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What is calcific tendinitis?
Calcific tendinitis is a condition in which calcium hydroxyapatite crystals are deposited in the tendons of the rotator cuff. The size of the deposits can reach several centimeters, causing severe pain and complete restriction of mobility.
The condition affects 2.7-20% of the population, more commonly women aged 30-60 years. In 80% of cases, the supraspinatus tendon is involved. Pain during an acute attack is one of the most severe in orthopedics.
Disease phases:
- Preformative — metaplasia of tendon tissue, preparation for calcification
- Formative — active calcium deposition, chronic pain
- Resorptive — the body attempts to dissolve the calcium. The most painful phase — acute pain, swelling
- Post-calcific — tendon remodeling
Causes:
- Exact cause unknown
- Impaired tendon blood supply
- Tissue hypoxia
- Hormonal factors (more common in women)
- Genetic predisposition
Facts about calcific tendinitis
- ICD-10: M75.3
- Prevalence: 2.7-20% of population
- Gender: women 1.5 times more often
- Age: 30-60 years
- Location: 80% — supraspinatus muscle
Symptoms of calcific tendinitis
Chronic phase
- Aching pain in the shoulder
- Worsens with arm elevation
- Night pain
- Moderate restriction of mobility
- May be asymptomatic
Acute attack (resorption)
- Sudden unbearable pain
- Complete inability to move the arm
- Swelling and redness of the shoulder
- Pain not relieved by standard analgesics
- Lasts days to weeks
Diagnosis
- X-ray — calcific deposits visible
- Ultrasound — size and structure of deposits
- MRI — tendon condition
- Calcific deposit type determines prognosis
Calcific tendinitis of the shoulder: treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Exercise therapy and physiotherapy | Reduces pain, strengthens muscles, improves function; the basis of treatment | Moderate evidence |
| Shockwave therapy | A course of 3–5 sessions; helps some patients with chronic pain | Moderate evidence |
| Corticosteroid injection | Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable | Moderate evidence |
| PRP / CGF | Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown | Little data |
| Removal of the calcification (lavage or arthroscopy) | If conservative treatment does not help or there is an indication | When indicated — the doctor decides |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
In tendinopathies the basis of treatment is graded loading of the tendon: specific exercises over 3–6 months. Shockwave therapy helps some patients. Evidence on PRP is conflicting: there are studies showing benefit in tennis elbow and plantar fasciitis, but no convincing evidence for other tendons. Corticosteroids relieve pain quickly, but the effect is often short, and repeated injections into a tendon are undesirable.
When surgery is discussed. Surgery is discussed for a complete tendon rupture or if pain persists for more than 6–12 months despite proper treatment.
If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.
Good to know: diagnosis, self-help, outlook
How to tell calcific tendinitis from similar conditions
In calcific tendinitis calcium is deposited in a rotator cuff tendon, most often the supraspinatus. In the resorptive phase sudden very severe pain occurs and the arm can hardly move; in the quiet phase the pain resembles impingement. The calcification is clearly visible on X-ray and ultrasound. Acute severe pain with fever requires ruling out joint infection.
What you can do yourself
In the acute phase rest the arm, use ice and take painkillers and anti-inflammatories as prescribed. When pain eases, start gentle mobility exercises and then exercises for the shoulder-blade and cuff muscles to prevent stiffness.
Outlook and timelines
Calcifications often resolve on their own within months, and the pain goes. For persistent pain, ultrasound-guided lavage of the deposit and shockwave therapy help; a corticosteroid injection eases the acute phase. Surgical removal of the calcification is rarely discussed.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Karjalainen TV et al. Surgery for rotator cuff tears. Cochrane Database Syst Rev, 2019.
- Sheth U et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am, 2012.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Frequently asked questions about calcific tendinitis treatment
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a request