Rotator Cuff Calcific Tendinopathy

Rotator Cuff Calcific Tendinopathy

Article by John Miller

Calcific Tendonitis

What is Rotator Cuff Calcific Tendinopathy?

Calcific tendinopathy is a condition that causes the formation of a small, usually about 1-2 centimetre size calcium deposit within the tendons of the rotator cuff. These deposits are typically found in patients at least 30-40 years old and have a higher incidence in people with diabetes. The calcium deposits are not always painful, and even when painful, they will often spontaneously resolve after one to four weeks.

What Causes Calcific Tendinopathy?

calcific tendonitis

The cause of calcium deposits within the rotator cuff tendon (calcific tendonitis) is not entirely understood. Different ideas have been suggested, including blood supply and ageing of the tendon, but the evidence to support these conclusions is not clear. Delayed healing is one of the most compelling arguments.

Usually, the tendon heals via the action of collagen forming cells known as fibroblasts. After weeks or months, the fibroblasts became less numerous in the region and replaced by osteoblasts (bone-forming cells). These osteoblasts stimulate the growth of bone (calcium) in the tendon. Hence the main reason for the development of calcific tendonitis appears to be delayed healing.

How Does Calcific Tendinopathy Progress?

Calcific tendonitis usually progresses predictably and almost always resolves eventually without surgery. The typical course is:

Pre-Calcification Stage

You usually do not have any symptoms at this stage. At this point, the calcification site tends to undergo cellular changes that predispose the tissues to develop calcium deposits.

Calcific Stage

During this stage, the calcium is excreted from cells and then blends into calcium deposits. When seen, the calcium looks chalky. It is not a solid piece of bone. Once the calcification has formed, a so-called resting phase begins. This is not a painful period and may last a varied length of time. After the resting phase, a resorptive phase begins–this is the most painful phase of calcific tendonitis. During this resorptive phase, the calcium deposit looks something like toothpaste.

Post-Calcific Stage

This phase is usually a painless stage as the calcium deposit disappears and is replaces a more normal appearing rotator cuff tendon.

Patients usually seek treatment during the painful resorptive phase of the calcific stage. Still, some patients have the deposits found incidentally as part of their evaluation of impingement syndrome, usually on X-ray.

What is Rotator Cuff Impingement Syndrome?

Impingement (impact on bone into rotator cuff tendon or bursa) should not occur during normal shoulder function.

When it does happen, the rotator cuff tendon becomes inflamed and swollen. A condition called rotator cuff tendonitis.

Likewise, if the bursa becomes inflamed, shoulder bursitis will develop. These conditions can co-exist or be present independently.

While a traumatic injury can occur, e.g. fall, it is repeated movement of your arm into the impingement zone overhead that most frequently causes the rotator cuff to contact the outer end of the shoulder blade (acromion).

When this repeatedly occurs, the swollen rotator cuff is trapped and pinched under the acromion.

Rotator Cuff Calcific Tendinopathy Treatment

Rotator cuff calcific tendinopathy is a common complaint that we see at PhysioWorks, and it is, unfortunately, an injury that often recurs if you return to sport or work too quickly – especially if an incomplete rehabilitation program.

Your rotator cuff is an essential group of control and stability muscles that maintain the “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This centralisation prevents injuries such as bursitis,  impingementsubluxations and dislocations.

We also know that your rotator cuff provides subtle glides and slides of the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.

Did you know that your arm only has one bony joint articulation where your collarbone (clavicle) attaches to the acromion (tip of the shoulder blade)?

The rest of your attachments are muscular, highlighting the importance of retraining and strengthening your shoulder muscles.

Calcific Tendinopathy Treatment

Researchers have concluded that there are mostly seven stages that need to be covered to rehabilitate these injuries and prevent recurrence effectively – these are:

  1. Early Injury Protection: Pain Relief & Anti-inflammatory Tips
  2. Regain Full Range of Motion
  3. Restore Scapular Control
  4. Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
  5. Restore Rotator Cuff Strength
  6. Restore High Speed, Power, Proprioception & Agility
  7. Return to Sport or Work

Calcific Tendinopathy Treatment Results

There is no specific time frame for when to progress from each stage to the next. Many factors will determine your injury rehabilitation status during your physiotherapist’s clinical assessment.

You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.

It is also crucial to carefully monitor each progression as attempting to progress too soon to the next level can lead to re-injury and frustration.

For more specific advice about your bursitis or rotator cuff injury, please get in touch with your PhysioWorks physiotherapist.

Common Shoulder Pain & Injury Conditions

Rotator Cuff

Adhesive Capsulitis

Shoulder Bursitis

Shoulder Instability

Acromioclavicular Joint

Bone Injuries

Post-Operative Physiotherapy

Muscle Conditions

Systemic Conditions

Referred Pain

Shoulder Treatment

Researchers have discovered that managing your shoulder injury with physiotherapy is usually successful. Typically, you have two options: a non-operative or a surgical approach. Your condition will dictate which option is best for you at this time. Non-operative care is conservative rehabilitation.

If shoulder surgery is required, then your physiotherapist may undertake:

Pre-operative rehabilitation  - either trial a non-operative/conservative treatment approach or condition and prepare your shoulder and body for a surgical procedure.

Post-operative physiotherapy will safely regain your normal range of movement, strength and function.

PhysioWorks physiotherapists have a particular interest and an excellent working relationship with leading shoulder surgeons. Our physiotherapy team provide you with both conservative and post-operative shoulder rehabilitation options. We aim for you to attain the best possible outcome for your shoulder injury.

For specific information regarding your shoulder, please consult your trusted shoulder physiotherapist.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.


If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  


Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.


Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.