How Long Does Calcific Tendinitis Last? The Stages of the Condition

 

Calcific tendinitis of the shoulder progresses through specific stages, each with a different duration and intensity of symptoms. Find out how long each phase lasts, why pain peaks toward the end, and when the condition resolves on its own.

At a glance

  • ✓It often resolves on its own: in many cases, the body naturally absorbs the calcium deposit.
  • ✓It progresses through stages: pre-calcific, calcific (formation – resting – resorption), and post-calcific.
  • ✓Duration varies significantly: from a few weeks to several years, depending on the phase.
  • ✓Severe pain occurs during the resorption phase: it is the most painful stage, but also the stage that leads toward healing.
  • ✓The resorption phase usually lasts from 3 weeks to 6 months, with the acute pain episode often subsiding within 1 to 2 weeks.
  • ✓Treatment is generally conservative. Arthroscopic removal is considered only when symptoms persist.

What is calcific tendinitis?

Calcific tendinitis is a form of shoulder tendinitis characterized by the deposition of calcium crystals within the rotator cuff tendons, most commonly the supraspinatus tendon. It is not simply wear and tear: it is an active, cell-regulated process in which the tendon locally transforms into fibrocartilage and subsequently becomes calcified.

It occurs most commonly between the fourth and sixth decades of life. Importantly, it does not always cause symptoms: a proportion of patients with calcium deposits have no discomfort at all. The condition is generally considered self-limiting, meaning that in many cases the body absorbs the deposit without surgery.

Stages of the condition

The classic description of the disease’s progression, as formulated by Uhthoff and Loehr, divides it into three major stages. The middle, calcific stage, is subdivided into three phases. Understanding these stages explains why pain is not constant but peaks at a specific point in time.

Stages of calcific tendinitisThe red curve shows pain intensity
Stage 1Pre-calcificThe tendon transforms into fibrocartilage, without calcium being present yetUsually asymptomatic
Stage 2Formation phaseCalcium is gradually deposited1 to 6 yearsPainless or mild pain
Stage 2Resting phaseThe deposit stabilizesUnpredictable durationNo or variable discomfort
Stage 2Resorption phaseAn inflammatory process absorbs the calcium3 weeks to 6 monthsAcute, severe pain
Stage 3Post-calcificThe tendon heals and remodelsSymptoms subside

1. Pre-calcific stage

The tendon undergoes a silent transformation into fibrocartilage, without calcium deposition occurring yet. This stage is generally asymptomatic and often goes unnoticed.

2. Calcific stage

This is the main stage of the disease and includes three successive phases:

  • Formation phase: calcium is gradually deposited within the tendon. It is usually painless or causes mild, chronic pain.
  • Resting phase: the deposit stabilizes and remains unchanged. It may be asymptomatic or accompanied by discomfort of varying intensity.
  • Resorption phase: the body activates an inflammatory process to absorb the calcium. This is the most painful phase, with acute and severe pain.

3. Post-calcific stage

After the calcium is resorbed, the tendon heals and remodels. Symptoms subside and shoulder function is gradually restored.

How long does each stage last?

The total duration of calcific tendinitis varies significantly from one patient to another and depends on the phase of the condition. Indicatively:

  • Formation phase: it may last from one to as long as six years, usually without severe symptoms.
  • Resting phase: its duration is unpredictable and may continue for a long period.
  • Resorption phase: it usually lasts from 3 weeks to 6 months. The acute, most severe pain episode often subsides within 1 to 2 weeks.

iIn simple terms: a calcium deposit may remain silent for years and suddenly become noticeable through severe pain. This is why two patients with the same condition may have completely different experiences in terms of duration. The size of the calcium deposit is not necessarily related to the intensity of symptoms.

What are the symptoms?

Symptoms vary depending on the phase. During the formation phase, pain is mild or absent. During the resorption phase, acute, severe pain occurs and may significantly limit movement. Night-time shoulder pain and difficulty raising the arm are also common. This presentation may resemble impingement syndrome or a rotator cuff tear, which is why an accurate diagnosis is important.

