When people hear the term “calcific shoulder,” they may think of complete calcification of the shoulder joint. However, calcific tendinitis of the shoulder refers to calcium deposits in specific areas of the shoulder.

The supraspinatus and infraspinatus tendons run through the narrow space between the shoulder joint and the acromion. These tendons and their associated muscles are primarily responsible for allowing us to raise our arms to the side and rotate them outward. Although the space through which the tendons move is very narrow, it does not cause problems in healthy individuals.

However, if this part of the body is subjected to excessive or prolonged strain, the space can become narrowed, placing pressure on the tendon and bursa. The tendon rubs against the bursa, increasing the strain on the tendon and causing it to lose elasticity and tension. If this persists over a longer period, calcifications or calcium deposits may develop within the tendon. These can be a late consequence of recurrent bursitis.

People affected by calcific tendinitis often experience severe pain that can significantly interfere with their daily lives. Typical symptoms include sudden, sharp shoulder pain during rotational movements and when raising the arm. Lying on the affected side may also cause so-called “night pain.”

Irritation or inflammation of the tendon can cause pain during physical activity. The range of motion may also be restricted due to pain.

Calcific deposits are easily visible on X-rays, as they appear similar to bony structures on this type of imaging. As a rule, three X-ray images of the shoulder are taken: a frontal view, a view with the arm elevated, and a lateral view. In cases of calcific tendinitis of the shoulder, additional images are taken with the upper arm rotated inward and outward.

An ultrasound examination can reveal calcific deposits in the shoulder. They appear as an acoustic shadow. Because calcium deposits and bone are highly dense materials, ultrasound waves cannot pass through these areas and instead produce what is known as an “acoustic shadow,” which the examiner can identify as a possible calcific deposit. An ultrasound examination provides information about the density of the calcifications and the stage they are in. The different stages of calcification are crucial in determining which treatment options can ultimately be considered.

Bursitis can also be clearly identified on ultrasound as a fluid collection. Associated conditions, such as partial or complete tears of the rotator cuff tendons, can also be assessed. Any calcifications can also be detected using MRI.

In some cases, calcific tendinitis of the shoulder can be a self-limiting condition, meaning that the body can naturally break down and absorb the calcific deposits. If the body is unable to resolve the calcifications on its own, or if the deposits are too extensive, other treatment options may be considered.

In the early stages, inflammation and irritation can be treated with anti-inflammatory medication (NSAIDs). Another treatment option is a corticosteroid injection. If corticosteroid treatment does not provide sufficient relief, shockwave therapy may be used to break up the calcific deposits. If the calcific deposits have not yet fully hardened, ultrasound-guided needling may also be considered. During this procedure, the calcifications are removed from the affected area using a needle under ultrasound guidance.

If shockwave therapy and needling are no longer suitable due to the advanced stage of the condition, the calcific deposits can be removed using a minimally invasive procedure (arthroscopy). Depending on the size and location of the calcifications, tendon repair may be necessary after the deposits have been removed. If the deposits are small and the affected areas of the tendon are intact, they are usually left without suturing.