Calcific tendonitis is a common condition resulting from the accumulation of calcium deposits, specifically calcium hydroxyapatite crystals, within a tendon. While these deposits can form in various locations throughout the body, they most frequently affect the tendons of the rotator cuff in the shoulder. The presence of these deposits often leads to significant pain and a restricted range of movement, which are the primary symptoms that motivate individuals to seek treatment. The overarching goal of any treatment approach is to alleviate this discomfort and restore full function to the affected joint, which can often be achieved without surgery.
Initial Non-Surgical Approaches
Initial treatment focuses on conservative strategies designed to manage symptoms while allowing the body time to naturally reabsorb the calcium deposit. This typically involves activity modification, often called relative rest. Patients should avoid activities that aggravate the pain, such as repetitive overhead movements, but should not completely immobilize the joint. Avoiding prolonged complete rest is important because it can lead to muscle atrophy and stiffening of the shoulder joint.
Symptom management includes the use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), which may be taken orally or applied topically. These medications control the inflammation and pain associated with the condition, particularly during the acute phase. The pain relief provided by NSAIDs is a temporary measure, as they do not directly cause the calcium deposits to break down.
Applying ice to the affected area can provide short-term pain relief by reducing the local inflammatory response. Conversely, heat application helps to soothe muscle tension surrounding the joint. The conservative approach is usually trialed for at least six to eight weeks, and often longer, before considering more advanced interventions.
Therapies to Promote Healing and Absorption
When conservative measures are insufficient, professional therapies are introduced to encourage the resolution of calcium deposits and improve joint function. Physical therapy (PT) is a primary component, focusing on exercises that maintain or improve the shoulder’s range of motion. Even during acute pain, gentle, passive exercises prevent stiffness and adhesive capsulitis, or “frozen shoulder.”
As pain allows, the PT program progresses to strengthening exercises for the rotator cuff muscles, which stabilizes the shoulder joint. This strengthening helps counteract the effects of disuse. A structured PT program is frequently combined with other active treatments to maximize functional recovery.
Extracorporeal Shock Wave Therapy (ESWT) is another advanced non-invasive option, using high-energy acoustic pulses directed at the calcification. This therapy mechanically breaks up the calcium crystals and stimulates blood flow to the tendon, promoting reabsorption. ESWT is typically administered in multiple sessions, ranging from one to four treatments, and is preferred before considering procedures that involve needles or surgery.
Corticosteroid injections may also be used to reduce severe inflammation in the joint space or bursa, which causes intense pain. By temporarily reducing pain and swelling, the injection creates a window for the patient to more effectively participate in physical therapy. The steroid is injected near the tendon, not directly into the calcium deposit, as it manages inflammation but does not treat the underlying calcification.
Interventional Procedures for Calcium Deposits
If symptoms persist after three to six months of dedicated conservative management, procedures aimed at physically removing the deposit become the next step. One common minimally invasive technique is needling and lavage, sometimes called barbotage. This procedure uses ultrasound guidance to precisely locate the calcium deposit.
A fine needle is inserted into the deposit, and sterile saline is repeatedly injected and aspirated to flush out the fragmented calcium material. This process reduces the size and pressure of the deposit. Following aspiration, a corticosteroid is often injected into the adjacent subacromial bursa to minimize post-procedural inflammation, making barbotage a highly effective, non-surgical outpatient procedure with a relatively quick recovery.
Surgical intervention, typically performed arthroscopically, is reserved as a last resort for chronic, debilitating cases that have not responded to any other treatment. During arthroscopy, a surgeon uses a small camera and specialized instruments inserted through tiny incisions to visualize and manually remove the calcium deposit from the rotator cuff tendon.
This method ensures maximum removal of the material and sometimes involves repairing a small defect left in the tendon. Recovery from isolated arthroscopic removal is generally quicker than older open surgical methods, though it still requires rehabilitation. Patients may wear a sling for up to six weeks, with a return to full activity often taking two to three months or longer.