Initial Treatment for Calcific Tendinitis
The initial treatment for calcific tendinitis should begin with NSAIDs (oral or topical), relative rest, and ice therapy, continued for 6-8 weeks before considering more invasive interventions. 1
First-Line Conservative Management
The American Academy of Family Physicians establishes a clear conservative approach as the foundation of treatment:
NSAIDs (oral or topical) provide pain relief and inflammation control during the acute phase 1
- Topical formulations offer equivalent pain relief while eliminating gastrointestinal hemorrhage risk associated with oral NSAIDs 2
Relative rest is essential to decrease repetitive loading of the affected tendon 1
Ice therapy provides short-term pain relief by reducing tissue metabolism and inflammatory response 1
- Apply through a wet towel for 10-minute periods 2
Physical therapy should be incorporated into the initial treatment regimen 3
Duration of Conservative Treatment
Continue initial conservative treatments for 6-8 weeks initially, and if improvement occurs, continue until symptoms resolve completely. 1 This timeframe is critical before escalating to more invasive interventions.
Understanding the Disease Process
Calcific tendinitis is a self-limiting disorder characterized by deposition of calcium salts in tendons, with a natural cycle during which the tendon repairs itself 4. The disease has distinct phases—formative and resorptive—which influence treatment decisions 5. Most cases resolve spontaneously with conservative management 4.
Critical Pitfalls to Avoid
Never inject corticosteroids directly into the tendon substance, as this inhibits healing, reduces tensile strength, and may predispose to tendon rupture 1, 2
- If corticosteroid injection is considered (typically after initial conservative measures fail), it should be into the bursal space or tendon sheath, not the tendon itself 6
Avoid prolonged complete immobilization, which leads to muscular atrophy and deconditioning 1, 2
Do not proceed to surgery without adequate conservative trial of at least 3-6 months 1, 2
When Initial Treatment Fails
If symptoms persist after 6-8 weeks of conservative management, consider:
Corticosteroid injections (subacromial or bursal, avoiding tendon substance) provide short-term relief but do not improve long-term outcomes 2, 6
- For intra-articular or bursal injection, doses range from 20-80 mg depending on joint size 6
Extracorporeal shock wave therapy (ESWT) appears safe and effective for chronic cases, causing fragmentation of calcium deposits 4, 7
Ultrasound-guided needling (barbotage) has shown promising results, particularly during the resorptive phase 5, 4, 7
Surgical excision should only be considered after 3-6 months of well-managed conservative treatment failure 1, 7