What is the management for calcific tendinopathy involving the supraspinatus?

Management of Calcific Tendinopathy Involving the Supraspinatus (11 mm)

Conservative management should be the first-line approach for calcific tendinopathy of the supraspinatus, with progression to more invasive techniques only if conservative measures fail. 1

Initial Conservative Management (First 3-6 months)

Pain Management

• NSAIDs: Short-term use for pain relief (though they don't affect long-term outcomes) 1
• Topical NSAIDs: Consider as alternative with fewer systemic side effects 1
• Superficial modalities: Heat/ice for symptomatic relief 2

Physical Therapy

• Eccentric strengthening exercises: Focus on rotator cuff and scapulothoracic muscles 1, 2
• Range of motion exercises: Restore full glenohumeral motion 2
• Deep transverse friction massage: May help reduce pain 1

Activity Modification

• Relative rest: Reduce activities that cause repetitive loading of the supraspinatus tendon 1
• Technique modification: For athletes and laborers to minimize repetitive stress 1

Second-Line Interventions (If no improvement after 6-8 weeks)

Therapeutic Modalities

• Extracorporeal Shock Wave Therapy (ESWT): Safe and effective for pain relief and promoting tendon healing 1, 3
• Therapeutic ultrasound: May decrease pain and increase collagen synthesis, though evidence is limited 1
• Phonophoresis: Can deliver medications through ultrasound, though evidence is limited 1, 4

Injections

• Corticosteroid injections: More effective than NSAIDs for acute pain relief but don't alter long-term outcomes 1
• Ultrasound-guided needle aspiration/drilling: For calcific deposits that don't respond to other treatments 3, 5
  • Particularly effective for soft, milky calcifications
  • Can be combined with corticosteroid injection

Third-Line Interventions (If no improvement after 3-6 months)

Surgical Management

• Arthroscopic removal: For persistent, symptomatic calcifications unresponsive to conservative treatment 1, 6
• Surgical techniques: Include excision of abnormal tendon tissue and longitudinal tenotomies 1

Monitoring and Follow-up

• Assess pain levels using Visual Analog Scale (VAS)
• Evaluate function using standardized measures (e.g., Simple Shoulder Test, DASH score)
• Obtain follow-up imaging to assess calcification status after treatment

Key Considerations

• The size of the calcification (11 mm) indicates a substantial deposit that may require more aggressive management if conservative treatment fails
• Calcific tendinopathy often has a self-limiting course with spontaneous resorption of calcium deposits 2
• Treatment should be guided by the stage of calcification (formative, resting, or resorptive phase)
• Successful outcomes have been reported with combined approaches (e.g., needling plus ESWT) 3

Common Pitfalls to Avoid

• Rushing to invasive treatments before adequate trial of conservative management
• Overlooking the importance of eccentric strengthening exercises
• Focusing only on the calcific deposit while neglecting overall shoulder mechanics and scapulothoracic function
• Continuing corticosteroid injections beyond recommended limits (risk of tendon weakening)
• Failing to address biomechanical factors that may contribute to impingement

Remember that while calcific tendinopathy can be painful and limiting, most cases will respond to appropriate conservative management, with only a small percentage requiring surgical intervention.