Calcific Tendinopathy: Understanding the Condition and Management Options

 At Alton Pain Clinic, we see a wide range of musculoskeletal conditions, and one that often causes significant discomfort is calcific tendinopathy. This condition occurs when calcium deposits form within a tendon, most commonly in the rotator cuff tendons of the shoulder. Although it can affect other tendons in the body, the shoulder remains the most frequent site.

While calcific tendinopathy can resolve on its own, the pain and restricted movement it causes can impact day-to-day activities, sleep, and overall quality of life. Our clinicians offer tailored assessment and management plans, including ultrasound-guided cortisone injections when appropriate, to help manage symptoms effectively.

Anatomy Overview

To understand calcific tendinopathy, it helps to look at the anatomy of the affected area.

The rotator cuff is a group of four muscles and their tendons — supraspinatus, infraspinatus, teres minor, and subscapularis — that help stabilise the shoulder joint and assist with arm movement. Tendons connect muscles to bone and are normally made of strong, flexible fibres.

In calcific tendinopathy, calcium crystals (most often hydroxyapatite) accumulate within the tendon tissue. This disrupts normal tendon function and may trigger inflammation in surrounding structures, such as the subacromial bursa, which can increase pain and stiffness.

Causes and Risk Factors

The exact cause of calcific tendinopathy is not fully understood, but several factors may contribute:

  • Degenerative changes — age-related wear and tear in tendon fibres.
  • Reduced blood flow — certain areas of tendons naturally have lower blood supply, making them more vulnerable.
  • Overuse or repetitive strain — repetitive lifting, throwing, or overhead movements.
  • Genetic predisposition — some individuals may be more prone to calcium deposit formation.
  • Metabolic factors — conditions such as diabetes may increase risk.

Symptoms of Calcific Tendinopathy

Symptoms can range from mild to severe and may include:

  • Localised pain in the shoulder, often worsening at night.
  • Pain with movement, particularly overhead activities.
  • Reduced range of motion due to discomfort or stiffness.
  • Weakness when lifting or rotating the arm.
  • Sudden, intense pain during the resorptive phase when calcium deposits break down.

Phases of Calcific Tendinopathy

Calcific tendinopathy tends to follow a progression:

  1. Formative phase — calcium begins to deposit in the tendon. Pain may be minimal.
  2. Resting phase — calcium deposits remain, sometimes without symptoms.
  3. Resorptive phase — the body starts breaking down the deposits, often causing sudden, severe pain.
  4. Post-calcific phase — tendon tissue repairs and symptoms gradually improve.

Diagnosis

A thorough clinical assessment is the first step. Our clinicians at Alton Pain Clinic carry out a detailed examination, asking about symptoms, activity level, and previous shoulder issues.

Imaging studies are often essential:

  • Ultrasound scans — detect deposit size and location, and identify associated inflammation.

Management Approaches

Treatment depends on the severity of symptoms, the phase of the condition, and the individual’s activity needs. Management options may include:

  • Activity modification — avoiding repetitive overhead actions or heavy lifting.
  • Pain relief measures — heat or ice therapy, and non-prescription analgesics (as advised).
  • Ultrasound-guided cortisone injections — offered at Alton Pain Clinic to target inflammation and discomfort in the surrounding tissues.
  • Needle aspiration/lavage — in some cases, calcium deposits can be broken up and washed out under ultrasound guidance.

Ultrasound-Guided Cortisone Injections at Alton Pain Clinic

When inflammation around the calcium deposits — often in the subacromial bursa — causes significant pain, an ultrasound-guided cortisone injection may be considered as part of a treatment plan.

At Alton Pain Clinic, our clinicians use ultrasound to precisely guide the injection into the affected area. Cortisone is a powerful anti-inflammatory medicine that can help calm local inflammation, allowing improved movement and function.

Why Choose Alton Pain Clinic?

  • Specialist musculoskeletal expertise — our clinicians focus on joint and soft tissue conditions.
  • Advanced imaging guidance — ultrasound ensures accuracy and safety during injections.
  • Tailored care — treatment plans are individualised based on symptoms and goals.
  • Comprehensive support — from initial assessment to rehabilitation advice.

Recovery and Prevention

Recovery time varies depending on the size of the deposits, the phase of the condition, and the treatment used. Preventative measures may include:

  • Maintaining shoulder strength and flexibility through regular exercises.
  • Avoiding excessive repetitive strain.
  • Addressing postural imbalances that put stress on the shoulder joint.

Conclusion

Calcific tendinopathy can be a painful and frustrating condition, particularly when it affects daily life and sleep. At Alton Pain Clinic, we combine detailed assessment, targeted treatment such as ultrasound-guided cortisone injections, and personalised rehabilitation advice to help individuals manage symptoms and support shoulder health.

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