Calcific Tendonitis Treatment Options

Calcific tendonitis develops when calcium crystals form inside a tendon. Over time, these deposits can harden and irritate the surrounding soft tissues, especially during the body’s attempt to reabsorb them. The exact cause of this condition is not always clear, but it may result from chronic wear and tear, poor blood flow to the tendon, or degenerative changes that occur with age. Some cases may be linked to repetitive motion or overuse, particularly among people whose work or sports involve frequent lifting or overhead activity.

Most cases of calcific tendonitis can be treated successfully without surgery. The goal is to relieve pain, reduce inflammation, and encourage the body to absorb the calcium deposits naturally.

• Rest and activity modification – Reducing repetitive or overhead movements that aggravate the shoulder helps minimize irritation. Short periods of rest can ease inflammation, although prolonged immobilization is not recommended, as it may lead to stiffness or frozen shoulder.
• Medications and anti-inflammatory therapy – Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help relieve pain and swelling. In some cases, corticosteroid injections may be recommended to provide longer-lasting relief by directly reducing inflammation around the tendon.
• Physical therapy – Once pain begins to subside, physical therapy is an important part of recovery. A customized exercise program focuses on stretching and strengthening the shoulder to restore mobility and prevent recurrence. Therapists may also use manual techniques or ultrasound therapy to promote blood flow and healing.
• Extracorporeal shock wave therapy (ESWT) – This noninvasive treatment uses high-energy sound waves to break up calcium deposits and stimulate healing in the affected tendon. ESWT is typically performed in an outpatient setting and may reduce the need for surgery in many patients.
• Ultrasound-guided needle lavage (barbotage) – In this minimally invasive procedure, a small needle is inserted into the calcium deposit under ultrasound guidance. The area is then flushed with saline solution to break down and remove calcium particles. Barbotage can be combined with corticosteroid injection for additional pain relief.
• Heat and cold therapy – Alternating heat and ice therapy can be helpful in managing pain and inflammation during flare-ups. Cold packs reduce swelling and numb discomfort, while heat promotes circulation and relaxation of tight muscles.
• Platelet-rich plasma (PRP) therapy – In some cases, PRP therapy may be considered to enhance tissue repair. This treatment involves injecting a patient’s own concentrated platelets into the tendon to accelerate healing and reduce inflammation.

When nonsurgical treatments fail to relieve symptoms after several months, or if calcium deposits are large and persistent, surgical intervention may be recommended.

• Arthroscopic removal – The most common surgical approach for calcific tendonitis is arthroscopic surgery, a minimally invasive procedure performed through small incisions. Using specialized instruments and a tiny camera, the surgeon locates and removes calcium deposits while preserving surrounding healthy tissue. Any associated tendon damage can be repaired during the same procedure. Arthroscopic surgery offers significant advantages, including smaller incisions, less postoperative pain, and faster recovery times compared to open surgery.
• Open surgical removal – In rare or complex cases where deposits are extensive or difficult to access arthroscopically, open surgery may be performed. This involves a larger incision that allows direct visualization and complete removal of the calcium deposits. Open surgery may be followed by a longer rehabilitation period but can achieve excellent results when necessary.

Recovery from calcific tendonitis treatment depends on the severity of the condition and the method used. Nonsurgical patients often experience gradual improvement over several weeks to months, while surgical patients typically regain motion and strength over a period of two to three months with dedicated physical therapy.

Rehabilitation focuses on gentle stretching exercises at first, progressing to strengthening exercises to restore shoulder stability. Most patients return to normal activities without pain once inflammation has resolved and strength is restored.

The prognosis for calcific tendonitis is generally excellent. With timely diagnosis and appropriate treatment, most patients achieve full pain relief and normal range of motion. However, recurrence can occur, especially if shoulder mechanics or repetitive stress are not addressed. Maintaining shoulder flexibility and strength through regular exercises can help prevent future flare-ups.