What is calcific tendonitis?

Calcific tendonitis is a painful shoulder condition where there is a build-up of calcium in the rotator cuff (calcific deposit). When calcium builds up in the tendon it is known as calcific tendonitis. Calcific tendonitis can cause a chemical irritation and increase in pressure which leads to pain. The pain can be extremely intense and is one of the worst pains in the shoulder (the other being Frozen Shoulder).

Calcific tendonitis causes calcium deposits to reduce the space between the rotator cuff and the acromion, as well as affecting the normal function of the rotator cuff. This may lead to subacromial impingement (rubbing) between the acromion and the calcium deposit in the rotator cuff when lifting the arm overhead.

Calcific tendonitis is a very common disorder of the rotator cuff and accounts for approximately 10% of all consultations presenting with a painful shoulder. It affects women more often than men with its peak incidence in the fifth decade.


The pain can be constant and nagging and is felt in the shoulder and sometimes down the arm/hand. It is made worse by elevating the arm. Some patients also have excruciating attacks of pain, which then abate to a lower level after a few days. The calcium can spontaneously absorb, and this process is associated with severe pain.

What causes calcific tendinitis?

The cause of the calcium build-up as a result of calcific tendonitis is unknown. Commonly found in people between the ages of 30-60 years. It does eventually disappear spontaneously, but this can take between 5 to 10 years to resolve.

There is evidence that the oxygen concentration and blood supply to the tendon may be decreased. It is certainly not related to diet, osteoporosis, exercise nor injury.

How is calcific tendonitis diagnosed?

Your orthopaedic surgeon may need the following imaging tests to confirm the diagnosis. These include:


The calcific deposit can be seen on plain x-rays; however, ultrasound scan is better to find small calcific deposits which can be missed on x-rays. Ultrasound also makes it possible to assess the size of the deposit in all directions. The clinician can also see the blood vessels around the calcific deposit.

Calcific Deposit Diagnosis

Ultrasound Scan

Calcific Deposit On Ultrasound Scan

How is calcific tendonitis treated?

Nonsurgical treatment

  1. Painkillers and anti-inflammatory medications

  2. Physiotherapy - keeps your shoulder strong and flexible, reduce the irritation and help you to maintain the range of movements in your shoulder.

  3. Subacromial injection of steroid

  4. Needle aspiration and irrigation

  5. Extracorporeal shockwave therapy – this utilizes acoustic waves to induce fragmentation of the mechanically hard crystals.

  6. Cortisone steroid injections - reduces inflammation and helps with the pain for a short-term basis but it does not take away the underlying problem – the calcium deposit.

  7. Ultrasound guided Barbotage: Under ultrasound guidance the calcific deposit is injected with a saltwater solution and the calcium is also sucked out into a syringe. The area is then repeatedly washed.

Surgical treatment

Arthroscopic Calcium Excision —

Surgery is required for calcific tendonitis if the pain is not controlled with the methods above and/or the pain is extremely severe, with night pain. The goal of any surgery for calcific tendonitis to reduce the effects of impingement. This is done arthroscopically ("key-hole surgery"). Two to three mini skin incisions (about 0.5 to 1cm each in size) are made around the shoulder. Through these arthroscopic portals, the camera as well as a variety of surgical instruments is inserted into the shoulder and the calcium is removed from the tendon under magnified vision. When the calcific tendinitis condition is acute, the calcium is easily expressed from the tendon using a fine needle and appears like a toothpaste material. When the calcific tendonitis condition is chronic, the calcium is more ‘stuck’ to the underlying tendon.

Arthroscopic calcium excision surgery increases the amount of space between the acromion and the rotator cuff tendons, which will then allow for easier movement and less pain and inflammation. The calcium deposit caused by calcific tendonitis is also debrided and released at the same time.

What to expect after calcific tendonitis surgery ?

There is dramatic instant relief of pain after surgery. Total recovery in terms of regaining full muscle power may take 3 to 4 months. There is no restriction on what you can and cannot do after surgery and most people return to work within a few days and return to sports as they feel comfortable

The most common complication is stiffness (approx. 10%), sometimes referred to as Frozen shoulder. This is more common in patients with diabetes. If it does occur, it does not mean that further surgery is necessary. It just means the recovery may take a little longer.