This protocol addresses patients with confirmed calcium deposits in the subacromial tendons (tendinosis calcarea) whose shoulder pain and function have not improved adequately within eight weeks of structured first-line treatment.

Clinical Scenario

Tendinosis calcarea with calcium deposits in the subacromial tendons is associated with persistent shoulder pain that can prove resistant to standard interventions. When pain and functional limitation continue despite a complete course of first-line care, escalation to a dedicated next-step approach is warranted.

Previous Treatment — Unmet Goals

The preceding protocol included specific shoulder exercise therapy (eccentric training, scapular stabilisation, myofascial trigger point treatment), subacromial corticosteroid injection under ultrasound guidance, and high-energy extracorporeal shockwave therapy (ESWT) or barbotage for proven calcium deposits. Escalation to this protocol is triggered by failure to achieve shoulder pain reduction and improved shoulder function within 8 weeks.

Next-Step Approach (Overview)

When subacromial pain syndrome becomes chronic and treatment-resistant — particularly where pain-perpetuating behaviour is a factor — management shifts to a specialised rehabilitation setting. The complete evidence-based regimen, including the specific interventions, their sequence, and selection criteria, is detailed in the full structured protocol.

References

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.
Rehabilitation can be considered for chronic, treatment-resistant SAPS, where pain-perpetuating behavior plays a role.

DOI: 10.3109/17453674.2014.920991

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Persistent Shoulder Pain in Tendinosis Calcarea After Exercise Therapy, Corticosteroid Injection, and ESWT

References