Calcific Tendonitis Treatment in Hyderabad
Barbotage, shockwave therapy & arthroscopic removal by Dr. Deepthi Nandan Reddy at Apollo Hospitals
What is Calcific Tendonitis?
Calcific tendonitis (also called calcific tendinopathy or calcifying tendinitis) is a condition where calcium deposits form within the rotator cuff tendons of the shoulder. These deposits can cause severe shoulder pain, especially during the resorptive phase when the body attempts to break down the calcium.
Epidemiology: Calcific tendonitis affects 2-7% of adults, with the highest prevalence in women aged 30-60 years. The supraspinatus tendon is involved in approximately 80% of cases, followed by the infraspinatus and subscapularis tendons.
Key Point: Unlike other forms of tendon degeneration, calcific tendonitis often has a self-limiting course. Many cases resolve spontaneously over 1-3 years, though this process can be extremely painful.
Symptoms of Calcific Tendonitis
• Sudden, severe shoulder pain (often described as excruciating)
• Pain that wakes you from sleep
• Inability to move the shoulder due to pain
• Tenderness over the affected tendon
• Pain radiating down the arm
• Dull, aching shoulder pain
• Pain with overhead activities
• Shoulder stiffness
• Impingement-like symptoms
• Night pain (less severe than acute phase)
Phases of Calcific Tendonitis
Fibrocartilaginous transformation of tendon tissue. Usually asymptomatic. Site predisposed to calcium deposition.
Calcium crystals deposit within the tendon. Pain may be mild or absent. Deposit appears chalky and well-defined on X-ray. Can last months to years.
Body attempts to reabsorb calcium through inflammatory process. Causes severe, acute pain. Deposit becomes soft and toothpaste-like. This is when most patients seek treatment in Hyderabad.
Calcium reabsorbed. Tendon heals with collagen remodeling. Pain resolves. Full recovery occurs.
Diagnosis
X-ray: The gold standard for diagnosis. Calcium deposits appear as white opacities within the tendon. X-rays can also help determine the phase (formative deposits are well-defined; resorptive deposits are fluffy/ill-defined).
Ultrasound: Excellent for visualizing calcium deposits and guiding treatment (barbotage). Can detect deposits as small as 2-3mm. Also useful for assessing surrounding structures.
MRI: Not always necessary but helpful to exclude other pathology like rotator cuff tears. May show bone marrow edema in the humeral head during acute phase.
Treatment Options in Hyderabad
• NSAIDs: For pain and inflammation control
• Physiotherapy: Maintain range of motion, avoid impingement positions
• Corticosteroid injection: Subacromial injection for acute pain relief
• Ice and rest: Activity modification during acute flares
Success rate: 60-70% of cases resolve with conservative measures over 1-2 years
Barbotage is a minimally invasive, image-guided procedure that offers faster relief than waiting for natural resorption. Dr. Deepthi Nandan Reddy performs this procedure at Apollo Hospitals, Financial District, Hyderabad.
How Barbotage Works:
1. Local anesthesia is administered to numb the shoulder
2. Under real-time ultrasound guidance, a needle is precisely inserted into the calcium deposit
3. Saline solution is injected to break up and fragment the calcium
4. The calcium slurry is aspirated (removed) through the needle
5. A corticosteroid injection may be given to reduce inflammation
Advantages of Barbotage:
• Outpatient procedure (30-45 minutes)
• No general anesthesia needed
• Immediate return to daily activities
• 60-75% success rate
• Can avoid surgery in most cases
What to Expect After:
• Mild soreness for 24-48 hours
• Pain relief within 1-2 weeks
• Return to work: 1-2 days
• Full recovery: 4-6 weeks
• May need repeat procedure in 10-15%
High-energy acoustic waves are directed at the calcium deposit to fragment it and promote resorption.
• Sessions: 4-6 treatments, 1 week apart
• Success rate: 70-80% improvement
• Best for: Formative phase deposits, patients preferring non-invasive treatment
• Note: May cause temporary increase in pain
Minimally invasive keyhole surgery to remove calcium deposits under direct visualization.
• Indications: Failed conservative/barbotage treatment after 6+ months
• Procedure: 2-3 small incisions, camera-guided calcium removal
• May combine with: Subacromial decompression if impingement present
• Success rate: 90%+ pain relief
• Recovery: Sling 1-2 weeks, physio 6-12 weeks, full recovery 3-4 months
Cost of Treatment in Hyderabad
Indicative costs at Apollo Hospitals Financial District (may vary based on individual case complexity):
Most insurance policies cover surgical treatment. Check with your provider for specific coverage.
Recovery Timeline
• Week 1-2: Pain management
• Week 2-6: Gradual activity increase
• Month 2-6: Progressive strengthening
• Month 6-24: Natural resolution
• Day 1-2: Local soreness
• Week 1-2: Significant pain relief
• Week 2-4: Return to full activities
• Week 4-6: Complete recovery
• Week 1-2: Sling, gentle motion
• Week 2-6: Range of motion exercises
• Week 6-12: Strengthening program
• Month 3-4: Full recovery
Scientific References
1. Louwerens JK, et al. Calcific tendinitis of the rotator cuff: A systematic review. J Shoulder Elbow Surg. 2014
2. Chiou HJ, et al. Ultrasound-guided percutaneous lavage for calcific tendinopathy of the rotator cuff. Skeletal Radiol. 2014
3. Verstraelen FU, et al. High-energy versus low-energy extracorporeal shockwave therapy for calcifying tendinitis. J Bone Joint Surg Am. 2014
Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)