Shoulder
Calcific Tendinitis
석회성 건염
Calcium hydroxyapatite deposits within the rotator cuff (esp. supraspinatus) causing severe shoulder pain
- How common
- Common (2–7% of adults)
- Typical age
- Ages 30–50, female predominant
What is it?
Calcium hydroxyapatite deposits form and then resorb within the tendon, triggering intense inflammation during the resorptive phase.
Commonly affected: Supraspinatus in >80% (1–2 cm distal to acromion)
How it develops
- Pre-calcificTendon metaplasia prepares for calcification
- Formative/CalcificHard calcium deposits form within tendon
- Resting PhaseCalcium stable; often asymptomatic
- Resorptive (most painful)Immune-mediated resorption triggers severe inflammation
- Post-calcificCalcium cleared, tendon remodels
Symptoms
- Acute Severe Shoulder PainSudden onset severe pain without trauma
- Sleep-Limiting Night PainSevere night pain prevents sleep
- Inability to Lift ArmActive elevation severely limited
- Functional Recovery Post-resorptionRapid recovery after resorptive phase
How it is examined
- Severely Limited Active ROMNear-total inability to actively elevate
- Passive ROM PreservedPassive motion maintained — differentiates from frozen shoulder
- Subacromial TendernessTenderness over supraspinatus insertion
Imaging
X-ray is diagnostic — directly visualizes calcium deposits.
- Calcium deposits within rotator cuff
- Most often in supraspinatus
- Size and density suggest phase
MRI evaluates associated pathology.
- Hypointense calcium
- Peri-calcific edema (resorptive)
- Associated RC pathology
Non-surgical care
- NSAIDs + IceFirst-line for acute pain
- Subacromial Steroid InjectionSubacromial steroid for rapid relief
- ESWTPromotes calcium breakdown and resorption
- US-guided BarbotageUS-guided needling and aspiration of calcium
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
6-month conservative failure, large persistent deposits
Procedures that may be discussed
- Arthroscopic calcium removal
- Combined with subacromial decompression
Outlook
70–80% resolve spontaneously after the resorptive phase.