Calcific Tendonitis of the Rotator Cuff

What is calcific tendonitis?

Calcific tendonitis is a condition that causes the formation of a small, usually about 1-2 centimeter size, calcium deposit within the tendons of the rotator cuff. These calcium deposits are usually found in middle aged individuals (age 30-60 years). Calcium deposits are more common in women (about 70%), more common in the right shoulder than the left, and more common in patients who have endocrine disorders (such as hypothyroidism or diabetes). Patients who have associated endocrine abnormalities tend to have worse symptoms, and tend to require more invasive treatments.

Women rubbing shoulder pain
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The calcium deposits are not always painful, and even when they are painful they will often spontaneously resolve. The deposits typically have the consistency of chalk or toothpaste, not the pebble that many people expect a calcium deposit to look or feel like.

Signs of Calcific Tendonitis

Most people with calcific tendonitis have gradually increasing shoulder pain that can become severe. There may be an injury that occurred, or this may seem to have come from nowhere. Often people remember an awkward maneuver or incident when the pain began, although this may have been a mere coincidence.

The usual symptoms of calcific tendonitis are:

  • Shoulder pain, most severe with movement
  • Pain at night that can interfere with sleeping
  • Difficulty lifting the arm away from the body

Many of the signs of calcific tendonitis are similar to the signs of a rotator cuff tear; your healthcare provider can help determine which is the source of your pain. People with calcific tendonitis will often be diagnosed after an X-ray shows the abnormal accumulation of calcium in the region of the rotator cuff tendons. Other tests including ultrasound or MRI used to confirm the suspected diagnosis and also to evaluate the condition of the rotator cuff tendons to see if there is a problem such as a tear.

Cause of Calcific Tendonitis

The cause of calcium deposits within the rotator cuff tendon is not entirely understood. Different ideas have been suggested, including blood supply and aging of the tendon, but the evidence to support these conclusions is not clear.

Calcific tendonitis usually progresses predictably, and almost always resolves eventually without surgery, though it typically takes 12 to 18 months. The typical course is:

  • Precalcification stage: Patients usually do not have any symptoms in this stage. At this point in time, the site where the calcifications tend to develop undergo cellular changes that predispose the tissues to developing calcium deposits.
  • Calcific stage: During this stage, the calcium is excreted from cells and then coalesces into calcium deposits. When seen, the calcium looks chalky, it is not a solid piece of bone. Once the calcification has formed, a so-called resting phase begins, this is not a painful period and may last a varied length of time. After the resting phase, a resorptive phase begins--this is the most painful phase of calcific tendonitis. During this resorptive phase, the calcium deposit looks something like toothpaste.
  • Postcalcific stage: This is usually a painless stage as the calcium deposit disappears and is replaced by more normal appearing rotator cuff tendon.

People usually seek treatment during the painful resorptive phase of the calcific stage, but some patients have the deposits found as part of their evaluation for rotator cuff tendonitis.

One of the most common questions I hear from patients is if they should eat less calcium-rich foods. It is important to note that calcium consumed from the diet has not been shown to have any effect on the formation or resolution of calcium deposits in the shoulder tendons . Therefore, the calcium deposit is not from drinking milk or eating cheese, and you should not alter your dietary intake of calcium to try to get rid of your calcific tendonitis.

Treatment of Calcium Deposits

Treatment of calcific tendonitis usually begins with some simple steps including rest, ice application, medications, and therapy. When these simple steps are ineffective, more invasive treatments, including possible surgical treatment, can be considered. The good news, is that with appropriate treatment for enough time, most patients find relief without having to undergo shoulder surgery.

If the symptoms do not improve with simpler treatments, there are surgical treatment options. The surgery to address a calcium deposit is usually performed arthroscopically. Your surgeon will clean the inflammation from around the shoulder and rotator cuff, and remove the calcium deposit from the tendons. One of the concerns of surgery, is to remove the calcium deposit, usually an area of damage to the rotator cuff will then need to be repaired. This type of surgical procedure is called a rotator cuff repair, and will use suture material to close the area of damage to the rotator cuff tendon. The rehabilitation following surgery will depend on the extent of damage to the rotator cuff, as this will need to be protected until full healing has taken place.

A Word From Verywell

Calcific tendinitis is a condition that can cause severe shoulder pain. The condition is characterized by the formation of a small deposit of calcium within the rotator cuff tendons. Over time, this calcium deposit will typically be absorbed by the body, and shoulder function will return to normal. People can typically manage their symptoms with noninvasive treatment options. In situations where people do not improve, a surgical procedure to remove the calcium deposit is a treatment option.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. DE Carli A, Pulcinelli F, Rose GD, Pitino D, Ferretti A. Calcific tendinitis of the shoulder. Joints. 2014;2(3):130–136. doi:10.11138/jts/2014.2.3.130

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By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.