Calcific Teninopathy
Calcific tendinopathy occurs when calcium deposits build up within a tendon, most often in the shoulder. These deposits can cause pain, stiffness, and difficulty moving the joint, especially during flare-ups. Although symptoms can be uncomfortable, the condition is treatable, and many people improve with the right diagnosis and care.
Overview | Symptoms & Causes | Diagnosis | Treatment Options
What is Calcific Tendinopathy?
Calcific tendinopathy is a condition where small deposits of calcium build up within a tendon, most often in the rotator cuff tendons of the shoulder. These calcium deposits can cause inflammation and irritation in the surrounding tissue, leading to pain, stiffness, and reduced movement in the affected joint.
Although it can occur in other tendons (such as the hip or elbow), it is most common in the shoulder. The exact cause isn’t always clear, but the condition often develops gradually and may resolve on its own over time.
Understanding Calcific Tendinopathy
Calcific tendinopathy occurs when calcium deposits form within a tendon - most often in the rotator cuff of the shoulder. These deposits can irritate and inflame the surrounding tissues, leading to pain and stiffness.
The symptoms can vary depending on the size and stage of the calcium deposits. Some people have no symptoms, while others may experience sudden or severe pain when the deposit becomes inflamed or starts to break down.
Common symptoms include:
- Shoulder pain: Often sharp or intense, particularly when lifting the arm or lying on the affected side.
- Stiffness and reduced movement: The shoulder may feel tight or difficult to move, especially in the morning.
- Pain at rest or at night: Discomfort can persist even without movement and may disturb sleep.
- Tenderness or swelling: The area around the shoulder may feel sore or mildly swollen.
What causes calcific tendinopathy?
The exact cause of calcific tendonitis isn’t fully understood, but it’s thought to result from small areas of tendon wear or reduced blood flow that trigger calcium buildup over time. The deposits can form even without a clear injury, any obvious risk factors or triggers.
| Age | Most common between 40 and 60, as tendon structure naturally changes with age, making calcium deposits more likely to form. |
| Sex | Occurs more often in women, possibly due to hormonal influences that may affect tendon health. |
| Shoulder strain | Repetitive overhead movements - seen in certain sports (e.g., tennis, swimming) or jobs (e.g., painters, manual labour) - can place repeated stress on the rotator cuff tendons. |
| Previous shoulder injury | A history of rotator cuff tears, impingement, or shoulder trauma may alter tendon mechanics and increase the likelihood of calcium buildup. |
| Metabolic or hormonal conditions | Conditions such as diabetes or thyroid disorders can affect tendon metabolism, making calcific deposits more likely to develop. |
Diagnosing Calcific Tendinopathy
A physiotherapist or clinician can often provide a clinical diagnosis of shoulder impingement syndrome, which occurs when the muscles and tendons in the shoulder become pinched or irritated. However, a clinical assessment alone cannot reliably diagnose calcific tendinopathy, as it requires imaging to confirm the presence of calcium deposits.
Common investigations include:
| Ultrasound | The most common and effective test. It can show calcium deposits, inflammation, and any bursitis (fluid around the tendon). |
| X-Ray | Helps identify the size, shape, and position of calcium deposits within the tendon. |
| MRI | May occasionally be used if symptoms are severe or if another shoulder condition, such as a tear, is suspected. |
Treatment Options
Most people recover from calcific tendonitis with simple, non-surgical treatments. The aim is to relieve pain, improve movement, and help the body naturally absorb or break down the calcium deposits over time.
Conservative Treatments
- Rest and activity modification: Avoiding movements that aggravate shoulder pain helps reduce irritation and allows inflammation to settle.
- Pain relief and anti-inflammatory medication: Paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help control pain and swelling.
- Physiotherapy: Targeted exercises can improve shoulder strength, flexibility, and posture, helping to prevent future irritation.
Procedural Options
These may be considered if symptoms are severe or persistent.
| Ultrasound-guided barbotage | A minimally invasive procedure where a needle is used under ultrasound guidance to break up and flush out calcium deposits. |
| Steroid injections | A steroid injection into the shoulder can reduce inflammation and pain, especially if bursitis (fluid around the tendon) is present. |
| Shockwave therapy | Uses sound waves to help break down calcium deposits and stimulate healing in the tendon. |
| Surgery | If symptoms remain severe and persistent despite other treatments, arthroscopic (keyhole) surgery may be recommended to remove calcium deposits and repair any tendon damage. Most people recover well with non-surgical options, although improvement can take several weeks or months as the tendon heals. |
How can Lanthorn help?
Musculoskeletal Ultrasound - £300
An ultrasound scan provides a detailed, real-time view of the tendons, allowing us to identify calcium deposits, assess inflammation, and check for any associated tendon irritation or tearing. It’s quick, accurate, and often the first step in diagnosis.
Ultrasound-guided barbotage - £550
Calcium barbotage (also called lavage) is a minimally invasive procedure that uses ultrasound guidance to precisely target the calcium deposit. The calcium is broken up and washed out with fluid, helping reduce pain and improve shoulder movement.
Ultrasound-guided steroid injection - £450
If inflammation is contributing to pain, a targeted steroid injection may be used to reduce swelling and pain around the affected tendon. Ultrasound guidance ensures the medication is delivered exactly where it’s needed for maximum benefit.
