Rotator cuff tendon calcific tendinitis treatment algorithm for primary care musculoskeletal physicians

PURPOSE: Calcific tendinitis of the shoulder is a common pathology encountered by primary care sports medicine physicians and orthopedic surgeons. Understanding the patient demographics responsible for calcific tendinitis outcomes from various treatment modalities may lead to greater understanding of appropriate management. METHODS: This was a retrospective study on patients who were diagnosed with calcific tendinitis by imaging (radiographs, MRIs) at our institution from 2014 to 2016. The data collection included patient demographics, clinical signs and symptoms management. Treatment outcomes were assessed by whether symptoms resolved and the number and type of treatment. RESULTS: A total of 250 medical records were reviewed out of which 237 were involved in the data analysis. There were 95 male and 141 female patients with a mean age of 54.9 ± 11.5 years. In all, 120 patients complained of right shoulder pain and 117 of left shoulder pain. Smokers had a higher VAS Pain at Rest and Activity of 6.1 ± 3.5 and 8.2 ± 2.4, respectively, with non-smokers scoring a lower VAS Pain Rest score of 4.2 ± 3.1 and 7.9 ± 2.0 (P = 0.18). The VAS Pain Rest score after follow-up from corticosteroid injection, ultrasound-guided injection with needling, and surgery were 3.9 ± 3.0, 3.5 ± 3.0, and 0.7 ± 1.4, respectively. CONCLUSION: An algorithm constructed from our results recommends initial management with a subacromial corticosteroid injection with physical therapy followed by ultrasound-guided injection with needling and PT if the initial treatment fails. Surgical management is considered when the patient is recalcitrant to the first two forms of non-operative treatment.