Are oral steroids effective for treating calcific tendinosis of the rotator cuff?

Oral Steroids for Calcific Tendinosis of the Rotator Cuff

Oral steroids are NOT recommended for calcific tendinitis of the rotator cuff—they have no established role in the treatment algorithm for this condition. 1

Evidence-Based Treatment Algorithm

First-Line Treatment (Start Here)

• NSAIDs combined with exercise programs are the recommended initial approach for symptomatic calcific tendinitis, supported by moderate-grade evidence from the American Academy of Orthopaedic Surgeons 1
• Paracetamol can be added concurrently with NSAIDs or COX-2 inhibitors for enhanced pain control 1
• Home exercise programs demonstrate significant improvements in pain at rest, nighttime pain, and functional scores after 3 months 1

Second-Line Treatment (If First-Line Fails)

• A single subacromial corticosteroid injection (not oral steroids) with local anesthetic provides short-term improvement in pain and function 1
• This injection is administered directly into the subacromial bursa, not systemically 2

Why Oral Steroids Are Not Used

The treatment paradigm for calcific tendinitis differs fundamentally from other inflammatory conditions:

• Calcific tendinitis is a self-limiting condition with a natural healing cycle where the tendon repairs itself 3
• The pathophysiology involves calcium hydroxyapatite deposition and resorption, not systemic inflammation requiring oral corticosteroids 4, 5
• Local injection therapy is preferred when steroids are indicated, as it targets the specific anatomical site without systemic effects 2

Critical Distinctions from Other Conditions

The evidence provided includes guidelines for ulcerative colitis 6, sudden hearing loss 6, and bullous pemphigoid 6—conditions where oral steroids ARE indicated. However, these are entirely different disease processes with systemic inflammatory components requiring systemic treatment. Calcific tendinitis is a localized musculoskeletal condition.

Important Caveats About Steroid Use

• Avoid multiple repeated corticosteroid injections—limit to single injections for short-term relief 1
• While one study showed steroid injections improved pain for 6 weeks and function for 3 months post-procedure, they did not affect calcification resorption rates (83% saline group vs 74% steroid group at 12 months) 2
• There is theoretical concern that steroids may prevent calcification resorption and negatively affect tendon healing, though this was not confirmed in the available trial 2

When Conservative Treatment Fails

• Reserve opioids strictly for rescue analgesia, not as routine treatment 1
• Consider ultrasound-guided needle aspiration and lavage techniques for long-term improvement 5, 7
• Extracorporeal shockwave therapy and minimally invasive surgery are options after conservative measures fail 7
• Surgical intervention is recommended only when all conservative treatments have been exhausted 3