Calcific tendonitis causes intense shoulder pain, leading people to seek answers about how long symptoms will last. The duration of this condition is highly variable, depending on the body’s natural process of dissolving the calcium deposits and whether medical intervention is used. While some cases resolve spontaneously in months, others can persist for a year or more. Understanding the biological timeline provides the best context for prognosis and recovery.
What Is Calcific Tendonitis?
Calcific tendonitis, also known as calcific tendinopathy, is characterized by the formation of calcium phosphate crystals within a tendon. These deposits, which are the same mineral found in bone, accumulate in the soft tissue. The condition most commonly affects the rotator cuff tendons in the shoulder, particularly the supraspinatus tendon. The exact cause for this abnormal crystal deposition remains largely unknown (idiopathic). It is more frequent in adults between 30 and 50 years old and is not linked to high calcium intake. The presence of these deposits leads to mechanical irritation and inflammation within the shoulder joint.
The Natural Timeline of Deposit Resorption
The course of calcific tendonitis is a self-limiting process divided into three main phases: formative, resorptive, and post-calcific. The duration of the condition is determined by how quickly the body moves through these stages, particularly the resorptive phase.
Formative Phase
The formative phase is when the calcium deposits are created within the tendon tissue, often beginning with a cellular change in the tendon fibers. This stage is frequently asymptomatic, meaning a person may have deposits without experiencing any pain. The deposits at this stage typically appear dense and well-defined on imaging.
Resorptive Phase
The highly painful symptoms that prompt medical help are characteristic of the resorptive phase. During this time, the body initiates an inflammatory response to break down and absorb the calcium. This causes intense pain due to chemical irritation and increased pressure within the tendon. The deposit consistency changes from a chalk-like mass to a softer, toothpaste-like material as resorption occurs.
For cases resolving without intervention, the duration of intense symptoms varies widely. While some cases resolve in a few weeks, the natural timeline for complete disappearance can span from 6 months up to several years. The size and chemical composition of the deposit influence this spontaneous resolution time.
Post-Calcific Phase
Once the deposits are fully reabsorbed, the post-calcific phase begins. This stage is characterized by the gradual remodeling and healing of the tendon tissue.
Treatment Options and Their Impact on Recovery
Interventions aim to manage the severe pain of the resorptive phase or accelerate the natural timeline of deposit removal. Conservative management is typically the first step, involving non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy focused on gentle stretching and maintaining mobility. These steps primarily address the symptoms and inflammation rather than directly speeding up deposit resorption.
Minimally Invasive Procedures
A more direct approach involves procedures designed to physically remove or break down the calcium.
Needle lavage, or barbotage, is a minimally invasive procedure often performed under ultrasound guidance. This technique involves inserting one or two needles into the deposit to break it up and physically wash out the calcium material with saline. By removing a substantial portion of the deposit, this procedure can dramatically accelerate symptom resolution, often leading to significant improvement in weeks to months rather than waiting years for natural resolution.
Extracorporeal Shockwave Therapy (ESWT) is another non-surgical option that uses mechanical shock waves delivered to the affected area. The energy from the shock waves stimulates the biological processes necessary for the body to resorb the calcium. A typical treatment course involves multiple sessions. Studies indicate that ESWT increases shoulder function and is effective in dissolving the calcifications within six months.
Surgical Removal
Surgical removal, usually performed arthroscopically, is reserved as a last resort for chronic cases that have not responded to conservative or minimally invasive treatments after four to six months. During this procedure, a surgeon uses small instruments and a camera to visualize and manually remove the calcium deposit. Recovery requires a sling for several weeks and a total rehabilitation period that can extend from three to six months for a full return to function.