CALCIFIC TENDINOPATHY
What Is Calcific Tendinopathy?
Calcific Tendinopathy — also known as calcific tendonitis — is a condition in which calcium deposits form within one of the tendons of the rotator cuff, the group of muscles and tendons that stabilise the shoulder joint. It is one of the more common causes of shoulder pain seen in clinic, and although it can develop in other joints, the shoulder is by far the most frequent site.
The process is sometimes described by clinicians as calcific deposition or calcific deposits forming within the tendon fibres. In many people this happens without any obvious trigger, and small deposits can be present for months or years without causing symptoms. Problems tend to arise when the deposit grows, or when the body begins to reabsorb it — a phase that can bring on a sudden, sharp flare-up of pain.
Symptoms
Symptoms vary considerably depending on which stage the deposit is in. A stable, dormant deposit may cause a dull ache with certain movements, or no symptoms at all. Why is calcific tendonitis so painful during a flare? The most severe pain usually occurs during the resorptive phase, when the body is actively breaking the deposit down — this can cause sudden, intense pain that limits shoulder movement almost entirely, sometimes waking people at night.
Common signs of shoulder calcification include:
- A deep ache at the front or side of the shoulder, often worse when reaching overhead
- Sudden, severe pain with little or no preceding injury
- Stiffness and reduced range of movement
- Difficulty sleeping on the affected side
- Tenderness directly over the affected tendon
Because a flare-up can closely mimic other shoulder problems — such as a rotator cuff tear or subacromial impingement — an accurate diagnosis is important before starting treatment.
Treatment We Offer
Treatment for shoulder calcification treatment needs is guided by symptom severity and the stage of the deposit, rather than a one-size-fits-all approach. Many mild or incidental deposits require no active treatment beyond monitoring, while painful or persistent cases may benefit from targeted intervention.
- Ultrasound-guided cortisone injection — our first-line treatment for most patients. Delivered precisely into the inflamed area around the calcium deposit, it reduces inflammation and pain, with many patients noticing improvement within 3–7 days.
- Barbotage — for larger or more persistent calcium deposits, this ultrasound-guided procedure uses a needle to break down and flush out the deposit itself, often combined with a cortisone injection to manage the accompanying inflammation.
- Hydrodilatation — where shoulder stiffness has developed alongside the calcific tendonitis, this can help expand the joint capsule and restore movement.
All procedures are carried out under real-time ultrasound guidance for accuracy and safety, and most patients are in and out within 30–45 minutes. Same-day assessment and treatment is available where appropriate, so diagnosis and treatment can often happen in a single visit.
Your Care Pathway with us
- To book an appointment you can call our reception line, 0142084487, or email to info@altonpainclinic.co.uk or click the button given below.
- Comprehensive Musculoskeletal examination and testing.
- Same day Ultrasound Guided Injection for pain relief.
- Discussion of your treatment plan, treatment plan can include advanced treatments for example Cortisone Injections, Hyaluronic injections and various other options tailored to your specific needs.
Calcific Tendonitis vs Calcific Tendinopathy
You may see this condition called calcific tendonitis, calcific tendinitis, or calcific tendinopathy — the terms are often used interchangeably online, although “tendinopathy” is generally considered the more clinically accurate term, since true inflammation (“-itis”) is not always present.
What Causes Calcium Deposits in the Shoulder?
The exact cause of calcium deposits in shoulder tendons is not fully understood. What is known is that the process typically passes through three overlapping stages:
- Pre-calcific stage: the tendon tissue begins to change in a way that makes calcium deposition possible.
- Calcific stage: calcium is laid down within the tendon, sometimes visible on imaging before symptoms even appear.
- Post-calcific stage: the body gradually reabsorbs the deposit and the tendon heals — this resorptive phase is often when pain is at its most intense.
Risk factors that have been associated with the condition include age (most common between 30 and 50), certain metabolic and thyroid conditions, and repetitive overhead activity, though many people have no identifiable risk factor at all.
Diagnosis
Diagnosis is usually straightforward once imaging is used. Ultrasound is often the first-line tool, as it allows clinicians to see the deposit in real time, assess its size and consistency, and rule out other causes of shoulder pain such as a tear.
Assessment will typically distinguish between:
- Formative or resting deposits: often picked up incidentally, with no active symptoms
- Active, resorptive deposits: softer in consistency and more likely to be causing acute pain
- Chronic, hardened deposits: more stable and typically less symptomatic
When the supraspinatus tendon is involved specifically, this may be documented as supraspinatus calcific tendinitis, reflecting the particular tendon affected.
Conclusion
Calcific tendonitis is a common and manageable cause of shoulder pain. If you are experiencing ongoing shoulder discomfort or a sudden painful flare-up, our clinicians can assess the shoulder using ultrasound and discuss the most appropriate treatment pathway for you.
Frequently Asked Questions
Why is calcific tendonitis so painful?
Pain is usually at its worst during the resorptive phase, when the body actively breaks the calcific deposit down. This process can irritate the surrounding tendon and bursa, producing sudden, intense pain that is often disproportionate to how the shoulder looks on imaging.
Will calcium deposits in the shoulder go away on their own?
In many cases, yes. Calcium deposits in shoulder tendons are frequently reabsorbed naturally by the body over time, and symptoms often ease as this happens, although the resorptive phase itself can be painful while it is occurring.
How is shoulder calcification treated?
Treatment depends on severity. Options range from watchful waiting and to shoulder calcification treatment delivered under ultrasound guidance, such as barbotage or injection-based approaches, for deposits that remain painful or limiting.
Is calcific tendonitis the same as a rotator cuff tear?
No. Calcific tendonitis involves calcium deposits forming within an intact tendon, whereas a rotator cuff tear involves a structural break in the tendon fibres. The two can cause similar symptoms, which is why imaging is important for an accurate diagnosis.
What does calcific tendonitis feel like day to day?
Outside of an acute flare, many people describe a background ache with overhead movement, or stiffness first thing in the morning. During a flare, pain can become severe and constant, sometimes disturbing sleep.