Is a corticosteroid (CS) injection, such as triamcinolone acetonide (TA), effective for treating calcific tendinitis of the shoulder?

Corticosteroid Injections for Calcific Tendinitis of the Shoulder

Corticosteroid injections can be used for short-term pain relief in calcific tendinitis of the shoulder, but they do not tend to alter long-term outcomes and should be used with caution due to potential negative effects on tendon healing.

Efficacy and Evidence

• Corticosteroid injections may be more effective than oral NSAIDs for relief in the acute phase of tendon pain 1
• However, there is limited high-quality evidence specifically for calcific tendinitis of the shoulder
• The American Academy of Orthopaedic Surgeons (AAOS) states they are "unable to recommend for or against the use of injectable corticosteroids" for glenohumeral osteoarthritis due to insufficient evidence 1
• For subacromial conditions, corticosteroid injections can be used when pain is thought to be related to injury or inflammation of the subacromial region 1

Treatment Algorithm for Calcific Tendinitis

1. First-line treatments (try these before injections):

   • Rest and activity modification to prevent ongoing damage
   • Ice therapy for 10-minute periods through a wet towel for acute pain relief
   • NSAIDs (oral or topical) for pain and inflammation
   • Physical therapy focusing on gentle stretching and progressive strengthening

2. When to consider corticosteroid injection:

   • When first-line treatments fail to provide adequate pain relief
   • When pain is severe and limits rehabilitation participation
   • For acute inflammatory phases with significant pain

3. Injection technique considerations:

   • Ultrasound guidance is beneficial for shoulder injections to ensure accurate placement 2
   • Strict aseptic technique is mandatory to minimize infection risk 2
   • Subacromial approach is typically used for calcific deposits in the rotator cuff

Comparative Effectiveness

• Ultrasound-guided needling with subacromial corticosteroid injection has been shown to be more effective than extracorporeal shock wave therapy (ESWT) for function restoration and pain relief 3
• This combined approach resulted in better American Shoulder and Elbow Surgeons assessment scores (90.3 vs 74.6), Simple Shoulder Test scores (83.3 vs 70.8), and pain scores (1.4 vs 3.3) at one-year follow-up 3

Important Cautions and Limitations

• Corticosteroids may inhibit healing and reduce the tensile strength of the tendon tissue 1
• There is potential risk of spontaneous tendon rupture with intratendinous injections 1
• Repeated injections may have long-term negative effects on bone health and joint structure 2
• Effects typically last only 4-8 weeks 2
• Avoid injections for 3 months preceding any planned joint replacement surgery 2
• Monitor patients with diabetes for transient hyperglycemia during days 1-3 post-injection 2

Alternative Approaches

• Needle fenestration (multiple punctures of the calcific deposit) combined with corticosteroid injection has shown excellent pain reduction and improved shoulder function 4
• Viscosupplementation (hyaluronic acid injections) may be considered as an alternative injectable option 2
• Ultrasound therapy has shown benefit in resolving calcifications and providing short-term clinical improvement 5

For calcific tendinitis that fails to respond to conservative measures including injections, arthroscopic removal of the calcific deposit may be indicated, with success rates up to 90% 6.