Neck & Shoulder

What It Is

Calcific tendinopathy happens when calcium deposits build up in the tendons of the shoulder, causing pain and stiffness, although some people have no symptoms (NICE, 2022). Four muscles and their tendons make up the rotator cuff, which surrounds the back and top of the shoulder. The tendons work together to hold the head of the humerus (upper arm bone) in the shoulder socket, as well as aiding shoulder movement. Calcific tendinopathy is also known as calcific tendonitis (or tendinitis). The deposits can narrow the space beneath the bony roof of the shoulder (the acromion) and may cause rubbing, which is why it may be related to or referred to as shoulder impingement (Calderdale and Huddersfield NHS Foundation Trust, n.d.; AAOS, n.d.).

The tendon most often affected is the supraspinatus tendon (ElShewy, 2016). The cause of the calcium build-up is not known (Calderdale and Huddersfield NHS Foundation Trust, n.d.), although it may be linked to overuse of the tendon (AAOS, n.d.). It is most common between the ages of 30 and 60. The calcium can cause chemical irritation, which leads to pain, and deposits can also disappear on their own (Calderdale and Huddersfield NHS Foundation Trust, n.d.).

Calcific Tendinopathy of the Shoulder Anatomy

The rotator cuff is a main component of the shoulder joint. The joint provides motion between the scapula (shoulder blade) and the humerus. The shoulder joint itself is a ball and socket: the ball is the head of the humerus and the socket (called the glenoid) is part of the shoulder blade. Muscles and ligaments work to stabilise the joint throughout use.

The condition usually passes through stages (ElShewy, 2016). In the pre-calcific stage, the tendon changes in ways that make the deposits more likely to form. In the calcific stage, calcium is deposited in the tendon; after a resting period, the body starts to reabsorb (break down) the deposits. This reabsorbing phase is when the most pain usually occurs. In the post-calcific stage, the body heals the tendon and it is remodelled with new tissue. Once this process has happened, the pain usually eases or goes away completely.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Calcific Tendinopathy of the Shoulder

1. Manual Therapy

Physical therapy focuses on restoring movement to your shoulder, with stretching exercises first and then strengthening exercises once pain and movement have improved (AAOS, n.d.). There is no solid evidence that machines such as ultrasound or deep heat change the course of the condition (ElShewy, 2016). I can help with hands-on work, a stretching and then strengthening programme, and advice on posture and shoulder control. See the My Approach tab for how I work.

2. Rest and Anti-Inflammatory Medications

Your doctor may suggest avoiding activities that cause or increase your symptoms (AAOS, n.d.). The American Academy of Orthopaedic Surgeons (AAOS, n.d.) lists anti-inflammatory medicines such as ibuprofen and naproxen to reduce pain and swelling in calcific tendinitis. (This medicine information comes from the American Academy of Orthopaedic Surgeons, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Steroid (cortisone) injection: if other treatments have not helped, an injection of a steroid, an anti-inflammatory medicine, into the shoulder may ease the pain (AAOS, n.d.).
Barbotage (needle lavage): a hospital outpatient procedure in which a needle is guided by ultrasound into the calcium deposit to break it up and draw it out; a steroid may be injected at the same time. There is a 60 to 70 percent chance of a significant or complete improvement in symptoms (Calderdale and Huddersfield NHS Foundation Trust, n.d.).
Shockwave therapy: NICE (2022) advises that this should only be done as part of a research study, because there is not yet enough evidence about how well it works.
Surgery: keyhole (arthroscopic) surgery to remove the calcium may be considered if other treatments have not worked (AAOS, n.d.).

How I can help (see the My Approach tab)

Hands-on work for the shoulder, neck and upper back

A graded stretching and strengthening programme

Advice on posture, activity and managing flares

Tips

Avoid lifting heavy objects to prevent placing undue strain on the shoulder joint.
Prolonged, repetitive activities such as painting, construction or sports can aggravate a painful shoulder.
Calcific tendinopathy is most common in adults aged 30 to 60, but it can happen to anyone (AAOS, n.d.).
When participating in sports, make sure to pay attention to any pain in the shoulders, as that could be a sign of something more severe.
Keep good posture, which will place the shoulders in a better position and reduce strain on the rotator cuff tendons.

