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Calcific Tendonitis of the Rotator Cuff

Calcific tendonitis of the rotator cuff is a relatively common yet frequently misunderstood shoulder condition. Characterized by the deposition of calcium crystals within the tendons of the rotator cuff, this ailment can lead to significant pain and limited mobility for the affected individual. 

While it often strikes seemingly out of the blue, its origins and progression are rooted in a combination of biological processes, genetics, and, potentially, lifestyle factors.

This article aims to delve deep into the intricacies of this condition, shedding light on its causes, symptoms, treatment options, and preventive measures. This article aims to delve deep into the intricacies of this condition, shedding light on its causes, symptoms, treatment options, and preventive measures. 

Whether you are a medical professional, a patient grappling with shoulder pain, or someone simply eager to learn, this comprehensive guide is designed to provide insights into the enigmatic world of calcific tendonitis.

What Is Calcific Tendonitis of the Rotator Cuff?

The rotator cuff is a group of four muscles and their associated tendons that help stabilize and move the shoulder joint. When calcium deposits, or calcifications, form within these tendons, it can lead to a condition known as calcific tendonitis of the rotator cuff. Let’s break down how these calcium deposits can cause pain and how this condition is distinct from other shoulder ailments.

Mechanism of Pain in Calcific Tendonitis

  • Inflammation: Calcium deposits can trigger an inflammatory response in the surrounding tissue. Inflammation generally results in swelling, warmth, redness, and pain. This inflammation can cause discomfort both at rest and during movement.
  • Pressure on nearby structures: The calcium buildup may exert pressure on neighboring ligaments, tendons, or bursae, leading to secondary pain and discomfort.
  • Impingement: As the calcium accumulates, it may lead to a thickening or enlargement of the tendon. This can result in the tendon impinging, or pinching, against the overlying bone (acromion) when the arm is lifted, causing pain.

How Calcific Tendonitis Differs from Other Shoulder Conditions

  • Nature of pain: Calcific tendonitis often presents with sharp, intense pain that can be acute in onset. This sudden flare-up of pain contrasts with conditions like osteoarthritis of the shoulder, which generally develops slowly over time and presents with a dull, aching pain.
  • Imaging findings: On imaging studies, such as X-rays or ultrasounds, the calcium deposits in calcific tendonitis appear as distinct white areas within the tendons. These findings are different from conditions like rotator cuff tears, which may show discontinuity in the tendon fibers or changes in tendon thickness.
  • Location: Calcific tendonitis specifically involves calcium deposits in the tendons. In contrast, conditions like bursitis involve inflammation of the bursa, a small fluid-filled sac that reduces friction between tissues, while conditions like adhesive capsulitis (frozen shoulder) involve stiffness and inflammation of the joint capsule.
  • Resolution: Unlike some other shoulder conditions, calcific tendonitis can sometimes resolve on its own as the body reabsorbs the calcium deposits. This spontaneous resolution is less typical for conditions like rotator cuff tears or osteoarthritis.

Symptoms of Rotator Cuff Calcific Tendonitis

Rotator cuff calcific tendonitis can cause various symptoms that can affect the shoulder and arm. These symptoms can significantly impact daily activities and should be addressed for proper diagnosis and treatment.

Sudden Onset of Shoulder Pain

Unlike many other shoulder conditions that develop gradually, one of the hallmarks of calcific tendonitis is the abrupt onset of pain. Patients often describe waking up with sharp shoulder pain or experiencing sudden discomfort during regular activities.

Intense Pain with Shoulder Movement

The pain associated with calcific tendonitis can intensify when moving the shoulder, especially during lifting, reaching, or overhead motions. Simple tasks such as getting dressed, combing hair, or reaching for an object can become excruciating.


Along with pain, the shoulder may feel stiff and resistant to movement. This stiffness can be particularly noticeable in the mornings or after periods of inactivity.

Loss of Range of Motion

Due to the combination of pain and stiffness, individuals may find it challenging to move their shoulder through its full range of motion. Actions like lifting the arm overhead or reaching behind the back might become difficult or impossible.

Pain That Disrupts Sleep

The intensity of pain from calcific tendonitis can be so severe that it disrupts sleep. Lying on the affected shoulder often exacerbates the discomfort, making it hard to find a comfortable sleeping position. For further insights on how shoulder pain can influence sleep, visit our article about shoulder pain at night.

Tenderness in the Rotator Cuff Area

Physical examination often reveals tenderness when pressing over the area of the rotator cuff, especially where the calcium deposits are located. This localized tenderness distinguishes it from other conditions where discomfort might be more diffuse.

Loss of Muscle Mass

If calcific tendonitis persists or becomes chronic, it can lead to disuse of the affected shoulder due to pain. Over time, this decreased activity can result in atrophy or loss of muscle mass, making the shoulder appear smaller or less defined than the unaffected side.

