Understanding and treating calcific tendinopathy of the shoulder

To assess your shoulder, we need to know when the pain occurs, how you are sleeping and which movements you can no longer manage. We examine your shoulder’s range of movement and function, among other things. We also consider other possible explanations, such as pronounced shoulder stiffness or a tendon injury. An X-ray can show a calcium deposit. Ultrasound can also help assess the affected tendon and nearby structures. The two methods answer different questions. Finding calcium alone does not mean an MRI is needed. It may be useful if there is a further question to investigate. Please also bring existing images and reports so that we can take them into account.

Treatment usually starts without surgery. During a very painful phase, the initial aim may be to help you sleep again and move your arm gently. Pain medication may be an option, depending on existing health conditions and other medicines. An injection may be considered for selected findings; its possible purpose and risks must be discussed separately. In our care for calcific tendinopathy of the shoulder, injections are more of an exception and do not automatically follow the discovery of calcium deposits. As the acute irritation settles, appropriate movement and gradually building your capacity for activity become more important. Guidance from a physiotherapist can help. Suitable exercises and how much to do depend on your current range of movement and pain response. Forcing yourself through a painful programme is not a useful measure of treatment progress.

If symptoms persist, shockwave therapy may be considered. This treatment delivers mechanical impulses into tissue from outside the body. Focused shockwaves and radial pressure waves spread differently. OrthoCoast offers both methods, but this does not mean they are equally suitable for every case of calcific tendinopathy of the shoulder. The focused method in particular has been described for targeted treatment of calcium deposits. Assessments of its benefit differ between specialist sources. It is not possible to predict reliably whether, or to what extent, symptoms or the deposit will change for an individual. We therefore discuss which findings support its use, what alternatives are available and how you would recognise a benefit. A severely irritated shoulder in an acute phase requires a different assessment from a longer-standing problem. You can find more details about the procedure and possible side effects on our shockwave therapy page.

If your daily life remains significantly affected, the previous assessment should be reviewed. Does the diagnosis still fit? Have you tolerated the agreed measures and given them an adequate trial? Is there another cause contributing to the pain? A fresh examination is then more useful than simply repeating the same treatment. In selected cases of persistent symptoms, procedures to treat the calcium deposit may also be discussed. This is a separate decision that weighs up benefits, risks and previous treatment. A visible deposit alone does not justify a procedure. You should understand what improvement in pain or function is expected from it.

Make a note of two or three situations that matter particularly to you, such as getting dressed, gardening or sleeping through the night. This helps us discuss specific goals and later assess whether treatment is helping. It is also useful to know which measures you have already tried and how your shoulder responded. Bring existing reports and access to your images, for example a QR code for your personal imaging portal or a CD. An up-to-date medication list is especially important if pain medication or further treatment is being discussed. You do not need to arrange additional imaging yourself simply for your first appointment.