Calcific Tendinitis

  • Simon Boyle
  • Geoffrey C. S. Smith


Calcific tendinitis is a commonly encountered but painful disorder presenting to general practitioners, musculoskeletal specialists and orthopaedic surgeons. It has a prevalence of 2.7–7.8% in shoulders and most frequently involves the supraspinatus tendon.

Its aetiology is considered to be either cell mediated or degenerative in nature and the pathology evolves in three phases. The most frequent clinical presentation is one of pain which tends to be at its most severe during the resorptive phase. The diagnosis of calcific tendinitis is based on clinical history and examination and is supplemented by plain x-rays.

Many patients may be managed symptomatically with NSAID’s and gentle physiotherapy as the natural history of a calcific deposit can be one of resolution and resorption over time. The painful phase can be eased with a subacromial injection of local anaesthetic and steroid.

When symptoms fail to resolve with more conservative means, ultrasound guided needle aspiration and barbotage or extracorporeal shock wave therapy offer safe and effective treatment options.

In more resistant cases, arthroscopic excision can result in up to 90% successful outcomes. Debate continues as to the need for routine repair the rotator cuff post excision of the calcific deposit and for the role of a supplemental a subacromial decompression.


Calcific tendinitis Shoulder Pain Ultrasound Shock wave therapy Arthroscopy 


  1. 1.
    Gärtner J, Simons B. Analysis of calcific deposits in calcifying tendinitis. Clin Orthop Relat Res. 1990;254:111–20.Google Scholar
  2. 2.
    Hernandez-Santana A, Yavorskyy A, Loughran ST, McCarthy GM, McMahon GP. New approaches in the detection of calcium-containing microcrystals in synovial fluid. Bioanalysis. 2011;3(10):1085–91.CrossRefGoogle Scholar
  3. 3.
    Riley GP, Harrall RL, Constant CR, Cawston TE, Hazleman BL. Prevalence and possible pathological significance of calcium phosphate salt accumulation in tendon matrix degeneration. Ann Rheum Dis. 1996;55(2):109–15.CrossRefGoogle Scholar
  4. 4.
    Bosworth B. Calcium deposits in the shoulder and subacromial bursitis. A survey of 12,122 shoulders. JAMA. 1941;116:2477–82.CrossRefGoogle Scholar
  5. 5.
    Louwerens JK, Sierevelt IN, van Hove RP, van den Bekerom MP, van Noort A. Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. J Shoulder Elb Surg. 2015;24(10):1588–93.CrossRefGoogle Scholar
  6. 6.
    Speed CA, Hazleman BL. Calcific tendinitis of the shoulder. N Engl J Med. 1999;340(20):1582–4.CrossRefGoogle Scholar
  7. 7.
    Uhthoff HK. Calcifying tendinitis. Ann Chir Gynaecol. 1996;85(2):111–5.PubMedGoogle Scholar
  8. 8.
    Depalma AF, Kruper JS. Long-term study of shoulder joints afflicted with and treated for calcific tendinitis. Clin Orthop. 1961;20:61–72.PubMedGoogle Scholar
  9. 9.
    Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis, and management. J Am Acad Orthop Surg. 1997;5(4):183–91.CrossRefGoogle Scholar
  10. 10.
    Oliva F, Via AG, Maffulli N. Physiopathology of intratendinous calcific deposition. BMC Med. 2012;10:95.CrossRefGoogle Scholar
  11. 11.
    Codman EA, Akerson IB. The pathology associated with rupture of the supraspinatus tendon. Ann Surg. 1931;93(1):348–59.CrossRefGoogle Scholar
  12. 12.
    Refior HJ, Krödel A, Melzer C. Examinations of the pathology of the rotator cuff. Arch Orthop Trauma Surg. 1987;106(5):301–8.CrossRefGoogle Scholar
  13. 13.
    Rui YF, Lui PP, Chan LS, Chan KM, Fu SC, Li G. Does erroneous differentiation of tendon-derived stem cells contribute to the pathogenesis of calcifying tendinopathy? Chin Med J. 2011;124(4):606–10.PubMedGoogle Scholar
  14. 14.
