Calcific Tendonitis: Causes, Symptoms & Advanced Treatments

Calcific Tendonitis Vs. Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder is an acute condition caused by thickening and tightening of the shoulder capsule, while calcific tendonitis is due to calcium deposits in the tendon. Both can co-occur, leading to severe, unresolved pain. (study)

Calcific Tendonitis and Subacromial Pain Syndrome

Subacromial pain syndrome (SAPS) is a leading cause of shoulder pain, especially during overhead activities. While SAPS and rotator cuff tendinitis are often confused, SAPS pain frequently radiates to the neck, whereas calcific tendonitis pain is more localized to the shoulder.

Stages of Calcific Tendinitis

Calcific tendonitis progresses through several stages:

• Pre-calcific stage: Cellular changes in the tendon, usually painless.
• Calcific stage: Calcium deposits form, causing pain and reduced motion. Includes formative and resting phases.
• Resorptive phase: The body attempts to clear calcium deposits, leading to increased pain and inflammation. (highlight)
• Post-calcific stage: Tendon remodeling and healing, with symptoms subsiding.

Signs and Symptoms

Calcific tendonitis is often asymptomatic, but when symptoms occur, they may include:

• Shoulder pain: Severe, acute pain, especially when raising the arm or reaching behind the back. (study)
• Decreased range of motion: Pain limits movement and impacts quality of life.
• Shoulder tenderness: Pain and reduced mobility on palpation.
• Sleep disturbance: Night pain disrupts rest and work efficiency.

Causes and Risk Factors

Calcific tendonitis most commonly affects the rotator cuff tendons (supraspinatus and infraspinatus) in the shoulder. It is a degenerative disorder, often linked to tendon degeneration, overuse, abnormal thyroid activity, diabetes, and genetic predisposition. Women aged 30–60 are at higher risk. (study)

It can also affect athletes, musicians, and those with repetitive shoulder activity.

Diagnosis

Diagnosis involves a medical history, physical exam, and imaging (X-ray for large deposits, ultrasound for small deposits). Accurate diagnosis guides effective treatment.

Treatment

Calcific tendonitis is often self-limiting, but treatment is needed for persistent or severe cases.

Home Management

• Rest and ice: Reduce inflammation and promote healing.
• Immobilization: Use a sling to protect the joint, but avoid complete immobility.
• Pendulum exercises: Gentle movement to improve mobility and reduce pain.

Conservative Treatment

• Physical therapy: Exercise and therapy improve blood flow, mobility, and calcium removal.
• Medications: NSAIDs and steroid injections for pain and inflammation.
• Steroid injections: Reserved for severe cases to reduce inflammation.
• Percutaneous needling (ultrasound-guided lavage): Fine needles irrigate and remove calcium deposits under ultrasound guidance. (study)
• Shockwave therapy: Radial and extracorporeal shockwave therapy break down calcium deposits and promote healing. (study, study, review)

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat calcific tendonitis. Published research has proven its pain-relieving, anti-inflammatory, and regenerative benefits. Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with calcific tendonitis. As prolotherapy is helping to treat the root cause of calcific tendonitis, it is deemed to be a permanent fix, preventing the symptoms from returning.

Surgical Treatment

• Arthroscopic surgery: Removal of calcific deposits to relieve pain and restore motion. (study)
• Subacromial decompression: Smoothing bone spurs; not always effective for calcific tendonitis. (study)
• Recent research suggests arthroscopic treatment and subacromial decompression without debridement can resolve symptoms. (2023 study)

Frequently Asked Questions

How do you treat calcific tendonitis?

Rest, ice, pendulum exercises, painkillers, physical therapy, shockwave therapy, ultrasound-guided needle lavage, and in some cases, arthroscopic surgery are all effective treatments. Prolotherapy is an advanced regenerative option that addresses the root cause.