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Calcific Tendinitis

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Calcific tendinitis causes shoulder pain from calcium deposits; treatment ranges from observation to washing out the calcium.

Updated Aug 202611 citations

Calcific tendinitis of the shoulder: a chalky calcium deposit builds up inside one of the rotator cuff tendons, often the supraspinatus, and can cause sudden severe pain when it inflames the surrounding tissue. Kieran Hirpara 4.0

What you're feeling

You might notice that your shoulder feels stiff or achy, even if you do not have sharp pain. It is common to have calcium deposits in the tendons of your shoulder without any symptoms at all. In fact, only one third of these deposits cause pain. If you are feeling discomfort, it often comes and goes in waves.

When the pain is active, it usually sits on the outside of your upper arm. You may feel a deep ache that worsens when you lift your arm above your head. Simple tasks like reaching for a cup on a high shelf or placing a bag in the boot of your car can become difficult. The pain often flares up at night, making it hard to find a comfortable position to sleep. You might also feel stiffness when you first wake up in the morning.

The intensity of your symptoms can vary. Some days you may feel fine, while on others, even small movements trigger pain. This condition is often self-limiting, meaning it can settle down on its own over time. However, if the calcium deposit is large, you are more likely to need surgery to remove it. Specifically, deposits larger than 1 cm make you nearly three times more likely to require an operation.

If your pain persists, your surgeon will check for other issues. There is a higher chance of having a rotator cuff tear alongside calcific tendinitis than previously thought. Your surgeon may recommend conservative treatments first, such as rest or therapy. These approaches lead to excellent or good results for 72% of patients, regardless of the size or type of deposit. If conservative care does not help, we may discuss other options like shock wave therapy or a minor procedure to wash out the calcium.

What's actually happening

Calcium deposits often form in the tendons of your shoulder. These are rope-like tissues that connect your muscles to your bones. It is a frequent occurrence in the general population. However, most of the time, these deposits cause no trouble at all. Only one third of people with calcific tendon deposits actually experience pain.

When symptoms do appear, the calcium builds up within the tendon fibres. This can make the tissue stiff and inflamed. The resulting irritation causes the sharp pain or stiffness you feel when moving your arm. Your shoulder may feel weak or simply refuse to move through its normal range.

In some cases, the body’s natural healing process breaks down the deposit. This can sometimes lead to a tear in the rotator cuff. The rotator cuff is the group of tendons that stabilise your shoulder joint. A tear here is the only factor that affects your complete recovery of shoulder function after treatment.

The shape of your shoulder bone does not seem to influence this condition. Research shows that the space above your joint is similar whether you have calcific tendinitis, a partial tear, or a full tear. The idea that a specific bone shape causes the pain has not been supported by evidence.

If the deposit is large, specifically greater than 1 cm, it is more likely that you will need surgery. Smaller deposits often respond well to conservative treatment. This includes rest, anti-inflammatory medication, or physical therapy. Many patients see clinically significant improvement with these non-surgical methods.

In chronic cases where pain persists, other options like extracorporeal shock wave therapy may be considered. This uses sound waves to break up the calcium. It is generally safe and well-tolerated. However, if you have factors that suggest a poor outcome with this therapy, your surgeon may recommend a different procedure.

Routine exploration of the shoulder joint during surgery is usually not beneficial. Intra-articular pathologies are rare in these cases and often do not require surgical treatment. The focus remains on removing the calcium and repairing any associated tendon damage to restore your movement.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition.

Calcific tendon deposits are common, but only one third cause pain. If you are in that group, we begin with self-management and physiotherapy. Your physiotherapist will guide you through exercises to restore movement and strengthen the shoulder muscles. This approach aims to reduce stiffness and improve function without invasive procedures. We typically recommend a trial of this conservative care for several weeks to see if your symptoms settle.

If pain persists, we move to medical management. We often prescribe oral anti-inflammatory medication to help reduce swelling and discomfort. For more targeted relief, we may offer corticosteroid injections. These injections deliver strong anti-inflammatory medicine directly to the affected area to calm the irritation. While effective for many, the relief is temporary and does not remove the calcium deposit itself. We also consider other injections, such as hyaluronic acid or platelet-rich plasma (PRP), to support tissue healing.

When conservative care reaches its limit, we discuss procedural options. Ultrasound-guided needling (barbotage) uses a needle to break up and wash out the calcium deposits. This is safe and effective for many patients. Another option is extracorporeal shock wave therapy (ESWT), which uses sound waves to treat the area. ESWT is well-tolerated and can significantly reduce pain and improve shoulder function. Radial ESWT, in particular, has shown a 14.28% reduction in pain and a 43% improvement in shoulder functional status compared to traditional physiotherapy alone.

