Will calcium tendinitis resolve on its own?

Will Calcium Tendinitis Resolve on Its Own?

Yes, calcium tendinitis is typically a self-limiting disorder that resolves spontaneously in most cases, though a subset of patients (10-30%) will have a complicated course requiring intervention. 1, 2

Natural History and Expected Outcomes

• Calcific tendinitis is characterized by deposition of calcium salts in tendons (most commonly the rotator cuff) followed by inflammatory breakdown and resorption of these deposits 1, 3
• The disease subsides spontaneously in the majority of patients without requiring invasive treatment 3
• However, 10-30% of patients will experience a complicated disease course with persistent pain, functional limitation, and deposits that show no signs of resolution 3, 2
• The main symptom is pain followed by activity restriction, which typically resolves on its own in most cases 1

Initial Conservative Management While Awaiting Resolution

For symptomatic patients, begin with 3-6 months of conservative management including relative rest, NSAIDs, cryotherapy, and eccentric strengthening exercises before considering invasive interventions. 4, 5

First-Line Conservative Measures:

• NSAIDs (oral or topical) provide short-term pain relief, though they do not affect long-term outcomes 6, 4
• Topical NSAIDs are preferable as they eliminate gastrointestinal hemorrhage risk associated with oral formulations 6, 5
• Cryotherapy through a wet towel for 10-minute periods provides effective acute pain relief 6, 4
• Relative rest is essential—reduce activities that worsen pain while maintaining some activity to prevent muscle atrophy 6, 4
• Complete immobilization must be avoided as it causes muscular atrophy and deconditioning 6, 5
• Eccentric strengthening exercises are the cornerstone of rehabilitation and can reverse degenerative changes 4, 5
• Physical therapy and deep friction massage may provide additional benefit 7, 1

When Conservative Management Fails

Approximately 80% of patients with overuse tendinopathies recover completely within 3-6 months with appropriate conservative treatment. 4, 8

Secondary Treatment Options for Non-Resolving Cases:

• Corticosteroid injections may provide short-term pain relief but do not improve long-term outcomes 4, 5
• Critical pitfall: Never inject directly into the tendon substance as this inhibits healing, reduces tensile strength, and may predispose to rupture 4, 5, 8
• Ultrasound-guided needling with barbotage has shown promising results and is more effective than ESWT for function restoration and pain relief 1, 9
• Extracorporeal shock wave therapy (ESWT) appears safe and effective for chronic calcific tendinitis, though it is costly and less effective than US-guided needling 4, 7, 9

Surgical Management:

• Surgery is justified only if pain persists despite 3-6 months of well-managed conservative treatment 4, 5, 8
• Arthroscopic excision with removal of calcium deposits remains the definitive management for patients with complications (such as cuff tears) or those who fail conservative treatment 1

Critical Pitfalls to Avoid

• Do not assume all cases will resolve—10-30% will have complicated courses requiring intervention 3, 2
• Avoid multiple corticosteroid injections as they may weaken tendon structure despite short-term symptom relief 4, 5
• Do not proceed to surgery without an adequate 3-6 month trial of conservative treatment 4, 5, 8
• If multiple tendons are symptomatic, evaluate for underlying rheumatic disease 6, 4