Management of Calcific Tendinopathy of the Rotator Cuff

Calcific tendinopathy refers to calcium deposits in tendons. By far, this occurs most commonly in the rotator cuff occurring in up to 20% of painful shoulders. There two primary mechanisms through which deposition occurs. One involves ‘calcific tendinitis’ where calcification occurs acutely within a healthy, well vascularized rotator cuff and tends to resolve spontaneously. The other, ‘dystrophic calcification’, occurs in non-viable, poorly vascularized cuff which worsens over time and is associated with other degenerative changes such as tears.

Management is generally conservative, although about ¼ of patients do not respond to non-operative management and require surgical intervention [1]. Initial therapy includes medications including NSAIDS, acetaminophen and topical medications including topical nitroglycerin or Glyceryl Trinitrate. Physical therapy is aimed at maintaining range of motion and strength of the rotator cuff. Corticosteroid injections (CSI) alone are controversial as this is generally not believed to be an inflammatory process with some studies showing positive, none or negative effects [2]. The role of CSI is probably in an acute, painful “attack” or flare.

There are a variety of other treatment modalities available. Therapeutic ultrasound and dry needling have been proposed although to date there is no published literature. Leduc et al found acetic acid iontophoresis combed with physical therapy was no different from physical therapy alone [3]. There is one case report of platelet rich plasma (PRP) which showed resolution of symptoms at 1 year after two injections [11], however no published studies yet exist.