Calcific Tendonitis of the Shoulder

Calcific tendonitis (CT) of the shoulder is a common, painful condition characterized by the deposition of calcium salts, typically calcium hydroxyapatite, in the rotator cuff tendons, which is a group of four muscles and their tendons that stabilize the shoulder.

As a result, local inflammation of the tendons occurs. These tendons are responsible for the movement and stability of the upper limb and shoulder, and the combination of calcium salt buildup and inflammation causes a very painful condition.

The exact cause of calcific tendonitis is still not completely understood. The condition typically affects adults between the ages of 30 and 60 and it is more common in women than in men, though the reasons for this are not fully established.

It is believed that repetitive injuries leading to rotator cuff degeneration. It has also been observed that diabetic patients tend to experience this form of tendonitis more frequently due to the effects of high blood sugars on tendons.

The clinical picture may vary from patient to patient, depending upon which phase the deposit is in, but pain is certainly the hallmark of this condition.

• Pain During Calcium Accumulation:
• The body sometimes deposits calcium salts in the tendon tissue for reasons not entirely clear.
• This phase, known as the calcific phase, is often painful as the calcium irritates the surrounding tissues.
• Sharp Pain with Arm Movement:
• Common with overhead or lifting motions.
• Pain can be sudden and intense, especially if the calcium deposit rubs against other shoulder structures.
• Pain at Rest:
• In some cases, the inflammation is severe enough to cause pain even without movement.
• This is more likely during the resorptive phase, when the body starts breaking down the calcium deposits, leading to increased inflammation and pressure in the surrounding tissues.
• Pain Location:
• Usually localized at the front or outer side of the shoulder.
• Pain may radiate down the upper arm, mimicking other conditions like rotator cuff tears or bursitis.
• Flare-Ups and Remissions:
• Symptoms can come and go.
• The condition may follow a cyclical pattern: painful flare-ups followed by periods of relief.
• Severe Cases:
• In some patients, pain may not be relieved by NSAIDs (like ibuprofen), steroid injections, or physiotherapy.
• Arthroscopic surgerymight be necessary to remove the calcium deposits and relieve symptoms.

Your surgeon will take a detailed medical history and will conduct a thorough physical examination of the shoulder. An X-ray will usually confirm the presence of calcium deposits and will also help to pinpoint the exact location. Several x-rays may be required over time to assist the surgeon track the calcium changes and determine whether surgery is required or not.

Ultrasound and MRI can also provide important information, revealing even small or deeply seated calcifications. The ultrasound is excellent for detecting small or early calcifications not visible on X-ray whereas MRI is useful for visualizing small or deeply seated calcifications.

In some cases, calcium deposits dissolve spontaneously over time without the need for medical intervention. For most patients, a combination of classic anti-inflammatory medications with physical therapy and cessation of sports activity is sufficient to address the problem.

If pain is severe or persistent, the doctor may administer a corticosteroid injection directly into the shoulder joint. This helps reduce inflammation and pain rapidly, but it does not remove the calcium deposit itself. These are generally used short-term due to potential side effects with repeated use.

However, if symptoms persist despite conservative treatments (e.g., physical therapy, rest, medications), the tendons show severe inflammation and pain becomes chronic and severely impacts daily activities and quality of life, then the surgical treatment (shoulder arthroscopy) is the only option. Shoulder arthroscopy is a minimally invasive surgical technique used to diagnose and treat joint problems. Through this procedure, a microscopic camera (arthoscope) is inserted into the shoulder through a small incision. The surgeon can view the interior of the joint on a screen and precisely locate calcium deposits in the tendons. Using tiny instruments, the calcium deposits are then removed or broken up. This procedure helps alleviate pain, improve shoulder mobility and reduce inflammation. Shoulder arthroscopy takes about 30 minutes. The patient can usually go home the same day and here’s no need to immobilize the arm post-surgery, allowing faster rehabilitation and return to his/her daily tasks.

Dr. Panagiotis Pantos is a specialist in upper limb orthopedic surgery, focusing on shoulder conditions. He is a highly experienced and specialized orthopedic surgeon who offers comprehensive care for calcific tendonitis of the shoulder. He has years of experience, particularly in treating calcific tendonitis, a painful condition caused by calcium deposits in the shoulder tendons. His individualized, minimally invasive, and evidence-based treatment strategies aim to relieve pain, restore function, and prevent future issues—making him a trusted provider for those dealing with this specific condition.

He has performed hundreds of shoulder arthroscopies, indicating a high level of surgical expertise and volume, which often correlates with better patient outcomes.

His approach includes a detailed assessment of each case, thorough patient education, and tailored treatment plans that are customized according to the severity, duration and patient needs.
The treatment plan that applies to his patients not only alleviates pain and restores mobility but also prevents recurrences ensuring a patient’s long-term quality of life. So, patients may return to normal activities without chronic discomfort.

Don’t let pain control your life. Contact the doctor to schedule an appointment and learn more about how he can help you regain a better quality of life.

How Painful Can It Be?

Quite often, the deposition of calcium salts, specifically calcium hydroxyapatite, in tendons, causes severe pain and shoulder impingement syndrome. This condition may lead to significant inflammation and pain often in the rotator cuff tendons, especially the supraspinatus.

Is conservative treatment quite effective for the treatment of calcific tendonitis?

Yes, in most cases, conservative treatment is effective. Although many patients respond well to non-surgical methods, in some cases the calcium deposits do not dissolve naturally and

continue to cause pain and inflammation. In these situations, arthroscopic removal is a highly effective and definitive solution. 

Can I take anti-inflammatory pills for pain?

Do not take any anti-inflammatory drug (NSAIDs) on your own! While these drugs may reduce inflammation and pain and are commonly used, they are not safe for everyone. People with certain medical conditions (e.g., high blood pressure, kidney problems, ulcers) are at increased risk of side effects like:

• Elevated blood pressure
• Stomach ulcers or bleeding
• Kidney damage
• Heart problems (in some individuals)

In this case, only a doctor can determine if it’s safe for you to use NSAIDs and may recommend alternative medications or therapies based on your medical history.

Is physical therapy effective for calcific tendonitis of the shoulder?

During conservative treatment, physical therapy for calcific tendonitis of the shoulder can help reduce inflammation, eliminate pain, restore range of motion and prevent stiffness.

Physical therapy is often effective for treating mild to moderate cases of calcific tendonitis of the shoulder and can help avoid the need for surgery. If symptoms persist, other treatments (e.g., steroid injections, shockwave therapy, or surgery) might be considered.

How long does recovery time last after shoulder arthroscopy for calcific tendonitis?

Pain relief typically begins right after shoulder arthroscopy, often noticeable from the first postoperative day. This is because the calcium deposits causing inflammation and irritation are removed.

The patient will wear a sling for the first 2-3 days to protect the shoulder and allow initial healing. Most patients can resume normal daily activities within a week, depending on individual healing and the type of activity.

However, full recovery—meaning complete restoration of shoulder strength, flexibility, and function—may take several weeks to a few months. Rehabilitation with physical therapy is often recommended to speed up recovery and improve outcomes.

Can calcific tendonitis recur after shoulder arthroscopy?

If shoulder arthroscopy is performed by a qualified and experienced orthopedic surgeon, recurrence of calcific tendonitis is very rare because the calcium deposits are thoroughly removed.