Chronic

Shoulder Calcification (Calcific Tendinitis)

Hydroxyapatite calcium deposit in the rotator cuff tendons. Uhthoff classification in 3 phases. Supraspinatus affected in 80% of cases.

Shoulder calcification (calcific tendinitis) is a deposit of hydroxyapatite calcium crystals within the rotator cuff tendons, most commonly the supraspinatus (80%). It affects 2.7-22% of adults (often asymptomatic), with a peak between 30 and 60 years, more common in women. The Uhthoff classification describes 3 phases: pre-calcific (metaplasia), calcific (formation → resting → resorption), post-calcific (remodeling). The resorptive phase is the most painful (acute hyperalgesic shoulder crisis) due to crystal release and inflammatory reaction. It is a self-limiting condition but can cause subacromial impingement if the calcification is large.

Characteristics

  • Chronic pain: progressive shoulder pain, worsened by overhead movements. Acute crisis (resorptive phase): sudden onset severe shoulder pain, functional impairment, pseudo-septic inflammation.
  • Standard radiographs: calcium deposit clearly visible. Size measurement (> 15 mm = risk of impingement). Gärtner classification: type I (well-defined, dense), type II (fragmented), type III (translucent, resorption).
  • Ultrasound: assessment of calcification consistency (hard, soft, liquid). Arc sign if subacromial impingement. Detection of subacromial bursitis.

Medical and surgical management

  • Acute crisis: NSAIDs + subacromial corticosteroid injection. Aspiration lavage (barbotage) under ultrasound guidance: needle aspiration of the calcification with saline injection.
  • Resistant chronic calcification: focused extracorporeal shockwave therapy (F-ESWT). Efficacy demonstrated in randomized studies (calcification disappearance in 50-75% of cases).
  • Failure of conservative treatment: arthroscopic calcification excision ± subacromial decompression. Indicated if > 12 months of symptoms with large symptomatic calcification.

Physiotherapy rehabilitation

  • Resorptive phase (acute): cryotherapy, rest, pain-free pendular exercises. Avoid any mobilization that reproduces the acute pain.
  • Chronic phase: rehabilitation identical to subacromial impingement. Dynamic humeral head re-centering, scapular stabilizer strengthening.
  • Shockwave therapy (ESWT): radial or focal shockwaves to fragment the calcification and stimulate resorption. Protocol: 3-5 sessions at weekly intervals.

Average duration

4 to 16 weeks

Book appointment

Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.