Calcific tendinitis of the shoulder is a condition in which calcium deposits (made of calcium hydroxyapatite crystals) form inside a rotator cuff tendon, most often the supraspinatus at the top of the shoulder. It can cause sudden, severe shoulder pain, or a longer-lasting ache with overhead activity. It is different from the age-related wear seen in rotator cuff tendinitis and from arthritis. Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, treats calcific tendinitis with non-surgical care first and arthroscopic removal of the deposit when needed.
- Calcium deposits form in a rotator cuff tendon, often in middle-aged adults
- In most people, the deposit eventually breaks down and the symptoms settle
- The most painful phase is often when the body is reabsorbing the calcium
- Treatment starts with pain control, therapy and injections; needling (barbotage) and shock wave therapy are options for persistent deposits
- Arthroscopic removal is reserved for symptoms that do not improve
How calcific tendinitis develops
Calcific tendinitis typically passes through stages: a formative stage, when calcium is deposited and the tendon may be only mildly painful; a resting stage; and a resorptive stage, when the body breaks down and removes the calcium. The resorptive stage usually causes the most pain, because the calcium becomes soft and can leak into the bursa, causing intense inflammation.1 Although the condition settles on its own in most cases, some people continue to have pain and the deposit does not resolve.2
Symptoms
- Sudden, severe shoulder pain, sometimes without an injury, that may make it hard to move the arm (often in the resorptive stage)
- A longer-lasting ache with overhead activity and at night
- Pain lying on the shoulder
- Stiffness or catching when lifting the arm
Diagnosis
X-rays show the calcium deposit, its size and location, and whether it looks dense and well defined or soft and cloudy, which helps tell the stage. Ultrasound shows the deposit within the tendon and can guide treatment. An MRI may be used to check the rotator cuff, the biceps tendon and the bursa, or to rule out other problems.1 Dr. Dold also checks for a stiff (frozen) shoulder, which can develop alongside calcific tendinitis.
Treatment without surgery
- Pain control: rest from aggravating activity, ice and anti-inflammatory medicine if safe for you
- Physical therapy to restore motion and strengthen the rotator cuff and shoulder-blade muscles
- Cortisone injection into the bursa to calm severe pain
- Ultrasound-guided needling and lavage (barbotage): a needle is used under ultrasound to break up and rinse out the calcium, usually with a cortisone injection into the bursa. In a randomized trial, barbotage plus a bursal cortisone injection gave better results at 1 year than the cortisone injection alone. At 5 years, both groups were doing well and no longer differed, but far fewer patients in the barbotage group needed further treatment (4 compared with 16).3
- Extracorporeal shock wave therapy (ESWT): sound waves applied through the skin. A 2024 meta-analysis of 16 randomized trials in rotator cuff tendinopathy (with and without calcium) found improvements in pain and function compared with control treatments.4
Surgery
When pain persists despite several months of non-surgical care and the deposit remains, Dr. Dold may recommend arthroscopic removal of the calcium deposit, often with removal of the inflamed bursa. If removing the deposit leaves a significant defect in the tendon, it can be repaired at the same time. In a series of 54 patients treated arthroscopically without a tendon repair, pain and shoulder scores improved substantially, most of the improvement occurred in the first 3 months, and no patient needed another operation.5
Recovery
After arthroscopic removal alone, most patients start moving the shoulder right away and progress with therapy over several weeks. If the tendon is repaired, recovery is similar to a rotator cuff repair, with a sling for several weeks. Dr. Dold will give you a specific plan.
Why see Dr. Dold
- Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
- Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
- Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
- Author of a SLAP repair book chapter (Springer, 2017) and research on shoulder suture anchors (KSSTA, 2013)
- Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
- D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google
Frequently asked questions
Will calcific tendinitis go away on its own?
Often yes. In most people the calcium is eventually reabsorbed and symptoms settle, although some people have persistent pain.2
Why is the pain so severe?
The most painful stage is often when the body is breaking down the calcium, which can leak into the bursa and cause intense inflammation.1
What is barbotage?
An ultrasound-guided procedure that uses a needle to break up and rinse out the calcium, usually combined with a cortisone injection. In a randomized trial, it led to fewer additional treatments over 5 years than cortisone alone.3
Does shock wave therapy work?
A 2024 meta-analysis found improvements in pain and function with shock wave therapy for rotator cuff tendinopathy, including calcific tendinitis.4
When is surgery needed?
When pain persists after several months of non-surgical treatment. Arthroscopic removal of the deposit has shown good results.5
Do you accept my insurance?
Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.
Research cited on this page
- Saran S, Babhulkar JA, Gupta H, et al. Imaging of calcific tendinopathy: natural history, migration patterns, pitfalls, and management: a review. Br J Radiol. 2024;97(1158):1099-1111. PubMed
- Merolla G, Singh S, Paladini P, et al. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment. J Orthop Traumatol. 2016;17(1):7-14. PubMed
- de Witte PB, Kolk A, Overes F, et al. Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Needling and Lavage Versus Subacromial Corticosteroids: Five-Year Outcomes of a Randomized Controlled Trial. Am J Sports Med. 2017;45(14):3305-3314. PubMed
- Xue X, Song Q, Yang X, et al. Effect of extracorporeal shockwave therapy for rotator cuff tendinopathy: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024;25(1):357. PubMed
- Philips T, Dejonghe M, Petre D, et al. Arthroscopic treatment of calcific tendinitis without rotator cuff repair using prospectively collected results. Acta Orthop Belg. 2023;89(2):195-200. PubMed
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. This page is general information, not medical advice. Individual results vary.
