Calcific Tendinitis of the Shoulder: Symptoms, Diagnosis, Treatment & Recovery
We provide diagnosis-first care for calcific tendinitis—pain caused by calcium deposits within the rotator cuff tendons, most commonly the supraspinatus. Our integrated surgeons–physiotherapists team focuses on rapid pain relief, targeted rehabilitation, and a safe return to work, life, and sport.
What Is Calcific Tendinitis?
Calcific tendinitis occurs when calcium (hydroxyapatite) deposits form inside a rotator cuff tendon—most often the supraspinatus. The condition typically passes through phases:
- Formative: calcium slowly accumulates; symptoms may be mild or absent.
- Resting: the deposit is stable; pain may be intermittent, especially with overhead use.
- Resorptive: the body breaks down the deposit—often causing severe, sharp pain and night ache due to inflammation in the subacromial bursa.
Calcific tendinitis is different from age-related rotator cuff tears, but the two can occasionally coexist.
Common Symptoms
- Sudden or escalating shoulder pain, often without a clear injury.
- Night pain and difficulty lying on the affected side.
- Painful arc on lifting the arm, reaching, or dressing.
- Weakness due to pain inhibition rather than tendon rupture.
- Occasional episodes of acute, severe pain during the resorptive phase.
Why Calcific Tendinitis Happens — Key Factors
- Tendon biology: changes in tendon cells can trigger calcium deposition.
- Mechanical load: repetitive overhead use may contribute but is not always present.
- Subacromial bursitis: inflammation around the deposit amplifies pain.
- Coexisting issues: impingement/bursitis, stiffness, or scapular control deficits may perpetuate symptoms.
How We Diagnose Calcific Tendinitis
Diagnosis combines history, examination, and targeted imaging to confirm calcium deposits and assess the surrounding bursa/tendons.
Clinical assessment
- Painful arc and subacromial tenderness; strength testing limited by pain.
- Screen for stiffness and scapular dyskinesis affecting mechanics.
Imaging
- X-rays: clearly show calcific deposits and their size/location.
- Ultrasound: visualises deposits and inflamed bursa; guides injections or needle lavage (barbotage).
- MRI (selected cases): evaluates associated cuff or labral pathology when symptoms are atypical or persistent.
Non-Operative Treatment (First-Line)
Most patients improve without surgery. We tailor a plan to the phase of disease, pain intensity, and activity goals.
1) Settle pain & inflammation
- Short course of analgesics/anti-inflammatories if appropriate.
- Activity modification: avoid heavy overhead work/pressing during flares; a sling may help briefly for severe pain.
- Image-guided subacromial corticosteroid injection in irritable bursitis to enable rehabilitation.
2) Restore movement & control
- Gentle range-of-motion work progressing to functional mobility.
- Scapular control (serratus anterior, lower trapezius) and rotator cuff endurance.
- Technique adjustments for pressing, reaching and sleep positions.
3) Shockwave therapy (ESWT)
- Considered for persistent symptoms; may aid deposit fragmentation and pain reduction in selected patients.
Procedures (When Symptoms Persist)
If severe pain continues or function is limited despite best conservative care, we may recommend a procedure:
- Ultrasound-Guided Barbotage (Needle Lavage): under local anaesthetic, the deposit is needled/washed to remove calcium, followed by a subacromial bursal injection to reduce inflammation. Many patients experience rapid pain relief over days to weeks.
- Arthroscopic Surgery: keyhole removal of the deposit and bursectomy when symptoms are refractory or when large/solid deposits persist. Concomitant procedures (e.g., rotator cuff repair or acromioplasty) are considered only if clearly indicated.
Risks & considerations
- Barbotage: temporary soreness, incomplete evacuation, recurrence (uncommon).
- Arthroscopy: infection, stiffness, persistent pain, rare tendon weakening if a cuff repair is required.
More detail: Shoulder Arthroscopy (Keyhole Surgery).
Recovery & Timelines
Non-operative or Injection-Only
- Acute flare: pain typically improves over days–2 weeks with medication, activity changes, and injection when needed.
- Barbotage: soreness for 24–72 hours is common; many report meaningful relief within 1–3 weeks as inflammation settles.
- Rehabilitation progresses to strengthening as pain allows.
After Arthroscopic Removal
- Day-surgery procedure; sling for comfort in the first few days.
- Early range-of-motion and swelling control; office duties usually 1–2 weeks depending on role.
- Strength and endurance build over 6–12 weeks; overhead/heavy tasks progress by criteria.
When Should I See a Shoulder Specialist?
- Severe night pain or acute episodes that don’t ease with simple measures.
- Recurrent painful arc affecting work, sleep, or sport.
- Failure to improve after a structured physiotherapy and injection plan.
- Concern for coexisting issues (e.g., stiffness, rotator cuff tear).
Calcific Tendinitis — FAQs
Will the calcium go away on its own?
Often yes. Many deposits resorb naturally over time, which is why symptoms can flare then settle. Treatment focuses on pain control and function while the process resolves.
Is calcific tendinitis the same as shoulder impingement?
No. Calcific tendinitis involves calcium within the tendon, whereas impingement refers to bursal inflammation and mechanical irritation. They commonly coexist and are treated together.
Does barbotage hurt?
It is performed under local anaesthetic. You may feel pressure during the procedure and have temporary soreness afterwards; most patients tolerate it well.
Do I need surgery?
Rarely. Ultrasound-guided barbotage plus rehabilitation settles most cases. Surgery is reserved for persistent pain or large, solid deposits that have not responded to less invasive care.
Can I keep training?
Yes, with modified loads and ranges. We guide safe alternatives and a criteria-based return to overhead or pressing movements as pain allows.