Algorithm of management based on treatment goals for calcifying tendonitis of the shoulder: rigidity, pain and size of calcification

Purpose: The objective of the present manuscript is to propose a step-by-step algorithm for the management of calcifying tendonitis (CT) of the shoulder based on treatment goals, from conservative to surgical approaches. Method: A clinical note to present the main treatments for the management of calcifying tendonitis of the shoulder based on pain, rigidity and size of calcification based on the clinical experience and previous publications of the authors has been performed. Arguments: Treatment is conservative and surgical although there is controversy on the most adequate treatment. Kinesiotherapy is the recommended therapy for shoulder rigidity. For pain management after NSAIDs; microwaves, short waves, TENS, ultrasounds and Interferentials are effective. For the management of size of calcification, Iontophoresis, Electroshock wave therapy, Ultrasound needle guided aspiration and arthroscopic surgeries are the recommended alternatives, in that order. Conclusions: CT of the shoulder must be treated based on specific goals, mainly pain, rigidity or size of calcification. The proposed step-by-step algorithm of treatment is suggested based on the effectiveness of available techniques. If rigidity is present, kinesiotherapy is the recommended technique. For pain management, physical therapy such as microwaves, short waves, TENS, Ultrasound and Interferentials are effective techniques. For the treatment of calcification, iontophoresis is the most common, safe and inexpensive technique. If all previous conservative techniques failed, advanced techniques such as ESWT, US guided aspiration and arthroscopy are recommended, although they are not exempt of risk factors and complications.