Calcific tendinitis in Vienna
The arm can hardly be lifted sideways any more, at night you find no position to lie in, and the pain seemed to come from nowhere. Behind this there is often a calcium deposit in a tendon of the rotator cuff. At my practice in Vienna-Döbling I assess this with ultrasound and treat it first without an operation.
In short
In calcific tendinitis (tendinitis calcarea) calcium is deposited in a tendon of the rotator cuff, usually in the supraspinatus tendon under the acromion. Typical signs are pain when lifting the arm sideways, night pain on the affected side and a sudden, very severe painful phase when the deposit dissolves. The assessment is made with the conversation, the clinical examination, ultrasound and an X-ray. Treatment is conservative first: physiotherapy, focused and radial shockwave, ultrasound-guided injection. If deposit and symptoms prove stubborn, the calcium can be cleared out arthroscopically.
What is calcific tendinitis?
The rotator cuff is a cap of four tendons that guides the humeral head and lifts and rotates the arm. In calcific tendinitis a small area of this tissue is remodelled: firm tendon tissue turns into tissue similar to fibrocartilage, in which calcium salts are deposited. Why the remodelling begins is not conclusively established; the blood supply to the tendon and mechanical load are discussed.
How calcific tendinitis runs its course
The condition runs in phases. Remodelling and calcification are followed by the resorptive phase, in which the body breaks the deposit down itself — often the most painful period, because soft calcium material can escape into the bursa and trigger a severe inflammation there (Bursitis subacromialis). The tendon then settles; how long the phases last differs from person to person.
This path is not a straight one. A deposit can stay silent for a long time and then quickly cause severe symptoms. The sudden peak of pain that brings many people to the practice often coincides with the resorptive phase — it feels threatening, but it belongs to the course.
What else hurts in a similar way
For as long as the deposit takes up room, it irritates the bursa directly above it; the symptoms then resemble subacromial bursitis, which used to be called impingement. A tear of the rotator cuff and a frozen shoulder hurt in a similar way. Telling these pictures apart is the purpose of the examination — they are treated differently.
Bursitis is not a counterpart to calcific tendinitis: a calcium deposit is one possible cause of it, but the bursa also becomes inflamed without a deposit, from overhead overload or next to tendon damage for instance. In a tear of the rotator cuff the tendon is interrupted, in a frozen shoulder the joint capsule has shrunk. For treatment that makes the decisive difference — which is why the examination comes first.
Typical symptoms
- Pain when lifting the arm sideways — above all in the middle part of the arc
- Night pain — lying on the affected shoulder is hardly possible
- A sudden peak of pain — in the resorptive phase the arm is held motionless
- Loss of strength — lifting and carrying become hard, partly through the protective posture
- Radiation — the pain draws into the outer upper arm
- Restricted movement — usually because of the pain, not because of a shrunken capsule
- Symptoms overhead — in overhead sport and when working above shoulder height
What you can do yourself until your appointment
Until the assessment, the night pain can often be eased a little. Avoid lying on the affected shoulder — lying down removes the relieving muscle tension and the pressure under the acromion rises. On your back or on the healthy side it is usually more bearable; a pillow under the affected arm takes the pull off the tendon. In the irritated phase many people find cooling pleasant. Over-the-counter painkillers can bridge a night — please check this at the pharmacy or with your doctor, particularly if you have other conditions or take other medication.
What you should not do: hold the arm completely still. Complete immobilisation leads to stiffness, and a stiff shoulder is more troublesome to treat than the calcium deposit itself. Keep the shoulder moving within the range that does not hurt. If the symptoms persist or grow severe quickly, have the shoulder assessed rather than waiting any longer.
How I make the diagnosis
It begins with the conversation: how long the symptoms have been there, which movements set them off, how the nights go. The clinical examination follows, with movement and function tests that separate calcific tendinitis from other causes of shoulder pain. In the practice I assess tendon, bursa and deposit with ultrasound, in motion as well. An X-ray shows the position, extent and density of the calcium. X-ray and MRI are not in the building — I arrange them and go through the images with you.
Please bring everything to the appointment that already exists: your e-card, previous findings and doctors' letters, and X-ray, CT or MRI images, older ones included. If images are held digitally, bring the data carrier and not only the written report; the images themselves show how a deposit has changed. You do not need a referral. Assessment and, where the findings allow it, the first step of treatment sit together in the same appointment — the ultrasound is in the practice for that.
Treatment: conservative first
The aim of treatment is to relieve the pain, to preserve movement and to support the body's own breakdown of the deposit. I avoid complete immobilisation, because the shoulder would otherwise stiffen. The reflex with severe shoulder pain is to stop moving the arm; but a shoulder that is held still loses range of movement, and a second problem needing treatment of its own would be added to the painful deposit. So the first task is to bring the pain down far enough for movement to be possible again.
