What it is
Calcific tendinopathy is the deposition of calcium crystals within the rotator cuff, most often the supraspinatus tendon. Deposits can be silent for years. When the body resorbs the calcium, the tendon and bursa become very painful. Movement of the arm, especially in overhead positions, can result in impingement of the rotator cuff, leading to pain and loss of function.
Pain settles when irritability is controlled and strength and movement patterns are rebuilt. Some cases benefit from procedures that break up the deposit.
What happens when it occurs
The deposit forms, then may soften and resorb. During resorption, the bursa is often irritable. Strength and smooth movement reduce compression while the biology runs its course.
Common causes and risk factors
- Adults in midlife
- Female sex features more often in clinic data
- Diabetes and thyroid conditions are associated
- Repetitive overhead loads
Who is most affected
Adults in their thirties to fifties. Women present more often than men.
Typical symptoms
- Sudden increase in shoulder pain without an apparent injury
- Night pain and difficulty lying on the shoulder
- Painful arc during elevation
When to seek care
If pain is severe, sleep is affected, or daily tasks become difficult.
How we diagnose
History and examination, plus X-ray or ultrasound to identify deposits. Ultrasound guidance is used for needling or injection when indicated.
Management
- Pain control and activity adjustments during irritable phases
- Strength for rotator cuff and scapular muscles with measured progressions
- Shockwave therapy in selected stubborn cases
- Ultrasound-guided needling and lavage for suitable deposits
- Surgery is rare and reserved for persistent disability
Rehabilitation milestones
Phase 1 weeks 0 to 2: pain control, isometrics, gentle range.
Phase 2 weeks 2 to 8: heavy, slow strength and scapular control.
Phase 3 weeks 8 to 16: overhead tolerance and work or sport drills.
Phase 4 months 4 to 6: endurance and power for higher demand roles.
Readiness to progress
- Night pain trend down
- Strength symmetry within 90 per cent
- Overhead tasks completed without next-day flare
Long-term care
- Keep shoulder strength balanced year-round
- Advance overhead loads in small steps
- Manage metabolic health and sleep
Australia snapshot
- Frequent in middle-aged adults in both general and sports clinics
- Women present more often than men
- Access to ultrasound-guided procedures and shockwave therapy is broad in metropolitan areas.
Latest insights
The worst pain often coincides with the resorption process. Relief plus strength gets you through that phase.
Deposits can return. Capacity and movement quality lower the odds.
