Calcific tendinitis what is it and how to manage

What is calcific tendinitis?

A disorder known as calcific tendinitis occurs when calcium-based deposits, usually hydroxyapatite crystals, develop inside a tendon, most frequently in the shoulder’s rotator cuff.

This is seen by the Elite Physiotherapy and Sports Injury Centre as a tendon-metabolic condition in which tendon tissue goes through phases of calcification, remodeling, resorption, and degeneration. These deposits may cause pain, decreased range of motion, and even serious malfunction by irritating the tendon and adjacent structures.

Unlike simple tendinitis, which involves tendon inflammation, calcific tendinitis develops crystal deposits and follows a more complex staging process.

A tendon cell-mediated process that results in calcium crystal deposition and fibro-cartilaginous metaplasia.
Decreased oxygen flow or tendon vascularity which may make calcification more likely.
Risk may be increased by endocrine or metabolic conditions like diabetes or hypothyroidism.
Although it is not exclusively an overuse condition, repetitive usage of the shoulder, particularly overhead exercise, may increase tendon stress and initiate the process.
Age: more common in women and middle-aged people (30–60 years).

Shoulder pain that develops suddenly or subtly, frequently without significant damage.
Lying on the afflicted shoulder during the night frequently makes the pain worse.
Reduced range of motion and shoulder movement, particularly overhead and internal rotation, exacerbate the pain.
Either a strong pain or a mild discomfort during the resorptive phase.
Clicking, catching, or impingement sensations when the deposit is beneath the acromion are examples of potential mechanical symptoms.
On physical examination, there may be scapular dyskinesis, a painful supraspinatus region, a reduced active range of motion relative to passive range of motion, and positive impingement tests.

A thorough history of the development of pain, things that aggravate or relieve it, sleep disturbances, and demands from work or sports.
Certain orthopaedic examinations are helpful, such as the Hawkins-Kennedy Test for impingement and the Empty Can Test for supraspinatus.
In particular, we could carry out:
- The empty can test: involves the patient abducting their arm around 90 degrees in the scapular plane with their thumbs down. The therapist applies downward force, and any pain or weakness indicates supraspinatus disease.
- Hawkins-Kennedy Test: the examiner rotates the arm internally after flexing the shoulder and elbow to 90 degrees; pain indicates involvement of the sub-acromial impingement location.
- Painful Arc Test: abduction pain between around 70 and 120 degrees indicates sub-acromial involvement.
At Elite, we combine these clinical tests with imaging to increase confidence and help direct our suspicions.
Other Investigations: Plain radiographs, Ultrasound, MRI / CT

With modern modalities and an evidence-based exercises program that emphasizes structure, function, and return to sport/work demands, we at the Elite Center customize care. Our physiotherapy treatment approach for calcific tendinitis is shown below.

Relative rest: To lessen tendon overload, decrease aggravating activities (particularly overhead lifts and repetitive rotation).
Pain management techniques include, for instance, using heat or ice as needed and teaching patients how to sleep to reduce pain at night.
Electro-modalities: Class IV High Intensity Laser Therapy is used to improve microcirculation, lessen pain, and accelerate healing. At Elite, we use this when movement is restricted due to acute or subacute discomfort.
Super Inductive System (SIS): We employ this high-energy electromagnetic therapy early in the rehabilitation protocol to reduce pain and promote exercise uptake. It also enhances tendon metabolic activity and deep tissue stimulation.
Extracorporeal shock wave therapy: There is evidence that shock wave therapy can reduce deposit size and improve results for deposits that are refractory or in the resorptive phase.
Dry needling and cupping: To ease myofascial constraints and improve local perfusion, we may use dry needling or therapeutic cupping in cases of peri-tendinous pain or related muscular tension (supraspinatus, infraspinatus, posterior cuff, scapular stabilisers).
Mobilization: to preserve joint mobility and avoid secondary stiffness, perform mild pendulum exercises and actively aid shoulder mobilization (flexion, abduction, internal/external rotation).

We implement targeted rotator cuff and scapular stabilizer strengthening, which is essential for preventing recurrence and enhancing function, as pain decreases and range increases.
Take care of your posture, kinetic chain, and scapular dyskinesis: Since shoulder mechanics affect tendon load, we at Elite focus on thoracic posture, scapula-humeral rhythm, and core/trunk stability.

We use sport/job-specific exercises like overhead catching/throwing, wrestling overhead lifts (if an athlete), shoulder conditioning, and eccentric cuff loading once fundamental strength and mechanics are restored.
At this stage, we use functional outcome measures (such as DASH and SPADI) to monitor and guarantee a pain-free return to the prior workload and sport.

First of all, Due to advanced physical therapy techniques (SIS, Shock-Wave Therapy, Class IV Laser)
Customized treatment programs depending on your employment, sport, and way of life
comprehensive evaluation with specific tests and objective measurements
Pain management, mobility restoration, strength/loading progression, and return to function are all part of an integrated program.
Proven results for calcific kinds of shoulder tendinopathies

When properly managed, calcific tendinitis is a difficult but very manageable illness. At the Elite Physiotherapy & Sports Injury Center, we guide you from pain and limited motion to full functional recovery by combining accurate assessment, cutting-edge modalities, and customized training regimens. Make an appointment for an evaluation with us if you have shoulder pain, difficulty sleeping, diminished overhead function, or suspect calcific deposits. Our team, led by will conduct a thorough evaluation and create a customized rehabilitation plan for you.