Calcific Tendinitis Info
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Video transcript
Calcific tendinitis happens when a small deposit of calcium forms inside one of the rotator cuff tendons in the shoulder. While it is forming it can be quietly uncomfortable, but when the body starts to break it down, the pain can become sudden and severe. The shoulder may feel hot and intensely sore, and moving it can be very hard for a while. It often arrives without warning, and without any injury. The deposit usually shows up clearly on an x-ray or an ultrasound. Encouragingly, these deposits often dissolve on their own with time. In the meantime, anti-inflammatory medication and gentle movement help you through the painful spell. Under ultrasound guidance, the deposit can be softened and drawn out through a fine needle, in a procedure called barbotage. A cortisone injection at the same time can settle the surrounding inflammation. For most people, these steps calm the shoulder without an operation. If a stubborn deposit keeps causing trouble, it can be removed with keyhole surgery. It is done with a camera and instruments through small incisions. The deposit is located within the tendon and cleared away, and the tendon is smoothed and repaired if needed. Any inflamed tissue around it is tidied up at the same time. The arm rests in a sling afterwards. Recovery depends on what was needed, and is often quicker than a full tendon repair. After barbotage, the sharp pain usually eases within days, as the inflammation settles. After surgery, the arm is rested in a sling for comfort, and physiotherapy starts gently to restore movement. Most people regain their range over the following months. The relief once the deposit is gone is usually lasting.
Calcific tendinitis causes shoulder pain from calcium deposits; treatment ranges from observation to washing out the calcium.
What you're feeling
You might notice a deep, aching pain in the front or side of your shoulder that doesn’t go away. It often feels like a sharp, stabbing sensation when you lift your arm above your head or reach behind your back. Many people find that the pain is worse at night, making it difficult to lie on the affected side.
The discomfort usually builds up gradually over weeks or months. You may feel a clicking or grinding sensation when you move your shoulder. Simple tasks like brushing your hair, reaching for a seatbelt, or lifting a grocery bag can become surprisingly painful. Unlike a sudden tear, this pain tends to come and go in flares, with periods of relative calm in between.
What's actually happening
Your shoulder is a complex ball-and-socket joint. The rotator cuff is a group of four tendons that wrap around the ball of your upper arm bone, holding it in place and helping you rotate your arm. In calcific tendinitis, calcium deposits build up within one of these tendons, most commonly the supraspinatus tendon.
Think of the tendon as a sturdy rope. Normally, it is smooth and flexible. In this condition, hard, chalky calcium crystals form inside the tendon tissue. These deposits can be small and painless, or large and inflamed. The body often tries to heal these deposits by breaking them down, which triggers significant inflammation. This inflammatory response is what causes the intense pain.
The condition typically progresses through stages. First, calcium builds up silently. Then, the body begins to resorb the calcium, causing pressure and inflammation. This is often the most painful phase. Finally, the body clears the calcium, and the tendon heals, though it may remain slightly weaker or stiffer for a while.
Several factors may increase your risk. Age is a common factor, with the condition most frequently seen in people between 40 and 60 years old. Women are affected more often than men. While the exact cause is not fully understood, it is not usually linked to a specific injury or overuse. It is considered a degenerative process, meaning it happens as part of the natural aging of the tendon tissue.
What we can do about it
Most cases of calcific tendinitis improve without surgery. Your surgeon will likely start with conservative treatments to manage pain and reduce inflammation.
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and swelling. If the pain is severe, a corticosteroid injection into the shoulder joint may provide significant relief. These injections calm the inflammation but do not remove the calcium deposit.
Physical therapy is a key part of recovery. A therapist will guide you through gentle stretching and strengthening exercises. The goal is to maintain your range of motion and keep the shoulder mobile while the inflammation settles. In the early, painful stages, movement might be limited, but gentle motion is important to prevent stiffness.
If conservative measures do not help after several months, your surgeon might discuss a procedure called barbotage. This is a minimally invasive technique where a needle is used to break up and wash out the calcium deposit under ultrasound guidance. It is often combined with a corticosteroid injection to reduce post-procedure pain.
Surgery is occasionally needed when the pain doesn't settle with non-operative treatment. The operation is done by keyhole (arthroscopic) surgery: your surgeon finds the calcium deposit, removes it, and cleans up the surrounding tendon. If the hole left in the tendon by removing the calcium is large enough, your surgeon will repair it with one or two small anchors — the same kind used in rotator cuff repair — to close the defect and let the tendon heal. Most people see significant improvement within a few months, though complete resolution can take up to a year.
When to see someone
You should schedule an appointment with a clinician if shoulder pain persists for more than a few weeks despite rest and over-the-counter pain relievers. Seek care sooner if you experience sudden, severe pain that prevents you from moving your arm. Also, consult a professional if you notice redness, warmth, or fever, as these could signal an infection rather than tendinitis. If you have a history of shoulder issues and the pain pattern changes, a clinical evaluation can help determine the best path forward.
