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Tendinosis Calcarea – Calcific Tendinitis: Causes & Treatment

Tendinosis calcarea is a condition in which calcium deposits form within shoulder tendons, causing significant pain and restricted movement.

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Things worth knowing about "Tendinosis calcarea"

Tendinosis calcarea is a condition in which calcium deposits form within shoulder tendons, causing significant pain and restricted movement.

What is Tendinosis Calcarea?

Tendinosis calcarea (also known as calcific tendinitis or calcifying tendinopathy) is a condition characterized by the deposit of calcium crystals within the tendons of the shoulder. The supraspinatus tendon, part of the rotator cuff, is most commonly affected. The condition can cause either acute, extremely intense pain or chronic, dull discomfort. It is one of the most frequent causes of shoulder pain in adults.

Causes

The exact cause of tendinosis calcarea is not yet fully understood. Recognized risk factors and contributing causes include:

Reduced blood supply to tendon tissue, leading to local tissue degeneration
Mechanical overuse of the shoulder through repetitive movements or heavy physical work
Degenerative changes in tendon tissue as part of the aging process
Metabolic disorders, such as thyroid disease or diabetes mellitus
Genetic predisposition

Calcium deposits develop in several stages: the tendon tissue first undergoes a fibrocartilaginous transformation, then calcium crystals form, and finally the deposits are reabsorbed – often accompanied by a pronounced pain reaction.

Symptoms

Symptoms can vary considerably depending on the stage of the disease:

Acute phase: Sudden onset of very severe shoulder pain, which may radiate into the arm. Even slight touch or minimal movement can be almost unbearable.
Chronic phase: Persistent, dull shoulder pain that worsens with specific movements, especially when lifting the arm.
Restricted range of motion: Shoulder mobility may be significantly reduced.
Night pain: Pain often intensifies at night, disrupting sleep.

Diagnosis

Diagnosis is typically established through the following assessments:

Physical examination: The physician evaluates tenderness, range of motion, and shoulder strength.
X-ray: Calcium deposits are clearly visible on standard X-ray images, allowing for rapid diagnosis.
Ultrasound (sonography): Provides detailed visualization of the tendon and calcium deposits, including their size and consistency.
MRI (magnetic resonance imaging): Used to exclude associated injuries such as tendon tears or bursitis.

Treatment

Conservative Treatment

In most cases, tendinosis calcarea can be managed without surgery:

Pain relievers and anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac relieve pain and inflammation.
Corticosteroid injections: Targeted injections into the bursa or shoulder joint can rapidly alleviate acute pain.
Physiotherapy: Strengthening exercises and manual therapy improve shoulder function and help prevent recurrence.
Extracorporeal shock wave therapy (ESWT): Sound waves are directed at the calcium deposit from outside the body to break it up and promote resorption. This is considered an effective, non-invasive approach.
Ultrasound-guided needling and lavage: A needle is used under ultrasound guidance to aspirate and flush out the calcium deposit.

Surgical Treatment

If conservative measures do not provide sufficient relief after several months, surgery may be considered. During arthroscopy (keyhole surgery of the shoulder), the calcium deposit is removed in a minimally invasive procedure. The intervention typically yields very good results.

Prognosis

The overall prognosis for tendinosis calcarea is favorable. In many patients, calcium deposits resolve spontaneously over time. With appropriate treatment, most patients are able to regain full shoulder function. Early physiotherapy and consistent adherence to prescribed exercises significantly improve recovery outcomes.

References

Gartner J, Heyer A. Calcific tendinitis of the shoulder. Orthopade. 1995;24(3):284-302.
Johansson K et al. Efficacy and safety of extracorporeal shock wave therapy for calcific tendinitis of the shoulder. Acta Orthopaedica. 2016;87(5):504-509.
Louwerens JK et al. Ultrasound-guided needling and lavage versus sham treatment in patients with calcific tendinitis of the shoulder. Annals of the Rheumatic Diseases. 2016;75(4):706-711.

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