Treatment of Calcific Tendinosis of the Rotator Cuff

Initial Conservative Management

The American Academy of Family Physicians recommends beginning with conservative management consisting of NSAIDs, physical therapy, and a single corticosteroid injection, which provides short-term pain relief and functional improvement in most patients 1, 2
Relative rest is recommended to reduce repetitive overhead activities that load the affected tendon, but avoid complete immobilization to prevent muscle atrophy and deconditioning 1, 3
The American Academy of Family Physicians suggests using NSAIDs for pain control and to manage any inflammatory component 1
A single corticosteroid injection with local anesthetic has moderate evidence to support short-term improvement in both pain and function 2, 4

Plain radiography may show calcific tendinosis, sclerosis, or spur formation of the acromion, according to the American Academy of Family Physicians 1, 5
Ultrasound is useful for detecting calcification and guiding interventional procedures, and shows tendon thickening and decreased echogenicity 1, 5
MRI is sensitive and specific for detecting rotator cuff tears, degeneration, and partial tears, but may be unnecessary if calcification is clearly visible on plain films 1, 5

The American Academy of Orthopaedic Surgeons recommends avoiding premature surgical intervention, as the natural history of calcific tendinosis includes spontaneous resolution in many cases 2, 4
The American Academy of Orthopaedic Surgeons suggests avoiding the use of platelet-rich plasma (PRP) due to limited evidence supporting its routine use for rotator cuff tendinopathy 2, 4
The American Academy of Orthopaedic Surgeons recommends avoiding multiple corticosteroid injections, as evidence supports only a single injection for short-term benefit 2, 4, 6

The American Academy of Orthopaedic Surgeons notes that older age is associated with higher failure rates and poorer outcomes after any rotator cuff intervention 2
Diabetes is associated with higher retear rates and poorer quality of life scores, according to the American Academy of Orthopaedic Surgeons 4