Between 2.5% and 7.5% of adults have calcifications in their shoulder tendons, mainly affecting women in their forties and fifties.[1,2]

Here's the good news: in most cases, these deposits resolve naturally. Your body has the ability to eliminate them on its own, and the intense pain you feel is a sign that this healing process is underway.

You will discover why these calcifications form, how to recognize the different stages, and, most importantly, how to regain full use of your shoulder.

What is calcific tendinitis of the shoulder?

Calcific tendinitis is the presence of calcium crystal deposits (hydroxyapatite) in the rotator cuff tendons.[1,4] The supraspinatus tendon is affected in 51.5% to 90% of cases.

Contrary to popular belief, these deposits are not hard pieces of bone. During certain phases, calcium forms a viscous liquid that can soften and be reabsorbed by your body.[3,5]

This condition is unique because it follows a predictable cycle with distinct phases, and the healing process often involves a period of intense pain before improvement.

Now that you understand what these deposits are, let's explore how this condition evolves over time.

What are the three phases of calcific tendinitis?

Calcific tendinitis follows a three-phase cycle: formation, rest, and resorption.[3,5,6]

Phase 1: Training

Cells in your tendon transform and actively deposit calcium in the tendon matrix. This phase lasts for months or years. Pain is often absent or mild. On X-rays, the deposit appears dense with clear contours.

Many people go through this phase without symptoms—calcifications are discovered by chance.

Phase 2: Rest

The deposits are stable, with no progression or resorption. Symptoms are absent or very mild. This phase can last for months or years.

Phase 3: Resorption

This is the most painful phase, but it is the one that leads to healing.[3,5,7] Your body reabsorbs the deposit through a strong inflammatory reaction. The calcium softens, its volume increases, and microcrystals are released into the subacromial bursa, triggering intense inflammation.[5,7]

Symptoms of the resorption phase:

• Severe and sudden pain, often without trauma
• Inability to actively raise the arm
• Intense nighttime pain with insomnia
• Marked stiffness of the shoulder

This phase lasts 1 to 6 months. The good news is that approximately two-thirds of patients see their deposits disappear completely or partially after this phase.[3,8]

The cycle can become blocked at any stage. Let's take a look at what triggers these calcifications.

What REALLY causes calcific tendinitis?

Popular belief: Calcifications are caused by too much calcium in the diet. The scientific reality: Calcifications are not related to your dietary calcium intake. They result from an active biological process in which tendon cells transform and deposit calcium locally.

The most widely accepted hypothesis suggests that tenocytes undergo metaplasia (transformation into cartilage-like cells), which triggers calcium deposition. Contributing factors include:

• Local decrease in oxygen
• Repetitive strain injury
• Genetic or metabolic predisposition
• Mechanical factors

What you need to remember: You haven't done anything "wrong." It's not your diet or how you use your shoulder. Your body can naturally reabsorb these deposits—the intense pain is a sign that this process is underway.

Some people are at greater risk.

Who is most at risk of developing calcific tendinitis?

Age: Occurs mainly between the ages of 30 and 50, rare after the age of 70. Gender: Women are affected twice as often (70% of cases).[1,2] Laterality: The right shoulder is more affected. 10% have bilateral calcifications. Medical conditions:

• Diabetes (increased risk, less effective treatments)
• Endocrine disorders
• Thyroid disorders

Professional factors:

• Jobs involving repetitive lifting of loads
• Arm in a prolonged elevated position
• Overhead sports (volleyball, tennis, swimming)

Even with these factors, it does not guarantee that you will develop the condition or prevent recovery.

Let's see how it manifests itself.

What are the symptoms of calcific tendinitis?

Symptoms vary depending on the phase.[3,5,11]

Training and rest phases:

• Mild or no pain
• Vague discomfort during certain movements
• Slight morning stiffness

35% of calcifications are completely asymptomatic.

Resorption phase:

• Sudden, intense pain with no obvious trauma
• Pain on the top or side of the shoulder, radiating down the arm
• Severe nighttime pain with insomnia
• Inability to actively raise the arm
• Touch sensitivity

Special feature: The resorption phase can begin very suddenly—you may wake up with intense pain even though everything was fine the day before.[5,7]

The next step: getting an accurate diagnosis.

How is calcific tendinitis diagnosed?

The diagnosis combines medical history, physical examination, and imaging.[2,5,11]

Clinical evaluation:

• Questions about onset (sudden or gradual), intensity, aggravating movements, impact on sleep
• Examination of range of motion, strength, palpation, orthopedic tests

Imaging: X-ray: First-line examination.[2,5] Clearly shows calcium deposits.

• Dense and well-defined: Formation/rest phase
• Translucent with blurred edges: Resorption phase (good sign)

Ultrasound scan: Sees the deposit in real time. Doppler ultrasound detects neovascularization—a sign of active resorption. MRI: Rarely necessary, unless other associated problems are suspected. Differentiate from other conditions:

• Subacromial impingement
• Tear in the rotator cuff
• Retractile capsulitis
• Septic arthritis (rare but serious)

Once diagnosed, how should it be treated?

What treatments are available for calcific tendinitis?

We always start with conservative treatments, reserving surgery for chronic cases.[8,13]

Conservative treatments: 1. Physical therapy[11,15]

• Gentle mobilization
• Progressive exercises
• Ice/heat depending on the phase
• Education (sleeping positions, ergonomics)

A 2025 meta-analysis shows that comprehensive approaches offer the best functional outcomes.

2. Shock waves (ESWT)[8,14]

Breaks down deposits and stimulates healing. 3 to 6 sessions required. Highly effective when combined with physical therapy.

3. Cortisone injections[8,11]

Quickly reduce inflammation during the resorption phase. Effect is often temporary.

