- 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. Exercises can help prevent this problem from occurring. - Anti-Inflammatory Medications
Anti-inflammatory medications can help treat 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. - Application of Moist Heat
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.
The calcific deposit will often remain in these patients, but the goal of treatment is to control the symptoms caused by this condition, not to necessarily make the calcium go away. Eventually, the calcium deposit will resolve.
When is surgery necessary?
Surgery is recommended in the following situations:
- When symptoms continue to progress despite treatment
- When constant pain interferes with routine activities (dressing, combing hair)
- When symptoms do not respond to conservative care
Needling is a procedure that is done under sedation or general anesthesia. 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. Injections of saline, novocaine, or sometimes cortisone, is then performed into the calcium deposit. Patients can resume activity shortly after the procedure.
Excision of the deposit is a larger procedure, but may be necessary, especially is cases of chronic calcific tendonitis. Either through a small incision or through the use of shoulder arthroscopy, the calcium deposit is identified and removed. Physical therapy is usually necessary after this procedure to help regain strength and motion in the affected shoulder.
Are other treatments available for calcific tendonitis?
Over the last decade, several reports have shown successful treatment of chronic calcific tendonitis with the use of shockwave 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 50-70% 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.
References:
- 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.
