[Health Column] Calcific Tendinitis: What If Your Shoulder Suddenly Feels Like It's Breaking? From Diagnosis to Non-Surgical Treatment

 

Hello. I am a specialist in Anesthesiology and Pain Medicine at Shintongbangtong Clinic. Oh Jin-seok no see.

 

Have you ever experienced a sudden, excruciating shoulder pain that felt like it was breaking, leaving you unable to even lift your arm and unable to sleep all night, even though you hadn't suffered any particular injury? "When I woke up, my shoulder hurt so much that I wondered if I should go to the emergency room." There are patients who come to the clinic asking this. Upon examination, it is often found that white calcium deposits have accumulated in the shoulder tendons.

 

This disease Calcific tendinitis It is called that. Because the name is unfamiliar and the pain is so severe, I receive many questions such as, "Do I need surgery?" or "Is it different from frozen shoulder?"

 

Today, I will explain in order why calcific tendinitis occurs, how it differs from frozen shoulder or rotator cuff tears, and the sequence of diagnosis and treatment.

 

Q1. What is calcific tendinitis?

Calcific tendinitis is A condition in which inflammation and pain occur as calcium accumulates inside the tendons. According to medical information from Seoul National University Hospital, it mostly occurs in the supraspinatus tendon, which lifts the shoulder, and primarily appears in people over 30 years of age and is more common in women than in men.

 

It has not yet been clearly determined why calcification occurs. It is said to be related to degenerative changes in the tendons or a reduction in microvascular blood flow to the tendons, and Asan Medical Center explains that it often occurs when the tendons lack oxygen or are frequently compressed.

 

📌 Scene of a consultation with a patient visiting due to shoulder pain

 

Just because calcium has accumulated does not mean it is always painful. Calcific tendinitis is The three stages: before lime formation, the period of lime accumulation and absorption, and after absorption. It is divided into stages, and the pain is most severe during the absorption phase, when the calcium begins to be absorbed into the body. Therefore, it is common for people to feel fine for a long time, only to experience sudden, severe pain one day.

 

Q2. How is calcific tendinitis different from frozen shoulder and rotator cuff tear?

When you have shoulder pain, you usually think of frozen shoulder first, but calcific tendinitis is The pattern of how the pain starts is quite different. The key features can be summarized as follows.

 

division	calcific tendinitis	frozen shoulder	Rotator cuff tear
Pain begins	It often starts suddenly and severely.	It gradually becomes painful and stiffens	After an injury or gradually
arm movements	Difficulty lifting due to pain	It doesn't go up well even when someone holds it.	Loss of power in a specific direction
When pressed	It hurts severely when I press on my shoulder.	Stiffness overall	pain in the tendon area
Night pain	May appear	May appear	May appear

 

📌 Scene of checking the shoulder condition and consulting in the examination room

 

💡 However It is difficult to distinguish based on symptoms alone. Calcific tendinitis can occur along with changes in the rotator cuff tendons, and if the shoulder is not moved for a long time due to pain, it can lead to frozen shoulder (adhesive capsulitis). Therefore, it is important to identify the exact cause through imaging tests.

 

Q3. How is calcific tendinitis diagnosed?

Calcific tendinitis can be confirmed with a relatively simple test. When taking a shoulder X-ray, white calcified lumps are visible in the tendon area.

 

📌 Shoulder X-ray — Calcium deposits in the tendon area appear white.

 

Here Ultrasound examination By combining this, it is possible to check in real-time the location and extent of calcium deposits within the tendons, whether they are hard or soft, and even whether there is inflammation in the surrounding tendons and bursae. This information serves as an important criterion for determining what treatment to pursue next.

 

If conservative treatment is ineffective and surgery needs to be considered, or if a tendon rupture is suspected, additional tests such as an MRI may be performed.

 

Because the treatment for the same shoulder pain varies depending on the cause, The more severe the pain, the first step is to identify the cause using imaging. no see.

 

Q4. How is calcific tendinitis treated?

According to medical information from Seoul National University Hospital, calcific tendinitis is Most respond well to conservative treatment. Treatment typically proceeds in the order of first alleviating pain and inflammation, and then restoring movement to prevent the shoulder from stiffening.

 

 

Stage 1 is medication and physical therapy It is. Control the pain with anti-inflammatory painkillers, and as soon as the pain subsides, start exercises such as stretching to prevent the shoulder from stiffening. If the pain is severe and makes daily life difficult, reduce inflammation Injection therapy We consider together.

 

If the pain persists or calcium remains Extracorporeal shockwave therapy You can try this treatment. It involves delivering shockwaves to the calcified area from outside the body, and a comprehensive analysis of 995 participants across 14 studies (Vavken et al., 2009) reported that it helped improve pain and shoulder function, as well as aid in calcium absorption. However, due to significant variations in the results of the studies included in the analysis, the effectiveness may vary from person to person.

 

If improvement is slow and calcium remains despite this treatment Ultrasound-guided calcium aspiration We consider this. Surgery (arthroscopy) is not frequently necessary, but it is reviewed in cases where pain persists for a long time without responding to non-surgical treatment.