Surgery is considered only when these non-operative treatments have not given enough improvement. Our surgical option involves arthroscopic debridement, where we remove the calcium deposits and clean the tendon. This is a safe and effective method, whether the calcium is in the tendon or has moved into the bone.

Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment, including history, examination, and imaging where needed, establishes the diagnosis. We work with you to decide on the best path forward, ensuring you understand the benefits and limits of each option.

What to expect

Calcium deposits in your shoulder tendon are common, but they do not always cause pain. In fact, only one third of people with these deposits experience symptoms. If you are in that group, you may notice that the pain comes and goes. The condition often follows a natural cycle where the calcium can eventually dissolve on its own. This process of resorption happens most frequently in the summer months, though it can occur at other times.

If your symptoms have been present for ten months or less, or if the deposit is small (10.82 mm or less), there is a good chance it will resolve without invasive treatment. Conservative management is the primary choice for most patients, especially in the early stages. With conservative care, 72% of patients achieve excellent or good results. This improvement happens regardless of where the deposit is located or how large it initially appears. Your surgeon will guide you through this phase, focusing on pain relief and maintaining movement.

For those with chronic symptoms, treatments like extracorporeal shock wave therapy (ESWT) or needle lavage can help. ESWT works best for smaller deposits and shorter symptom durations. Needle lavage, which involves washing out the deposit, provides notable pain reduction at two months. However, its effectiveness may decrease over the long term. If your deposit is larger than 1 cm, you are nearly three times more likely to need surgical removal if conservative methods do not work.

Surgical removal of the calcium deposit leads to good short-term outcomes. These results are similar whether or not your surgeon performs additional decompression of the shoulder space at the same time. The key factor for success is the complete removal of the calcium. If any deposit remains, functional recovery may be limited. While rotator cuff tears can occur alongside calcific tendinitis, they are not always present and do not always require separate surgical treatment during this procedure. Your outlook depends largely on the size of the deposit and how long you have had symptoms.

When to see someone

Calcific deposits in the shoulder are common, but only one third cause pain. You may have these deposits without any symptoms at all. However, if you have subacromial pain syndrome, there is a 42.5% chance of calcific deposits. See your GP if you experience persistent shoulder pain that does not improve with rest. Seek specialist review if the pain interferes with your sleep or daily work. Larger deposits greater than 1 cm are more likely to need surgery. Your surgeon will assess whether imaging is needed to rule out other issues like rotator cuff tears.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Calcific tendinitis is worth the extra reading because it behaves unlike most shoulder conditions: the deposit is common in people with no pain at all, the body usually dissolves it without help, and the treatment that removes the calcium is not the one that relieves the pain fastest.

The deposit is a common finding, not automatically a diagnosis

A calcium deposit reported on your scan is easy to read as the cause of the problem, because it is visible and the pain is real. The prevalence data complicate that. Among 1,219 adults, deposits were present in 7.8% of people without symptoms and 42.5% of those with subacromial pain syndrome [1]. In a separate series of 302 shoulders, deposits were frequent in the general population and only about one third were painful [2].

So the deposit raises the probability that it is the source, substantially — but roughly one in thirteen painless shoulders has one too. What appears to shift a deposit from silent to symptomatic is partly size and position: the highest likelihood of genuinely symptomatic disease was in women aged 30 to 60 with subacromial pain and a deposit longer than 1.5 cm [1], and pain correlated with location in supraspinatus and with involvement of more than one tendon [2].

It usually dissolves, and that shapes everything

The natural course is towards resorption, which is why so many treatments appear to work. The clearest illustration comes from a randomised trial in which every patient had needling and lavage and was then randomised to a steroid or saline injection: at twelve months the calcification had resorbed in 83% of the saline group and 74% of the steroid group [3].

Read that carefully, because it contains the counter-intuitive result. The steroid improved pain for six weeks and function for three months — and had no significant effect on whether the calcium disappeared [3]. Pain relief and calcium clearance are separate processes. A treatment can deliver one without the other, and the visible thing on the scan is not the thing driving the symptoms week to week.

Which is why the non-operative options perform alike

If the deposit largely resolves regardless, the treatments are competing to make the interval tolerable rather than to cure. That is what the comparisons show. Across 257 patients, physical therapy, corticosteroid injection and ultrasound-guided barbotage produced similar rates of avoiding surgery [4]. In 239 patients the same three approaches were largely successful, with physiotherapy alone carrying the highest failure rate [5].

