From the Guidelines
The recommended treatment for calcification tendinitis of the shoulder typically begins with conservative measures including rest, ice application, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce pain and inflammation. Physical therapy focusing on gentle stretching and strengthening exercises should be initiated once acute pain subsides, usually continuing for 4-6 weeks. For persistent symptoms, corticosteroid injections (such as methylprednisolone 40mg mixed with lidocaine) into the subacromial space may provide relief 1. Ultrasound-guided needling (barbotage) can be effective for breaking up calcium deposits, often combined with a steroid injection. Extracorporeal shock wave therapy (ESWT) is another non-invasive option that can help disintegrate calcium deposits over several sessions. Surgery (arthroscopic removal of calcium deposits) is typically reserved for cases that fail to respond to 3-6 months of conservative treatment. These treatments work by either reducing inflammation around the calcium deposit or directly addressing the deposit itself, allowing the body's natural healing processes to resolve the condition and restore shoulder function. Some key considerations in the treatment approach include:
- The use of imaging studies such as MRI or ultrasound to confirm the diagnosis and guide treatment decisions 1.
- The potential benefits and risks of different treatment options, including the use of NSAIDs, corticosteroid injections, and surgery.
- The importance of a multidisciplinary approach to treatment, including physical therapy and patient education. It's worth noting that the provided evidence 1 is focused on the treatment of chronic non-bacterial osteitis (CNO) and does not directly address calcification tendinitis of the shoulder. However, the general principles of treatment for musculoskeletal conditions, including the use of NSAIDs, corticosteroid injections, and physical therapy, may still be applicable. Ultimately, the treatment approach should be individualized based on the specific needs and circumstances of each patient.
From the Research
Treatment Options for Calcification Tendinitis of the Shoulder
The recommended treatment for calcification tendinitis of the shoulder includes:
- Conservative treatment, such as physical therapy, iontophoresis, deep friction, local or systemic application of noninflammatory drugs, needle irrigation-aspiration of calcium deposit, and subacromial bursal steroid injection 2
- Minimally invasive extracorporeal shock wave therapy (ESWT) as an alternative to surgery 2, 3
- Ultrasound therapy to promote angiogenesis and calcium uptake to fibroblasts 4
- Rest, physical therapy, nonsteroidal anti-inflammatory drugs, and subacromial infiltration with corticosteroids for chronic calcific tendonitis 5
Surgical Intervention
Surgery is recommended when conservative treatment fails, and may include:
- Arthroscopic and open procedures to curette the calcium deposit 2
- Subacromial decompression if necessary 2
Effectiveness of Treatment Options
Studies have shown that:
- ESWT is a safe and effective noninvasive treatment for patients with calcific tendinitis of the shoulder, with a symptom recurrence rate of 6.5% 3
- Ultrasound therapy can help resolve calcifications of shorter disease duration, but calcifications of longer disease duration tend to persist despite treatment 4
- Conservative treatment can be effective in managing acute calcific tendinitis, with a team-management approach by physical therapy and orthopaedics services emphasized 6