Calcific tendinitis is a chalky deposit of calcium inside one of your rotator cuff tendons, the tendons that wrap around the top of your shoulder. It can sit there quietly for years, ache on and off, or suddenly become some of the WORST pain people describe.
That sudden, severe pain usually means your body has started breaking the calcium down. It’s a sign the deposit is on its way out. The worst of it usually lasts a few days and settles within 1 to 2 weeks.
Most people get better without surgery.
Needling the deposit, shockwave therapy and injections all help when it doesn’t settle. Only a small minority end up having an operation.
What the calcium is
- It isn’t linked to the calcium in your diet. Cutting out dairy or calcium tablets won’t cure it
- It forms inside the tendon itself, most often the supraspinatus, the tendon on top of the shoulder. That’s the site in about 8 in 10 cases
- It mostly affects people aged about 30 to 60, slightly more often women
- It’s common on X-rays of people with no pain. Just under 1 in 10 adults without shoulder symptoms have a deposit. So a deposit on your X-ray isn’t always the cause of your pain
The stages
- Forming stage: the calcium builds up. Often painless, or a dull ache when lifting the arm, similar to rotator cuff tendinitis
- Resting stage: the deposit sits there, hard and chalky. It may cause catching pain as you raise the arm, or nothing at all
- Resorptive stage: your body starts clearing the calcium. The deposit softens to a toothpaste-like paste, and the area becomes intensely inflamed. This is the very painful part
- Healing stage: the calcium is gone and the tendon remodels. Pain eases, sometimes quickly, sometimes over months
The stages don’t run to a timetable. Some people go through them once and are done. Others have flare-ups on and off for years.
In calcific tendinitis, the worst pain is often a sign of healing, not damage.
The very painful stage
- How it feels: pain that builds over hours to a day or two, until you can barely move the arm. Many people can’t sleep and hold the arm tight to their body
- Why it hurts so much: the softened calcium can leak into the bursa, the fluid-filled sac above the tendon, and set off a strong inflammatory reaction. See subacromial bursitis
- It can look like infection, with warmth and sometimes redness over the shoulder. If you also feel unwell or have a fever, get checked the same day
- What helps right now: pain relief as your doctor advises, ice or heat (whichever you prefer), and resting the arm in a comfortable position. This is the one time a short rest is right
- A same-week appointment is worth pushing for. Needling or an injection at this stage often brings fast relief
How often it goes away on its own
- Most people improve without an operation, with pain relief, exercise, time and, if needed, needling or an injection
- The deposit itself can take a while to disappear. On repeat X-rays, many deposits are still there a year later, even when pain is better. Pain and calcium don’t always move together
- Soft, cloudy-looking deposits on X-ray are more likely to clear on their own than dense, sharp-edged ones
Treatments when it doesn’t settle
- Exercise: once the acute pain calms, a program to strengthen the rotator cuff and shoulder blade muscles, as for other cuff problems. It helps with the pain and stiffness around the deposit, even if it doesn’t dissolve it
- Cortisone injection: into the bursa above the tendon. Good for calming a flare quickly. On its own, it rarely clears the deposit. See how long a cortisone shot lasts
- Shockwave therapy: sound waves aimed at the deposit over several sessions. This is where shockwave has its best evidence. The deposit often shrinks or disappears, and pain improves. It can be uncomfortable during treatment
- Barbotage (needling): under ultrasound, a needle is placed into the deposit, which is then washed and drawn out, usually with a cortisone injection into the bursa at the same time. It works well in about 7 in 10 people, and is often the go-to for the very painful stage
- Anti-inflammatory tablets: help pain in the short term. They won’t remove the calcium
The Cleveland Clinic guide to calcific tendonitis explains the stages and treatments in more detail.
When surgery comes up
- It’s uncommon. Only a minority need it, usually after months of pain despite the treatments above
- The operation is keyhole surgery to scrape the deposit out of the tendon
- Recovery takes weeks to a few months. Most people get a good result
- Stiffness can follow, after surgery or after a bad flare. A shoulder that stops moving in every direction may be turning into frozen shoulder, which needs a different plan
Go today if
- Your shoulder is hot, swollen and very painful and you feel unwell or have a fever
- Pain came on after a fall and you can’t lift the arm at all
- You have shoulder pain with chest pain, breathlessness or sweating. Call emergency services
Get it checked if
- A severe flare hasn’t started easing after a week
- Pain has gone on for 3 months despite exercise and simple treatment
- The shoulder is getting stiffer in every direction, not just painful
- Night pain keeps waking you week after week
The worst pain often means the calcium is leaving. The best result rarely needs an operation.