    Loew M, Jurgowski W, Mau HC, Thomsen M. Treatment of calcifying tendinitis of rotator cuff by extracorporeal shock waves: a preliminary report. J Shoulder Elb Surg. 1995;4(2):101–6.CrossRefGoogle Scholar
  15. 15.
    Harvie P, Pollard TC, Carr AJ. Calcific tendinitis: natural history and association with endocrine disorders. J Shoulder Elb Surg. 2007;16(2):169–73.CrossRefGoogle Scholar
  16. 16.
    Gärtner J, Heyer A. Calcific tendinitis of the shoulder. Orthopade. 1995;24(3):284–302.PubMedGoogle Scholar
  17. 17.
    Molé D, Kempf JF, Gleyze P, Rio B, Bonnomet F, Walch G. Results of endoscopic treatment of non-broken tendinopathies of the rotator cuff. 2. Calcifications of the rotator cuff. Rev Chir Orthop Reparatrice Appar Mot. 1993;79(7):532–41.PubMedGoogle Scholar
  18. 18.
    Noël E. Treatment of calcific tendinitis and adhesive capsulitis of the shoulder. Rev Rhum Engl Ed. 1997;64(11):619–28.PubMedGoogle Scholar
  19. 19.
    Ogon P, Suedkamp NP, Jaeger M, Izadpanah K, Koestler W, Maier D. Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulder. Arthritis Rheum. 2009;60(10):2978–84.CrossRefGoogle Scholar
  20. 20.
    Cho NS, Lee BG, Rhee YG. Radiologic course of the calcific deposits in calcific tendinitis of the shoulder: does the initial radiologic aspect affect the final results? J Shoulder Elb Surg. 2010;19(2):267–72.CrossRefGoogle Scholar
  21. 21.
    Cole BF, Peters KS, Hackett L, Murrell GA. Ultrasound-guided versus blind subacromial corticosteroid injections for subacromial impingement syndrome: a randomized, double-blind clinical trial. Am J Sports Med. 2016;44(3):702–7.CrossRefGoogle Scholar
  22. 22.
    Maman E, Yehuda C, Pritsch T, Morag G, Brosh T, Sharfman Z, et al. Detrimental effect of repeated and single subacromial corticosteroid injections on the intact and injured rotator cuff: a biomechanical and imaging study in rats. Am J Sports Med. 2016;44(1):177–82.CrossRefGoogle Scholar
  23. 23.
    Sconfienza LM, Viganò S, Martini C, Aliprandi A, Randelli P, Serafini G, et al. Double-needle ultrasound-guided percutaneous treatment of rotator cuff calcific tendinitis: tips & tricks. Skelet Radiol. 2013;42(1):19–24.CrossRefGoogle Scholar
  24. 24.
    Yoo JC, Koh KH, Park WH, Park JC, Kim SM, Yoon YC. The outcome of ultrasound-guided needle decompression and steroid injection in calcific tendinitis. J Shoulder Elb Surg. 2010;19(4):596–600.CrossRefGoogle Scholar
  25. 25.
    Oudelaar BW, Ooms EM, Huis In 't Veld R, Schepers-Bok R, Vochteloo AJ. Smoking and morphology of calcific deposits affect the outcome of needle aspiration of calcific deposits (NACD) for calcific tendinitis of the rotator cuff. Eur J Radiol. 2015;84(11):2255–60.CrossRefGoogle Scholar
  26. 26.
    de Witte PB, Selten JW, Navas A, Nagels J, Visser CP, Nelissen RG, et al. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med. 2013;41(7):1665–73.CrossRefGoogle Scholar
  27. 27.
    de Witte PB, Kolk A, Overes F, Nelissen RGHH, Reijnierse M. Rotator cuff calcific tendinitis: ultrasound-guided needling and lavage versus subacromial corticosteroids: five-year outcomes of a randomized controlled trial. Am J Sports Med. 2017;45(14):3305–14.CrossRefGoogle Scholar
  28. 28.
    del Cura JL, Torre I, Zabala R, Legórburu A. Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder: short- and long-term results. AJR Am J Roentgenol. 2007;189(3):W128–34.CrossRefGoogle Scholar
  29. 29.
    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 – nonrandomized controlled trial. Radiology. 2009;252(1):157–64.CrossRefGoogle Scholar
  30. 30.
    Rompe JD, Kirkpatrick CJ, Küllmer K, Schwitalle M, Krischek O. Dose-related effects of shock waves on rabbit tendo Achillis. A sonographic and histological study. J Bone Joint Surg Br. 1998;80(3):546–52.CrossRefGoogle Scholar
