Shoulder pain is a common complaint affecting up to a third of the general population. One cause of shoulder pain is calcific tendonitis shoulder, a very frustrating condition causing high levels of pain that can last for months. Calcium deposits in the shoulder are irritating to the tendons. So, what should you do if you have shoulder calcification and are treatments like shockwave therapy and shoulder lavage effective?

What is calcific tendonitis shoulder?  

Calcific tendonitis shoulder occurs when calcium deposits form in a rotator cuff tendon. The rotator cuff tendons connect your upper arm to your shoulder. Usually, calcium deposits in the shoulder lead to severe shoulder pain and restriction in movement.

Why do calcium deposits form in the shoulder? 

We don’t know why some people develop calcium deposits in the shoulder.

Firstly, some conditions that increase calcium build-up include hormonal problems such as thyroid abnormalities and metabolic diseases such as diabetes. Secondly, calcification in shoulder is more common in women between 40 and 60. Also, people who use their arms, such as labourers and athletes, are more at risk. Finally, a fall on the shoulder can also precipitate a calcium deposit.

Generally, there are three stages to the formation of calcification. Usually, the last stage, known as ‘resorptive,’ is the most painful.

How do you identify calcific tendonitis shoulder? 

Usually, calcium deposits in shoulder cause severe shoulder pain and stiffness. Often, the pain is so intense that sleeping is difficult. In addition, lifting the arm in different directions is limited.

X-ray of the shoulder shows more extensive hard calcium deposits. However, ultrasound can pick up smaller deposits that can be missed on an X-ray. Also, ultrasound can stage the calcification (i.e., resorptive stage) to know whether it’s likely to cause pain. Therefore, it is essential to understand that the presence of calcification in shoulder on an X-ray does not necessarily mean the calcium is causing pain.

Calcium build-up in shoulder vs. frozen shoulder 

Sometimes, it can be challenging to differentiate between these two common shoulder problems – calcific tendonitis vs. frozen shoulder. However, calcific tendonitis of shoulder generally comes on suddenly (although not always). Also, movement restriction is limited to one plane, whereas all movements are restricted in frozen shoulder. Nevertheless, it can still be challenging to differentiate between these common shoulder conditions in the early stages. Sometimes, an MRI is needed to help with the diagnosis.

 

X-ray showing shoulder calcification

Treatment of calcific tendonitis shoulder 

Most calcium deposits in the shoulder improve with treatment. At least 75% of patients with calcification in the shoulder will respond to simple treatments. 

Simple treatments:

Treatment of shoulder calcification mirrors other shoulder conditions. Generally, a combination of treatments is more effective than just one.

  • Physiotherapy treatment for calcification in the shoulder: As shoulder calcification causes loss of mobility, exercises can improve the range of motion. Also, exercise reduces the risk of developing another shoulder condition called frozen shoulder.

Other treatments for shoulder calcification:

If simple treatments are unsuccessful, then other therapies can help. However, these treatments need more specialised equipment.

  • Cortisone injection for calcific tendonitis: Cortisone is a potent anti-inflammatory and is more effective if delivered to the source of pain. Usually, for shoulder calcification, injection of cortisone in the bursa above the calcium deposits improves pain. Ultrasound is essential to direct the cortisone shot for calcific tendonitis into the right spot. Overall, cortisone injections are helpful, but you may need more than one.
  • Orthopaedic barbotage: Overall, this procedure, also called shoulder lavage treatment, is more invasive than a simple cortisone shot. After using a local anaesthetic, we use a larger special needle to suck out or break down the calcium deposits. Generally, the aim is to remove or break down most of the calcification. Breaking down the calcification helps the body break it down further. You will be sore for 1-2 weeks but should feel better after 2-4 weeks. Sometimes, you may need more than one barbotage. Evidence suggests that shoulder lavage treatment or calcification is more effective than other treatments, such as shockwave therapy. Moreover, most people find benefits in lavage treatment. This video shows the lavage treatment using ultrasound to perfect the technique.

 

  • Surgery: In general, calcific tendonitis shoulder surgery is reserved for cases that fail other treatments. Most doctors agree that surgery should only be considered after six months. Surgery involves removing the calcium deposits and opening the space between the shoulder tendons and bone. Overall, calcific tendonitis shoulder surgery risks include infection, ongoing pain, and a return of calcium deposits.

Frequently asked questions about calcification in the shoulder:

Why is calcific tendonitis so painful? 

Calcification of tendons is common. Most cases are symptom-free. However, when the body decides to get rid of calcification, it mounts an immune response, which can be painful. 

Causes of calcific tendonitis shoulder: Is it due to your diet?   

Generally no. Diet or nutrition does not directly affect whether you get calcific tendonitis in the shoulder. However, we know that people who are overweight or have diabetes are more likely to get more severe pain from calcific tendonitis.

What is shoulder lavage treatment for calcific tendonitis shoulder? 

Shoulder lavage treatment is similar to barbotage. However, we try to aspirate or suck out the calcium from the tendon in shoulder lavage treatment rather than break it up. Then, we inject cortisone into the shoulder bursa to help settle inflammation.

Generally, lavage treatment is a more complicated procedure and should only be performed by a doctor with experience in advanced ultrasound-guided techniques.

A recent systematic review found that shoulder lavage procedure was more effective for improving pain and shoulder function than shockwave for calcific tendonitis in the shoulder.

Should you have shockwave therapy for calcific tendonitis shoulder? 

Recent evidence suggests that shockwave therapy is as effective as injections for calcific tendonitis shoulder. However, treatment often takes longer (1 weekly session for five weeks). Generally, we recommend a high-energy focussed shockwave. A recent study found that high-energy shockwave is better than low-energy for calcific shoulder tendonitis.

How does surgery compare to other treatments for calcific tendonitis shoulder?

A recent study comparing surgery to non-surgical treatments (such as injections and shockwave) found that surgery was slightly better – although both groups improved. 

Therefore, you should only consider surgery after trialling other treatments such as shockwave and 1-2 injections – either barbotage or shoulder lavage.

Final word from Sportdoctorlondon about calcific tendonitis shoulder

Shoulder calcification is a common cause of sudden severe shoulder pain. Overall, if simple steps are ineffective, then sucking out (aspirating) the calcification is usually adequate. However, you should find a doctor experienced in this advanced procedure. Many other therapists, such as physiotherapists, are doing injections but do not have the experience of doctors.

Other common shoulder conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.