New Advances in Treatment for Calcific Tendonitis of the Shoulder

Calcific tendonitis of the shoulder is a condition where calcium (the stuff bone is made of) gets deposited into the rotator cuff (specifically the supraspinatous muscle). This condition is actually a common occurrence with up to 3% of the population having it (and its painful in about 1/3 of those people).  Lets look at how its been treated, and what new treatments are available.

1) Anti-inflammatories.

Anti-inflammatory medication (called NSAIDS) like ibuprofen, aleive, etc. helps about 75% of people that are symptomatic from this condition.  Sometimes it will take a few months for the inflammation to completely subside, but the good news is that most cases it will with time.  The cases that fail to respond to medication are those affecting both shoulders, those with larger calcium deposits and those that extend deep into the shoulder.  

2) Shock Wave therapy

Shock wave therapy has been effectively used over the past 20 years in other parts of the body, and has grown in popularity recently for shoulder calcific tendonitis based on studies that demonstrate good results (especially in those that fail to respond to medication).  A high-energy monophasic pulse (high peak pressure, short duration) improves shoulder function and pain.  The treatment causes resorption of the calcium (and the smaller the deposit becomes, the better people improve).  The biggest disadvantage of the treatment is that it can be painful (people feel like they got punched in the arm after each treatment), but its non-invasive which is great. 

3) Ultrasound-Guided Needle Levage 

This is a treatment that is used after anti-inflammatories have failed to improve symptoms after 3-6 months.  An ultrasound probe (which shows the tissue under the skin, like that used to tell pregnant women how their baby looks) can show the calcium deposits, and a doctor can aim a needle at those deposits and physically break up the collection, while injecting and aspirating fluid to suck up the debris (this is called "irrigation").  As it sounds, this treatment can be painful, and some people will not tolerate the procedure despite being given local numbing medicine and generalize pain medication.   Studies show a lot of promise for this treatment.  However, this remains a fairly new procedure, and so the risk of injury to the surrounding rotator cuff, and the long-term effectiveness of the treatment still requires further investigation.  

4) Arthroscopic debridement

Arthroscopic debridement is a surgical procedure and is thus reserved for only those cases that fail to resolve despite multiple noninvasive treatment attempts.  Arthroscopic means the use of a small camera and very small incisions, which is great.  A recent study also showed great results with 90% of people feeling good 2 years after undergoing the procedure.  However, the long-term impact on the rotator cuff of removing calcium (and some surrounding tendon) needs to be studied more, but the short-term success is certainly encouraging.  

References

1) Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: Pathogenesis, diagnosis, and management. JAAOS 1997; 5: 183-191. full article. review.

2) Cho NS et al. Radiologic course of the calcific deposits in the calcific tendinitis of the shoulder: Does the initial radiologic aspect affect the final results? J Shoulder Elbow Surg 2010; 19: 267-272. full article. nsaids very effective.

3) Wang CJ et al. Shock wave therapy for calcific tendinitis of the shoulder: A prospective clinical study with two-year follow up. Am J Sports Med 2003; 31: 425-430. full article. better than placebo, dose-dependent improvement.

3) Gerdesmeyer L et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: A randomized control trial. JAMA 2003; 290: 2573-2580. full article. high-energy better than low-energy, ouch.

4) de Witte PB et al. Calcific tendinitis of the rotator cuff: A randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med 2013; 41: 1665-1673. full article.  

5) Seil R et al. Arthroscopic treatment of chronically painful calcifying tenditis of the supraspinatus tendon. Arthroscopy 2006; 22: 521-527. full article. 90% good at 2 yrs.