The shoulder is one of the most continuously used joints in our body, from eating and bathing to virtually every daily activity. As the only joint capable of 360-degree rotation, frequent use makes it susceptible to various conditions. When weakened tendons experience decreased blood circulation and degenerative changes begin, calcific tendinitis becomes more likely. Calcific tendinitis is also known to occur more frequently with diabetes or thyroid conditions, though it can develop without any clear cause, requiring caution across all age groups. When calcific tendinitis develops, think of it as stones forming in the rotator cuff tendons that control shoulder function. Most patients with calcific tendinitis experience severe shoulder pain. Pain is worse during the absorption phase (when calcium dissolves) than the formation phase. In severe cases, patients may visit the emergency room with shoulder swelling and fever, and shoulder range of motion may decrease. Night pain is especially intense, with many patients reporting that it disrupts sleep and significantly diminishes quality of life.
Calcific tendinitis progresses through formation, resting, and dissolution phases. As mentioned, pain intensifies during the dissolution phase when hardened calcium suddenly begins to dissolve, releasing pain-causing chemical substances. Why does the pain worsen at night? First, posture plays a role. During the day, sitting or standing reduces gravitational compression, widening the shoulder joint space and lessening pain. But lying down at night narrows the joint space, worsening inflammation and triggering night pain. Second, hormones are a factor. Melatonin — a sleep-inducing hormone released primarily at night — stimulates inflammatory cytokines, intensifying shoulder pain at night. Combined with pressure differences in the joint between day and night, calcific tendinitis pain inevitably worsens at night. Diagnosis is relatively straightforward. Large calcium deposits are visible on basic X-ray, but micro-calcifications require ultrasound for detection. So should patients with large X-ray-visible calcium skip the ultrasound?
Considering the cause of calcium formation provides a quick answer. Calcium forms when degenerative changes and poor posture stress the rotator cuff, weakening the tendons. Therefore, even if X-ray confirms calcium deposits, ultrasound is still needed to check for secondary conditions such as tendon weakening or tears. There are various treatment options for calcific tendinitis. Extracorporeal shockwave therapy is the most commonly performed treatment — its purpose is not so much to break up the calcium but to improve blood supply to the tendons. For micro-calcifications, just a few sessions of shockwave therapy can show significant improvement. However, as mentioned, by the time patients seek treatment, the calcium has typically already grown large and hardened — making dramatic results from conservative treatment alone unlikely. For patients who haven't improved despite prolonged conservative treatment, a more aggressive option is barbotage (calcium aspiration). What is barbotage?
Using ultrasound to precisely locate the calcified tissue, a specialized needle is used to break up and extract the calcium. The tendon space left after calcium removal also requires additional regeneration therapy. Followed by anti-inflammatory treatment and lifestyle modifications, patients typically show gradual improvement. Since the procedure can be done same-day without extended hospitalization and allows immediate return to daily activities, many patients can receive treatment without significant disruption. Calcific tendinitis causes pain that is distinctly different from simple muscle soreness. When pain develops, don't delay seeking medical care — pursue active treatment. Please don't endure shoulder pain. Find the cause and seek proper treatment. Watch the calcific tendinitis barbotage procedure video
