Treatment of Calcific Tendinitis
Begin with conservative management including NSAIDs, physical therapy, and activity modification for at least 3-6 months before considering invasive interventions, as calcific tendinitis is typically a self-limiting condition that resolves spontaneously in most cases. 1, 2
Initial Conservative Treatment (First-Line)
Start all patients with the following core interventions:
- NSAIDs (oral or topical) for pain relief and inflammation control during the acute phase 3, 2
- Relative rest to decrease repetitive loading of the affected tendon 4
- Ice therapy for short-term pain relief by reducing tissue metabolism and inflammatory response 4
- Physical therapy including stretching exercises and activity modification 5, 2, 6
Continue these treatments for 6-8 weeks initially. If improvement occurs, continue until symptoms resolve completely 3.
Second-Line Conservative Treatment (If No Improvement After 6-8 Weeks)
If initial conservative measures fail, escalate to:
- Subacromial corticosteroid injections for persistent pain 5, 2
- Extracorporeal shock wave therapy (ESWT) as a minimally invasive option that causes fragmentation of calcium deposits with pain relief 5, 6
- Ultrasound-guided needle aspiration and lavage of the calcium deposit, but only during the resorptive phase of the disease 1, 6
Critical Caveat on Treatment Timing
Understanding the disease phase is paramount: surgical removal or aspiration may be indicated during the formative phase, but only under exceptional circumstances during the resorptive phase when the body is naturally resorbing the calcium 1. Attention to radiologic characteristics helps differentiate these phases 1.
Surgical Management (After 3-6 Months of Failed Conservative Treatment)
Consider surgery only after a well-managed trial of conservative treatments for at least 3-6 months 4:
- Arthroscopic excision of calcium deposits with or without subacromial decompression 5, 6
- Surgery is the definitive management for patients with complications such as rotator cuff tears or for uncomplicated patients who fail all conservative measures 6
Common Pitfalls to Avoid
- Do not inject corticosteroids directly into the tendon substance, as this inhibits healing, reduces tensile strength, and may predispose to tendon rupture 4
- Avoid complete immobilization for extended periods, which leads to muscular atrophy and deconditioning 4
- Do not perform aspiration/lavage during the formative phase—this procedure should only be done during the resorptive phase when the deposit is soft and amenable to removal 1
- Recognize that chronic calcific tendinitis represents a blocked healing cycle, and the natural tendency is toward spontaneous resolution in most cases 2, 7