Among the procedural options, high-energy shockwave therapy is the most thoroughly studied minimally invasive treatment and has been shown safe and effective in the short to medium term, while ultrasound-guided needling has not been shown superior to an ultrasound-guided subacromial injection [6]. Pooling 1,258 patients, shockwave, needling and arthroscopy all produced good clinical outcomes [7], and barbotage across 908 patients was safe with a high success rate but has never been compared head-to-head against the other major options [8].

What surgery adds, stated precisely

Surgery is not without an advantage, and the size of it is worth quoting rather than characterising. Pooling 2,352 patients from randomised trials, surgical treatment produced larger improvement in functional scores and comparable pain reduction to non-operative treatment, particularly ultrasound-guided needling — with both routes achieving clinically significant improvement [9]. Among surgical techniques themselves there was no significant difference, and removing the deposit alone performed similarly to removing it plus a subacromial decompression [10].

The function-versus-pain split is the useful detail. If pain is the dominant complaint, the evidence does not clearly favour an operation. If stiffness and loss of function dominate and have persisted, it favours one more.

The association most often missed

Calcific tendinitis is not evenly distributed. In 102 patients, those with an associated endocrine disorder — thyroid disease and diabetes principally — developed symptoms at a younger age, had a significantly more protracted course, and more frequently required surgery [11].

This is worth raising with your GP if your course has been unusually long or began early, not because treating the endocrine condition resolves the shoulder, but because it changes what a realistic timeline looks like. Being told a condition is self-limiting is difficult to reconcile with two years of pain; the endocrine association is one explanation for why the usual reassurance does not fit every case.

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Reviewed by Dr Kieran Hirpara · 7 August 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References for the advanced reading

1. Louwerens JK, Sierevelt IN, van Hove RP, van den Bekerom MP, van Noort A. Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. J Shoulder Elbow Surg. 2015;24(10):1588-93.
2. Sansone V, Consonni O, Maiorano E, Meroni R, Goddi A. Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders. Skeletal Radiol. 2015;45(1):49-55.
3. Darrieutort-Laffite C, Varin S, Coiffier G, Albert J, Planche L, Maugars Y, et al. Are corticosteroid injections needed after needling and lavage of calcific tendinitis? Randomised, double-blind, non-inferiority trial. Ann Rheum Dis. 2019;78(6):837-43.
4. Gilbert R, Dadoo S, Lin R, Bhardwaj N, McMahon S, Steuer F, et al. Comparison of physical therapy, corticosteroid injections, and ultrasound-guided barbotage for nonoperative management of calcific tendinitis. Orthop J Sports Med. 2026;14(4).
5. Drummond M, Ayinon C, Lin A, Dunn R. Relative efficacy of three nonsurgical treatments for calcific tendinitis: physical therapy vs steroid injection vs barbotage. Orthop J Sports Med. 2021;9(7_suppl4).
6. Louwerens JK, Sierevelt IN, van Noort A, van den Bekerom MP. Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2014;23(8):1240-9.
7. Louwerens JK, Veltman ES, van Noort A, van den Bekerom MP. The effectiveness of high-energy extracorporeal shockwave therapy versus ultrasound-guided needling versus arthroscopic surgery in the management of chronic calcific rotator cuff tendinopathy: a systematic review. Arthroscopy. 2015;32(1):165-75.
8. Gatt DL, Charalambous CP. Ultrasound-guided barbotage for calcific tendonitis of the shoulder: a systematic review including 908 patients. Arthroscopy. 2014;30(9):1166-72.
9. Angileri HS, Gohal C, Comeau-Gauthier M, Owen MM, Shanmugaraj A, Terry MA, et al. Chronic calcific tendonitis of the rotator cuff: a systematic review and meta-analysis of randomized controlled trials comparing operative and nonoperative interventions. J Shoulder Elbow Surg. 2023;32(8):1746-60.
10. Anam E, Zahran S, Roy A, Daneshvar P, Bicknell RT, Janssen I. Surgical approaches of shoulder calcific tendonitis: a systematic review and meta-analysis. JSES Rev Rep Tech. 2024;4(3):353-8.
11. Harvie P, Pollard TC, Carr AJ. Calcific tendinitis: natural history and association with endocrine disorders. J Shoulder Elbow Surg. 2007;16(2):169-73.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• Calcific tendon deposits of the shoulder are a frequent occurrence in the general population [1].
• Only one third of calcific tendon deposits are painful [1].
• The primary choice of treatment for calcific tendinitis is conservative, especially in patients with acute calcific tendinitis [7].
• Conservative treatment for calcific tendinitis of the shoulder showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits [3].
• Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment in the setting of calcific tendinitis of the shoulder [2].
• Extracorporeal shock wave therapy (ESWT) can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder due to its good tolerance, safety, and clinical radiological response [6].
• Patients with calcific tendinitis of the shoulder who have factors identified for a poor outcome after ESWT should undergo a different procedure [38].
• Utilization of barbotage as a treatment for calcific tendonitis of the shoulder appears to produce notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation [9].
• The incidence of rotator cuff tears in cases of calcific tendonitis is higher than previously reported [10].
• Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of calcific tendinitis due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment [8].
• The short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression [14].