  31. 31.
    Daecke W, Kusnierczak D, Loew M. Long-term effects of extracorporeal shockwave therapy in chronic calcific tendinitis of the shoulder. J Shoulder Elb Surg. 2002;11(5):476–80.CrossRefGoogle Scholar
  32. 32.
    Albert JD, Meadeb J, Guggenbuhl P, Marin F, Benkalfate T, Thomazeau H, et al. High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial. J Bone Joint Surg Br. 2007;89(3):335–41.CrossRefGoogle Scholar
  33. 33.
    Louwerens JK, Veltman ES, van Noort A, van den Bekerom MP. The effectiveness of high-energy extracorporeal shockwave therapy versus ultrasound-guided needling versus arthroscopic surgery in the management of chronic calcific rotator cuff tendinopathy: a systematic review. Arthroscopy. 2016;32(1):165–75.CrossRefGoogle Scholar
  34. 34.
    Gerdesmeyer L, Wagenpfeil S, Haake M, Maier M, Loew M, Wörtler K, et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA. 2003;290(19):2573–80.CrossRefGoogle Scholar
  35. 35.
    Lee SY, Cheng B, Grimmer-Somers K. The midterm effectiveness of extracorporeal shockwave therapy in the management of chronic calcific shoulder tendinitis. J Shoulder Elb Surg. 2011;20(5):845–54.CrossRefGoogle Scholar
  36. 36.
    Haake M, Deike B, Thon A, Schmitt J. Exact focusing of extracorporeal shock wave therapy for calcifying tendinopathy. Clin Orthop Relat Res. 2002;397:323–31.CrossRefGoogle Scholar
  37. 37.
    Kim YS, Lee HJ, Kim YV, Kong CG. Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. J Shoulder Elb Surg. 2014;23(11):1640–6.CrossRefGoogle Scholar
  38. 38.
    Krasny C, Enenkel M, Aigner N, Wlk M, Landsiedl F. Ultrasound-guided needling combined with shock-wave therapy for the treatment of calcifying tendonitis of the shoulder. J Bone Joint Surg Br. 2005;87(4):501–7.CrossRefGoogle Scholar
  39. 39.
    Liu HM, Chao CM, Hsieh JY, Jiang CC. Humeral head osteonecrosis after extracorporeal shock-wave treatment for rotator cuff tendinopathy. A case report. J Bone Joint Surg Am. 2006;88(6):1353–6.CrossRefGoogle Scholar
  40. 40.
    Ebenbichler GR, Erdogmus CB, Resch KL, Funovics MA, Kainberger F, Barisani G, et al. Ultrasound therapy for calcific tendinitis of the shoulder. N Engl J Med. 1999;340(20):1533–8.CrossRefGoogle Scholar
  41. 41.
    Louwerens JK, Sierevelt IN, van Noort A, van den Bekerom MP. Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis. J Shoulder Elb Surg. 2014;23(8):1240–9.CrossRefGoogle Scholar
  42. 42.
    Bosworth B. Examination of the shoulder for calcium deposits. Technique of fluoroscopy and spot film roentgenography. J Bone Joint Surg. 1942;23:567–77.Google Scholar
  43. 43.
    Rubenthaler F, Ludwig J, Wiese M, Wittenberg RH. Prospective randomized surgical treatments for calcifying tendinopathy. Clin Orthop Relat Res. 2003;410:278–84.CrossRefGoogle Scholar
  44. 44.
    Ark JW, Flock TJ, Flatow EL, Bigliani LU. Arthroscopic treatment of calcific tendinitis of the shoulder. Arthroscopy. 1992;8(2):183–8.CrossRefGoogle Scholar
  45. 45.
    Seil R, Litzenburger H, Kohn D, Rupp S. Arthroscopic treatment of chronically painful calcifying tendinitis of the supraspinatus tendon. Arthroscopy. 2006;22(5):521–7.CrossRefGoogle Scholar
  46. 46.
    Castagna A, DE Giorgi S, Garofalo R, Conti M, Tafuri S, Moretti B. Calcifying tendinitis of the shoulder: arthroscopic needling versus complete calcium removal and rotator cuff repair. A prospective comparative study. Joints. 2015;3(4):166–72.CrossRefGoogle Scholar
  47. 47.
    Ambacher T, Kirschniak A, Holz U. Intraoperative localization of calcification in the supraspinatus via a percutaneous marking suture after preoperative ultrasound. J Shoulder Elb Surg. 2007;16(2):146–9.CrossRefGoogle Scholar
  48. 48.