Treatment

My Approach

Calcific tendinopathy can be very painful while your body breaks the calcium down, but that stage usually passes and the pain often eases. My aim is to keep you comfortable through it, keep the shoulder moving, then rebuild strength and control for everyday life, work and sport.

I start by assessing how your shoulder and shoulder blade move, testing rotator cuff and shoulder blade strength, and checking your neck, upper back and posture. How irritable the shoulder is right now shapes how hard we work.

When It's Very Painful

Cutting back what provokes it, such as overhead reaching and heavy carrying, rather than stopping everything
Gentle, pain-free holds, such as pressing your hand out against a wall or doorframe, which often ease pain
Hands-on work for the neck, upper back and shoulder blade muscles, keeping pressure off the sore tendon
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
Breathing and relaxation to help with pain and sleep

As It Settles

Stretching and mobility first, then strengthening once pain and movement have improved
Release of tight chest, lat and shoulder blade muscles; chest wall work needs your informed consent and a signed consent form, and work near the armpit needs your informed consent
Gentle mobilisation of the shoulder joint and upper back, with no quick thrusts
Training the muscles that hold your shoulder blade steady, with wall push-ups and rows, then rotator cuff strengthening, avoiding pinching positions early on
Building towards overhead, faster and work- or sport-specific movement, including gym work
A home programme with a simple flare plan: a little discomfort during exercise is okay, but pain shouldn't rise at night, at rest or over the next 24 hours; if it flares, take two days off and restart at the last level that felt fine

If pain stops you progressing, injections or barbotage are options your family doctor or nurse practitioner may discuss.

What to Expect

Typical Course

Typical course: Most people come in once or twice a week at first, then weekly, spacing visits out as you manage more on your own, with a reassessment at around 4 to 6 weeks. Many people improve over a few months, although the painful reabsorbing stage can make it feel worse for a while before it eases.

What I Focus On

Calming the Painful Stage

Pain-Free Holds

Shoulder Blade Control

Progressive Cuff Strength

Flare Plan

Sources

References

ElShewy, M.T. (2016) 'Calcific tendinitis of the rotator cuff', World Journal of Orthopedics, 7(1), pp. 55–60. doi: 10.5312/wjo.v7.i1.55
Calderdale and Huddersfield NHS Foundation Trust (n.d.) Ultrasound guided barbotage (leaflet csph0106). Available at: https://plr.cht.nhs.uk/download/648/Ultrasound%20Guided%20Barbotage%20%20%20A4 (Accessed: 7 October 2026).
National Institute for Health and Care Excellence (NICE) (2022) Extracorporeal shockwave therapy for calcific tendinopathy in the shoulder: information for the public (HTG645). Available at: https://www.nice.org.uk/guidance/htg645/informationforpublic (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (AAOS) (n.d.) Calcific tendinitis of the shoulder. Available at: https://www.orthoinfo.org/diseases--conditions/calcific-tendinitis-of-the-shoulder/ (Accessed: 8 October 2026).

Massage therapy · Kitchener–WaterlooCalcific Tendinopathy of the Shoulder

What It Is

Calcific Tendinopathy of the Shoulder Anatomy

Self-Care & Treatment

How to Treat Calcific Tendinopathy of the Shoulder

1. Manual Therapy

2. Rest and Anti-Inflammatory Medications

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Very Painful

As It Settles

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooCalcific Tendinopathy of the Shoulder

What It Is

Calcific Tendinopathy of the Shoulder Anatomy

Self-Care & Treatment

How to Treat Calcific Tendinopathy of the Shoulder

1. Manual Therapy

2. Rest and Anti-Inflammatory Medications

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Very Painful

As It Settles

Typical Course

References

Related Conditions

Acromioclavicular Joint Sprain

Biceps Brachii Tendinopathy

Biceps Tendonitis of the Shoulder

Glenohumeral Joint Osteoarthritis

Book a session