Calcific Tendinitis of the Shoulder — Causes and Treatment of Severe Pain
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Sometimes a shoulder that was perfectly fine the day before suddenly becomes immobilized by severe pain. Some patients are unable to sleep through the night and head to the emergency room because of unbearable pain — in such cases, calcific tendinitis is a likely cause.
What is calcific tendinitis?
It is a condition in which calcium (lime) deposits form within the tendon tissue of the rotator cuff. It is most common in those aged 40–60 and tends to occur more often in women. There are typically few symptoms during the formation phase when calcium accumulates, but during the resorptive phase — when the calcium breaks down and is reabsorbed — sudden, severe pain develops.
Stages of calcific tendinitis
- Formative phase (pre-calcific) — tendon tissue transforms into fibrocartilage; almost no pain
- Calcific phase — calcium deposits harden; mild pain or no symptoms
- Resorptive phase — calcium dissolves, triggering surrounding inflammation and severe acute pain
- Recovery phase — calcium fully absorbed, tendon tissue heals, pain subsides
Treatment approach
Because calcific tendinitis often resolves on its own, conservative treatment is the first choice.
- Herbal medicine and acupuncture to control acute pain
- Pharmacopuncture for local anti-inflammation and to promote calcium resorption
- Once pain subsides, exercises to restore shoulder range of motion
- Combined physical therapy such as extracorporeal shockwave therapy (ESWT)
Cautions
Paradoxically, the resorptive phase with severe pain means that the calcium is breaking down, so it can be viewed as a sign of recovery. Acute pain usually peaks within 1–2 weeks and then gradually improves. However, if calcification persists for more than 6 months or recurs repeatedly, additional treatment should be considered.