Rapid Radiographic Improvement in Large Multilobulated Shoulder Calcific Tendinitis After Ultrasound-Guided Prolotherapy and Adjunctive Nutritional and Metabolic Support: A Case Report.

Calcific tendinitis of the shoulder is a common disorder characterized by calcium hydroxyapatite deposition within or near the rotator cuff tendons. Although the condition is often self-limited, large multilobulated calcific deposits may be less responsive to conservative treatment and can prompt consideration of more invasive procedures. We report a case of a 49-year-old man who presented with acute severe right shoulder pain, sleep disturbance, and marked functional limitation. At presentation, pain was 10/10 on the visual analog scale, and the shoulder range of motion could not be formally assessed because of severe pain. Plain radiographs demonstrated a large multilobulated calcific deposit measuring approximately 3 cm in the subacromial region, with a smaller adjacent calcification. Ultrasound-guided prolotherapy was performed using a solution of 10% dextrose with a final lidocaine concentration of 0.2%, with 5 mL injected into the glenohumeral joint and 5 mL into the subacromial space. Adjunctive management included hydration, physical therapy, activity modification, and adjunctive nutritional and metabolic support consisting of vitamin C, vitamin D, magnesium, methylsulfonylmethane, and L-arginine. At two weeks, pain improved to 2/10; passive range of motion was nearly full; active range of motion was full, with only mild pain at terminal motion; and follow-up radiographs demonstrated near-complete resorption of the calcific deposit. Although causality cannot be established from a single case, this report suggests that selected patients with calcific tendinitis may experience rapid improvement with a multimodal nonoperative strategy incorporating adjunctive nutritional and metabolic support before escalation to invasive treatment.