Anatomy & Pathophysiology

• Only one third of calcific tendon deposits in the general population are painful [1].
• Calcific tendinitis of the shoulder in the Korean population has demographic, radiographic, and clinical features that are not different from those of Western populations [5].
• Imaging and functional data indicate that calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis [11].
• The acromion index is not different between shoulders with calcifying tendinitis, partial-thickness rotator cuff tears, or full-thickness rotator cuff tears [17].
• The acromion index of shoulders with calcific tendinitis is comparable to that of shoulders with subacromial impingement [27].
• The theoretical concept that a high acromion index results in increased upward force against the subacromial space, influencing pain and function in calcifying tendinitis, was not supported [40].
• A rotator cuff tear was the only factor affecting the complete recovery of shoulder function in patients treated for calcific tendinitis [35].

Classification

• Symptoms of calcific tendinitis can be protracted, resulting in time off work and impaired quality of life [4].
• The demographic, radiographic, and clinical features of calcific tendinitis in the Korean population are not different from those of Western populations [5].
• The acromion index is not different between shoulders with calcifying tendinitis, partial- or full-thickness rotator cuff tears [17].
• Calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis [11].
• Calcification in medial epicondylitis was more commonly identified than previously reported and was distributed over a relatively broad area [13].
• Conservative treatment for calcific tendinitis showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits [3].
• Shock wave therapy is a heterogeneous but effective treatment for calcifying tendinitis of the shoulder [18].

Clinical Presentation

• Only one third of calcific tendon deposits in the shoulder are painful [1].
• The prevalence of calcific deposits within the rotator cuff tendons is 7.8% in asymptomatic patients [21].
• The prevalence of calcific deposits within the rotator cuff tendons is 42.5% in patients with subacromial pain syndrome [21].
• Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment [2].
• The demographic, radiographic, and clinical features of calcific tendinitis in the Korean population were not different from those of Western populations [5].
• Acute calcific deposition of the hand and wrist is a benign self-limiting disease [15].
• Clinical criteria predictive for shoulder rotator cuff calcific tendinopathy can help clinicians suspect this musculoskeletal disease early and with certainty [22].

Investigations

• Calcific tendinitis symptoms can be protracted, resulting in time off work and impaired quality of life [4].
• Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis [16].
• Sonographic or MRI evaluation has accuracy limitations when assessing for rotator cuff tears in the context of calcific tendinitis [16].
• The condition of articular chondrocalcinosis is characterized by multiple calcific deposits in the articular cartilage, primarily in the deeper and mid-portions of the cartilage above the tidemark [41].
• The dynamic pathological process of calcific tendinopathy includes migration patterns of calcium deposits [12].

Treatment

• Calcific tendon deposits are a frequent occurrence in the general population, although only one third are painful [1].
• Nonsurgical management remains the mainstay of treatment for calcific tendinitis of the rotator cuff, with most patients improving with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections [19].
• Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain, and thus it is reasonable to trial ultrasound-guided needling (barbotage) and extracorporeal shock wave therapy (ESWT) as first-line treatment [36].
• ESWT can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder due to its good tolerance, safety, and clinical radiological response [6].
• ESWT in calcific tendinitis of the shoulder is very effective [20].
• ESWT has a therapeutic effect on tendinosis calcarea [29].
• Radial extracorporeal shock wave therapy (rESWT) showed a 14.28% reduction in pain, a 43% improvement in shoulder functional status, and significant increases in shoulder flexion, abduction, extension, and external rotation compared to traditional physiotherapy [26].
• Needle aspiration of calcific deposits (NACD) is safe and effective for calcific tendinitis of the rotator cuff [30].
• Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement [31].

