Calcific Tendonitis: Treatment options

Non-surgical treatment

Painkillers
Pain medication and anti-inflammatory medicines will help to ease your symptoms of pain and stiffness. If your symptoms are mild, this may be enough to keep your condition manageable.

Physiotherapy
An individual programme of exercises will be devised for you. These may include exercises to strengthen the muscles around your shoulder blade, improve your posture, strengthen your rotator cuff and improve stretching. Although the exercises may at times be hard work, tight or uncomfortable, they should not be painful. Should you need any other form of treatment, such as injections or surgery; physiotherapy will form an important part of your rehabilitation and recovery.

Injections
Depending on the extent and duration of your symptoms, you may benefit from a steroid injection. Steroids (such as cortisone) are good at reducing the inflammation. However, it is unlikely that you will able to have more than three steroid injections during one year.

Ultrasound-guided barbotage
An ultrasound image is used to identify the exact area of calcification. Under ultrasound guidance and with local anaesthetic the calcific deposit can be punctured, possibly aspirated and flushed out. A steroid injection is also applied to treat the inflammation. Barbotage is completed as an outpatient, day procedure. You may be in some discomfort following it, so it is a good idea to ask someone to drive you home. You should be able to return to driving the following day though.

The procedure is successful in 60-70% of patients, although some people require two treatments. If you do not respond to the barbotage, you may need surgery, although Mr. Cole will advise you of this.

Extracorporeal Shock Wave Treatment

Using a specialised machine shockwaves are passed through the tendon. This is done usually without the need for local anaesthetic or injections. This can be very effective in some patients and 3 treatments as an outpatient are usually required. It has recently been studied and approved for calcific tendonitis in the shoulder by NICE (National Institute for Clinical Excellence)

Exercises
Exercising your shoulder is an important part of your recovery. It can help
to minimise stiffness and avoid further possible complications such as
muscle atrophy (where your muscles start to waste away because they are
not used). An exercise programme will be devised for you by your team of
physiotherapists, in conjunction with Mr. Cole. It will last for several weeks
and is something you will need to do every day.

Surgical treatment

Should you need surgery, Mr. Cole will advise you on what type of
treatment would best suit you and your situation. He will choose the most
appropriate and least invasive for you.

Arthroscopic treatment
This is a keyhole surgery where a camera is used to help identify and
target specific problem areas. A Subacromial Decompression is performed
and any large calcific deposits can be removed from the tendon at the
same time. This is normally completed as day surgery and is minimally
invasive.

Exercises
Following your surgery, your team of physiotherapists will work with you
to devise an exercise programme. This will be designed with advice from
Mr. Cole to help you recover as quickly and efficiently as possible.