What are the treatment options for a small calcium deposit near the shoulder, potentially indicative of calcific tendonitis?

Treatment of Small Calcium Deposits Near the Shoulder (Calcific Tendonitis)

For small calcium deposits near the shoulder, initial conservative management with NSAIDs, physical therapy, and rest should be the first-line approach, with joint aspiration and corticosteroid injection reserved for acute flares unresponsive to initial measures. 1

Initial Diagnostic Approach

• Start with plain radiographs as the initial screening tool to identify calcifications and exclude other bony pathology 2
• Add ultrasound when radiographs are negative but clinical suspicion remains high, or when precise localization of calcium deposits is needed for treatment planning 2
• Ultrasound demonstrates superior spatial resolution for identifying the exact anatomic location of calcifications within individual tendon components 2

Conservative Treatment Algorithm

First-Line Management

• Rest and activity modification with temporary avoidance of aggravating movements 1
• Cool packs applied to the affected area 1
• Oral NSAIDs with gastroprotective treatment for symptomatic relief 1
• Physical therapy including range of motion and strengthening exercises 3, 4

Second-Line Management (If First-Line Fails After Several Weeks)

• Joint aspiration combined with corticosteroid injection for acute symptomatic episodes 1
• Low-dose colchicine (0.5-1.0 mg daily) may be considered for prophylaxis against recurrent acute attacks 1
• Needle irrigation-aspiration of the calcium deposit can be performed under ultrasound guidance 3

Third-Line Management (If Conservative Measures Fail After Several Months)

• Extracorporeal shock wave therapy (ESWT) as a minimally invasive option before considering surgery 3
• Parenteral or oral corticosteroids for those unresponsive or unsuited to other measures 1

Surgical Intervention

Surgery is recommended only when conservative treatment fails after several months 4

• Arthroscopic excision of calcium deposits is the preferred surgical approach, showing good results even with atypical locations 5, 6
• Additional subacromial decompression can be performed if necessary during arthroscopic removal 3
• Open procedures remain an option but are less commonly used 3

Critical Management Points

• Asymptomatic calcium deposits require no treatment - the presence of calcification alone without symptoms does not warrant intervention 1
• Calcific tendonitis follows a natural healing cycle where the tendon repairs itself; chronic presentation occurs when this cycle is blocked 4
• The condition is typically self-limiting, especially during early phases 5
• Treatment should be escalated in a stepwise fashion, reserving invasive procedures for refractory cases 4

Common Pitfalls to Avoid

• Do not rush to surgical intervention - the majority of cases respond to conservative management 4
• Do not treat asymptomatic calcifications found incidentally on imaging 1
• Ensure adequate trial of conservative therapy (several months) before considering surgery 3, 4
• When performing needle aspiration or injection, ultrasound guidance improves accuracy of calcium deposit localization 2