Complications

• Calcific tendon deposits of the shoulder are a frequent occurrence in the general population, although only one third are painful [1].
• Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis and aware of the accuracy limitations of sonographic or MRI evaluation [16].
• The prevalence rate of calcific deposits in the rotator cuff is 7.8% in asymptomatic patients and 42.5% in patients with subacromial pain syndrome [21].

Recovery

• The dynamic pathological process of calcific tendinopathy includes migration patterns of calcium deposits, which are relevant to functional recovery [12].
• Arthroscopic bursectomy and debridement of the calcific deposit provides short-term functional outcomes that are not influenced by whether subacromial decompression is performed in combination [14].
• Outcome after arthroscopic treatment seems to correlate strongly only with the presence of residual calcium deposits in the tendon, with complete removal recommended [48].
• Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques [23].
• There was no significant difference in short- and long-term clinical outcomes between single- and double-needle US-guided percutaneous irrigation of calcific tendinopathy [24].
• Utilization of barbotage produces notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation [9].
• Only with one-time needling, radiologic changes in size and/or density were seen in 76.6% of the calcific tendinitis patients at 4 weeks after the index procedure [28].
• A symptom duration of ≤10 months or calcification size of ≤10.82 mm represented the clinical scenarios most likely to show resorption after ESWT [44].
• In ESWT studies, Type III calcifications and shorter symptom duration were associated with better outcomes [46].
• The onset of calcium resorption in acute calcific tendinitis occurs most frequently in the summer in Japan [47].
• The minimal and substantial clinical benefit (MCID, SCB) and responsiveness for patients with long-lasting rotator cuff calcific tendinitis treated with minimally invasive treatment options have been established for the Constant-Murley score and Disabilities of the Arm, Shoulder and Hand score [32].

