Shoulder pain is one of the most common musculoskeletal complaints, especially in active individuals who rely heavily on repetitive arm movement. A patient seen recently at Chicago Arthritis and Regenerative Medicine presented with chronic right shoulder pain that had been occurring intermittently for years. She is right-hand dominant, physically active, and works as a physical therapist herself.

On examination and ultrasound evaluation, several important findings were identified:

• Mild arthritis of the AC (acromioclavicular) joint on top of the shoulder
• Chronic rotator cuff tendon changes, especially involving the supraspinatus tendon
• A partial-thickness tendon tear
• Significant calcifications within the tendon consistent with calcific tendonitis

In her case, the shoulder findings were stable compared to prior imaging, meaning the condition had not significantly progressed. However, the ongoing pain and dysfunction still required treatment.

Understanding the Root Cause

Many patients with chronic shoulder pain do not have a single isolated issue. Instead, multiple structures contribute to the problem.

This patient likely experienced strain to the inferior glenohumeral ligament at some point during years of physical activity. When this ligament becomes weakened or unstable, the shoulder joint can subtly shift upward. Over time, this creates excess stress on both the AC joint and the rotator cuff tendons.

That instability can eventually lead to:

• Chronic tendon irritation
• Partial tendon tearing
• Calcific deposits within the tendon
• Joint arthritis

Even though she had already done all the appropriate conservative treatments — including exercises, activity modification, anti-inflammatory nutrition, and supplements — the structural issues remained.

Recommended Non-Surgical Treatment Approach

Because the calcification within the tendon was moderate in size, a procedure called percutaneous barbotage was recommended. This involves:

1. Numbing the area with local anesthetic
2. Using ultrasound guidance to place a needle into the calcification
3. Breaking up and removing portions of the calcium deposit

This can significantly reduce irritation within the tendon.

In addition, platelet-rich plasma (PRP) treatment was recommended to help support healing of:

• The injured rotator cuff tendon
• The arthritic AC joint
• The unstable inferior glenohumeral ligament

PRP uses concentrated platelets from the patient’s own blood to support tissue repair and improve function.

Expected Outcome

Because this patient remains healthy, active, and maintains excellent shoulder mobility, the expectation is that treatment will improve:

• Shoulder stability
• Pain levels
• Tendon healing
• Overall function

The goal is not only symptom relief, but also helping her continue an active lifestyle without surgery.

If you are dealing with chronic shoulder pain, calcific tendonitis, or rotator cuff injury and want a non-surgical evaluation, learn more at Chicago Arthritis or DM to schedule an evaluation.