Calcific Tendinopathy of the Rotator Cuff

Calcific Tendinopathy of the Rotator Cuff

What Is It?

Calcific tendinopathy is when calcium builds up inside the rotator cuff tendons (usually the supraspinatus). It can cause pain but is often found in people with no symptoms at all.

Who Gets It?

• Common in adults aged 30–60
• More frequent in women
• Linked with diabetes, hypothyroidism, and frozen shoulder
• Not caused by heavy lifting or injury

What Causes It?

The exact cause isn’t fully known. It may involve:

• Tendon cells turning into bone/cartilage-forming cells
• Poor healing or overuse
• Possibly genetic or metabolic factors

It goes through three stages:

1. Pre-calcific – no symptoms
2. Calcific – calcium appears (may or may not hurt)
3. Post-calcific – body absorbs calcium and tendon heals

What Are the Symptoms?

• Shoulder pain (can come on suddenly or build up slowly)
• Worse at night
• Limited movement
• But remember: up to 50% feel nothing at all

How Is It Diagnosed?

• Ultrasound is the best tool
• X-rays can show larger deposits
• MRI is sometimes used but not always needed
• Imaging doesn’t always match symptoms – so don’t treat the scan alone!

Treatment Options

First-line:

• Reassurance: Often gets better on its own
• Pain relief: Paracetamol or NSAIDs
• Exercise: Improves movement and strength
• Education: Helps patients manage flare-ups

Additional Options (if symptoms persist):

• Shockwave therapy
• Ultrasound-guided lavage (needling and flushing)
• Steroid injections (used sparingly)

Surgery:

• Only after 6 months of failed conservative treatment
• Not always necessary or better than other options

Key Takeaways for Clinicians

• Many people have calcium in their shoulder tendons without pain
• Pain usually happens when the body reabsorbs the calcium
• Start with simple care: reassurance, exercise, and pain relief
• Use imaging to support, not drive, your decisions
• Reserve injections or surgery for persistent, disabling cases

Video coming soon…