Typical findings include pain when raising the arm, reduced mobility and, during acute episodes, difficulty finding a comfortable position, even for sleeping.

How is it diagnosed?

The diagnosis is confirmed through imaging. X-rays show the calcium deposits, while ultrasound helps determine the phase and density of the deposit. Magnetic resonance imaging is used when other shoulder injuries need to be ruled out.

Shoulder ultrasound for checking calcium deposition in the tendon

How is it treated?

Because the condition often resolves on its own, treatment is conservative in the vast majority of cases. The goal is to relieve pain until the body completes the resorption of the calcium.

  • Conservative treatment: rest, anti-inflammatory medication and targeted physiotherapy to maintain mobility.
  • Extracorporeal shock wave therapy (ESWT): shock waves that may stimulate its resorption.
  • Corticosteroid injection: may relieve the acute pain of the resorption phase.

When symptoms persist despite conservative treatment, shoulder arthroscopy may be considered to remove the deposit. This is a minimally invasive technique performed through small incisions, with a smooth recovery.

When is surgery necessary?

Surgical removal is considered when pain and dysfunction persist for a long period, do not respond to conservative methods and significantly affect the patient’s daily life.

Frequently asked questions

How long does calcific tendinitis last overall?

There is no fixed duration. The deposit may remain silent for years, while the severe painful episode of the resorption phase usually lasts from 3 weeks to 6 months, with the acute component often subsiding within 1 to 2 weeks.

Can it go away on its own without treatment?

Yes, in many cases. Calcific tendinitis often resolves on its own as the body absorbs the deposit. Treatment is mainly aimed at managing pain until this process is complete.

Why is the pain so severe during certain phases?

Severe pain corresponds to both the formation phase and the resorption phase of the calcium deposit.

Is it associated with another condition?

In most cases, it occurs without a clear cause. However, an association has been observed with endocrine disorders, such as diabetes mellitus and thyroid diseases, which may affect its progression.

Is surgery always necessary?

No. Arthroscopic removal is considered only when symptoms persist and do not respond to other treatment methods.

When should I see a specialist?

If your shoulder pain is severe, persists or wakes you at night and limits your movements, it is advisable to be evaluated by an orthopaedic surgeon so that the diagnosis can be confirmed and an appropriate treatment plan established.

What is calcific tendinitis?

Calcific tendinitis is a form of shoulder tendinitis characterized by the deposition of calcium crystals within the rotator cuff tendons, most commonly the supraspinatus tendon. It is not simply wear and tear: it is an active, cell-regulated process in which the tendon locally transforms into fibrocartilage and subsequently becomes calcified.

It occurs most commonly between the fourth and sixth decades of life. Importantly, it does not always cause symptoms: a proportion of patients with calcium deposits have no discomfort at all. The condition is generally considered self-limiting, meaning that in many cases the body absorbs the deposit without surgery.

Stages of the condition

The classic description of the disease’s progression, as formulated by Uhthoff and Loehr, divides it into three major stages. The middle, calcific stage, is subdivided into three phases. Understanding these stages explains why pain is not constant but peaks at a specific point in time.

Stages of calcific tendinitisThe red curve shows pain intensity
Stage 1Pre-calcificThe tendon transforms into fibrocartilage, without calcium being present yetUsually asymptomatic
Stage 2Formation phaseCalcium is gradually deposited1 to 6 yearsPainless or mild pain
Stage 2Resting phaseThe deposit stabilizesUnpredictable durationNo or variable discomfort
Stage 2Resorption phaseAn inflammatory process absorbs the calcium3 weeks to 6 monthsAcute, severe pain
Stage 3Post-calcificThe tendon heals and remodelsSymptoms subside

1. Pre-calcific stage

The tendon undergoes a silent transformation into fibrocartilage, without calcium deposition occurring yet. This stage is generally asymptomatic and often goes unnoticed.

