Initial Management of Calcific Tendinosis of the Left Rotator Cuff
Begin with conservative management consisting of NSAIDs, physical therapy, and a single corticosteroid injection, which provides short-term pain relief and functional improvement in most patients. 1
First-Line Conservative Treatment
The initial approach should prioritize non-operative management, as approximately 90% of patients with calcific tendinosis respond to conservative treatment 2:
- NSAIDs for pain control to manage both pain and any inflammatory component 1
- Physical therapy program including range of motion exercises, pendulum exercises, and modalities such as heat or cold application 1, 2
- Relative rest by reducing repetitive overhead activities that load the affected tendon, but avoid complete immobilization to prevent muscle atrophy and deconditioning 1
- Single corticosteroid injection with local anesthetic, which has moderate evidence supporting short-term improvement in both pain and function 1
Diagnostic Imaging Approach
Plain radiography is the initial imaging modality of choice 1:
- Standard shoulder radiographs can identify calcific deposits, sclerosis, or spur formation of the acromion 1
- Ultrasound is useful for detecting calcification, guiding interventional procedures, and showing tendon thickening with decreased echogenicity 1
- MRI is typically unnecessary if calcification is clearly visible on plain films, though it remains sensitive and specific for detecting rotator cuff tears and degeneration 1
Critical Management Pitfalls
Avoid premature surgical intervention, as the natural history of calcific tendinosis includes spontaneous resolution in many cases 1, 2, 3:
- Do not use multiple corticosteroid injections beyond a single injection, as evidence supports only one injection for short-term benefit 1
- Avoid platelet-rich plasma (PRP) due to limited evidence supporting its routine use for rotator cuff tendinopathy 1
- Do not immobilize completely, as this leads to muscle atrophy and joint stiffness 1
Prognostic Considerations
Certain patient factors predict poorer outcomes and should inform your treatment intensity 1:
- Older age is associated with higher failure rates and poorer outcomes after any rotator cuff intervention 1
- Diabetes correlates with higher retear rates and poorer quality of life scores 1
When Conservative Management Fails
If symptoms persist after 3-6 months of conservative treatment, consider advanced interventions 2, 3, 4:
- Extracorporeal shockwave therapy (ESWT) as a second-line non-operative option 5, 4
- Ultrasound-guided percutaneous irrigation of the calcific deposit 5, 4
- Surgical intervention (open or arthroscopic removal) is reserved for patients resistant to all conservative measures 2, 3
The natural cycle of calcific tendinosis involves self-repair of the tendon, but in chronic cases this healing cycle becomes blocked 3. Most patients will improve with the initial conservative approach outlined above, making aggressive early intervention unnecessary and potentially harmful 1, 2.