- Physiotherapy and exercise therapy — in-house at the Orthozentrum Döbling, with targeted strengthening of the shoulder-stabilising muscles
- Ultrasound-guided injection — placed under visual control exactly where the irritation lies
- Shockwave therapy — the focused shockwave acts at depth on the deposit, the radial one superficially on muscle and tendon insertion
- Magnetic field therapy — as an adjunct for a strongly irritated shoulder
- Adjusting load — overhead work and training are adapted, not dropped
Which of these measures makes sense, and when, depends on the phase of the deposit and on how far you are restricted in daily life. My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. The page on the private practice explains how this works.
What happens during an ultrasound-guided injection
An injection is not a shot in the dark. I first image the shoulder with ultrasound and see where the irritation actually sits — in the bursa, at the tendon or at the deposit. Under visual control I guide the needle there and follow on the screen where the medication arrives. The space under the acromion is narrow, and a medication acts where it lies. This step makes sense above all when the pain blocks every movement: once the irritation has settled, physiotherapy can take hold again. The injection is thus a door-opener for the actual treatment, not a substitute for it.
Focused and radial shockwave in practice
With calcific tendinitis, the shockwave is the treatment that is aimed at the deposit itself. The focused form concentrates its energy on a point at depth; I set the target point beforehand on the deposit with ultrasound. The radial form spreads its energy more superficially and reaches muscle and tendon insertion — the area that suffers along with the protective posture. For the shoulder that means: the focused shockwave aims at the calcium, the radial one at what it has done to the surrounding tissue; I often combine the two.
Treatment takes place in the practice, with contact gel and without an anaesthetic; the application is clearly felt, and I steer the intensity by what is bearable for you. How many sessions make sense, and at what intervals, depends on the findings and the course — there is no fixed scheme. More on the procedure is on the page about shockwave therapy.
When an operation is necessary
Most calcific shoulders need no procedure. I advise one only once the conservative options have been exhausted, the symptoms persist and the deposit can still be demonstrated. Surgery is arthroscopic, in keyhole technique: through small incisions I clear out the deposit and remove inflamed bursa tissue; I treat an accompanying tendon tear in the same session.
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
After the procedure
Once the deposit has been cleared out, the aim is the same as before: the shoulder should come back into movement early. The build-up is taken on by physiotherapy and exercise therapy at the Orthozentrum Döbling; I carry out the check-ups myself and clear the next steps. I do not set off-the-peg timetables — when daily life, work and sport come round again depends on the findings at operation and on how healing progresses. If a tendon tear had to be treated in the same session, the aftercare follows that repair: a repaired tendon needs protection at first, and clearance is correspondingly more cautious.
We decide together whether and when an operation makes sense for you, as soon as examination and imaging are available.
Frequently asked
Frequently asked questions about calcific tendinitis
Often it does. In the resorptive phase the body breaks the deposit down itself, and the tendon then settles. This cannot be predicted: some deposits stay silent, others cause severe symptoms. Conservative treatment supports the breakdown and relieves the pain in the meantime. Whether to wait or treat actively depends on the findings and the symptoms.
Through the conversation and the clinical examination: certain movement tests separate calcific tendinitis from other causes. In the practice I assess tendon, bursa and calcium deposit with ultrasound, in motion as well. An X-ray shows the position, extent and density of the deposit. I arrange an MRI only when I additionally suspect a tendon tear or another accompanying injury.
The shockwave is one pillar of conservative treatment. The focused shockwave acts at depth on the calcium deposit, the radial one more superficially on muscle and tendon insertion; I often combine the two. It is applied in the practice and needs no anaesthetic. How many sessions make sense depends on the findings and the course. That a deposit will disappear cannot be guaranteed.
In calcific tendinitis a calcium deposit sits in the tendon. In subacromial bursitis, formerly called impingement, the bursa above the tendon is irritated and thickened. The deposit can irritate the bursa above it, so both can occur together. But bursitis also occurs without any calcium. Ultrasound and X-ray show which applies in your case.
When you lie down, the relieving muscle tension falls away and the pressure under the acromion rises — particularly if you lie on the affected side or put the arm above your head. In addition the bursa is irritated in the acute phase and reacts sensitively to pressure. Night pain occurs with other shoulder conditions as well and should be assessed.
In most cases not. I suggest a procedure only once physiotherapy, shockwave and injection have been exhausted and the symptoms persist. Surgery is arthroscopic: the deposit is cleared out through small incisions, inflamed bursa tissue is removed and accompanying tendon damage is treated at the same time. We take the decision together, as soon as all the findings are in.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. For operations, direct settlement with a supplementary private insurance is possible. You do not need a referral; please bring your e-card, previous findings and any images you have.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.