Common Causes of Rotator Cuff Calcific Tendonitis

Rotator cuff calcific tendonitis occurs when calcium deposits build up in the tendons of the rotator cuff, leading to inflammation and irritation. Several factors can contribute to the development of this condition. Let’s explore some common causes of rotator cuff calcific tendonitis.


One of the most common factors associated with calcific tendonitis is the natural aging process. As we age, the tendons lose their elasticity and resilience, making them more susceptible to micro-tears and degeneration. Over time, the body may try to heal these small injuries by forming calcium deposits within the tendons. As a result, older adults are more likely to develop calcific tendonitis compared to younger individuals.

Trauma or Injury

Direct trauma or injury to the shoulder can accelerate the wear and tear process. An injury might cause micro-tears or damage to the tendon fibers, prompting the body’s healing response. In some cases, this healing process can lead to abnormal calcium deposit formation, thus setting the stage for calcific tendonitis.

Repetitive Motion

Activities that involve repetitive shoulder movements, such as swimming, tennis, or certain jobs like painting or construction work, can contribute to wear and tear of the rotator cuff tendons over time. Consistent strain and overuse can lead to microscopic injuries in the tendons, increasing the risk of calcification. Such repetitive motions, especially without proper technique or adequate rest, can increase the likelihood of developing calcific tendonitis.

Poor Blood Supply

Good blood flow is crucial for tissue health, as it brings nutrients and oxygen to cells and helps remove waste products. The rotator cuff tendons, especially the supraspinatus tendon, have areas with relatively poor blood supply. This reduced blood flow can compromise the tendon’s ability to heal and regenerate effectively. Over time, this compromised healing may encourage calcium deposits to form as part of the body’s flawed repair process.

More Symptoms Associated with this Condition

Arm Pain at Night

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Arm Throbbing

In many patients, irritated neck nerves don’t present as a symptom in the neck. In fact, sometimes the only symptoms of irritated nerves in the neck occur in the arm muscles, as either tightness, throbbing, or both. While the arm throbbing might be frustrating as it’s happening, you might not think a whole lot about it, especially if it only happens on occasion. However, ignoring it is not a good idea since it is often a warning signal of a bigger problem in the neck. These body connections occur all the way back to when we were a fetus, like the neck, shoulder, and arm.

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Left Shoulder Blade Pain

Learn to know the symptoms and causes of shoulder blade pain as well as the diagnostic tests to run for it and its treatment options. Shoulder blade pain can be a common, annoying, hard to diagnose problem. There are many different causes of shoulder blade pain and the exact cause of the shoulder blade pain will determine what type of treatments would be recommended.

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Muscle Spasm In Shoulder

A muscle spasm, also known as a muscle cramp, is a sudden and involuntary contraction or tightening of a muscle or group of muscles. This can occur in any part of the body but is most commonly experienced in the legs, arms, and back. These spasms can last for a few seconds up to many minutes. Occasional muscle spasms may not be something to worry about, but chronic muscle spasms can be a serious issue. In the shoulder, there are many muscles that can go into spasm. These spasms or cramps can cause pain, stiffness, and limited mobility.

Read More About Muscle Spasm In Shoulder

Shoulder Pain Radiating Down Arm to Fingers

Common Cervical Radiculopathy symptoms include neck pain, arm pain, shoulder pain radiating down arm to fingers, numbness, tingling, and weakness. Cervical Radiculopathy is a clinical condition in which a nerve or nerves in your neck become irritated or compressed. It is also known as ” a pinched nerve,” The causes are discussed below. It can affect individuals of any age with peak prominence between ages 40-50 years of age. Cervical Radiculopathy is due to spinal nerve inflammation, irritation, or compression. The most common causes of Cervical Radiculopathy are: Disc Injury – The disc is an important shock absorber. Unfortunately, it is susceptible to injury.

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Shoulder Pain When Reaching Across Body

Shoulder pain can make simple chores almost impossible.  Have you ever reached for an object high on a shelf only to have pain that takes your breath away?  What causes shoulder pain when reaching across the body?  What is shoulder impingement?  What does shoulder impingement feel like?  Can a shoulder X-ray show shoulder impingement?  What are the treatment options for shoulder pain when reaching across the body? ulder impingement and rotator cuff injuries are among the most common causes of shoulder pain (1).  Both can cause shoulder pain when reaching across the body. Shoulder impingement is a painful condition in which the bursa and muscles of the shoulder are pinched or compressed. 

Read More About Shoulder Pain When Reaching Across Body

Shoulder Pain When Sleeping

There are several reasons why shoulder pain at night occurs or is aggravated; The common explanations include: Sleep typically involves a static position lasting hours at a time with little or no movement. Sleeping on your side places additional pressure on the tendons and bursa of the shoulder. Sleep can cause muscles and tendons to settle in a slightly different position resulting in additional pressure and reduced blood flow. Identifying the underlying problem is important!  This allows therapy to focus exclusively on the exact problem or problems.  When appropriate conservative care is always the first line of treatment.  Focus is typically on strengthening and improving range of motion. 

