Calcific tendinitis of the shoulder is a condition in which calcium deposits form within the rotator cuff tendons — most often the supraspinatus tendon — causing inflammation and pain. It is one of the most common causes of acute and chronic shoulder pain in adults.
Calcific tendinitis frequently coexists with subacromial impingement syndrome and shoulder bursitis — the calcium deposit can occupy space in the subacromial space, compressing the bursa and worsening impingement symptoms. MRI is particularly valuable here because it evaluates all three conditions simultaneously, clarifying which structure is the primary pain generator and guiding the most appropriate treatment.
Causes
Tendon cell changes
The exact cause of calcium deposition is not fully understood, but it appears to result from changes in tendon cells (tenocytes) that trigger an abnormal healing response, leading to calcium crystal formation within the tendon tissue. The process is thought to be related to local oxygen deprivation and cell stress rather than systemic calcium metabolism.
Risk factors
Calcific tendinitis most commonly affects adults between the ages of 30 and 60. Women are slightly more affected than men. Thyroid disorders, diabetes, and repetitive overhead activity have been identified as contributing risk factors.
Symptoms
Symptoms vary widely depending on the phase of calcium formation. Some patients have no symptoms at all. During the acute phase — when calcium is being reabsorbed — patients may experience severe, sudden-onset shoulder pain that is among the most intense of any musculoskeletal condition. The chronic phase typically presents as a dull, persistent ache worsening with overhead activity. Pain is often localized to the front and outer aspects of the shoulder and may interfere with sleep. Symptoms can closely mimic those of a rotator cuff tear, making imaging essential to distinguish between the two.
Diagnosis
Physical examination assesses tenderness, range of motion, and impingement signs (Hawkins-Kennedy and Neer tests). X-rays can identify calcium deposits within the shoulder and are often the first imaging study. A dedicated shoulder MRI provides more detailed information — including the size and consistency of the deposit, the degree of associated tendon inflammation or damage, and whether subacromial bursitis is present. MRI also evaluates the rotator cuff tendons for concurrent tearing, helping to rule out other sources of shoulder pain and guide treatment decisions.
Deposit classification (Gärtner)
Calcium deposits are classified based on their appearance on imaging:
- Type I: Dense, well-defined deposit with hard consistency. Typically seen in the chronic phase — least likely to resolve spontaneously and most often requiring intervention.
- Type II: Mixed density deposit with partial definition. Intermediate presentation between Type I and III.
- Type III: Translucent, poorly defined deposit with soft, toothpaste-like consistency. Associated with the acute severe pain phase but most likely to resolve spontaneously as the body reabsorbs the calcium.
Treatments
Treatment depends on symptom severity, deposit type, and how long symptoms have been present.
During an acute flare, rest, ice, activity modification, and anti-inflammatory medications are recommended.
Conservative treatment: Physical therapy, NSAIDs, and corticosteroid injection into the subacromial space are highly effective for reducing inflammation and pain in most patients. Many cases — particularly Type III deposits — resolve over time as the body naturally reabsorbs the calcium. Patience is warranted as the reabsorptive phase, though painful, is self-limiting.
Persistent symptoms not responding to conservative care
Needling and lavage (barbotage) is a minimally invasive procedure in which a needle punctures the calcium deposit and flushes it out with saline, performed under ultrasound guidance. Extracorporeal shock wave therapy (ESWT) uses sound waves to break down the deposit and stimulate reabsorption. Both are particularly effective for deposits unresponsive to medications and injections, especially Type I and II deposits.
Large or chronic deposits unresponsive to other treatments
Arthroscopic surgical removal is reserved for refractory cases. This allows direct removal of the deposit with minimal disruption to surrounding tissue, and any concurrent rotator cuff pathology can be addressed at the same time. A structured physical therapy program after surgery restores shoulder motion and strength.
Get an MRI to Confirm Your Diagnosis
Before surgical planning or starting treatment, a clear MRI diagnosis ensures the right path forward. First Look MRI offers self-pay Shoulder MRI scans — no doctor's order or insurance required — at our locations in Georgia, Texas, and Colorado.