Calcific Tendinitis of the Shoulder: What to Expect

Calcific tendinitis of the shoulder is a chalky calcium deposit inside a rotator cuff tendon, most often the one on top of the shoulder. Some deposits cause no pain at all. Others cause a long-running ache when lifting the arm. When the body starts breaking a deposit down, the shoulder can become suddenly and severely painful for a few days to a few weeks. Most people recover without surgery, though the whole course often runs over several months.

It is most common between about 30 and 60, and slightly more common in women. The cause is not fully understood. It is not linked to calcium in your diet, so cutting back on dairy does not help.

Deposits are usually seen on an X-ray or ultrasound. Many people with a deposit on a scan have no symptoms from it, so the scan is read alongside how the shoulder behaves.

Key takeaways

What it is: a calcium deposit inside a rotator cuff tendon, usually seen on X-ray or ultrasound.
Two common patterns: a long-running ache when lifting the arm, or a sudden, very severe flare when the deposit is being reabsorbed.
The severe phase: the resorptive phase often peaks over a few days and eases over 1 to 3 weeks.
Treatment: pain relief, exercise, and sometimes an injection, shockwave therapy or an ultrasound-guided procedure to break up the deposit. Surgery is used for a small minority.
Diet: the deposit is not caused by calcium in your diet.

Where are you right now?

It has just flared: read “The severe phase” in the timeline and the safety sections. A hot, red shoulder or fever needs a doctor today.
Weeks in and not settling: go to “Treatment options” and “If it isn’t going to plan”.
After an injection, shockwave or a needling procedure: a short increase in pain for a few days is common. The weeks after are used to rebuild movement and strength.
Getting back to work or sport: the “When can I…” table gives typical ranges.

Week by week

The deposit tends to move through a forming stage, a resting stage and a resorptive stage. Not everyone has every stage, and the length of each varies widely.

Forming and resting stages, often months: a mild to moderate ache, worse lifting the arm or lying on it. Some people feel nothing.
The severe phase, days 1 to 7: pain can build over hours to a day or two and become intense, even at rest. Many people cannot lift the arm or find any comfortable position, and sleep is badly disturbed.
Weeks 1 to 3: the intense pain usually eases. A sore, stiff shoulder remains.
Weeks 3 to 12: gentle movement, then strengthening. Many people can use the arm for most daily tasks by the end of this period.
Months 3 to 12: where an ache persists, it often behaves like rotator cuff tendinopathy and responds to graded loading over months.

Treatment options

Pain relief and positioning: medicine your doctor or pharmacist advises, ice or heat for comfort, and resting the arm on a pillow.
Exercise: gentle movement during the severe phase, then rotator cuff and shoulder blade strengthening as pain allows.
Steroid injection: sometimes used to calm severe pain, particularly into the fluid sac above the tendon.
Shockwave therapy: used for some long-running painful deposits.
Ultrasound-guided needling (barbotage): a needle is used under ultrasound to break up and draw out some of the deposit.
Surgery: keyhole removal of the deposit, considered when months of other treatment have not helped.

The worst week is often the body clearing the deposit, not the shoulder getting worse.

Where else this could be coming from

Infection in the joint or bursa: can also cause sudden severe pain, but usually with heat, redness, swelling or fever. This needs a doctor the same day.
Gout or pseudogout: crystal flares that can affect the shoulder, often with a hot, swollen joint.
Frozen shoulder: pain with steadily increasing stiffness over weeks to months, rather than a sharp peak.
Rotator cuff tear: weakness after a fall or heavy lift.
The neck: pain spreading from the neck down the arm with tingling, which changes with neck movement.
The heart: left shoulder pain with chest pain, breathlessness or sweating is an emergency.

Is this normal?

“The pain came out of nowhere.” Common in the severe phase. There is often no injury and no obvious trigger.
“I cannot lift my arm.” During the severe phase, pain often stops the arm moving. Strength usually returns as pain settles. If it does not, get it checked.
“The deposit is still there on my scan.” Deposits can shrink slowly, and pain often settles before the scan changes.
“It hurt more after the procedure.” A few days of extra soreness after needling or shockwave is common.

If it isn’t going to plan

Perhaps the severe week passed two months ago, but the shoulder still aches every time you lift a pan from the top shelf. The thought is that the calcium is still in there, so nothing will change until it is removed. The deposit matters, but so does what happened during the weeks the arm was protected: the rotator cuff lost strength and the shoulder lost range. That alone can keep the ache going.

Rebuilding movement and strength gradually often settles the remaining pain, whether or not the deposit has fully gone. If it has not eased after about 3 months of steady work, a procedure to treat the deposit may be discussed. Get assessed by a physical therapist or doctor and ask:

Deposit: what size and stage is the deposit, and is it likely to be causing my pain now?
Exercise: is my exercise program at the right level for this stage?
Procedures: would shockwave, needling or an injection suit me, and what are the usual after-effects?
Surgery: at what point would surgery be considered?

When can I…

Activity	Typical range
Sleep on that side	Often 4 to 12 weeks after a severe flare
Drive	Usually not during the severe phase; often within 1 to 3 weeks once you can steer and react safely
Reach overhead	Often 4 to 12 weeks after a severe flare, built up gradually
Lift	Light loads close to the body after the severe phase; heavier loads over 6 to 12 weeks
Desk work	Often possible within days to 2 weeks, with the arm supported
Manual work or sport	Overhead or heavy work often 2 to 4 months after a severe flare

If you have had surgery, your surgeon’s protocol comes first.

Call your local emergency number or go to the emergency department if

Chest symptoms: sudden shoulder pain, especially on the left, comes with chest pain or pressure, breathlessness, sweating or nausea.
Very unwell with a hot shoulder: severe shoulder pain comes with high fever, shivering or feeling confused.

See a doctor today if

Hot or swollen shoulder: sudden severe pain comes with heat, redness, swelling or a fever. Infection must be ruled out.
Uncontrolled pain: you cannot sleep or find any position of comfort despite the pain relief you have been advised to take.
After a procedure: pain, redness or fever increase rather than settle 2 to 3 days after an injection or needling.

Get it checked soon if

Weakness persists: you still cannot lift the arm after the severe pain has settled.
Stiffening: the shoulder gets stiffer in every direction over the following weeks.
Ongoing ache: pain lifting the arm has not eased after about 3 months of exercise.