What is the treatment for shoulder tendon calcinosis?

Treatment of Shoulder Tendon Calcinosis

Initial conservative management with relative rest, NSAIDs, and physical therapy should be the first-line approach for shoulder calcific tendinosis, with most patients (approximately 80%) recovering within 3-6 months. 1

First-Line Conservative Treatment (3-6 months)

Activity Modification and Rest

• Implement relative rest by reducing activities that provoke pain while maintaining some movement to prevent muscle atrophy and deconditioning. 1
• This prevents further tendon damage and promotes natural healing of the calcium deposits. 1

Pain Management

• NSAIDs provide effective short-term pain relief but do not alter long-term outcomes. 1
• Topical NSAIDs are equally effective as oral formulations with fewer systemic side effects, particularly eliminating gastrointestinal hemorrhage risk. 1
• Ice therapy can reduce acute pain and blunt the inflammatory response. 2

Physical Therapy

• Eccentric strengthening exercises are the cornerstone of rehabilitation, as they stimulate collagen production and guide proper alignment of newly formed collagen fibers. 1
• Stretching exercises are widely accepted as beneficial for tendon rehabilitation. 2
• Deep transverse friction massage may reduce pain when combined with eccentric exercises. 2

Second-Line Interventions (If Conservative Treatment Fails)

Corticosteroid Injections

• Subacromial corticosteroid injections may provide more effective acute pain relief than oral NSAIDs, but they do not improve long-term outcomes. 1, 3
• Use with caution: corticosteroids may inhibit healing, reduce tensile strength, and potentially predispose to tendon rupture. 1

Extracorporeal Shock Wave Therapy (ESWT)

• ESWT is a safe, noninvasive, and effective treatment option for chronic calcific tendinosis before considering surgery. 1, 4
• The mechanism involves acoustic waves causing fragmentation of calcium deposits with subsequent pain relief. 5
• This is an expensive but evidence-supported option for refractory cases. 1

Ultrasound-Guided Needle Aspiration and Lavage

• Aspiration and lavage of calcium deposits should only be performed during the resorptive phase of the disease, not during the formative phase. 6
• Ultrasound-guided needling barbotage has shown promising results for symptomatic relief. 5

Surgical Management

Indications for Surgery

• Surgery should be reserved for patients who have failed 3-6 months of well-managed conservative treatment. 1, 3
• Surgical intervention is also indicated for complications such as rotator cuff tears. 5

Surgical Technique

• Arthroscopic excision of calcium deposits with curettage is the definitive treatment, with additional subacromial decompression performed if necessary. 3, 5
• The procedure typically includes excision of abnormal tendon tissue and longitudinal tenotomies to release scarring and fibrosis. 2
• Any resulting tendon defects should be repaired arthroscopically back to the bone. 7

Important Clinical Considerations

Disease Phases

• Differentiate between the formative phase and resorptive phase, as this determines treatment approach. 6
• Surgical removal may be indicated during the formative phase if conservative treatment fails, but only under exceptional circumstances during the resorptive phase. 6
• The natural cycle involves spontaneous tendon repair and calcium resorption in most cases. 3, 6

Prognosis

• Approximately 80% of patients with shoulder calcific tendinosis fully recover within 3-6 months with appropriate conservative treatment. 1
• The condition is typically self-limiting, with calcium deposits often disappearing spontaneously. 5, 6

Common Pitfalls to Avoid

• Do not rush to surgery before completing an adequate 3-6 month trial of conservative therapy. 1
• Avoid corticosteroid injections as first-line treatment due to potential tendon weakening effects. 1
• Do not perform needle aspiration during the formative phase of calcium deposition. 6