Management of Calcific Tendinitis of the Supraspinatus

Conservative Management (First‑Line)

A 3–6 month trial of combined relative rest, cryotherapy (10 min ice through a wet towel), eccentric strengthening exercises, and short‑term NSAIDs is recommended for patients with calcific supraspinatus tendinitis. 1
Relative rest should limit activities that load the supraspinatus tendon while preserving pain‑free motion; complete immobilization is avoided to prevent muscle atrophy. 1
Cryotherapy applied for 10‑minute intervals using a wet towel reduces acute shoulder pain. 1
Progressive eccentric loading is a cornerstone of tendinopathy rehabilitation because it promotes proper collagen synthesis and fiber alignment. 1
Oral or topical NSAIDs provide effective short‑term pain relief; topical formulations are preferred when gastrointestinal risk is a concern, although NSAIDs do not improve long‑term functional outcomes. 1

Peritendinous or subacromial corticosteroid injections can give superior acute pain relief compared with oral NSAIDs, but they do not alter long‑term outcomes; intratendinous injection should be avoided because it reduces tendon tensile strength and raises rupture risk. 1

Plain radiographs may demonstrate calcium deposits but are not required for diagnosis; advanced imaging (ultrasound or MRI) is reserved for ambiguous cases or pre‑procedural planning. 4
Presence of muscle atrophy on physical examination signals a more chronic disease state and may predict a longer recovery period. 4

Approximately 80 % of patients with overuse‑related shoulder tendinopathies achieve full recovery within 3–6 months when managed with appropriate conservative measures. 2

Orthopedic surgical referral is indicated when pain persists after 3–6 months of well‑managed conservative care, including at least one trial of ultrasound‑guided lavage. [1][3]
Indication for surgery: failure of conservative therapy after the 3–6‑month period. [1][3]
Surgical technique involves arthroscopic or open excision of calcium deposits combined with debridement of abnormal tendon tissue. 3
Arthroscopic excision provides the greatest functional gain (≈ 38‑point improvement in Constant‑Murley Score) and comparable pain reduction (≈ 4.6‑point decrease in VAS) to non‑operative options. 3
Post‑operative radiographic resolution of calcium deposits occurs in about 85 % of cases. 3