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This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• Calcific tendon deposits of the shoulder are a frequent occurrence in the general population [1].
• Only one third of calcific tendon deposits are painful [1].
• The primary choice of treatment for calcific tendinitis is conservative, especially in patients with acute calcific tendinitis [7].
• Conservative treatment for calcific tendinitis of the shoulder showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits [3].
• Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment in the setting of calcific tendinitis of the shoulder [2].
• Extracorporeal shock wave therapy (ESWT) can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder due to its good tolerance, safety, and clinical radiological response [6].
• Patients with calcific tendinitis of the shoulder who have factors identified for a poor outcome after ESWT should undergo a different procedure [38].
• Utilization of barbotage as a treatment for calcific tendonitis of the shoulder appears to produce notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation [9].
• The incidence of rotator cuff tears in cases of calcific tendonitis is higher than previously reported [10].
• Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of calcific tendinitis due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment [8].
• The short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression [14].

Anatomy & Pathophysiology

• Only one third of calcific tendon deposits in the general population are painful [1].
• Calcific tendinitis of the shoulder in the Korean population has demographic, radiographic, and clinical features that are not different from those of Western populations [5].
• Imaging and functional data indicate that calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis [11].
• The acromion index is not different between shoulders with calcifying tendinitis, partial-thickness rotator cuff tears, or full-thickness rotator cuff tears [17].
• The acromion index of shoulders with calcific tendinitis is comparable to that of shoulders with subacromial impingement [27].
• The theoretical concept that a high acromion index results in increased upward force against the subacromial space, influencing pain and function in calcifying tendinitis, was not supported [40].
• A rotator cuff tear was the only factor affecting the complete recovery of shoulder function in patients treated for calcific tendinitis [35].

Classification

• Symptoms of calcific tendinitis can be protracted, resulting in time off work and impaired quality of life [4].
• The demographic, radiographic, and clinical features of calcific tendinitis in the Korean population are not different from those of Western populations [5].
• The acromion index is not different between shoulders with calcifying tendinitis, partial- or full-thickness rotator cuff tears [17].
• Calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis [11].
• Calcification in medial epicondylitis was more commonly identified than previously reported and was distributed over a relatively broad area [13].
• Conservative treatment for calcific tendinitis showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits [3].
• Shock wave therapy is a heterogeneous but effective treatment for calcifying tendinitis of the shoulder [18].

Clinical Presentation

• Only one third of calcific tendon deposits in the shoulder are painful [1].
• The prevalence of calcific deposits within the rotator cuff tendons is 7.8% in asymptomatic patients [21].
• The prevalence of calcific deposits within the rotator cuff tendons is 42.5% in patients with subacromial pain syndrome [21].
• Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment [2].
• The demographic, radiographic, and clinical features of calcific tendinitis in the Korean population were not different from those of Western populations [5].
• Acute calcific deposition of the hand and wrist is a benign self-limiting disease [15].
• Clinical criteria predictive for shoulder rotator cuff calcific tendinopathy can help clinicians suspect this musculoskeletal disease early and with certainty [22].

Investigations

• Calcific tendinitis symptoms can be protracted, resulting in time off work and impaired quality of life [4].
• Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis [16].
• Sonographic or MRI evaluation has accuracy limitations when assessing for rotator cuff tears in the context of calcific tendinitis [16].
• The condition of articular chondrocalcinosis is characterized by multiple calcific deposits in the articular cartilage, primarily in the deeper and mid-portions of the cartilage above the tidemark [41].
• The dynamic pathological process of calcific tendinopathy includes migration patterns of calcium deposits [12].

Treatment

• Calcific tendon deposits are a frequent occurrence in the general population, although only one third are painful [1].
• Nonsurgical management remains the mainstay of treatment for calcific tendinitis of the rotator cuff, with most patients improving with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections [19].
• Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain, and thus it is reasonable to trial ultrasound-guided needling (barbotage) and extracorporeal shock wave therapy (ESWT) as first-line treatment [36].
• ESWT can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder due to its good tolerance, safety, and clinical radiological response [6].
• ESWT in calcific tendinitis of the shoulder is very effective [20].
• ESWT has a therapeutic effect on tendinosis calcarea [29].
• Radial extracorporeal shock wave therapy (rESWT) showed a 14.28% reduction in pain, a 43% improvement in shoulder functional status, and significant increases in shoulder flexion, abduction, extension, and external rotation compared to traditional physiotherapy [26].
• Needle aspiration of calcific deposits (NACD) is safe and effective for calcific tendinitis of the rotator cuff [30].
• Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement [31].

Complications

• Calcific tendon deposits of the shoulder are a frequent occurrence in the general population, although only one third are painful [1].
• Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis and aware of the accuracy limitations of sonographic or MRI evaluation [16].
• The prevalence rate of calcific deposits in the rotator cuff is 7.8% in asymptomatic patients and 42.5% in patients with subacromial pain syndrome [21].

