Calcific Tendonitis is Best Treated Conservatively


Calcific tendonitis occurs when tiny deposits of calcium form on or in a tendon, which then can result in pain and inflammation.  While this can be caused by a number of things, such as poor body mechanics or hypothyroidism, it typically affects people between 30 and 60 years old and more females are affected than males. Frequently these calcium deposits occur on the rotator cuff tendons surrounding the shoulder joint.

The exact reason why these calcium deposits appear is still being argued. The current leading theory is that normal cells in the tendon are replaced by abnormal cells, which is kick started by tendon misuse and abuse. Once the tendon is stressed, the process towards calcific tendonitis is classified into three phases: precalcific state, calcific state, and postcalcific state. This process is often cyclical with the postcalcific state including a return to a normal tendon.

Calcific tendonitis symptoms include primarily pain and a decrease in shoulder motion and strength. X-rays, MRIs, and ultrasounds are often used for diagnosis. Typically the tendonitis is managed without surgery and includes anti-inflammatory medication, physical therapy, and corticosteroid injections. Other conservative and promising treatment options include extracorporeal shock wave therapy and ultrasound-guided needle lavage. Extracorporeal shock wave therapy involves pulses of waves used to blast the calcifications. An ultrasound-guided needle lavage includes a needle inserted adjacent to the calcium deposit with an injection of a saline and anesthetic mixture and a continual flushing of the tissue until the calcification material no longer comes out. However, research for each of these newer treatments has yet to delineate specific effective techniques.

Surgery is reserved for calcific tendonitis that does not respond to conservative methods. Techniques are controversial and have mixed reviews in the literature.

The lead author of a recent review of all available research for treatment and outcomes of people with calcific tendonitis of the rotator cuff concluded that all patients should initially be treated conservatively and informed of the natural progression of the disease. Health providers should emphasize that typically the most pain and tendon inflammation occurs during the re-absorptive state of the calcium deposit, prior to return to fairly normal healthy tendon. Conservative treatment should last three to six months prior to seeking other help. If three months passes without relief, then ultrasound-guided needle lavage is recommended. If this does not work, then at the six-month mark surgery, specifically an arthroscopic decompression is recommended followed by physical therapy.