Treatment of Calcific Tendinitis of the Rotator Cuff

First-Line Conservative Management

• The American Academy of Orthopaedic Surgeons recommends starting with NSAIDs combined with exercise programs as the initial approach for symptomatic calcific tendinitis, based on moderate-grade evidence 2, 1
• Paracetamol can be used concurrently with NSAIDs or COX-2 inhibitors for more effective pain control in patients with calcific tendinitis 1
• Home exercise programs have demonstrated significant improvements in pain at rest, nighttime pain, and functional scores after 3 months of treatment in patients with calcific tendinitis 1
• The American Academy of Orthopaedic Surgeons suggests reserving opioids strictly for rescue analgesia when other methods fail, not as first-line treatment for calcific tendinitis 1

Second-Line Interventional Treatment

• A single subacromial corticosteroid injection with local anesthetic provides short-term improvement in pain and function, supported by moderate evidence in patients with calcific tendinitis 1
• The American Academy of Orthopaedic Surgeons advises avoiding multiple repeated corticosteroid injections—limit to single injections for short-term relief in patients with calcific tendinitis 1

Modalities with Insufficient Evidence

• The American Academy of Orthopaedic Surgeons cannot recommend for or against ice, heat, iontophoresis, massage, TENS, or PEMF due to lack of sufficient evidence for the treatment of calcific tendinitis 3, 1

Common Pitfalls to Avoid

• The American Academy of Orthopaedic Surgeons recommends not using opioids as first-line treatment—they should only be used for rescue analgesia in patients with calcific tendinitis 1
• The American Academy of Orthopaedic Surgeons advises avoiding overusing corticosteroid injections—multiple injections are not supported by evidence and should be limited in patients with calcific tendinitis 1