Calcific Tendonitis Treatment Guidelines Handout

What is Calcific Tendonitis?

Shoulder calcific tendonitis (also spelled calcific tendinitis) is a condition characterized by the deposition of calcium phosphate crystals in the rotator cuff tendons, predominantly the supraspinatus tendon. This condition often occurs in individuals aged 30 to 50 and is twice as common in women as in men. The disease is most frequently seen in the right shoulder joint and can affect both shoulders in approximately 10% of patients. The causes of calcific tendonitis are not fully understood, but theories include degenerative changes due to aging and a reactive process involving cellular metaplasia and inflammation.

Calcific tendonitis progresses through three stages:

1. Precalcific stage: This stage involves early changes within the tendon that set the stage for the calcium deposition. This stage is when metaplasia occurs, where tenocytes (tendon cells) transform into chondrocytes (cartilage cells). This transformation leads to the formation of fibrocartilaginous tissue within the tendon.
2. Calcific stage: This stage is characterized by the actual deposition of calcium crystals within the tendon. It can be further divided into three phases:
   • Formative phase: Calcium crystals start to form and gradually increase in size within the tendon.
   • Resting phase: The calcium deposit growth halts, and the deposits remain stable within the tendon.
   • Resorptive phase: The body begins to break down and absorb the calcium deposits. This process involves cell-mediated phagocytosis, where macrophages and giant cells engulf and digest the deposits. Acute pain is often present due to the inflammatory response triggered by the resorption process.
3. Postcalcific stage: This final stage involves the healing and remodeling of the tendon following the resorption of calcium deposits. The spaces left by the absorbed calcium deposits are filled with granular tissue, which eventually remodels into normal tendon tissue. This stage typically results in the resolution of symptoms as the tendon heals.

Symptoms of calcific tendonitis can vary depending on the stage of the disease. During the formative and resting phases, patients may experience mild or no symptoms. In the resorptive phase, however, acute and severe sudden shoulder pain often occurs, especially at night. Other symptoms include restricted shoulder movement, localized tenderness, and sometimes visible swelling. If left untreated, calcific tendonitis can lead to a frozen shoulder, a rotator cuff tear, or other complications.

How to manage and treat Calcific Tendonitis

Managing and treating calcific tendonitis involves a combination of conservative and surgical approaches, depending on the severity and response to initial treatments.

Rest and activity modification

Avoid activities that exacerbate shoulder pain. Use an arm sling to reduce stress on the affected tendons.

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce pain and inflammation. Subacromial corticosteroid injections can provide relief from severe pain.

Physical therapy

Engage in gentle stretching and strengthening exercises to improve shoulder mobility and strengthen surrounding muscles. Ultrasound therapy may also be used to reduce inflammation and pain.

Extracorporeal shock wave therapy (ESWT)

Shockwave therapy is a non-invasive treatment delivers shock waves to break up calcium deposits and stimulate healing, reducing pain and improving function.

Ultrasound-guided barbotage

A needle is inserted into the calcium deposits under ultrasound guidance to aspirate and wash out the deposits, often combined with a corticosteroid injection for pain relief.

Surgical treatment

Orthopedic surgery is considered when conservative treatments fail after six months, or for chronic cases with significant functional impairment. It may also be necessary for large calcium deposits, rotator cuff tears, or coexisting shoulder pathologies.

Arthroscopic surgery

This minimally invasive procedure allows for the visualization and removal of calcific deposits while preserving surrounding tissues. Subacromial decompression may also be performed.

Open surgery

Used when arthroscopic surgery is not feasible, providing direct access to the calcific deposits and rotator cuff repair.

Post-treatment management

Start passive and active range of motion exercises soon after surgery, followed by strengthening exercises. Physical therapy continues for several months to ensure full recovery. Use medications and ice therapy for initial postoperative pain management to ensure comfort and compliance with rehabilitation exercises.

Regular follow-up appointments are necessary to monitor healing progress, address any complications, and adjust the rehabilitation program as needed.

How to use our treatment guidelines handout template?

The Calcific Tendonitis Treatment Guidelines Handout is designed to help healthcare professionals effectively manage and treat calcific tendonitis. This handout includes detailed information on the stages of calcific tendonitis, conservative and surgical treatment options, and post-treatment care. It is suitable for use by orthopedic specialists, physical therapists, and primary care physicians.

Step 1: Access this template

To begin, download the Calcific Tendonitis Treatment Guidelines Handout from the Carepatron app or website. You can customize the template on the app too.

Step 2: Use the handout

Introduce the handout to your patient or to the colleagues or medical students who will use it, explaining the purpose and contents. Highlight the stages of calcific tendonitis and the importance of following the recommended treatment guidelines for optimal recovery.

Discuss the conservative and surgical treatment options detailed in the handout. Tailor the discussion to the patient’s specific condition, or come up with a fictitious patient case for medical students, emphasizing the benefits and potential outcomes of each treatment method.

You can also use the "Additional notes" section at the bottom of the handout to document any personalized recommendations, specific instructions, or follow-up plans.

Benefits of using this handout

Using our Calcific Tendonitis Treatment Guidelines Handout offers several advantages for healthcare professionals:

• Comprehensive information: The handout provides detailed guidelines, ensuring that healthcare professionals have all the necessary information at their fingertips.
• Education: This handout can be used to educate patients about their condition and treatment plan, enhancing their understanding and compliance. It also helps medical students and any healthcare professional brush up on Calcific Tendonitis Treatment Guidelines.
• Evidence-based: The handout is based on research by Raja et al. in 2019, published in J Family Med Prim Care, and research by Kim et al. in 2020, published in Clin Shoulder Elb, both of which involved studies of various patients' medical history and treatment. This ensures that the treatment provided is up-to-date and effective.

References

Kim, M.-S., Kim, I.-W., Lee, S., & Shin, S.-J. (2020). Diagnosis and treatment of calcific tendinitis of the shoulder. Clinics in Shoulder and Elbow, 23(4), 203–209. https://doi.org/10.5397/cise.2020.00318

Raja, A., Craig, E. V., & Braman, J. P. (2019). Rotator cuff tendon calcific tendinitis treatment algorithm for primary care musculoskeletal physicians. Journal of Family Medicine and Primary Care, 8(5), 1647. https://doi.org/10.4103/jfmpc.jfmpc_110_19