Key Evidence

• [L3] Calcific tendon deposits of the shoulder are a frequent occurrence in the general population, although only one third are painful. [1] (10.1007/s00256-015-2240-3)
• [L3] Patients with calcific lesions >1 cm had a 2.8 increased likelihood to undergo operative treatment in the setting of calcific tendinitis of the shoulder. [2] (10.1016/j.jseint.2021.01.013)
• [L2] Conservative treatment for calcific tendinitis of the shoulder showed clinically significant improvement, with 72% of excellent or good results regardless of the location, radiologic type and size, and initial symptoms of calcific deposits. [3] (10.1016/j.jse.2009.07.008)
• [L3] Calcific tendinitis is a poorly understood condition in which symptoms can be protracted, resulting in time off work and impaired quality of life. [4] (10.1016/j.jse.2006.06.007)
• [L4] This study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in the Korean population, which were not different from those of Western populations. [5] (10.5397/cise.2020.00010)
• [L2] Because of its good tolerance, safety, and clinical radiological response, ESWT can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder. [6] (10.1136/ard.62.3.248)
• [L5] The primary choice of treatment for calcific tendinitis is conservative, especially in patients with acute calcific tendinitis. [7] (10.5397/cise.2020.00318)
• [L3] Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of calcific tendinitis due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment. [8] (10.1186/s12891-017-1839-z)
• [L4] Utilization of barbotage as a treatment for calcific tendonitis of the shoulder appears to produce notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation. [9] (10.1016/j.jseint.2024.06.005)
• [L4] The incidence of rotator cuff tears in cases of calcific tendonitis in this cohort of patients who underwent MRI is higher than previously reported. [10] (10.1016/j.arthro.2019.11.127)
• [L2] Imaging and functional data indicate that calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis that should be considered in clinical and surgical practice. [11] (10.1016/j.jse.2008.09.016)
• [L5] The paper illustrates the dynamic pathological process of calcific tendinopathy, including migration patterns of calcium deposits, and discusses clinical and sonographic assessment to optimize diagnosis, rehabilitation, and interventional management for functional recovery. [12] (10.3390/diagnostics12123097)
• [L3] Calcification in medial epicondylitis was more commonly identified than previously reported and was distributed over a relatively broad area. [13] (10.1016/j.jse.2021.08.031)
• [L1] This study has demonstrated that the short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression. [14] (10.1016/j.arthro.2015.05.015)
• [L5] Acute calcific deposition of the hand and wrist is a benign self-limiting disease. [15] (10.1016/j.jhsa.2014.06.011)
• [L3] Shoulder surgeons should be cautious about rotator cuff tears as a comorbidity in calcific tendinitis and aware of the accuracy limitations of sonographic or MRI evaluation. [16] (10.5397/cise.2021.00094)
• [L3] The acromion index is not different between shoulders with calcifying tendinitis, partial- or full-thickness rotator cuff tears. [17] (10.1007/s00402-011-1263-z)
• [L1] Shock wave therapy is a heterogeneous but effective treatment for calcifying tendinitis of the shoulder. [18] (10.1177/1941738108331197)
• [L5] Nonsurgical management remains the mainstay of treatment for calcific tendinitis of the rotator cuff, with most patients improving with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. [19] (10.5435/jaaos-22-11-707)
• [L1] ESWT in calcific tendinitis of the shoulder is very effective. [20] (10.1007/s00256-004-0849-8)
• [L3] The prevalence rates of 7.8% in asymptomatic patients and 42.5% in patients with subacromial pain syndrome provide a current view on the epidemiology of calcific deposits in the rotator cuff. [21] (10.1016/j.jse.2015.02.024)
• [L3] These clinical criteria, predictive for shoulder RCCT, can be crucial to help all clinicians suspect this musculoskeletal disease early and with certainty, thus allowing for an appropriate and prompt diagnosis path. [22] (10.1177/17585732241244515)
• [L4] Percutaneous needle aspiration and lavage is effective in the short term and in the long term in calcific tendinitis of the shoulder, with results similar to or better than those published for other techniques, and it is only slightly invasive and painful. [23] (10.2214/ajr.07.2254)
• [L1] There was no significant difference in short- and long-term clinical outcomes between single- and double-needle US-guided percutaneous irrigation of calcific tendinopathy. [24] (10.1148/radiol.2017162888)
• [L2] Specifically, the rESWT group showed a 14.28% reduction in pain, a 43% improvement in shoulder functional status, and significant increases in shoulder flexion, abduction, extension, and external rotation. [26] (10.5606/archrheumatol.2019.7081)
• [L4] The AI of shoulders with calcific tendinitis is comparable to that of shoulders with subacromial impingement. [27] (10.1007/s00167-012-2327-5)
• [L4] Only with one-time needling, radiologic changes in size and/or density were seen in 76.6% of the calcific tendinitis patients at 4 weeks after the index procedure. [28] (10.1016/j.arthro.2013.03.033)
• [L2] ESWT has a therapeutic effect on tendinosis calcarea. [29] (10.1007/s00776-003-0720-0)
• [L4] Needle aspiration of calcific deposits (NACD) is safe and effective for calcific tendinitis of the rotator cuff. [30] (10.1016/j.ejrad.2016.01.018)
• [L3] Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement. [31] (10.1007/s00167-022-06870-2)
• [L2] This study established the MCID, SCB, and responsiveness for patients with long-lasting rotator cuff calci fi c tendinitis who were treated with minimally invasive treatment options. [32] (10.1016/j.jseint.2020.05.001)
• [L3] A rotator cuff tear was the only factor affecting the complete recovery of shoulder function. [35] (10.1177/03635465231217733)
• [L1] Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain, and thus it is reasonable to trial UGN and ESWT as first-line treatment. [36] (10.1016/j.jse.2023.03.017)
• [L3] Patients with calcific tendinitis of the shoulder who have the factors identified for a poor outcome after ESWT should undergo a different procedure. [38] (10.1302/0301-620x.99b12.bjj-2016-1178.r1)
• [L2] The theoretical concept of a high acromion index resulting in an increased upward force against the subacromial space, which influences pain and function in calcifying tendinitis of the shoulder, was not supported. [40] (10.1007/s00167-011-1563-4)
• [L5] The condition is characterized by multiple calcific deposits in the articular cartilage, primarily in the deeper and mid-portions of the cartilage above the tidemark. [41] (10.2106/00004623-197254040-00015)
• [L3] A symptom duration of ≤10 months or calcification size of ≤10.82 mm represented the clinical scenarios most likely to show resorption after ESWT. [44] (10.1177/23259671241231609)
• [L3] In SWT studies, Type III calcifications and shorter symptom duration were associated with better outcomes. [46] (10.1177/17585732251414964)
• [L3] The onset of calcium resorption in acute calcific tendinitis occurs most frequently in the summer in Japan; however, the reasons for seasonal variation remain unclear, and further studies will be needed. [47] (10.1186/s12891-020-03773-6)
• [L4] Outcome seems to correlate strongly only with the presence of residual calcium deposits in the tendon; complete removal is recommended. [48] (10.1016/j.jse.2004.04.001)

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