Read More About Shoulder Pain When Sleeping
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Conventional Treatments for Chronic Pain from Calcific Tendonitis

When it comes to chronic pain caused by calcific tendonitis, there are several conventional treatments worth considering. These treatments, which aim to alleviate discomfort and promote healing, can make a significant difference in managing this condition.

Pain Medication

One of the primary methods of managing pain from calcific tendonitis is through over-the-counter or prescribed pain medications. NSAIDs (non-steroidal anti-inflammatory drugs) are commonly recommended as they help reduce inflammation and alleviate pain. These medications work by blocking enzymes responsible for producing pain-causing substances in the body.

Common examples include ibuprofen, naproxen, and aspirin. However, long-term use can have side effects, and it’s essential to use them under a doctor’s guidance. For a deeper dive into the topic, read our article on the Top 5 Things You Should Know About NSAIDs.

Physical Therapy

Physical therapy plays a pivotal role in treating calcific tendonitis. A skilled physical therapist can guide patients through specific exercises and stretches designed to improve the shoulder’s range of motion, strength, and overall function. Moreover, therapy can help break down calcium deposits and prevent their recurrence. Regular sessions can also decrease pain and enhance the speed of recovery.

Therapeutic Ultrasound

Therapeutic ultrasound is a non-invasive treatment used to manage and treat pain from calcific tendonitis. The ultrasound waves generate heat that can improve blood flow, reduce muscle spasms, and accelerate the healing process. Additionally, the mechanical vibration of ultrasound can assist in breaking down calcium deposits in the tendons.

Cortisone Shots

Cortisone shots, or corticosteroid injections, are powerful anti-inflammatory agents that can be directly injected into the affected area of the shoulder. These injections can reduce inflammation and provide rapid relief from pain.

However, their effects might be temporary, and repeated injections can weaken tendons over time. It’s also essential to note that while cortisone shots can alleviate symptoms, they don’t treat the underlying cause of calcific tendonitis. For potential risks and considerations related to these injections, explore What If the Cortisone Shot Doesn’t Work? The Alarming Truth.


In cases where conventional treatments do not bring relief, surgery might be considered, especially if calcium deposits are large or cause persistent pain. The surgical procedure typically involves removing the calcium deposits and, in some cases, performing a subacromial decompression to relieve impingement.

The decision to undergo surgery should be made after a thorough evaluation and discussion with an orthopedic surgeon. For more on this topic and potential alternatives, refer to When Not to Have Rotator Cuff Surgery? Know Your Options.

Risk Factors for Calcific Tendonitis

Understanding the risk factors associated with this condition is crucial for early detection and effective management.

  • Age

    Age as a prime suspect: One of the most significant risk factors for developing calcific tendonitis is age. The condition most commonly affects people in their 40s and 50s, suggesting that wear and tear on the shoulder over time might play a role.

    Degenerative changes: As we age, the tendons of our shoulders experience degenerative changes. This degeneration, combined with the body’s reparative processes, might contribute to the formation of calcium deposits within the tendons.
  • Gender

    More common in women: Studies have shown that calcific tendonitis is more prevalent in women than in men. The reasons for this disparity are not entirely clear, but hormonal differences, variations in tendon structure, or differences in physical stresses placed on the shoulder might contribute.
  • Post-Menopausal Factor

    There’s some evidence to suggest that post-menopausal women may be at a higher risk, possibly due to changes in hormone levels that affect bone and tendon health.
  • Genetic Predisposition

    Some studies suggest that there might be a genetic component, where individuals with a family history of the condition are at a higher risk.
  • Metabolic Conditions

    Disorders such as diabetes might increase the risk due to metabolic changes that influence calcium deposition in tissues.
  • Shoulder Overuse

    Repetitive shoulder use, especially in sports or jobs that require overhead activities, can contribute to wear and tear, potentially increasing the risk.
  • Previous Shoulder Injuries

    A history of shoulder trauma or injury can trigger changes in the tendon, making it more susceptible to calcium buildup.

An Alternative to Conventional Treatments

At the Centeno-Schultz Clinic, we continue to innovate and keep up with the most up-to-date procedures and evidence-based medicine. The world of calcific tendinopathy has changed forever, thanks to a newer procedure called “Tenex.” 

A new device, designed to be used under ultrasound guidance, Tenex is minimally invasive with little risk and few side effects. The device is designed to break up the calcification and simultaneously aspirate the calcium. The minimally invasive aspect is preferred, as compared to surgery, which would require an open procedure, it is far easier with a much faster recovery!

Find Superior Pain Relief for Calcific Tendonitis in the Rotator Cuff

If you have been diagnosed with rotator cuff calcific tendonitis and conservative treatment has failed, contact us today for an evaluation. Our experts will evaluate your shoulder and discuss all treatment options, which may include the Tenex procedure.

Are you a Candidate?

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Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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