Calcific Tendonitis of the Shoulder: Symptoms and Treatment

01What

What is calcific tendonitis?

In calcific tendonitis, calcium hydroxyapatite crystals form in a rotator cuff tendon. The cause is not fully understood; it is not simply “wear and tear” and does not mean the tendon is torn. The supraspinatus tendon is most commonly involved, but infraspinatus and subscapularis can also be affected. It is more common in people with diabetes or thyroid disease and in those with sedentary or desk-based jobs.

The condition progresses through stages: a formative stage with deposits forming (often painless or mildly painful), a resorptive stage when the body breaks down and removes the calcium (often very painful), and a post-calcific stage of healing.

02Symptoms

Symptoms

• Shoulder pain that may come on suddenly and be severe in the resorptive phase, often worst at night.
• Pain when lifting the arm, reaching or lying on the affected side.
• Stiffness and reduced range of motion, sometimes mimicking a frozen shoulder.
• Tenderness at the outer part of the shoulder.
• Pain that may spread down the upper arm.
• In the chronic phase, a dull ache and pain with overhead activity.

03Diagnosis

How it is diagnosed

A doctor or physical therapist examines the shoulder for tenderness, movement and strength and rules out other causes of shoulder pain (rotator cuff tear, frozen shoulder, neck problems, arthritis). An X-ray usually shows the calcium deposit, which appears as a white spot near the tendon. Ultrasound can show the deposit, its texture and associated inflammation, and MRI is used if a tear or other problem is suspected. See tendinopatía calcificante (Spanish).

04Natural

Natural history: it often goes away

Most calcific deposits resolve spontaneously, often within 1–3 years, and many people recover with conservative treatment alone. Pain tends to be the worst during the resorptive phase, when the deposit is soft and the body is clearing it. This is why the intensity of pain does not always match the size of the deposit, and why patience and symptom management are central. Larger deposits and those with a firm, dense appearance may take longer to resolve.

05Self-care

Self-care and pain relief

• Pain relief: paracetamol and, if suitable, short courses of anti-inflammatory medication.
• Heat or ice for comfort.
• Relative rest: avoid painful overhead activities but keep the shoulder moving to prevent stiffness.
• Sleep position: support the arm with a pillow, avoid lying on the painful shoulder.
• Gentle pendulum and range-of-motion exercises within pain limits.
• Avoid forcing movement or heavy lifting in the acute phase.

06Physio

Physical therapy and exercise

Physical therapy aims to reduce pain, restore movement and strengthen the rotator cuff and shoulder blade muscles. Early on it focuses on pain relief and gentle mobility; later, graded strengthening (external rotation, scapular control, elevation in the plane of the scapula) and functional training. Evidence suggests exercise is helpful, and it is usually the first-line approach, alongside patient education and pacing. See supraspinatus exercises (Spanish) and supraspinatus injury.

07Procedures

Procedures for persistent or severe pain

• Corticosteroid injection into the subacromial space can reduce pain in the short term; it may also be used to enable physical therapy.
• Extracorporeal shockwave therapy (ESWT): acoustic pulses directed at the deposit; high-energy protocols have shown benefit in dissolving deposits and reducing pain in studies, with mild side effects such as bruising.
• Ultrasound-guided needling and lavage (barbotage): a needle is used to break up and wash out the calcium; many patients improve, though some experience a rebound of pain.
• Arthroscopic surgery to remove the deposit is reserved for people who do not respond to months of non-surgical treatment.
• Choose procedures after discussion with a specialist, as indications and evidence vary.

08Recovery

What to expect

The acute painful phase often lasts a few weeks to a couple of months, and it is often followed by a rapid improvement once the calcium is resorbed. Many people regain full movement and function within 6–12 months. Recurrence on the same shoulder is uncommon, but deposits can form in the other shoulder. Regular exercise after recovery helps maintain shoulder health.

10Cases

Three common situations

A 45-year-old woman wakes with severe shoulder pain and cannot lift the arm: possible resorptive phase; seek assessment, relieve pain and start gentle movement.

Months of dull shoulder ache and a calcium spot on X-ray: exercise-based physical therapy is a good first step.

Persistent pain despite months of treatment: discuss shockwave, lavage or injection options with a specialist.

11Summary

Key points to remember

Calcific tendonitis is painful but usually temporary. Pain relief, gentle movement and physical therapy help most people; injections, shockwave or lavage are options for persistent pain, and surgery is rarely required. Our physical therapy team can assess your shoulder and guide your recovery.

This guide is for general information and does not replace an assessment by your own doctor or physical therapist.