Question 1

What exactly is calcific tendinitis and why does it happen?

Accepted Answer

Calcific tendinitis is a condition where calcium hydroxyapatite crystals (the same mineral in bones and teeth) deposit inside rotator cuff tendons - most commonly the supraspinatus tendon. The calcium forms a white chalky paste or solid mass within the tendon substance. Why it happens is largely unknown - it is NOT related to dietary calcium intake or blood calcium levels (these are normal). Theories include localized areas of reduced blood flow in tendons causing cell death and calcium deposition, or metabolic factors in susceptible individuals. It affects 3% of adults, peak age 30-50, women more than men. The condition goes through three phases: 1) Formative phase (calcium slowly building up over weeks to months - often painless or mild ache), 2) Resorptive phase (body tries to dissolve and remove calcium - this causes SEVERE inflammation and excruciating pain 8-10/10), 3) Post-calcific phase (healing occurs, symptoms resolve). The resorptive phase is when patients present with sudden severe shoulder pain.

Question 2

Why is the pain so severe and sudden?

Accepted Answer

The sudden excruciating pain occurs during the RESORPTIVE PHASE. After calcium has been sitting quietly in the tendon for weeks to months (formative phase), the body suddenly recognizes it as foreign material and mounts an intense inflammatory response to dissolve and remove it. Inflammatory cells invade the calcium deposit, the calcium becomes liquid/paste-like, and the deposit swells under pressure. This causes massive inflammation in the confined space of the tendon and subacromial bursa - like squeezing a balloon inside a tight box. Patients describe pain as 8-10/10, 'worst pain of my life', 'worse than childbirth'. Pain is worst at night (lying down increases pressure). The good news: this severe pain phase usually means the condition is trying to RESOLVE itself - the body is actively removing the calcium. But the pain is so severe most patients need urgent intervention (injection or barbotage) rather than waiting months for natural resolution.

Question 3

Will the calcium deposits go away on their own without treatment?

Accepted Answer

Yes, in many cases. Natural history studies show that 85% of calcific tendinitis cases resolve spontaneously within 3 years, and 10% resolve within the first year. The resorptive phase (when calcium dissolves) is actually the body's attempt to remove the calcium naturally. However, there are several important caveats: 1) The resorptive phase can cause SEVERE pain lasting many weeks to months - most patients cannot tolerate waiting for natural resolution. 2) Large solid deposits (over 2cm) and deposits in the chronic phase (over 2 years) are much less likely to resolve spontaneously. 3) Even if calcium eventually resorbs naturally, the months of severe pain and sleep deprivation severely impact quality of life. 4) Without treatment, there's risk of developing frozen shoulder (adhesive capsulitis) as a secondary complication from prolonged pain and immobility. This is why most doctors recommend intervention (injection, barbotage, or ESWT) rather than waiting - to relieve severe pain and prevent complications, even though many cases would eventually resolve on their own.

Question 4

What is barbotage and is it better than surgery?

Accepted Answer

Barbotage (also called percutaneous needle aspiration and lavage) is a procedure where calcium deposits are removed using a large-bore needle rather than surgery. Done under ultrasound guidance with local anaesthetic in radiology clinic. The radiologist inserts a 14-18 gauge needle directly into the calcium deposit (seen on ultrasound), aspirates the calcium with a syringe, then flushes saline in and out multiple times to wash out remaining calcium. Takes 20-30 minutes. Success rate: 70-90% for liquid/paste-like deposits (resorptive phase), but only 30-50% for hard solid deposits. ADVANTAGES over surgery: No general anaesthetic, minimal invasive (just needle punctures), can return to work next day, Medicare covered (bulk-billed at most places), immediate pain relief in successful cases. DISADVANTAGES: Only works for liquid/paste deposits - won't work for hard solid calcium. 10-20% have no calcium removed. May need repeat procedure. Painful during procedure despite local anaesthetic. Barbotage is now considered first-line treatment BEFORE surgery for liquid deposits. Surgery reserved for: failed barbotage, large solid deposits not suitable for barbotage, or chronic cases with failed conservative treatment over 12 months.

Question 5

What is the success rate of each treatment?

Accepted Answer

Treatment success rates vary by method and deposit characteristics: CONSERVATIVE (NSAIDs, injections, physiotherapy): 60-70% achieve significant pain reduction within 6-12 months, but many have residual symptoms. Corticosteroid injections provide temporary relief (6-12 weeks) in 60-70% but don't remove calcium. BARBOTAGE: 70-90% success for liquid/paste deposits (resorptive phase), only 30-50% for solid deposits. When successful, provides rapid relief (1-3 days). ESWT (shock wave therapy): 60-80% achieve significant pain reduction and partial deposit resorption over 3-6 months. Works better for medium-sized deposits (1-1.5cm). SURGERY (arthroscopic removal): 85-95% achieve excellent pain relief and return to full function. Very low recurrence rate (under 5%). Surgery is most effective treatment but most invasive. Current treatment algorithm: Try NSAIDs and injection first (4-6 weeks). If still severe pain and liquid deposit on ultrasound, try barbotage (70-90% success). If barbotage fails or solid deposit, consider ESWT or surgery. If symptoms persist 12+ months despite proper conservative treatment, surgery recommended (85-95% success).

Medical Disclaimer

Calcific Tendinitis of the Shoulder (Calcium Deposits in Rotator Cuff)

📖What is Calcific Tendinitis of the Shoulder (Calcium Deposits in Rotator Cuff)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention