Calcific tendinitis is a build-up of calcium inside the rotator cuff tendons that move the shoulder; it is popularly called 'calcification of the shoulder' and is a different condition from wear of the shoulder joint (osteoarthritis) [1][3]. Most deposits disappear by themselves in time and treatment starts without surgery in most people; the evidence for shock-wave therapy and needle lavage is limited or conflicting, and surgery comes up for the small number of people whose pain continues despite other treatment [1][2][4][5].
What does 'calcification' of the shoulder mean?
In everyday speech 'calcification' of the shoulder (in Turkish, 'omuz kireçlenmesi') is used for two different things. The first is a build-up of calcium inside the rotator cuff tendons that move the shoulder (calcific tendinitis); that is the subject of this article [1][2]. The second is wear of the shoulder joint itself (osteoarthritis): the cartilage covering the joint surfaces wears away, it usually appears after the age of 50, and on X-ray it is recognised by narrowing of the joint space and bony spurs [3]. The two are different conditions and are not treated in the same way [1][3].
In calcific tendinitis the calcium deposit irritates the tendon, contributes to inflammation and may rub against the bony point at the top of the shoulder (the acromion) [1][2]. According to an NHS patient information leaflet, it is not a harmful or serious condition [2].
What symptoms are typical?
A calcium deposit does not always cause pain [2]. When there are symptoms, the main ones are [1][2]:
- Pain and tenderness at the front or side of the shoulder; the pain sometimes spreads into the arm
- Pain that may be severe and may come on without an injury or movement
- Pain that can disturb sleep or make it hard to lie on the shoulder
- Difficulty moving the arm, a feeling of stiffness or loss of movement
- Weakness in the shoulder
Who gets it?
Why it develops is not fully known; it is thought that it may be linked to overuse of the tendon [1][2]. It is more common in adults between 30 and 60 but can happen to anyone; it is slightly more common in women than in men and can affect one shoulder or both [1][2].
How is it diagnosed?
The doctor feels the shoulder and checks range of movement and arm strength [1]. An X-ray shows the calcium deposits around the rotator cuff and may be requested to confirm the diagnosis [1][2]. MRI can show the surrounding soft tissues, fluid, inflammation and tendon tears [1].
Not every deposit seen on X-ray is the cause of the pain, so the imaging result is weighed together with the examination findings [2]. Ultrasound can be used to guide the needle during an injection and during needle lavage [1][2].
Does the calcium go away by itself?
Most deposits disappear by themselves [2]. It can take up to 9 months, and sometimes longer, for the calcium to dissolve naturally; the pain, however, often settles within a few weeks [2].
The pain can come on suddenly and be very intense. This often means that the deposit is dissolving by itself [2]. Even so, the course is not the same for everyone: in a study of patients whose symptoms had lasted at least three months, 143 of 220 participants received additional treatment after four months because they had not improved enough [5].
First-line treatment
In most people treatment starts without surgery; many improve in time and regain use of the shoulder, although full recovery can take weeks or months [1]. The main measures:
- Relative rest: avoiding for a while the movements that bring on or increase the pain; rather than keeping the arm completely still, continuing to move it as far as pain allows [1][2]
- Painkillers and anti-inflammatory medicines; ice packs [1][2]
- Physiotherapy and exercise: stretching exercises to restore shoulder movement, with strengthening later on [1][2]
- Steroid injection: if other measures do not relieve the pain, it can be given into the sac (bursa) beneath the acromion; the pain may return later but is often not as severe as before [1][2]
Shock-wave therapy, needle lavage and surgery
Other treatments may be considered for people who do not get enough relief from first-line treatment. For some of them the evidence is limited or conflicting [4][5][6]:
- Shock-wave therapy (ESWT): shock waves generated by a machine are directed at the deep tissues of the shoulder, with the idea that they may break up the deposits [1]. According to a Cochrane review, low- to moderate-certainty evidence shows very few clinically important benefits for pain and function compared with placebo; no difference was found between patients with and without calcium deposits. There is uncertainty about its safety, and because treatment protocols differed widely between studies, any benefit may appear smaller than it is [4]
- Ultrasound-guided needle lavage (barbotage): a needle is passed into the deposit and saline is injected so that the calcium is broken up or drawn out [1][2]. A systematic review based on three trials reported, on low-quality evidence, that it may be more effective than shock-wave therapy or a steroid injection alone [6]. In a later trial that compared 220 patients with a sham (placebo) procedure, however, neither lavage combined with a steroid nor a steroid alone was found to be better than the sham procedure at four months or at two years; no serious adverse events were reported [5]
- Arthroscopic (keyhole) surgery: comes up when non-surgical treatment does not relieve the pain and is rarely needed; the aim is to remove the calcium and to repair any associated tendon tear [1][2]
How long does recovery take?
