Calcific tendinitis is a painful shoulder condition caused by calcium deposits forming within the rotator cuff tendons. It often presents with sudden, severe shoulder pain and is considered one of the most painful musculoskeletal conditions. Ultrasound is the primary imaging tool for confirming the diagnosis and guiding treatment. At Alton Pain Clinic, we provide ultrasound-guided cortisone injections to reduce pain and inflammation, as well as ultrasound-guided barbotage (needling and lavage) to remove calcium deposits and relieve symptoms. These minimally invasive treatments help patients regain shoulder function, with most achieving significant improvement without surgery.
What is Calcific Tendinitis of the Shoulder?
Calcific tendinitis is a condition in which calcium deposits form within the tendons of the rotator cuff — the group of muscles and tendons that stabilise the shoulder and allow it to move. The supraspinatus tendon (at the top of the shoulder) is most commonly affected.
The calcium deposits can cause severe pain, particularly if they become resorbed — a stage during which the body attempts to dissolve the calcium and the area becomes acutely inflamed. This resorptive phase is responsible for the sudden, intense shoulder pain that is the hallmark presentation of calcific tendinitis
Why does my shoulder click?
Shoulder clicking (crepitus) is a common complaint and has several potential causes. In the context of calcific tendinitis, a calcium deposit within the rotator cuff can occasionally cause mechanical symptoms including clicking or catching.
However, shoulder clicking alone does not indicate calcific tendinitis. Other common causes of a clicking or clunking shoulder include:
- Rotator cuff impingement — the tendon catching under the acromion with certain movements
- Labral pathology — damage to the cartilage rim around the shoulder socket
- Shoulder osteoarthritis — degeneration of the joint surfaces
- Biceps tendon problems
- Normal anatomical variation — many people have painless clicking shoulders that require no treatment
If shoulder clicking is accompanied by pain, weakness, or restricted movement, it is worth having it assessed.
Symptoms of calcific tendinitis
- Sudden onset of severe shoulder pain — often so acute it can wake patients from sleep
- Pain with all shoulder movements, particularly lifting the arm
- Tenderness over the front and top of the shoulder
- Severe restriction of shoulder movement in the acute phase
- Some patients experience milder chronic pain prior to or following an acute episode
In some cases, particularly outside the acute resorptive phase, calcific tendinitis causes a more chronic aching pain that can be confused with other shoulder conditions.
Signs of Arthritis in the Shoulder — How is it Different?
Shoulder osteoarthritis and calcific tendinitis are distinct conditions that can sometimes be confused, as both cause shoulder pain and stiffness. Key differences:
- Calcific tendinitis typically presents suddenly and very acutely; shoulder arthritis tends to develop gradually
- Arthritis pain is often worse with all movements and associated with loss of range of motion that worsens over time
- Calcific tendinitis pain is often most severe in the acute phase and can resolve significantly once the calcium is resorbed or treated
How is calcific tendinitis diagnosed?
Calcific tendinitis is most reliably diagnosed with ultrasound, which can identify the calcium deposit, assess its size and characteristics, and determine whether it is in the formative or resorptive phase.
At Alton Pain Clinic, our consultant uses diagnostic ultrasound as part of the assessment, giving an accurate and real-time picture of the shoulder.
Treatment for calcific tendinitis
Ultrasound-Guided Needling and Lavage (Barbotage)
The most effective non-surgical treatment for calcific tendinitis is ultrasound-guided percutaneous needle aspiration and lavage — commonly called barbotage. Under real-time ultrasound imaging, a needle is inserted directly into the calcium deposit and saline solution is used to break up and wash out the calcium material.
This procedure can provide dramatic and rapid pain relief, particularly for patients in the acute resorptive phase. It can be combined with a cortisone injection to reduce post-procedure inflammation.
Ultrasound-Guided Cortisone Injection
A steroid injection into the subacromial space (the area beneath the bony arch of the shoulder) can significantly reduce inflammation and relieve pain, particularly in the acute phase. While it does not remove the calcium deposit, it can provide effective short-term pain relief while the condition runs its natural course.
Takeaway
At Alton Pain Clinic, we provide expert, ultrasound-guided treatment for calcific tendinitis, including cortisone injections and barbotage (needling and lavage). Our personalized, minimally invasive approach is designed to relieve pain, restore shoulder function, and help most patients avoid surgery.
This article is intended for informational purposes only and should not replace professional medical advice. If you are experiencing persistent symptoms, please consult a qualified clinician.
Frequently Asked Questions
How long does calcific tendinitis last?
The natural history of calcific tendinitis varies. Some patients have a single acute episode that resolves completely; others experience a more chronic pattern. With appropriate treatment — particularly barbotage — most patients achieve significant improvement within weeks to months
Will calcific tendinitis go away on its own?
Calcium deposits can resolve spontaneously as the body resorbs them, but this process can take months to years and may be accompanied by severe pain. Treatment significantly accelerates resolution and reduces suffering.
Is calcific tendinitis the same as a frozen shoulder?
No — they are distinct conditions. Frozen shoulder (adhesive capsulitis) involves inflammation and thickening of the shoulder joint capsule, causing gradual loss of movement. Calcific tendinitis involves calcium deposits in the rotator cuff. The two can occasionally coexist.