What is the diagnosis and treatment for calcific tendinitis?

From the Guidelines

Calcific tendinitis should be treated with a combination of relative rest, reduced activity, and eccentric strengthening exercises, as these methods have been shown to promote healing and pain relief. The treatment of calcific tendinitis typically begins with conservative measures, including relative rest and reduced activity to prevent further damage and promote healing and pain relief 1. Cryotherapy, such as repeated applications of melting ice water through a wet towel for 10-minute periods, can provide acute relief of tendinopathy pain 1.

Treatment Options

• Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes 1
• NSAIDs, such as ibuprofen or naproxen, are recommended for short-term pain relief but have no effect on long-term outcomes 1
• Topical NSAIDs may be effective and have fewer systemic side effects, but it is unclear whether they are better than other analgesics 1
• Locally injected corticosteroids may be more effective than oral NSAIDs in acute-phase pain relief but do not alter long-term outcomes 1
• Extracorporeal shock wave therapy appears to be a safe, noninvasive, effective but expensive means of pain relief for chronic tendinopathies 1
• Surgery is an effective option in carefully selected patients who have failed three to six months of conservative therapy 1

Prevention of Recurrence

Maintaining proper posture and avoiding repetitive overhead activities can help prevent recurrence once symptoms improve. It is essential to note that the condition often resolves spontaneously over time as the body reabsorbs the calcium deposits, though this process may take months. A multidisciplinary approach, including physical therapy and pain management, is crucial in treating calcific tendinitis and improving patient outcomes.

From the Research

Diagnosis of Calcific Tendinitis

• Calcific tendinitis is characterized by the deposition of calcium salts in the rotator cuff muscles, leading to pain and activity restriction 2
• The condition is typically self-limiting, with symptoms resolving on their own in most cases 2
• Diagnosis is often based on clinical presentation and radiographic findings, with classification of calcifications into different types (e.g. type I, II, and III) possible using radiography 3

Treatment Options for Calcific Tendinitis

• Conservative treatment options include:
  • Physical therapy 4, 2
  • Iontophoresis 4
  • Deep friction 4
  • Noninflammatory drugs 4
  • Needle irrigation-aspiration of calcium deposit 4
  • Subacromial bursal steroid injection 4, 5, 6
• Minimally invasive treatment options include:
  • Extracorporeal shock wave therapy (ESWT) 4, 2, 5, 6
  • Ultrasound-guided needling (UGN) with subacromial corticosteroid injection 5, 6
• Surgical treatment options include:
  • Arthroscopic excision of calcium deposits 2
  • Open procedures to curette the calcium deposit, with possible additional subacromial decompression 4

Comparison of Treatment Options

• Ultrasound-guided needling with subacromial corticosteroid injection has been shown to be more effective than ESWT for function restoration and pain relief in patients with calcific tendinitis of the shoulder 5
• High-energy ESWT and UGN have been compared in a randomized controlled trial, with both techniques showing improvement in function and pain, but UGN being more effective in eliminating the calcific deposit 6
• The size and morphology of the calcium deposits can influence the effectiveness of treatment, with smaller deposits being more responsive to treatment 3, 5