 

Q5. What kind of treatment is ultrasound-guided calcification aspiration?

Ultrasound-guided calcium aspiration is A procedure in which a fine needle is inserted while directly viewing the location of the calcium deposit on an ultrasound screen to break it up, wash it out with saline solution, and extract it with a syringe. It is performed under local anesthesia without an incision.

 

When the lime is in a soft state, it may leak into the syringe in the form of white powder or paste. The photo below shows the lime components collected in the syringe during the actual lime aspiration process.

 

📌 Calcium components collected in the syringe during the calcium aspiration process (Photo of the procedure)

 

A network meta-analysis comparing 1,105 people from 14 randomized controlled studies (Wu et al., 2017) suggested that ultrasound-guided calcium aspiration and extracorporeal shockwave therapy are effective options for reducing pain and eliminating calcium deposits in chronic calcific tendinitis that does not respond to initial conservative treatment.

 

⚠️ However, not all lime is absorbed.
· Suction may be difficult if the limescale is very hard or depending on its size and location.
· In some cases, pain may actually increase for a few days after the procedure.
· After the procedure, it is important to continue with gradual exercises to prevent the shoulder from stiffening.

 

 

❓ Frequently Asked Questions

Q1. Does lime disappear on its own if left alone?

A1. Calcific tendinitis is a condition that can improve over time as the calcium is absorbed. However, it is difficult to predict when absorption will occur, and pain may actually be most severe during this period. Since avoiding prolonged use of the shoulder due to pain can cause it to stiffen, it is advisable to get an examination rather than simply enduring the pain if it is severe.

 

Q2. Can calcific tendinitis lead to frozen shoulder?

A2. That is possible. Medical information from Seoul National University Hospital also explains that if adhesive capsulitis (frozen shoulder) develops due to pain, the resulting symptoms can persist. It is important to consistently move the shoulder within a manageable range while controlling the pain.

 

Q3. Is extracorporeal shockwave therapy painful?

A3. Since shock is transmitted to the treatment area, you may experience pain or a stiff sensation during the procedure. The intensity is adjusted while monitoring the level of pain, and the number of treatments and intervals are determined in consultation with the attending medical staff based on the size of the calcification and changes in symptoms.

 

Q4. Does the pain disappear immediately after calcium aspiration?

A4. There are individual differences. While some people feel better relatively quickly after the procedure, others may experience increased pain for a few days before gradually subsiding. It is recommended to monitor your progress and continue with exercise and necessary treatments.

 

Q5. Are there cases where surgery is necessary?

A5. It is not very common. Most patients respond well to non-surgical treatment, but arthroscopic surgery may be considered if pain persists for a long time despite various treatments or if a tendon rupture is present. In such cases, the decision is made after confirming the condition through additional tests, such as an MRI.

 

Organize 🧭

Calcific tendinitis is a disease caused by calcium deposits in the shoulder tendons, especially Cases where sudden, severe pain occurs during the period when calcium is being absorbed There are many.

 

Fortunately, it can be confirmed relatively easily with X-rays and ultrasounds, and most cases are treated with medication, physical therapy, injections, extracorporeal shockwave therapy, and ultrasound-guided aspiration. Management through non-surgical treatment You can do it.

 

However, even with the same shoulder pain, the causes can differ, such as frozen shoulder or a rotator cuff tear, and the appropriate treatment varies depending on the size and condition of the calcification. Since treatment outcomes also vary from person to person, we recommend confirming the exact cause through imaging tests and consulting with medical specialists to determine the course of treatment.

 

Sudden shoulder pain Identifying the cause first, rather than enduring and holding it in, is the beginning of protecting your shoulder. no see.

 

📚 Reference Materials

The medical content of this column was written by referencing medical information from Seoul National University Hospital and Asan Medical Center, as well as international academic papers on the non-surgical treatment of calcific tendinitis.
· Seoul National University Hospital Medical Information, "Calcific Tendinitis"
· Asan Medical Center Disease Encyclopedia, "Calcific Tendinitis"
· Vavken P, Holinka J, Rompe JD, Dorotka R. (2009). Focused Extracorporeal Shock Wave Therapy in Calcifying Tendinitis of the Shoulder: A Meta-Analysis. Sports Health 1(2):137-144.
· Wu YC, Tsai WC, Tu YK, Yu TY. (2017). Comparative Effectiveness of Nonoperative Treatments for Chronic Calcific Tendinitis of the Shoulder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Archives of Physical Medicine and Rehabilitation 98(8):1678-1692.

 

 

Shintongbangtong Clinic

Director Oh Jin-seok

- Anesthesiology and Pain Medicine Specialist
- Fellow and Visiting Professor at the Pain Center, Catholic University of Korea Seoul St. Mary's Hospital
- (Former) Director of the Non-Surgical Treatment Center at OK Hospital
- Completed the Advanced Pain Management Course at the Korean Pain Society
- Completion of the Korean Pain Society's specialized interventional procedure training course
- EMS Extracorporeal Shockwave Therapy (ESWT) Instructor
- Regular member of the Korean Pain Society and the Korean Spine Pain Society
- Current Director of Shintongbangtong Clinic