4. Guided aspiration (bubbling)[8,11]

Under ultrasound guidance, the softened calcium is aspirated. Particularly effective during resorption. PRP after aspiration improves function (85% probability).

5. Anti-inflammatory drugs

Control pain and inflammation in the short term.

Surgery:

Reserved for failures after 6-12 months.[8,13]

Indications:

• Deposition >1 cm (2.8 times greater risk of requiring surgery)
• Chronic debilitating pain
• Endocrine conditions (conservative treatment less effective)

By arthroscopy: locate, excise, clean, repair if necessary. Similar results for all techniques.

Let's see what you can do yourself.

What can I do at home to relieve my calcific tendinitis?

Acute pain management:

• Relative rest (do not immobilize completely)
• Ice for 15-20 minutes, 3-4 times a day
• Anti-inflammatory drugs as recommended
• Change in activities

Sleeping positions:

• Avoid sleeping on the painful shoulder
• Avoid putting your arm behind your head
• Pillow that fills the hollow of the neck
• Pillow under the affected arm
• Semi-sitting position if necessary

Maintaining mobility:

• Gentle pendulum exercises
• Light stretching
• Gradual resumption of activities

When to consult:

• Persistent pain after 10 days
• Difficulty with daily activities
• Nighttime pain that affects quality of life

You do not need to see a doctor before consulting a physical therapist.

What to expect for recovery?

What is the prognosis for calcific tendinitis?

The prognosis is generally favorable.[3,8]

Natural evolution:

• Spontaneous resolution: Two-thirds of cases resolve spontaneously within 1–2 years.[3,8]
• Resorption phase: 1-6 months of intense pain
• Recovery: Most people regain normal function.

Results with treatments:

• Conservatives: Significant improvement in 3-6 months[8,14]
• Surgery: Improvement in >90% of cases, recurrence very rare

Best prediction:

• Age 30-50
• Active resorption phase
• Dépôt <1 cm
• Absence of diabetes
• Early intervention

Prognosis uncertain:

• Deposits >1.5 cm
• Metabolic comorbidities
• Very dense calcifications
• Chronic symptoms >2 years

What you need to remember:

This pain is temporary. The resorption phase eventually ends. Severe pain is a sign that your body is eliminating the deposit.

You are not alone. Thousands of people experience this every year and regain normal function.

Treatments help. Physical therapy, shock wave therapy, and guided suction accelerate the process and reduce pain.

Your shoulder is not "broken." With the right support, you will regain full use of your shoulder.

Summary

Calcific tendinitis is the presence of calcium deposits in the tendons of the shoulder, mainly affecting women aged 30-50. It progresses in three phases: formation, rest, and resorption.

The resorption phase, although very painful, means that your body is eliminating calcium—it is a step toward healing. Two-thirds of patients see their deposits resorb naturally.

Conservative treatments (physical therapy, shock wave therapy, guided aspiration) are effective in most cases. Surgery is reserved for chronic, resistant cases.

The prognosis is excellent when the condition is well understood and treated appropriately.

If you experience sudden, severe shoulder pain that prevents you from sleeping, consult a professional for an accurate diagnosis and appropriate treatment plan.

To learn more, check out our comprehensive guide to shoulder pain and find out how physical therapy can help. You may also want to read our article on the differences between tendonitis and tendinopathy.

References

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• Speed CA, Hazleman BL. Calcific tendinitis of the shoulder. N Engl J Med. 1999;340(20):1582-1584.

• Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis, and management. J Am Acad Orthop Surg. 1997;5(4):183-191.

• Bosworth BM. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12,122 shoulders. JAMA. 1941;116(22):2477-2482.

• Chianca V, Albano D, Messina C, et al. Rotator cuff calcific tendinopathy: from diagnosis to treatment. Acta Biomed. 2018;89(1-S):186-196.

• Uhthoff HK, Sarkar K, Maynard JA. Calcifying tendinitis: a new concept of its pathogenesis. Clin Orthop Relat Res. 1976;(118):164-168.

• Fam AG. Calcium pyrophosphate dihydrate and hydroxyapatite crystal deposition diseases. In: Hochberg MC, Silman AJ, Smolen JS, et al., eds. Rheumatology. 5th ed. Philadelphia: Mosby Elsevier; 2011:1793-1804.

• Louwerens JKG, Sierevelt IN, van Noort A, van den Bekerom MPJ. Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2014;23(8):1240-1249.

• Serafini G, Sconfienza LM, Lacelli F, Silvestri E, Aliprandi A, Sardanelli F. Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle US-guided percutaneous treatment. Radiology. 2009;252(1):157-164.

• Maier D, Jaeger M, Izadpanah K, et al. Rotator cuff preservation in arthroscopic treatment of calcific tendinitis. Arthroscopy. 2013;29(5):824-831.

• Hurt G, Baker CL Jr. Calcific tendinitis of the shoulder. Orthop Clin North Am. 2003;34(4):567-575.

• Kim YS, Lee HJ, Kim YV, Kong CG. Which method is more effective in treatment of calcific tendinitis in the shoulder? J Shoulder Elbow Surg. 2014;23(11):1640-1646.

• Sconfienza LM, Viganò S, Martini C, et al. Double-needle ultrasound-guided percutaneous treatment of rotator cuff calcific tendinitis: tips & tricks. Skeletal Radiol. 2013;42(1):19-24.

• Moggio L, de Sire A, Marotta N, et al. Efficacy of conservative approaches on pain relief and function in patients with rotator cuff calcific tendinopathy: which is the best option? A systematic review and network meta-analysis. Orthop Surg. 2025;17(1):23-37.

• Grasso A, Milano G, Salvatore M, Falcone G, Deriu L, Fabbriciani C. Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study. Arthroscopy. 2009;25(1):4-12.