Calcific Tendonitis in Shoulder: How Do We Manage It?
Shoulder pain affects up to a third of the population. One frustrating cause is calcific tendonitis of the shoulder — calcium deposits that irritate the rotator cuff tendons and produce severe pain, sometimes for months. So what should you do about shoulder calcification? And which treatments actually work? This guide covers the causes, symptoms, diagnosis, and every treatment option, from tablets to the barbotage procedure.
What is calcific tendonitis shoulder?
Calcific tendonitis occurs when calcium deposits form in a rotator cuff tendon — the tendons connecting your upper arm to your shoulder blade. These calcium deposits in the shoulder typically cause severe pain and restricted movement when they become inflamed.
Why do calcium deposits form in the shoulder?
Nobody fully knows. Several factors increase the risk: hormonal disorders such as thyroid abnormalities, metabolic conditions such as diabetes, and heavy arm use — labourers and athletes are more affected. Shoulder calcification most often occurs in women aged 40–60, and a fall onto the shoulder can trigger its formation.
Calcification passes through three stages. The final stage — resorption, when the body breaks the deposit down — usually hurts the most. The pain comes not from the calcium itself but from the immune response that dissolves it.
Symptoms and diagnosis of shoulder calcification
Calcium deposits in the shoulder cause severe pain and stiffness when active. Sleep becomes difficult, and lifting the arm in certain directions feels impossible. Attacks often start suddenly, without warning.
X-rays show larger, harder deposits. Ultrasound does more: it detects small deposits that X-rays miss, and it stages the calcification — a ‘soft’ deposit is resorbing and likely painful, a ‘hard’ deposit is usually quiet. This matters because calcium on an X-ray does not automatically explain your pain. Most deposits never hurt at all.
Shoulder calcification vs frozen shoulder
These two conditions can look alike, especially early on. Calcific tendonitis typically presents acutely, with movement restricted in one plane. Frozen shoulder restricts movement in all planes. When the picture remains unclear, an MRI helps distinguish between them.
Treatment of calcific tendonitis shoulder
The outlook is good: at least 75% of patients respond to simple treatments. Combining treatments works better than relying on a single treatment.
Simple treatments for calcium deposits in the shoulder
- Medication: anti-inflammatory tablets such as ibuprofen or naproxen are the first-line treatment — check with your doctor that you can take them.
- Physiotherapy: calcification costs you mobility, and exercises restore the range of motion. Staying mobile also lowers the risk of developing a secondary frozen shoulder.
- Shockwave therapy: sound waves break down calcium deposits. High-energy focused shockwave works best, usually over 3 to 5 sessions.
Other treatments for shoulder calcification
When simple treatments fail, more specialised options follow:
- Cortisone injection: Cortisone injected into the bursa above the calcium deposit effectively reduces pain. Ultrasound guidance is essential for accurate placement of the cortisone, and you may need more than one injection.
- Barbotage (shoulder lavage): the most effective single procedure for painful deposits. Under ultrasound guidance and local anaesthetic, we needle the calcification and flush it out with sterile water, then settle the bursa with cortisone. Expect soreness for 1–2 weeks and improvement from 2–4 weeks. Studies show barbotage outperforms shockwave therapy in both the short and long term, and most patients benefit. Dr Masci performs barbotage in London as a one-stop visit from £420 — read the full procedure guide here.
- Tenex procedure: an advanced technique using ultrasonic energy and water irrigation to disrupt and flush out stubborn calcification — an option when barbotage has not fully cleared the deposit.
- Surgery: reserved for cases that fail everything else, and considered only after six months. The surgeon removes the deposits and creates space between the tendon and the bone. Risks include infection, ongoing pain, and the calcium returning.
Frequently asked questions about calcification in the shoulder
Why is calcific tendonitis so painful?
The calcium itself rarely hurts. Around 25% of people have shoulder calcification, and most feel nothing. Pain strikes when the body mounts an immune response to dissolve the deposit — an inflammatory process that can be excruciating.
How long does calcific tendonitis last?
It varies. An intense immune response can clear a deposit quickly; a weaker one can grumble for months or years. Treatments work by helping the immune system dissolve calcification more quickly.
Is calcific tendonitis caused by diet or calcium supplements?
No. Diet and calcium supplements do not cause calcium deposits in the shoulder — the calcification reflects a local tendon process, not your calcium intake. However, people who are overweight or diabetic tend to experience more severe pain from the condition.
What is shoulder lavage treatment?
Shoulder lavage is the same procedure as barbotage — you will also hear it referred to as aspiration. We needle the deposit, flush it out with sterile water, and inject cortisone into the bursa. It is a complex procedure that only a physician experienced in advanced ultrasound-guided techniques should perform. A systematic review found lavage more effective than shockwave therapy for pain and shoulder function.
Should you have shockwave therapy for calcific tendonitis?
It is a reasonable non-invasive option: shockwave matches injections in effectiveness but requires weekly sessions for about five weeks. Choose a high-energy focused shockwave — it clearly outperforms low-energy machines. For faster, single-visit results, barbotage beats shockwave in head-to-head studies.
Can I return to sport after an acute attack settles?
Usually, yes — gradually. Acute resorptive attacks are dramatic but rarely recur. Return to activity as pain allows, and keep high-dose anti-inflammatory medication, such as ibuprofen, on hand at the first sign of another flare. If symptoms recur, see a doctor experienced in musculoskeletal conditions promptly.
How does surgery compare to other treatments?
A recent study found that surgery was slightly better than non-surgical treatment, though both groups improved. Given the risks, try shockwave and one or two barbotage procedures first. Most people never need an operation.
Final word from Sport Doctor London about calcific tendonitis shoulder
Shoulder calcification is a common cause of sudden, severe shoulder pain — and the outlook is good. Start with anti-inflammatories, physiotherapy, and shockwave. If pain persists, the barbotage procedure removes the calcium directly and outperforms the alternatives. Choose a physician who is genuinely experienced in advanced ultrasound-guided procedures; many practitioners now offer injections without doctor training.
Dr Masci treats calcific tendonitis of the shoulder at his London clinics, including one-stop barbotage from £420. Contact his team here or call +44 (0) 203 488 0350.
Is injection in shoulder is painful?
It doesn’t have to be painful if done with local anesthetic and performed by a practitioner with injection experience. LM
How painful is shockwave vs lavage? How long do you have movement restrictions after lavage?
Lavage can be painful if the calcification is acute – but we use local anesthetic, so the pain is short-lived. Shockwave is less painful overall – but you need up to 5 sessions.
Your shoulder is usually painful for 3-5 days after lavage. I suggest rest from overhead activities, including rehab for 7-10 days after lavage.
Would Calcium supplements help?
No calcification does not occur because of dietary influences
I developed this suddenly out of the blue one month ago. The pain was excruciating for 11 days and then suddenly greatly improved. I’ve had a deep ache in my deltoid since then and finally was given a cortisone shot 30 days after the acute attack. That has taken away most the pain. My local Dr doesn’t believe these deposits ever cause pain which is frustrating. I have my ROM back but I am afraid resuming my gym and outdoor activities will re-inflame my shoulder. Is it ok to do activates such as skiing right away or should I wait awhile? Just wondering if this is a one-time experience or something more chronic I need to worry about. I couldn’t take another severe attack of pain like that again – -it was horrible!
Hi Abby, As I describe in my blog, calcific tendonitis of the shoulder usually becomes very painful when the body decides to get rid of it ie the resorptive phase.
Generally, these ‘acute attacks’ are rare so your chances of another attack are low but not impossible.
If you experience the beginning of what you think is another episode, I suggest taking high-dose anti-inflammatories such as ibuprofen and making an appointment with a doctor experienced in musculoskeletal conditions.
LM
Thanks so much for validating what I’m going through and the advice! I hope it never happens again, but now I know what to expect and jump on it with NSAIDS. I hope this reabsorption phase acts quickly and can get rid of the deposits. I am making an appt with a shoulder specialist in a larger city that understands this condition. I always get the strange things ….
I had the Lavage procedure about a week ago to break up the calcium deposits in my shoulder. I usually have a low white blood cell count in my bloodwork, and see a hemotoligist, for many years, to keep track of it. Today was my appointment, and my white blood count was higher then it ever was. I am usually in the 2.8 to 3.4 range, and it was 4.5 which is in the normal range. I was wondering, could it be higher because I had the Lavage procedure last week?
Many thanks for your comments.
A cortisone injection can increase the white cell count for a few weeks. If your doctor used cortisone as part of the lavage procedure (most do), the increase in the white cell count could be attributed to the procedure. However, I’d expect the increase to be only temporary. I’d speak to your haematologist to clarify.
Lorenzo