From the Guidelines
The recommended management for calcification tendinosis with hydroxyapatite deposition should prioritize non-invasive treatments, with Extracorporeal Shock Wave Therapy (ESWT) being a safe and effective option, as evidenced by studies such as 1. When considering treatment options, it's crucial to weigh the benefits and risks, focusing on minimizing morbidity, mortality, and improving quality of life.
- Key considerations include:
- The use of ESWT, which appears to reduce pain and promote tendon healing, although further research is needed to clarify its mechanisms and optimal treatment strategies 1.
- Other modalities like ultrasonography, iontophoresis, and phonophoresis may offer some benefits but lack strong evidence to support their consistent use in tendinopathies 1.
- Technique modification is essential for athletes and manual laborers to minimize repetitive stresses on tendons, aiming to eliminate pain and promote healing 1. Given the current evidence, a treatment plan starting with ESWT, alongside technique modification and potentially other non-invasive methods, seems to be the most prudent approach for managing calcification tendinosis with hydroxyapatite deposition, considering the need to balance efficacy with the safety profile and the impact on the patient's quality of life.
- It's also important to note that while other treatments like NSAIDs, physical therapy, and corticosteroid injections can be beneficial, their use should be tailored to the individual patient's response and needs, always keeping in mind the goal of minimizing morbidity and mortality while improving quality of life.
From the Research
Recommended Management for Calcification Tendinosis with Hydroxyapatite Deposition
The management of calcification tendinosis with hydroxyapatite deposition can be approached through various methods, including conservative treatment and surgical intervention.
- Conservative management is often the first line of treatment and may include rest, physical therapy, and oral NSAIDs administration 2.
- Imaging-guided treatments, such as ultrasound-guided percutaneous lavage (UGPL), are considered minimally-invasive and effective methods to treat calcific tendinopathy, with a success rate of about 80% 2.
- For patients with acute calcific tendinitis, conservative treatment can be successful in managing symptoms, with improvements in pain and function 3, 4.
- In cases where conservative treatment fails, surgical intervention may be necessary, particularly for patients with chronic calcific tendinitis or those experiencing prolonged severe pain 5, 4.
- The choice of treatment depends on the severity of symptoms, the location and size of the calcific deposits, and the patient's response to initial treatment 4, 6.
Treatment Options
- Conservative treatment: rest, physical therapy, oral NSAIDs administration 2
- Imaging-guided treatments: ultrasound-guided percutaneous lavage (UGPL) 2, 6
- Surgical intervention: arthroscopic excision 4
- Extracorporeal shock wave therapy 6
- Operative debridement 6