Recovery

• The dynamic pathological process of calcific tendinopathy includes migration patterns of calcium deposits, which are relevant to functional recovery [12].
• Arthroscopic bursectomy and debridement of the calcific deposit provides short-term functional outcomes that are not influenced by whether subacromial decompression is performed in combination [14].
• Outcome after arthroscopic treatment seems to correlate strongly only with the presence of residual calcium deposits in the tendon, with complete removal recommended [48].
• Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques [23].
• There was no significant difference in short- and long-term clinical outcomes between single- and double-needle US-guided percutaneous irrigation of calcific tendinopathy [24].
• Utilization of barbotage produces notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation [9].
• Only with one-time needling, radiologic changes in size and/or density were seen in 76.6% of the calcific tendinitis patients at 4 weeks after the index procedure [28].
• A symptom duration of ≤10 months or calcification size of ≤10.82 mm represented the clinical scenarios most likely to show resorption after ESWT [44].
• In ESWT studies, Type III calcifications and shorter symptom duration were associated with better outcomes [46].
• The onset of calcium resorption in acute calcific tendinitis occurs most frequently in the summer in Japan [47].
• The minimal and substantial clinical benefit (MCID, SCB) and responsiveness for patients with long-lasting rotator cuff calcific tendinitis treated with minimally invasive treatment options have been established for the Constant-Murley score and Disabilities of the Arm, Shoulder and Hand score [32].

Key Evidence

• [L3] Calcific tendon deposits of the shoulder are a frequent occurrence in the general population, although only one third are painful. [1] (10.1007/s00256-015-2240-3)
• [L3] Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment in the setting of calcific tendinitis of the shoulder. [2] (10.1016/j.jseint.2021.01.013)
• [L2] Conservative treatment for calcific tendinitis of the shoulder showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits. [3] (10.1016/j.jse.2009.07.008)
• [L3] Calcific tendinitis is a poorly understood condition in which symptoms can be protracted, resulting in time off work and impaired quality of life. [4] (10.1016/j.jse.2006.06.007)
• [L4] This study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in the Korean population, which were not different from those of Western populations. [5] (10.5397/cise.2020.00010)
• [L2] Because of its good tolerance, safety, and clinical radiological response, ESWT can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder. [6] (10.1136/ard.62.3.248)
• [L5] The primary choice of treatment for calcific tendinitis is conservative, especially in patients with acute calcific tendinitis. [7] (10.5397/cise.2020.00318)
• [L3] Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of calcific tendinitis due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment. [8] (10.1186/s12891-017-1839-z)
• [L4] Utilization of barbotage as a treatment for calcific tendonitis of the shoulder appears to produce notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation. [9] (10.1016/j.jseint.2024.06.005)
• [L4] The incidence of rotator cuff tears in cases of calcific tendonitis in this cohort of patients who underwent MRI is higher than previously reported. [10] (10.1016/j.arthro.2019.11.127)
• [L2] Imaging and functional data indicate that calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis that should be considered in clinical and surgical practice. [11] (10.1016/j.jse.2008.09.016)
• [L5] The paper illustrates the dynamic pathological process of calcific tendinopathy, including migration patterns of calcium deposits, and discusses clinical and sonographic assessment to optimize diagnosis, rehabilitation, and interventional management for functional recovery. [12] (10.3390/diagnostics12123097)
• [L3] Calcification in medial epicondylitis was more commonly identified than previously reported and was distributed over a relatively broad area. [13] (10.1016/j.jse.2021.08.031)
• [L1] This study has demonstrated that the short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression. [14] (10.1016/j.arthro.2015.05.015)
• [L5] Acute calcific deposition of the hand and wrist is a benign self-limiting disease. [15] (10.1016/j.jhsa.2014.06.011)
• [L3] Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis and aware of the accuracy limitations of sonographic or MRI evaluation. [16] (10.5397/cise.2021.00094)
• [L3] The acromion index is not different between shoulders with calcifying tendinitis, partial- or full-thickness rotator cuff tears. [17] (10.1007/s00402-011-1263-z)
• [L1] Shock wave therapy is a heterogeneous but effective treatment for calcifying tendinitis of the shoulder. [18] (10.1177/1941738108331197)
• [L5] Nonsurgical management remains the mainstay of treatment for calcific tendinitis of the rotator cuff, with most patients improving with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. [19] (10.5435/jaaos-22-11-707)
• [L1] ESWT in calcific tendinitis of the shoulder is very effective. [20] (10.1007/s00256-004-0849-8)
• [L3] The prevalence rates of 7.8% in asymptomatic patients and 42.5% in patients with subacromial pain syndrome provide a current view on the epidemiology of calcific deposits in the rotator cuff. [21] (10.1016/j.jse.2015.02.024)
• [L3] These clinical criteria, predictive for shoulder RCCT, can be crucial to help all clinicians suspect this musculoskeletal disease early and with certainty, thus allowing for an appropriate and prompt diagnosis path. [22] (10.1177/17585732241244515)
• [L4] Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques, and it is only slightly invasive and painful. [23] (10.2214/ajr.07.2254)
• [L1] There was no significant difference in short- and long-term clinical outcomes between single- and double-needle US-guided percutaneous irrigation of calcific tendinopathy. [24] (10.1148/radiol.2017162888)
• [L2] Specifically, the rESWT group showed a 14.28% reduction in pain, a 43% improvement in shoulder functional status, and significant increases in shoulder flexion, abduction, extension, and external rotation. [26] (10.5606/archrheumatol.2019.7081)
• [L4] The AI of shoulders with calcific tendinitis is comparable to that of shoulders with subacromial impingement. [27] (10.1007/s00167-012-2327-5)
• [L4] Only with one-time needling, radiologic changes in size and/or density were seen in 76.6% of the calcific tendinitis patients at 4 weeks after the index procedure. [28] (10.1016/j.arthro.2013.03.033)
• [L2] ESWT has a therapeutic effect on tendinosis calcarea. [29] (10.1007/s00776-003-0720-0)
• [L4] Needle aspiration of calcific deposits (NACD) is safe and effective for calcific tendinitis of the rotator cuff. [30] (10.1016/j.ejrad.2016.01.018)
• [L3] Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement. [31] (10.1007/s00167-022-06870-2)
• [L2] This study established the MCID, SCB, and responsiveness for patients with long-lasting rotator cuff calci fi c tendinitis who were treated with minimally invasive treatment options. [32] (10.1016/j.jseint.2020.05.001)
• [L3] A rotator cuff tear was the only factor affecting the complete recovery of shoulder function. [35] (10.1177/03635465231217733)
• [L1] Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain, and thus it is reasonable to trial UGN and ESWT as first-line treatment. [36] (10.1016/j.jse.2023.03.017)
• [L3] Patients with calcific tendinitis of the shoulder who have the factors identified for a poor outcome after ESWT should undergo a different procedure. [38] (10.1302/0301-620x.99b12.bjj-2016-1178.r1)
• [L2] The theoretical concept of a high acromion index resulting in an increased upward force against the subacromial space, which influences pain and function in calcifying tendinitis of the shoulder, was not supported. [40] (10.1007/s00167-011-1563-4)
• [L5] The condition is characterized by multiple calcific deposits in the articular cartilage, primarily in the deeper and mid-portions of the cartilage above the tidemark. [41] (10.2106/00004623-197254040-00015)
• [L3] A symptom duration of ≤10 months or calcification size of ≤10.82 mm represented the clinical scenarios most likely to show resorption after ESWT. [44] (10.1177/23259671241231609)
• [L3] In SWT studies, Type III calcifications and shorter symptom duration were associated with better outcomes. [46] (10.1177/17585732251414964)
• [L3] The onset of calcium resorption in acute calcific tendinitis occurs most frequently in the summer in Japan; however, the reasons for seasonal variation remain unclear, and further studies will be needed. [47] (10.1186/s12891-020-03773-6)
• [L4] Outcome seems to correlate strongly only with the presence of residual calcium deposits in the tendon; complete removal is recommended. [48] (10.1016/j.jse.2004.04.001)

References

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[2] Predictive factors for failure of conservative management in the treatment of calcific tendinitis of the shoulder. JSES International. 2021. DOI: 10.1016/j.jseint.2021.01.013

[3] Radiologic course of the calcific deposits in calcific tendinitis of the shoulder: Does the initial radiologic aspect affect the final results?. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.07.008

[4] Calcific tendinitis: Natural history and association with endocrine disorders. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.06.007

[5] Calcific tendinitis of the shoulder in the Korean population: demographics and its relation with coexisting rotator cuff tear. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2020.00010

[6] Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study. Annals of the Rheumatic Diseases. 2003. DOI: 10.1136/ard.62.3.248

[7] Diagnosis and treatment of calcific tendinitis of the shoulder. Clinics in Shoulder and Elbow. 2020. DOI: 10.5397/cise.2020.00318

[8] Examination of concomitant glenohumeral pathologies in patients treated arthroscopically for calcific tendinitis of the shoulder and implications for routine diagnostic joint exploration. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1839-z

[9] Determining the efficacy of barbotage for pain relief in calcific tendinitis. JSES International. 2024. DOI: 10.1016/j.jseint.2024.06.005

[10] Calcific Tendonitis of the Shoulder: Protector or Predictor of Cuff Pathology? A Magnetic Resonance Imaging–Based Study. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.127

[11] Osteolytic lesion of greater tuberosity in calcific tendinitis of the shoulder. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.09.016

[12] Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review. Diagnostics. 2022. DOI: 10.3390/diagnostics12123097

[13] Radiologic evaluation and clinical effect of calcification in medial epicondylitis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.08.031

[14] Short‐Term Outcome After Arthroscopic Bursectomy Debridement of Rotator Cuff Calcific Tendonopathy With and Without Subacromial Decompression: A Prospective Randomized Controlled Trial. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.05.015

[15] Acute Calcium Deposits in the Hand and Wrist. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.011

[16] Is common the rotator cuff tear in the calcific tendinitis?. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00094

[17] Intraarticular lesions in calcifying tendinitis: incidence and association with the acromion index. Archives of Orthopaedic and Trauma Surgery. 2011. DOI: 10.1007/s00402-011-1263-z

[18] Focused Extracorporeal Shock Wave Therapy in Calcifying Tendinitis of the Shoulder: A Meta-Analysis. Sports Health: A Multidisciplinary Approach. 2009. DOI: 10.1177/1941738108331197

[19] Calcific Tendinitis of the Rotator Cuff. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-11-707

[20] Extracorporeal shock wave therapy in calcific tendinitis of the shoulder. Skeletal Radiology. 2004. DOI: 10.1007/s00256-004-0849-8

[21] Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.02.024

[22] Clinical features in rotator cuff calcific tendinopathy: A scoping review. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241244515

[23] Sonographically Guided Percutaneous Needle Lavage in Calcific Tendinitis of the Shoulder: Short- and Long-Term Results. American Journal of Roentgenology. 2007. DOI: 10.2214/ajr.07.2254

[24] Rotator Cuff Calcific Tendinopathy: Randomized Comparison of US-guided Percutaneous Treatments by Using One or Two Needles. Radiology. 2017. DOI: 10.1148/radiol.2017162888

[26] Comparison of Radial Extracorporeal Shock Wave Therapy and Traditional Physiotherapy in Rotator Cuff Calcific Tendinitis Treatment. Archives of Rheumatology. 2019. DOI: 10.5606/archrheumatol.2019.7081

[27] Acromial morphology in patients with calcific tendinitis of the shoulder. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2327-5

[28] The Radiologic Results of Ultrasonography‐Assisted One‐time Needling in Calcific Tendinitis Patients (SS‐26). Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.03.033

[29] Efficacy of extracorporal shock-wave treatment for calcific tendinitis of the shoulder: experimental and clinical results. Journal of Orthopaedic Science. 2003. DOI: 10.1007/s00776-003-0720-0

[30] Needle aspiration of calcific deposits (NACD) for calcific tendinitis is safe and effective: Six months follow-up of clinical results and complications in a series of 431 patients. European Journal of Radiology. 2016. DOI: 10.1016/j.ejrad.2016.01.018

[31] Intraosseous calcific tendinitis of the rotator cuff yields similar outcomes to those of intratendinous lesions despite worse preoperative scores. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-06870-2

[32] Quantifying the minimal and substantial clinical benefit of the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand score in patients with calcific tendinitis of the rotator cuff. JSES International. 2020. DOI: 10.1016/j.jseint.2020.05.001

[35] Arthroscopic Surgery Versus Nonoperative Treatment for Calcific Tendinitis of the Shoulder: A Retrospective Cohort Study. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465231217733

[36] Chronic calcific tendonitis of the rotator cuff: a systematic review and meta-analysis of randomized controlled trials comparing operative and nonoperative interventions. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.03.017

[38] Prognostic factors for the outcome of extracorporeal shockwave therapy for calcific tendinitis of the shoulder. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b12.bjj-2016-1178.r1

[40] Do anatomic variants of the acromion shape in the frontal plane influence pain and function in calcifying tendinitis of the shoulder?. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1563-4

[41] Articular Chondrocalcinosis, Hydroxyapatite Deposition Disease, in Adult Mature Rabbits. The Journal of Bone & Joint Surgery. 1972. DOI: 10.2106/00004623-197254040-00015

[44] Treatment Algorithm for the Resorption of Calcific Tendinitis Using Extracorporeal Shockwave Therapy: A Data Mining Study. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671241231609

[46] Prognostic factors for outcomes following needling and shockwave therapy in rotator cuff calcific tendinitis: A systematic review. Shoulder & Elbow. 2026. DOI: 10.1177/17585732251414964

[47] Seasonal variation in the onset of acute calcific tendinitis of rotator cuff. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03773-6

[48] Arthroscopic treatment of calcifying tendinitis of the shoulder: Clinical and ultrasonographic follow-up findings at two to five years. Journal of Shoulder and Elbow Surgery. 2004. DOI: 10.1016/j.jse.2004.04.001