7 Treatment Options for Calcific Tendonitis of the Shoulder

Treatment should start simple and progress as needed

shoulder pain
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Calcific tendonitis is a common source of shoulder pain, and can be a frustration given the severity of pain and the duration of symptoms. However, the news is not all bad! On a positive note, the vast majority of patients do find relief with nonsurgical treatments for this condition. In fact, studies have shown about 75 percent success with simple steps for treatment. While treatment often takes 3 to 6 months, there are typically improvements without having to undergo surgery.

Simple Steps

The treatment plan for patients with calcific tendonitis is similar to the treatment for impingement syndrome of the shoulder, with a few additional options. Treatment should always begin with some simple steps, and proceed to more invasive options only if simpler treatments aren't effective.

  • Physical Therapy/Exercises: Exercises and stretching can help prevent a stiff shoulder. One of the most difficult problems associated with calcific tendonitis is the development of a frozen shoulder because of pain. Specific exercises can help to improve the mechanics of the shoulder and decrease the burden on the tendons specifically affected by the problems.
  • Anti-Inflammatory Medications: Anti-inflammatory medications can help decrease the pain associated with the calcific tendonitis. No studies have shown a significant change in the time course of symptoms with these medications, but patients certainly have lessened symptoms. Before beginning any new medication be sure to confirm with your doctor the medication is safe for you to take.
  • Application of Heat and Ice: The application of moist heat is tremendously helpful with pain relief from calcific tendonitis. A warm washcloth is a perfect way to deliver this warmth to the shoulder. Ice packs can help to reduce inflammation from the tendonitis, and can be very helpful to reduce pain associated with this condition.

    Less-Invasive Options

    The next steps in treatment are considered minimally invasive, in that they do not require a surgical procedure, but they may require the use of a needle or specialized instruments to help address the calcific deposit.

    • Cortisone Injections: Cortisone is a powerful anti-inflammatory treatment that is delivered directly to the source of the pain (as opposed to a medication taken by mouth, that must work its way through the body to get to the shoulder). Cortisone injections can be helpful at both reducing inflammation and also limiting pain to allow patients to work with physical therapy. Many patients find a cortisone injection helpful, and sometimes more than one is needed for successful treatment. While there is debate about how much cortisone is safe, most agree that one or two shots are reasonable for treatment.
    • Extracorporeal Shock Wave Therapy: Shockwave therapy is thought to work by inducing so-called 'microtrauma' and stimulates blood flow to the affected area. Most reports on this method of treatment of calcific tendonitis show guarded success—perhaps 50 to 70 percent of patients improving after one or two high-energy shockwave treatments. This treatment of calcific tendonitis can be painful, and usually requires anesthesia in order for it to be tolerated by the patient. The good news is that there is a very low complication rate from shockwave therapy. Most patients will develop a hematoma (bruising) from the treatment, but otherwise there are few complications.
    • Untrasound-Guided Needle Lavage: Needling is a procedure that is done with local anesthetic or more general sedation. Your surgeon will direct a large needle into the calcium deposit and attempt to aspirate, or suck out, as much of the calcium deposit as possible. The consistency of the calcium deposits are variable, but are often less like a rock and more like toothpaste. Typically an ultrasound machine can help to ensure the needle placement is directed appropriately right at the calcific deposit. Injections of saline, Novocaine, or sometimes cortisone, is then performed into the calcium deposit.

    Surgical Treatment

    Surgical treatment is generally reserved for patients who don't find relief despite months of simpler treatment steps. As mentioned earlier, the vast majority of patients will find relief with nonsurgical treatment options, but there are times that patients don't find relief despite appropriate treatment steps. Most surgeons agree that a minimum of 3 months, if not closer to 6 months, of nonsurgical treatment should be pursued before considering a more invasive option.

    Surgical treatment is usually performed as an arthroscopic shoulder surgery, although open surgical treatment can also be considered as an option. The usual approach is to attempt to remove some, if not all, of the calcium deposit, and clean up the inflammation surrounding the tendon. In addition, some surgeons recommend removing some bone to create more space for the healing tendon, called a subacromial decompression. One result of removal of the calcium deposit can be a hole or defect in the rotator cuff tendon. Because the calcium deposit was inside the tendon, removing it can leave a gap. For that reason, sometimes your surgeon will also have to repair the damaged rotator cuff tendon. This can make the surgical recovery longer, as there may be restrictions in activity. Full recovery for surgical treatment can be as quick as 6 weeks, but is more commonly around 3 months. If the rotator cuff requires surgical repair the recovery may be up to 6 months in duration.

    Sources:

    Suzuki K, Potts A, Anakwenze O, Singh A. "Calcific tendinitis of the rotator cuff: management options" J Am Acad Orthop Surg. 2014 Nov;22(11):707-17. doi: 10.5435/JAAOS-22-11-707.

    HK Uhthoff and JW Loehr. "Calcific Tendinopathy of the Rotator Cuff: Pathogenesis, Diagnosis, and Management" J. Am. Acad. Ortho. Surg., Jul 1997; 5: 183 - 191.

    Daecke W, et al. "Long-term effects of extracorporeal shockwave therapy in chronic calcific tendonitis of the shoulder. " J Shoulder Elbow Surg. 2002 Sep-Oct;11(5):476-80.

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