Calcific tendinitis is the deposition of calcium hydroxyapatite crystals within a rotator cuff tendon, most often the supraspinatus. The condition causes severe shoulder pain that can appear without warning and is one of the most acutely painful shoulder conditions an orthopaedic surgeon treats. Most cases resolve with non-surgical treatment, though stubborn deposits sometimes require intervention.
What Is Calcific Tendinitis?
Calcium deposits can form within the substance of the rotator cuff tendon as part of a reactive process that is not fully understood but involves metaplasia of the tendon tissue. The deposits typically form in three sequential phases:
- Formative phase: calcium deposits grow silently within the tendon, often without symptoms
- Resorptive phase: the body begins breaking down the deposits, producing acute inflammation and severe pain
- Post-calcific phase: the deposits resolve and the tendon gradually remodels
The resorptive phase is the most symptomatic and the reason most patients seek care. Pain during this phase can be so severe that patients hold the arm motionless against the body. The condition is most common in women between 30 and 60 and can be bilateral in 10 to 20 percent of cases.
Causes and Risk Factors
- Age 30 to 60
- Female sex (more common than in men)
- Diabetes and thyroid disorders, both of which are associated with higher incidence and slower resolution
- Unclear role for repetitive use, as the condition occurs in sedentary patients as often as in active ones
Symptoms
- Acute onset of severe shoulder pain, often without a precipitating injury
- Pain that can be so severe it is described as worse than a fracture
- Pain disproportionate to the examination findings
- Difficulty sleeping and inability to lie on the affected side
- Guarding of the arm against the body in the acute resorptive phase
- Chronic low-grade pain during the formative phase, sometimes mistaken for impingement
Diagnosis
Dr. Chudik’s evaluation includes the pain history and pattern of onset, followed by a physical examination focused on impingement signs and rotator cuff strength. X-rays are the primary imaging study and show the calcium deposit as a well-defined opacity within the tendon substance. The appearance on X-ray can suggest the phase of the condition: dense, well-defined deposits indicate the formative phase, while fluffy or cloudy-appearing deposits indicate active resorption. Ultrasound and MRI characterize the deposit location and size, and evaluate the surrounding tendon for associated disease. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical treatment is effective for most cases. Options include:
- Activity modification and anti-inflammatory medication
- Physical therapy for motion and strength preservation
- Subacromial corticosteroid injection for pain control during the acute resorptive phase
- Ultrasound-guided needling or barbotage, in which the deposit is aspirated and lavaged, sometimes with corticosteroid injection, to accelerate resolution
- Extracorporeal shock wave therapy, which can fragment the deposit and stimulate resorption
Surgery is reserved for cases that fail a prolonged non-surgical trial. Dr. Chudik performs arthroscopic calcium deposit removal, extracting the deposit from the tendon through small incisions and repairing any residual tendon defect. Associated rotator cuff pathology, when present, is addressed at the same procedure.
Recovery and Outcomes
Acute pain during the resorptive phase typically resolves within a few weeks whether treated or not, though targeted intervention can shorten the course significantly. After needling or barbotage, patients often experience substantial pain relief within days as the deposit is cleared. After arthroscopic removal, recovery depends on whether tendon repair was required and typically follows a similar timeline to arthroscopic rotator cuff surgery.
Recurrence at the same site is uncommon once the deposit fully resolves, though calcific tendinitis can develop in a different tendon later.
When to See Dr. Chudik
Schedule an evaluation if sudden severe shoulder pain has developed without injury, if conservative treatment is not controlling symptoms, or if imaging has identified a calcium deposit in the rotator cuff. Call 630-324-0402 or request an appointment online.