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. 2025:11:9.
doi: 10.1051/sicotj/2025003. Epub 2025 Feb 20.

Therapeutic options in rotator cuff calcific tendinopathy

Daniel Moya  1 , Mustafa Rashid  2 , Sergio Rowinski  3 , Saad Al-Qahtani  4 , Pedro Bernáldez Domínguez  5 , Diego Gómez  1 , Ignacio Dallo  5
Affiliations

Therapeutic options in rotator cuff calcific tendinopathy

Daniel Moya et al. SICOT J. 2025.

Abstract

There are many variables that influence the decision-making process in the treatment of rotator cuff calcifications. The stage of the deposit, prognostic factors, previous failed treatments, pain level, and functional disability must all be considered. The tendency for spontaneous resolution is an important reason to always exhaust conservative treatment, being non-invasive options the first line of treatment. The emergence of focused shock wave therapy offered a powerful tool for the non-invasive management of rotator cuff calcifications. High-energy focused shock waves have a high degree of recommendation for the treatment of rotator cuff calcifications, supported by meta-analyses and systematic reviews. If non-invasive techniques fail, there is the possibility of moving to a minimally invasive procedure such as ultrasound-guided barbotage. Finally, classic invasive techniques are also a frequent indication, including open surgery and arthroscopy. As each treatment has advantages and disadvantages, the most advisable strategy is to progress from the least invasive therapeutic methods to the most invasive ones without losing sight of the clinical stage of the disease and the general context of each patient.

Keywords: Calcific tendinopathy; ESWT; Rotator cuff; Shock waves; Ultrasound-guided barbotage.

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Conflict of interest statement

All authors certify that he has no financial conflict of interest (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) in connection with this article.

Figures

Figure 1
Figure 1
(A) AP view of a right subacromial space showing a Gärtner type II calcification located in the supraspinatus tendon. (B) The same X-ray projection after three sessions of focused shock waves.
Figure 2
Figure 2
(A) Ultrasound image of a calcification in the supraspinatus tendon (short axis). (B) Ultrasound image of the long axis of the same case. (C) Ultrasound-guided barbotage technique. (D) Ultrasound image of the procedure.
Figure 3
Figure 3
(A) Calcium aspiration in a syringe. (B) Ultrasound image of the sign of Nidus (break in the thickness of the supraspinatus (long axis). (C) Infiltration with intralesional PRP (3mL in nidus) and 6 mL in the bursa. (D) An image showing a syringe with the calcium deposits after the barbotage technique.
Figure 4
Figure 4
Arthroscopic view performing blunt compression of the calcification after opening the supraspinatus superficial layer.
Figure 5
Figure 5
Radioscopic view of a curette and an arthroscope on C-ARM during the treatment of calcific tendonitis in the supraspinatus tendon.
See this image and copyright information in PMC

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