From the Guidelines
For supraspinatus and infraspinatus tendinosis with calcification, I strongly recommend a comprehensive treatment approach prioritizing rest, physical therapy, and anti-inflammatory medications, with corticosteroid injections considered for persistent pain, as these methods have shown to be effective in promoting healing and pain relief 1.
Key Recommendations
- Relative rest and reduced activity are crucial to prevent further damage and promote healing and pain relief, although the duration of rest is not clearly defined 1.
- Cryotherapy, such as applying ice for 10-15 minutes several times daily, provides acute relief of tendinopathy pain and is widely accepted 1.
- Eccentric strengthening is an effective treatment that may reverse degenerative changes, and should be incorporated into physical therapy sessions 1.
- NSAIDs, like ibuprofen or naproxen, are recommended for short-term pain relief but have no effect on long-term outcomes, and should be used judiciously 1.
Treatment Approach
Begin with NSAIDs for 1-2 weeks to reduce inflammation and pain, and apply ice regularly. Physical therapy should focus on gentle stretching and strengthening exercises for the rotator cuff muscles, typically 2-3 sessions weekly for 6-8 weeks. For persistent pain, consider a corticosteroid injection administered by an orthopedic specialist. In severe cases with significant calcification causing persistent symptoms, ultrasound-guided needling or arthroscopic surgery may be necessary to remove the calcium deposits, as surgery is an effective option in carefully selected patients who have failed conservative therapy 1.
Important Considerations
- Recovery typically takes 3-6 months with proper treatment, and maintaining good posture and avoiding overhead activities during healing is essential to prevent recurrence.
- The condition results from degeneration of the rotator cuff tendons with calcium hydroxyapatite crystal deposition, often due to repetitive overhead activities, aging, or poor biomechanics.
- Therapeutic ultrasonography, corticosteroid iontophoresis, and phonophoresis are of uncertain benefit for tendinopathy, and extracorporeal shock wave therapy may be considered for chronic tendinopathies, but its high cost should be weighed against potential benefits 1.
From the Research
Treatment Options for Supraspinatus and Infraspinatus Tendinosis with Calcification
- Acetic acid iontophoresis has been shown to be effective in treating calcific tendinopathy of the rotator cuff, with marked resorption of the calcific deposit observed after treatment 2.
- Extracorporeal shock-wave therapy (ESWT) is also a valid intervention for supraspinatus calcifying tendinitis, with higher energy levels (0.20 mJ/mm²) appearing to be more effective than lower energy levels (0.10 mJ/mm²) in pain relief and functional improvement 3.
- Conservative treatment solutions, such as rest, isometrics, and pain-free range of motion, may also be prescribed for patients with supraspinatus tendon calcification 2.
- Exercise, including eccentric training, may be beneficial for supraspinatus tendinopathy, although more research is needed to confirm its effectiveness 4.
Diagnostic Tools for Infraspinatus Tendinosis with Calcification
- Diagnostic musculoskeletal ultrasound (MSK-US) is a valuable tool for assessing the infraspinatus muscle and tendon, offering real-time, dynamic assessment capabilities essential for precise diagnosis and effective rehabilitation planning 5.
- MSK-US can be used to identify common pathologies such as tears, tendinopathy, and calcifications in the infraspinatus muscle and tendon 5.
Management Options for Calcific Tendinitis of the Rotator Cuff
- Nonsurgical management, including oral anti-inflammatory medication, physical therapy, and corticosteroid injections, is the mainstay of treatment for calcific tendinitis of the rotator cuff tendons 6.
- Surgical management options, including arthroscopic procedures to remove calcific deposits and subacromial decompression, may be considered for patients who fail nonsurgical treatment, although the role of subacromial decompression and repair of rotator cuff defects remains controversial 6.