Calcific tendonitis is a common condition involving the formation of calcium deposits within the tendons, most frequently affecting the rotator cuff of the shoulder. This accumulation of calcium phosphate crystals can lead to significant pain and functional limitations. The primary concern for many patients is whether this painful condition will eventually resolve on its own. The natural progression of calcific tendonitis is often a self-healing process, but understanding its specific stages is necessary to grasp the likely prognosis.
Understanding Calcific Tendonitis
Calcific tendonitis is characterized by the presence of calcium hydroxyapatite crystals deposited within a tendon, most commonly the supraspinatus tendon in the shoulder. The exact cause remains debated, though theories focus on a cell-mediated process, possibly triggered by local tissue changes like hypoxia or metabolic disorders. It is not considered a direct consequence of injury, trauma, or wear-and-tear.
The presence of these deposits irritates the surrounding tendon tissue, leading to a range of symptoms. Patients commonly experience deep, aching shoulder pain, which often worsens with movement or at night. This irritation can also cause stiffness and a noticeable reduction in the shoulder’s active range of motion, making simple overhead tasks difficult. The condition is most frequently diagnosed in adults between the ages of 30 and 50.
The Natural Course: Does It Go Away?
Calcific tendonitis generally resolves spontaneously, but the timeline is highly unpredictable, ranging from a few months to several years. The condition follows a distinct biological cycle with two phases: the formative phase and the resorptive phase. During the formative phase, calcium deposits slowly accumulate within the tendon tissue, often presenting with mild or intermittent chronic pain, or sometimes no pain at all.
The resolution process begins with the resorptive phase, which is paradoxically the most painful stage. The body initiates a spontaneous mechanism where specialized cells, such as macrophages, invade the deposit site to break down and absorb the calcium crystals. This active cellular reaction causes intense inflammation and a spike in local pressure, resulting in acute, severe pain.
Radiographic studies show that deposits appear dense during the less painful formative phase, but become cloudy during the intensely painful resorptive phase. After the calcium is fully resorbed, the tendon enters a post-calcific stage where it undergoes remodeling and healing, leading to complete pain relief. While many cases resolve naturally, the severe pain during resorption often prompts patients to seek medical intervention.
Non-Surgical Interventions
When pain is debilitating or the condition fails to progress naturally, physicians typically begin with a conservative approach to manage symptoms and encourage deposit resorption. First-line treatments include rest, nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation, and specific physical therapy exercises to maintain the shoulder’s range of motion. Corticosteroid injections, delivered directly into the inflamed area, can offer temporary relief by reducing the local inflammatory response.
A more targeted non-surgical option is Extracorporeal Shockwave Therapy (ESWT), which delivers high-energy acoustic waves to the calcified area. These focused shock waves stimulate an active inflammatory response, which helps fragment the calcium deposits and promotes increased blood flow. This mechanism attempts to accelerate the body’s natural resorptive phase. High-energy ESWT is effective in achieving both pain reduction and calcium resorption in chronic cases.
Advanced and Surgical Treatments
For patients whose pain is severe and unresponsive to conservative management, more direct methods of calcium removal are considered. One common minimally invasive technique is ultrasound-guided percutaneous needle aspiration, often referred to as barbotage. This procedure uses a needle, guided by real-time ultrasound imaging, to repeatedly puncture the calcium mass, breaking it into smaller fragments. Saline solution is then injected to wash out the loosened calcium material, and a steroid is often injected afterward to reduce inflammation.
If non-surgical and minimally invasive options fail, arthroscopic surgery remains the definitive treatment option. This keyhole procedure uses small incisions and a camera to visually access the rotator cuff tendon. The surgeon incises the tendon over the deposit and manually scrapes out the calcium material, which often resembles a chalky white paste. The resulting defect in the tendon is then repaired with sutures, offering a reliable path to resolution for resistant cases.