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Calcific Tendonitis: Causes & Diagnosis

Sudden, severe shoulder pain is an experience that cannot be ignored. In many cases, the cause is not a serious injury, but a lesser-known, extremely painful condition: Calcific Tendonitis. It is a form of tendonitis that, if not diagnosed and treated promptly, can dramatically affect the patient’s quality of life.

What is Calcific Tendonitis?

Calcific tendonitis is a specific form of tendon inflammation, in which calcium deposits appear within the tendon tissue. It occurs most often in the shoulder and more specifically in the supraspinatus tendon, which is part of the rotator cuff. This tendon is vital for overhead arm movements, and it is easy to overuse in our daily lives. These calcium deposits build up gradually. Initially, they have a texture reminiscent of soft paste. At this stage, they are relatively easy to remove. However, if they remain there without treatment, over time they harden and look more like small pebbles, making treatment more complex.

Who is affected by Calcific Tendonitis?

Although it can happen to anyone, calcific tendonitis occurs most often in people aged 30 to 60, with a clear predominance in women. We do not know the exact reasons, but it is believed that hormonal and anatomical factors play a role. In addition, lifestyle factors, such as long hours of sedentary work, poor posture or repetitive shoulder movements, create fertile ground for the development of the problem.

What are the symptoms?

The main symptom is a sharp pain in the shoulder area, which often appears suddenly, without clear warning signs. The pain can be so intense that even the slightest attempt to raise the upper limb becomes extremely painful. Often, the discomfort is not limited to daytime hours, as many patients report waking up at night due to pain. The subjective sensation is often described as an “internal blockage” in the shoulder, as if some painful structure is trapped within the joint.

How is the diagnosis made?

The diagnosis of calcific tendonitis is usually immediate, as long as there is appropriate clinical suspicion and the necessary experience. A simple shoulder X-ray is the first-line examination, as in most cases it clearly highlights calcium deposits in the rotator cuff tendons. In cases where radiography is not sufficient, either due to the small size of the calcification or its atypical location, ultrasound or MRI can be used to more accurately capture the inflammatory process and the condition of the tendon. Early diagnosis is crucial.

The earlier the calcification is recognized, the more conservative and effective the therapeutic intervention can be, limiting the need for more invasive techniques.

What is the treatment?

Treatment depends on the stage of the disease and the intensity of the symptoms.

Conservative treatment

In the initial phase, when the calculus is still soft, conservative treatment may be sufficient:

• Anti-inflammatory drugs to relieve pain
• Local injections (e.g. cortisone or PRP)
• Rest and avoid straining
• Physical therapy to improve mobility

In many cases, this approach leads to a reduction in pain and, gradually, to absorption of the calculus. There are cases where, within a few weeks, X-rays show a clear shoulder.

Minimally invasive treatment: Arthroscopy

When conservative measures do not work or when the calcification is extensive and persists, we proceed to arthroscopic removal. Arthroscopy is a minimally invasive procedure that is performed with a camera and special tools, through very small incisions. The surgeon locates the calcium within the tendon and removes it with precision. In some cases, a small incision is also required in the tendon to completely remove the material. The entire procedure takes about 30 minutes, the patient leaves the hospital the same day and recovery is very fast. The next day, he can move his arm without severe pain, while a physical therapy program contributes to a full recovery.

Postoperative course

Despite the particularly intense pain caused by calcific tendonitis, the clinical response after appropriate therapeutic intervention is remarkably immediate. In many cases, shoulder girdle mobility is restored completely within hours, with a parallel spectacular reduction in pain.