Calcific Tendinitis of the Shoulder:
Phases, Treatment & What Actually Helps

1. What is calcific tendinitis?

In calcific tendinitis of the shoulder (tendinosis calcarea), calcium is deposited in a tendon of the rotator cuff — the cap of muscle and tendon that guides the head of your upper arm bone in its socket. The tendon involved is usually the supraspinatus tendon, which runs beneath the roof of the shoulder. The deposit itself is neither an inflammation nor a fragment of bone, but a chalk-like material within the tendon tissue that can at times have almost the consistency of toothpaste.^¹

One point is key to understanding it: calcium in the tendon does not automatically mean pain. Deposits are often picked up by chance on X-rays taken for entirely different reasons — in people who have never had any symptoms. The typical, often severe pain only appears once the calcium narrows the gliding space beneath the roof of the shoulder, or once the body starts to break it down.

Calcific tendinitis has to be told apart from other causes of shoulder pain, above all from impingement syndrome, from a rotator cuff tear and from osteoarthritis of the shoulder joint. That distinction is usually straightforward, because the deposit shows up directly on an X-ray.

2. The phases: why the pain comes and goes

According to the classic model described by Uhthoff, calcific tendinitis passes through several stages. This model explains why symptoms can simmer for months and then suddenly escalate — and why patience is a genuine treatment strategy.^¹,²

• Pre-calcification stage: the tendon tissue starts to change. Usually there are no symptoms.
• Calcification phase: calcium is laid down and the deposit grows. Typical features are pain on loading, trouble with overhead work and night pain when lying on the shoulder.
• Resorption phase: the body actively breaks the calcium down. The deposit softens, can leak into the bursa and trigger intense irritation. This is the most painful phase — often acute, worse at night, with an arm that will barely take any load.
• Repair phase: the tendon remodels and the symptoms settle. Afterwards the tendon often looks entirely unremarkable.

The good news in all of this: the worst phase is precisely the one in which the body is already solving the problem itself. That is why surgery is usually not the first step — instead the pain is bridged until the breakdown is complete. How long that takes cannot be predicted in an individual case; courses lasting many months to years are possible.

3. Symptoms and consequences

The typical symptoms

• Pain on loading above shoulder height — washing your hair, hanging out the laundry, slipping into a jacket.
• Night pain — lying on the affected side becomes impossible, and sleep often suffers considerably.
• Painful arc — symptoms mainly when raising the arm between roughly 60 and 120 degrees.
• Sudden, excruciating pain — in the resorption phase the pain can come on within hours, sometimes with no trigger at all.
• Protective posture — the arm is held close to the body, which over time leads to tension in the neck and shoulder.

Possible consequences

The most relevant consequence is not the deposit itself but the loss of movement caused by protecting the joint. If the shoulder is barely moved for weeks, the joint capsule can contract — up to a frozen shoulder, which takes considerably longer to settle than the calcific tendinitis itself. That is why early, pain-adapted movement belongs in every treatment plan. Sleep problems caused by night pain are a serious issue too, because they further amplify how pain is perceived.

4. Causes and risk factors

Why calcium forms in a tendon of all places is, according to current knowledge, not fully understood. The main factors under discussion are the local blood supply and remodelling processes in the tendon tissue. The following count as risk factors:^²,³

• Age and sex — the peak falls in middle adulthood, and women are affected somewhat more often.
• Metabolic conditions — links with an underactive thyroid and with diabetes have been described; the evidence is limited.
• Overhead strain at work and in sport — painters, the building trades, throwing and racket sports.
• Pre-existing tendon damage — earlier irritation of the rotator cuff.

5. Diagnosis: X-ray, ultrasound, Gärtner type

The diagnosis is usually uncomplicated, because imaging shows the deposit directly. A typical sequence looks like this:

• History: when does it hurt, since when, and at night? Was there a trigger? Which medicines are you already taking?
• Physical examination: range of movement, painful arc, targeted tests of the rotator cuff.
• X-ray: the standard for confirming the diagnosis. The deposit is visible, and its position and density can be assessed.
• Ultrasound: additionally assesses the bursa, the tendon structure and any accompanying irritation — without radiation.
• MRI: not routinely needed; useful if a tendon tear is suspected or before planned surgery.

On the X-ray the deposit is often graded according to Gärtner: sharply outlined, dense deposits suggest a quiet phase, while cloudy, ill-defined deposits suggest that resorption is already under way. This grading matters in practice because it shapes the choice of treatment — a deposit that is currently dissolving calls for pain relief and time rather than shockwave therapy.^²

6. Treatment: what comes first, what comes later

Treatment follows the phase and the burden of symptoms, not the size of the deposit. As a rule it proceeds in steps — conservative measures first, invasive procedures only once months have passed without improvement. The decision is always made by your treating practice together with you.

7. Medicines for calcific tendinitis

Medicines treat the pain and the accompanying inflammation — they do not dissolve the calcium deposit. That is precisely why they are meant as a bridge and not as a permanent solution.

NSAIDs: effective, but not harmless

Non-steroidal anti-inflammatory drugs such as ibuprofen, diclofenac or naproxen are the option of choice in the acute phase. Naproxen lasts longer and is therefore often preferred where night pain is the problem. To weigh up the choice in an individual case, it is worth a look at our painkiller comparison.

Paracetamol and metamizole

Where NSAIDs are not an option, paracetamol or metamizole are used instead. Neither has an anti-inflammatory effect, but both can dampen the pain sufficiently. Metamizole is prescription-only in Germany and calls for attention to rare but serious changes in the blood count.

Corticosteroids

Injected beneath the roof of the shoulder, prednisolone or a comparable glucocorticoid can quickly calm an acute flare of irritation. As a tablet, corticosteroids are not usually given long term for calcific tendinitis. The general picture is set out in our cortisone guide.

8. Shockwave, needling and surgery compared

Plenty of promises circulate around calcific tendinitis. Here is a sober look at the three procedures that come up most often.

One thing that keeps standing out in studies: many cases improve even without any of these procedures. That makes individual methods hard to judge — and at the same time it is the strongest argument for a watchful first step.

9. Everyday life with calcific tendinitis

• Move rather than immobilise — pain-adapted, but every day. Complete rest is the fastest route to a stiff shoulder.
• Adjust how you sleep — lie on the healthy side and rest the affected arm on a pillow so that it does not sink backwards.
• Rearrange your overhead work — clear out the high cupboard, use a step ladder instead of stretching, choose long-handled tools. Small changes save a lot of pain spikes.
• Adapt your sport rather than dropping it — cycling and leg work are almost always fine, while throwing and racket sports take a break. Pointers in the guide Medications and exercise.
• Write your painkillers down — when, how much, and how well they worked. That makes the next conversation at the practice far more precise.

The last point in particular rewards consistency: many people take NSAIDs “as needed” for weeks and underestimate the total amount. How to keep a clean record is set out in How to take medications and, once several products come together, in Drug interactions.

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