Calcific tendinitis


Shoulder anatomy
Shoulder anatomy, anterior.
Shoulder anatomy, posterior.
  • Self-limiting disorder of calcium hydroxyapatite deposition within one or more tendons of the rotator cuff
    • Usually spontaneous, not necessarily caused by trauma or overuse
    • With time, the calcium undergoes painful resorption with subsequent tendon healing
  • Middle-aged patients 30-50 years are most commonly affected (rarely seen in patients >70yrs), and women are moreso affected[1]
  • Adhesive capsulitis is most common complication
  • Inflammatory reaction may exhibit warmth, swelling, or erythema that may mimic septic arthritis

Clinical Features

Precalcific phase

  • Fibrocartilaginous metaplasia of the tendon, leading to chondrocyte formation
  • Pain-free

Calcification phase

  • Formative phase
    • Characterized by cell-mediated calcific deposits
    • +/- Shoulder pain
  • Resting phase
    • Lacks inflammation or vascular infiltration
    • +/- pain
  • Resorptive phase (1-2 wks)
    • Characterized by phagocytic resorption and vascular infiltration
    • Most painful phase; due to inflammation in the resorptive process, increase in intratendinous pressure, or subacromial impingement
      • Pain may be similar to rotator cuff tendinopathy; usually at rest, worse at night and with laying on affected side
      • Leakage of calcium crystals onto the bursa may lead to sudden dramatic pain
      • Any shoulder motion reproduces significant pain; shoulder impingement tests are usually positive
      • TTP over proximal humerus near tendinous insertion of rotator cuff; may also be near AC joint or deltoid

Post-calcific phase

  • Calcific deposits have been resorbed; tendon returns to normal
  • Variable levels of pain and shoulder dysfunction

Differential Diagnosis

Shoulder and Upper Arm Diagnoses



Refered pain & non-orthopedic causes:


Calcific tendinitis
  • Imaging
    • Plain films will show calcification in the tendon(s) of the rotator cuff
      • Usually in the supraspinatus tendon, proximal to its insertion site on the greater tuberosity[2]
      • Amount of calcification may not correlate with severity of symptoms[3]
      • Note: calcification is not specific for calcific tendinitis (may occur in asymptomatic patients)
    • Ultrasound is sensitive for detecting calcifications
      • May show hyperechoic areas and posterior acoustic shadowing
      • Can simultaneously detect rotator cuff tears or bursitis


  • Nonoperative management is successful in most cases
    • NSAIDs, oral and topical
    • Physical therapy for rotator/glenohumeral strength and ROM
    • Stretch and strengthening
      • Avoid immobilization
        • Rest shoulder in abduction on back of a chair as soon as tolerable
        • Sleep with pillow beneath axilla
    • Subacromial corticosteroid injection


  • Primary care referral within 1wk
  • If chronic, may consider ortho referral for extracorporeal shock wave therapy, ultrasound-guided lavage, or operative management

See Also


  1. Merolla G, Singh S, Paladini P, Porcellini G. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment. J Orthop Traumatol. 2016 Mar;17(1):7-14. doi: 10.1007/s10195-015-0367-6. Epub 2015 Jul 12. PMID: 26163832; PMCID: PMC4805635.
  2. Kim MS, Kim IW, Lee S, Shin SJ. Diagnosis and treatment of calcific tendinitis of the shoulder. Clin Shoulder Elb. 2020 Nov 27;23(4):210-216. doi: 10.5397/cise.2020.00318. PMID: 33330261; PMCID: PMC7726362.
  3. Catapano, Michael, Robinson, David M., Schowalter, Sean and McInnis, Kelly C.. "Clinical evaluation and management of calcific tendinopathy: an evidence-based review" Journal of Osteopathic Medicine, vol. 122, no. 3, 2022, pp. 141-151.