Subacromial Bursitis with Tendinosis Calcarea When Relative Rest and Oral NSAIDs Have Not Reduced Shoulder Pain

This protocol addresses subacromial bursitis presenting with calcium deposits in the subacromial tendons (tendinosis calcarea) in patients whose initial management with relative rest and a short course of oral NSAIDs did not achieve adequate pain reduction within the expected timeframe.

Previous Treatment — Escalation Trigger

The preceding step — relative rest in the acute phase combined with oral NSAIDs for 1 to 2 weeks — did not meet its intended goal: shoulder pain reduction within 1 to 2 weeks. Failure to achieve this target is the clinical criterion that warrants progression to the structured regimen described here.

Clinical Situation

The defining feature of this scenario is confirmed calcium deposits within the subacromial tendons. Evidence distinguishes this population: interventions specifically suited to calcium deposition show meaningful benefit here that they do not demonstrate in patients without such deposits. This distinction directly shapes the protocol's approach.

Protocol Approach (Partial Overview)

The regimen centres on a targeted shoulder exercise programme, with particular attention to eccentric training and scapular stabilisation. For patients with confirmed calcium deposits, specific procedure-based interventions directed at the deposit itself are incorporated into the approach.

The full sequence — including the order, conditions, and criteria governing each intervention — is available through the complete protocol.

Goal: Shoulder pain reduction & improved shoulder function within 8 weeks

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.3109/17453674.2014.920991

High-energy extracorporeal shockwave therapy (ESWT) is more effective than low-energy ESWT or placebo in reducing pain and improving shoulder function in patients with tendinosis calcarea.

ESWT (all forms) is no more effective than placebo or other treatments in reducing pain or in improving shoulder function of patients without calcium deposition in the tendons.

Exercise should preferably be performed at low intensity and high frequency, within the pain threshold, and focusing on eccentric training.

Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage).

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