2. Calcific stage

This is the main stage of the disease and includes three successive phases:

  • Formation phase: calcium is gradually deposited within the tendon. It is usually painless or causes mild, chronic pain.
  • Resting phase: the deposit stabilizes and remains unchanged. It may be asymptomatic or accompanied by discomfort of varying intensity.
  • Resorption phase: the body activates an inflammatory process to absorb the calcium. This is the most painful phase, with acute and severe pain.

3. Post-calcific stage

After the calcium is resorbed, the tendon heals and remodels. Symptoms subside and shoulder function is gradually restored.

How long does each stage last?

The total duration of calcific tendinitis varies significantly from one patient to another and depends on the phase of the condition. Indicatively:

  • Formation phase: it may last from one to as long as six years, usually without severe symptoms.
  • Resting phase: its duration is unpredictable and may continue for a long period.
  • Resorption phase: it usually lasts from 3 weeks to 6 months. The acute, most severe pain episode often subsides within 1 to 2 weeks.

iIn simple terms: a calcium deposit may remain silent for years and suddenly become noticeable through severe pain. This is why two patients with the same condition may have completely different experiences in terms of duration. The size of the calcium deposit is not necessarily related to the intensity of symptoms.

What are the symptoms?

Symptoms vary depending on the phase. During the formation phase, pain is mild or absent. During the resorption phase, acute, severe pain occurs and may significantly limit movement. Night-time shoulder pain and difficulty raising the arm are also common. This presentation may resemble impingement syndrome or a rotator cuff tear, which is why an accurate diagnosis is important.

Typical findings include pain when raising the arm, reduced mobility and, during acute episodes, difficulty finding a comfortable position, even for sleeping.

How is it diagnosed?

The diagnosis is confirmed through imaging. X-rays show the calcium deposits, while ultrasound helps determine the phase and density of the deposit. Magnetic resonance imaging is used when other shoulder injuries need to be ruled out.

Shoulder ultrasound for checking calcium deposition in the tendon

How is it treated?

Because the condition often resolves on its own, treatment is conservative in the vast majority of cases. The goal is to relieve pain until the body completes the resorption of the calcium.

  • Conservative treatment: rest, anti-inflammatory medication and targeted physiotherapy to maintain mobility.
  • Extracorporeal shock wave therapy (ESWT): shock waves that may stimulate its resorption.
  • Corticosteroid injection: may relieve the acute pain of the resorption phase.

When symptoms persist despite conservative treatment, shoulder arthroscopy may be considered to remove the deposit. This is a minimally invasive technique performed through small incisions, with a smooth recovery.

When is surgery necessary?

Surgical removal is considered when pain and dysfunction persist for a long period, do not respond to conservative methods and significantly affect the patient’s daily life.

Frequently asked questions

How long does calcific tendinitis last overall?

There is no fixed duration. The deposit may remain silent for years, while the severe painful episode of the resorption phase usually lasts from 3 weeks to 6 months, with the acute component often subsiding within 1 to 2 weeks.

Can it go away on its own without treatment?

Yes, in many cases. Calcific tendinitis often resolves on its own as the body absorbs the deposit. Treatment is mainly aimed at managing pain until this process is complete.

Why is the pain so severe during certain phases?

Severe pain corresponds to both the formation phase and the resorption phase of the calcium deposit.

Is it associated with another condition?

In most cases, it occurs without a clear cause. However, an association has been observed with endocrine disorders, such as diabetes mellitus and thyroid diseases, which may affect its progression.

Is surgery always necessary?

No. Arthroscopic removal is considered only when symptoms persist and do not respond to other treatment methods.

When should I see a specialist?

If your shoulder pain is severe, persists or wakes you at night and limits your movements, it is advisable to be evaluated by an orthopaedic surgeon so that the diagnosis can be confirmed and an appropriate treatment plan established.

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