With non-surgical treatment symptoms ease gradually in many people; full recovery can take from a few weeks to a few months [1]. In general, shoulder pain can take six months or longer to settle; during this time the advice is to keep moving the shoulder gently rather than stop using it altogether [7].
After surgery the arm is kept in a sling for a short time and shoulder exercises then begin; complete relief of pain usually takes 2 to 4 months and in some people up to a year [1].
When not to wait
Pain from calcium deposits can also come on suddenly and be very severe, but only an examination can show that this is the cause [1][2]. See a doctor if the pain does not improve within two weeks or it becomes hard to move the arm; assessment without delay is needed for [7]:
- Sudden or very severe shoulder pain
- Being unable to move the arm
- A change in the shape of the shoulder or marked swelling
- Tingling or numbness in the arm that does not go away, or the arm feeling hot or cold
- Pain that began after a fall or an accident
- Severe pain in both shoulders at once, or pain with a fever
Frequently asked questions
- Are 'calcification' of the shoulder and calcific tendinitis the same thing?
- In everyday speech 'calcification' is used both for a calcium deposit inside a tendon (calcific tendinitis) and for wear of the joint cartilage (osteoarthritis); these are different conditions [1][3].
- Do calcium deposits in the shoulder go away by themselves?
- Most deposits disappear by themselves; this can take up to 9 months and sometimes longer, while the pain often settles within a few weeks [2].
- Why did my pain suddenly become very severe?
- Sudden, very intense pain often means that the deposit is dissolving by itself [2]. Even so, sudden or very severe shoulder pain should be examined without delay [7].
- Does shock-wave therapy work?
- According to a Cochrane review it has very few clinically important benefits compared with placebo and there is uncertainty about its safety; the certainty of the evidence is low to moderate [4].
- Do I need the calcium removed with a needle, or an operation?
- Most people do not; treatment starts without surgery [1]. The evidence for needle lavage is conflicting: a trial comparing it with a sham procedure did not show it to be better [5][6]. Surgery comes up rarely, for people whose pain continues despite other treatment [1][2].
This article is a general summary; diagnosis and treatment decisions are made by the doctor who examines you.
Sources
- Calcific Tendinitis of the Shoulder. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Calcific Tendinopathy: Information for patients. NHS Lothian, 2025. policyonline.nhslothian.scot
- Arthritis of the Shoulder. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Shock wave therapy for rotator cuff disease with or without calcification. Cochrane Database of Systematic Reviews (Surace SJ, et al.), 2020. pubmed.ncbi.nlm.nih.gov
- Ultrasound guided lavage with corticosteroid injection versus sham lavage with and without corticosteroid injection for calcific tendinopathy of shoulder: randomised double blinded multi-arm study. BMJ (Moosmayer S, et al.), 2023. pubmed.ncbi.nlm.nih.gov
- Is ultrasound-guided lavage an effective intervention for rotator cuff calcific tendinopathy? A systematic review with a meta-analysis of randomised controlled trials. BMJ Open Sport & Exercise Medicine (Lafrance S, et al.), 2019. pubmed.ncbi.nlm.nih.gov
- Shoulder pain. NHS (nhs.uk), 2023. nhs.uk
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
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