calcific tendinopathy involving the supraspinatus tendon and reactive bursitis includes:
- Conservative management protocols, such as phonophoresis with Movelat cream followed by cross-friction massage to the supraspinatus tendon and range of motion exercises 3
- Rest, isometrics, and pain-free range of motion, combined with iontophoresis 4
- Conservative management involving rest, physical therapy, and oral NSAIDs administration 5
- Imaging-guided treatments, such as ultrasound-guided percutaneous lavage (UGPL), which has been shown to be an effective treatment for shoulder calcific tendinopathy 6
Considerations for Treatment
It is essential to note that:
- Patients with acute calcific tendinitis respond well to conservative treatment and rarely require surgery 7
- Patients with chronic calcific tendinitis often do not respond to conservative treatment and may require surgery 7
- Clinical improvement takes time, even after surgical treatment 7
- The pathogenetic mechanism of rotator cuff calcific tendinopathy is still unclear, but it seems to be related to cell-mediated disease 5
Treatment Goals
The primary goals of treatment for calcific tendinopathy involving the supraspinatus tendon and reactive bursitis are to: