What it is
Calcific tendinitis is a build-up of calcium crystals inside a rotator cuff tendon, most often the supraspinatus at the top of the shoulder. The deposit can irritate the tendon and the bursa above it, causing pain and limiting motion.
Why it happens is not fully understood. It is not caused by eating too much calcium, and it is different from the wear-related calcification sometimes seen alongside rotator cuff tears. Many people have a deposit on an X-ray and never feel it.
How it behaves
Calcific tendinitis tends to move through stages over months or even years.
- Forming
Calcium is laid down in the tendon as a firm, chalky deposit. This may cause no pain, or a mild, recurring ache.
- Resting
The deposit stays stable. Symptoms are often mild or absent.
- Resorptive
The body begins to break the deposit down, and it softens to a paste-like consistency. Inflammation during this stage is often the most painful part, with sudden, severe pain that can make it hard to move the arm or sleep.
- Healing
As the calcium clears, the tendon remodels and pain usually settles.
Because the resorptive phase is the body clearing the deposit, a painful flare often settles on its own over a period of weeks.
Symptoms
- Sudden, severe shoulder pain, sometimes with no injury at all
- Pain at night that makes it hard to sleep, especially on that side
- Pain and difficulty lifting the arm away from the body or overhead
- A dull, recurring ache over the outside of the shoulder
- Stiffness, as pain makes you guard the shoulder
Diagnosis
Diagnosis starts with a careful history and an examination of motion and strength. An X-ray usually shows the deposit clearly, including its size and location. Ultrasound shows the deposit within the tendon, can suggest whether it is firm or soft, and is used to guide treatment with a needle. MRI is added when a rotator cuff tear or another problem is suspected.
Treatment options
Non-surgical
- Activity modification, avoiding painful overhead positions while the shoulder calms
- Ice and anti-inflammatory medication when appropriate
- A guided physical therapy program to restore motion and strengthen the rotator cuff and shoulder blade muscles
- A corticosteroid injection into the bursa above the tendon to settle a painful flare
- Ultrasound-guided barbotage (lavage). Under local anesthetic and ultrasound guidance, a needle is used to break up the deposit and rinse calcium out of the tendon, often followed by a corticosteroid injection in the same visit.
Surgical
- Arthroscopic calcium removal. When pain persists despite a dedicated course of non-surgical care, the deposit is located through small incisions and carefully removed from the tendon. Inflamed bursa tissue is cleared at the same time.
- Rotator cuff repair when needed. If removing the deposit leaves a sizeable defect, or the tendon is also torn, it is repaired with sutures and anchors in the same operation.
- Surgery is an option for a minority of patients; most improve without it.
Recovery
- After a flare
Pain from the resorptive phase often eases over several weeks with medication, activity changes or an injection.
- After lavage
Soreness for a few days is common. Therapy follows, and improvement builds over the following weeks.
- After arthroscopic removal
A sling is used for comfort for a short time, then motion and strength are rebuilt with therapy. If the tendon was repaired, the sling and rehabilitation follow a rotator cuff repair schedule.
- Full recovery
Most patients return to full activity within a few months; recovery after a repair can take longer.
Timelines are typical ranges, not guarantees. Recovery depends on the specific injury, the procedure, your health and your rehabilitation, and your plan is individualized.
Questions patients ask
Is it caused by too much calcium in my diet?
No. Calcific tendinitis is not linked to how much calcium you eat or to calcium supplements.
Will the deposit go away on its own?
Often, yes. Many deposits are reabsorbed by the body over time, although symptoms can come and go along the way.
Is calcific tendinitis the same as a rotator cuff tear?
No. The deposit sits inside the tendon rather than tearing it, but the two can occur together, which is one reason an accurate diagnosis matters.
Does a deposit that does not hurt need treatment?
Usually not. A deposit found by chance on an X-ray, without symptoms, generally does not need treatment.
This page is general patient education and is not a substitute for an in-person evaluation.