    Balke M, Banerjee M, Vogler T, Akoto R, Bouillon B, Liem D. Acromial morphology in patients with calcific tendinitis of the shoulder. Knee Surg Sports Traumatol Arthrosc. 2014;22(2):415–21.CrossRefGoogle Scholar
  49. 49.
    Porcellini G, Paladini P, Campi F, Paganelli M. Arthroscopic treatment of calcifying tendinitis of the shoulder: clinical and ultrasonographic follow-up findings at two to five years. J Shoulder Elb Surg. 2004;13(5):503–8.CrossRefGoogle Scholar
  50. 50.
    Balke M, Bielefeld R, Schmidt C, Dedy N, Liem D. Calcifying tendinitis of the shoulder: midterm results after arthroscopic treatment. Am J Sports Med. 2012;40(3):657–61.CrossRefGoogle Scholar
  51. 51.
    Clement ND, Watts AC, Phillips C, McBirnie JM. Short-term outcome after arthroscopic bursectomy debridement of rotator cuff calcific tendonopathy with and without subacromial decompression: a prospective randomized controlled trial. Arthroscopy. 2015;31(9):1680–7.CrossRefGoogle Scholar
  52. 52.
    Marder RA, Heiden EA, Kim S. Calcific tendonitis of the shoulder: is subacromial decompression in combination with removal of the calcific deposit beneficial? J Shoulder Elb Surg. 2011;20(6):955–60.CrossRefGoogle Scholar
  53. 53.
    Rokito A, Loebenberg M. Frozen shoulder and calcific tendonitis. Curr Opin Orthop. 1999;10:294–304.CrossRefGoogle Scholar
  54. 54.
    Neviaser RJ. Painful conditions affecting the shoulder. Clin Orthop Relat Res. 1983;173:63–9.Google Scholar
  55. 55.
    Chen SK, Chou PH, Lue YJ, Lu YM. Treatment for frozen shoulder combined with calcific tendinitis of the supraspinatus. Kaohsiung J Med Sci. 2008;24(2):78–84.CrossRefGoogle Scholar
  56. 56.
    Jacobs R, Debeer P. Calcifying tendinitis of the rotator cuff: functional outcome after arthroscopic treatment. Acta Orthop Belg. 2006;72(3):276–81.PubMedGoogle Scholar
  57. 57.
    Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS. Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy. 2009;25(8):880–90.CrossRefGoogle Scholar
  58. 58.
    Wolfgang GL. Surgical repair of tears of the rotator cuff of the shoulder. Factors influencing the result. J Bone Joint Surg Am. 1974;56(1):14–26.CrossRefGoogle Scholar
  59. 59.
    Hsu HC, Wu JJ, Jim YF, Chang CY, Lo WH, Yang DJ. Calcific tendinitis and rotator cuff tearing: a clinical and radiographic study. J Shoulder Elb Surg. 1994;3(3):159–64.CrossRefGoogle Scholar
  60. 60.
    Gotoh M, Higuchi F, Suzuki R, Yamanaka K. Progression from calcifying tendinitis to rotator cuff tear. Skelet Radiol. 2003;32(2):86–9.CrossRefGoogle Scholar
  61. 61.
    Chan R, Kim DH, Millett PJ, Weissman BN. Calcifying tendinitis of the rotator cuff with cortical bone erosion. Skelet Radiol. 2004;33(10):596–9.CrossRefGoogle Scholar
  62. 62.
    Flemming DJ, Murphey MD, Shekitka KM, Temple HT, Jelinek JJ, Kransdorf MJ. Osseous involvement in calcific tendinitis: a retrospective review of 50 cases. AJR Am J Roentgenol. 2003;181(4):965–72.CrossRefGoogle Scholar
  63. 63.
    Porcellini G, Paladini P, Campi F, Pegreffi F. Osteolytic lesion of greater tuberosity in calcific tendinitis of the shoulder. J Shoulder Elb Surg. 2009;18(2):210–5.CrossRefGoogle Scholar
  64. 64.
    Merolla G, Dave AC, Paladini P, Campi F, Porcellini G. Ossifying tendinitis of the rotator cuff after arthroscopic excision of calcium deposits: report of two cases and literature review. J Orthop Traumatol. 2015;16(1):67–73.CrossRefGoogle Scholar
  65. 65.
    Ozaki J, Kugai A, Tomita Y, Tamai S. Tear of an ossified rotator cuff of the shoulder. A case report. Acta Orthop Scand. 1992;63(3):339–40.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Simon Boyle
    • 1
  • Geoffrey C. S. Smith
    • 2
  1. 1.York Teaching HospitalYorkUK
  2. 2.St George HospitalSydneyAustralia

Personalised recommendations