- What it is
- Calcium deposit in the rotator cuff
- Pain pattern
- Often severe, acute onset
- Imaging
- Plain X-ray (highly sensitive)
- First-line
- Analgesia, image-guided injection or barbotage
- Surgical
- Arthroscopic excision (selective)
What calcific tendinitis is.
Calcific tendinitis is a condition in which deposits of calcium hydroxyapatite form in the substance of a rotator cuff tendon — most commonly the supraspinatus. The cause of the deposit is incompletely understood and likely multifactorial. The deposit itself goes through a natural cycle: a formative (silent) phase, a resting phase, and a resorptive phase. The resorptive phase is when the body attempts to break the calcium down — and is also when the deposit is most painful.
This natural history matters because treatment is timed to where the deposit is in the cycle.
Symptoms.
Calcific tendinitis classically presents in one of two ways:
- Acute resorptive phase — sudden onset of severe shoulder pain, often described by patients as the "worst pain I've ever had". The arm is held immobile. Night sleep is impossible. Even minor movement causes intense pain.
- Chronic background pain — a more typical impingement-pattern shoulder pain, with the deposit found incidentally on imaging.
How the diagnosis is made.
Plain radiographs are highly sensitive for calcific tendinitis — the deposit is opaque and easily seen. The location, size and morphology of the deposit guide treatment. Ultrasound is the most useful additional test, particularly for guiding barbotage. MRI is rarely needed unless an associated cuff tear is suspected.
Treatment.
Acute resorptive phase
- Pain control with adequate analgesia and a short course of anti-inflammatories.
- Image-guided barbotage (needling and lavage of the deposit), usually combined with a corticosteroid injection — the highest-yield single intervention in the painful phase.
- Time. The acute phase often settles within 1–2 weeks once treatment is started.
Chronic phase
- Activity modification, physiotherapy, and analgesia.
- Image-guided barbotage if symptoms persist.
- Selective arthroscopic excision when symptoms are persistent and the deposit is well-defined and amenable to surgical removal.
Surgery.
Arthroscopic excision of calcific deposit is performed in patients with persistent symptoms despite non-operative treatment, particularly where the deposit is large, well-organised, and located in a position amenable to safe excision. The procedure is performed under general anaesthesia as day surgery, with rapid recovery and an excellent prognosis in selected cases.
Frequently asked questions.
Is the pain of calcific tendinitis worse than a fracture?
Many patients in the resorptive phase describe the pain as the worst they have experienced — comparable with or worse than acute trauma. The pain is intense because the body is actively breaking the deposit down, releasing irritant material into the surrounding tissue.
Can the calcium go away on its own?
Yes — in many patients the deposit resolves spontaneously over months to years. The challenge is managing the symptoms during that window.
Will barbotage work?
Image-guided barbotage with corticosteroid injection is effective in the majority of patients with symptomatic calcific tendinitis. It is the highest-yield single intervention in the painful phase.
Will I need an operation?
Most patients do not. Surgery is reserved for the minority with persistent symptoms despite non-operative treatment, where the deposit is large and amenable to arthroscopic excision.
Can it come back in the same shoulder?
Recurrence after successful treatment is uncommon. A small subset of patients develop deposits in the opposite shoulder over time.
References.
- Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis, and management. J Am Acad Orthop Surg. 1997;5(4):183–191.
- Louwerens JK, et al. Comparing ultrasound-guided needling combined with a subacromial corticosteroid injection versus high-energy extracorporeal shockwave therapy. Am J Sports Med. 2016;44(7):1727–1735.