--- title: "Calcific Tendonitis of the Shoulder | Dr. Avi Chezar" description: "Calcific tendonitis of the shoulder: what the calcium deposits are, why they hurt, how they are diagnosed, and when medication, injection or arthroscopy helps." canonical: https://www.catef4u.com/en/calcific-tendonitis translation-of: https://www.catef4u.com/calcific-tendonitis last-updated: 2026-11-03 language: en source: catef4u.com --- # Calcific Tendonitis of the Shoulder > Calcific tendonitis of the shoulder: what the calcium deposits are, why they hurt, how they are diagnosed, and when medication, injection or arthroscopy helps. Treating acute pain caused by calcium deposits in the tendons ## In brief Summarized and reviewed by Dr. Avi Chezar, shoulder surgery specialist, Assuta Haifa and RMC Afula. **What it is:** A build-up of calcium material inside the rotator cuff tendons, for an unknown reason. The deposits can be paste-like or solid, and on an X-ray they usually look like a stone lying in the shoulder. **Symptoms:** Persistent shoulder pain without any injury, more common at night, sometimes to the point of disabling pain. There is chronic pain that flares up in attacks, sometimes with marked restriction of movement caused by the pain. **Diagnosis:** An X-ray to locate the calcifications; an ultrasound to rule out a rotator cuff tear as a parallel cause of the pain. **Treatment:** First stage: NSAIDs and local heat; if there is no response – a subacromial cortisone injection. A large deposit that causes pain over a long period can be removed arthroscopically – after which the calcification does not come back in the same shoulder. ## How does it typically present? Persistent shoulder pain without any injury, sometimes to the point of disabling pain. The pain is more common at night, to the point of marked difficulty sleeping. There is usually some restriction of movement, and sometimes the restriction is marked. The restriction is caused by the pain. There is chronic shoulder pain that gets worse in attacks. It is common in people who do office work and in homemakers. ## What are calcifications in the rotator cuff tendons? A chalk-like material that builds up inside the rotator cuff tendons. The reason the calcifications form is not known, but it is known that cells inside the tendons produce a calcium material that accumulates inside the tendon. ## What do the calcifications look like? The calcifications can be: - paste-like - or a solid, chalk-like material On an X-ray they usually look like a stone lying in the shoulder. When the calcification is very small, up to 3 mm, it is usually of no significance. ## A few facts about the condition - There is **no** connection with osteoporosis ("loss" of calcium from the bones). - There is **no** connection with a lack or excess of calcium in the body, for any reason. - There is **no** connection with calcifications forming elsewhere in the body. - Although the calcifications form inside the rotator cuff tendons, there is **no** connection between them and tears of these tendons. ## How are the calcifications diagnosed? In addition to the typical presentation and the examination findings, an imaging test that shows the calcifications is needed. The calcifications are usually visible on X-rays of the shoulder. It is advisable to also have an ultrasound of the shoulder, to rule out a rotator cuff tear as the cause of the pain. Small calcifications may not be visible on an X-ray, only on ultrasound. Tiny calcifications are a common finding on ultrasound and are usually of no significance. In my experience, if a calcification is small and not visible on an X-ray, it is probably not the cause of the shoulder pain. ## What causes the pain when there are calcifications in the tendons? The pain has two main causes: 1. Because of its position inside the tendon, the calcification thickens the tendon and increases the pressure around it. So with certain movements, mainly raising the arm, pain develops, similar to impingement syndrome. 2. The calcification causes a kind of chemical irritation in the shoulder. The body tries to absorb the calcification, and an inflammatory reaction against it develops. The inflammation causes severe, sharp pain. This is the pain that wakes people from sleep and makes them unable to move the shoulder because of the pain. ## How are calcifications in the rotator cuff tendons treated? Bear in mind that the calcifications are absorbed over time even without any treatment, but the process may take 5 to 10 years. Treatment is intended to relieve the pain and allow a return to normal daily activity. ### First stage When the pain is not severe: - anti-inflammatory medication from the NSAID family - and local heat ### Second stage When there is no response to the treatment above, or when the pain is very acute: - a subacromial cortisone injection can be given These treatments are **not** intended to remove the calcifications, but in many cases they reduce the pain and allow the natural absorption of the calcification to take place over time. ### Surgical treatment When there is a large calcification that causes pain over a long period, surgical removal of the calcifications can be considered. The procedure is performed by [arthroscopy](https://www.catef4u.com/en/shoulder-arthroscopy). During the operation the position of the calcification inside the tendon is located, and it is suctioned out of the tendon. Once the calcifications have been removed, they do not come back in the same shoulder. Rehabilitation after the operation is usually relatively quick and takes a few weeks. Bear in mind that sometimes a rotator cuff tear that needs repair is also found during the operation, and in that case rehabilitation takes longer. ## Are there other treatments? Other treatments are offered for this condition, including: - shock waves - and therapeutic ultrasound However, these treatments do not remove the calcification. They are intended to: - increase blood flow to the area - and so help the body speed up the process of clearing the calcification (unlike shock-wave treatment of a kidney stone). **Note that the professional literature supports these treatments only to a limited extent, so consult your treating physician before having them.** ## Further reading from leading medical sources - [Calcific Tendinitis of the Shoulder — OrthoInfo (AAOS)](https://orthoinfo.aaos.org/en/diseases--conditions/calcific-tendinitis-of-the-shoulder/) – Calcium deposits in the shoulder tendons – diagnosis and treatment --- Canonical HTML: https://www.catef4u.com/en/calcific-tendonitis Hebrew original: https://www.catef4u.com/calcific-tendonitis Site index for agents: https://www.catef4u.com/llms.txt _This Markdown is the text-only variant of the page above, served for `Accept: text/markdown`. It is an English translation of Dr. Avi Chezar's Hebrew page. Medical information here is general and does not replace a personal consultation._