Emergency Department Treatment

The emergency department management of calcific tendinitis should be tailored to reduce the patient's symptoms and help protect shoulder function. During an acute attack, analgesics are usually necessary to calm the intense pain. A sling for brief periods of immobilization may be provided, but prolonged immobilization should be avoided to prevent loss of motion. The patient should be instructed to rest the shoulder in abduction on the back of a chair as often as is tolerable. Sleeping with a pillow beneath the axilla can also help prevent restricted motion. Gentle and progressive range-of-motion exercises should be emphasized and encouraged. In the acute phase, local application of ice for 10 to 15 min, two to three times per day, may provide analgesia and help control inflammation and edema. Local heat application may be used once acute symptoms have diminished.

Local needling of the calcific deposits in the emergency department has been described for the patient in acute pain. A point of maximum tenderness on palpation can be isolated, and the presence of calcification can be confirmed with radiographs. A local anesthetic, such as 2 percent xylocaine or bupivacaine without epinephrine, is used to anesthetize subcutaneous tissues corresponding to the anticipated site of needle placement. An 18-gauge needle can then be placed at the site of calcification. This may decompress the tendon and ease the pain acutely and may speed ultimate resorption of the deposit. Following this procedure, analgesics should be prescribed. Nonsteroidal anti-inflammatory agents for 7 to 10 days may also be helpful.

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