{"id":14441,"date":"2023-03-13T14:45:48","date_gmt":"2023-03-13T14:45:48","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=14441"},"modified":"2026-07-16T11:06:37","modified_gmt":"2026-07-16T10:06:37","slug":"shoulder-calcific-tendinopathy","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/shoulderelbow\/shoulder-calcific-tendinopathy\/","title":{"rendered":"Calcific tendinopathy"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Patient resources<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/services.nhslothian.scot\/musculoskeletal\/self-help-information\/\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian MSK Self Help Resources Webpage<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Definition<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Calcific tendinopathy (or calcific tendonitis) refers to a build up of calcium within a viable and well vascularised rotator cuff tendon, most often the supraspinatus tendon.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Typical signs and symptoms<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Formative phase: may extend from 1 to 6 years and is usually asymptomatic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Resorptive phase: extends from 3 weeks up to 6 months. During the acute resorptive phase the patient may present with sudden, insidious, severe shoulder pain that can spread to the arm, along with reduced movement\/function and sleep disturbance due to pain.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Usually unilateral, can be bilateral in up to 25% of cases<\/li>\n\n\n\n<li>More persistent symptoms may be similar to those of rotator cuff related shoulder pain<\/li>\n\n\n\n<li>Symptoms may wax and wane<\/li>\n\n\n\n<li>May have a non-capsular restriction in movement<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Prevalence and risk factors<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Approximately 10% of patients with shoulder pain<\/li>\n\n\n\n<li>Mean age 30-60 years, slightly more prevalent in females than males<\/li>\n\n\n\n<li>Risk factors: uncertain; possibly some genetic and biological factors e.g. diabetes, gout<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Prognosis\/ risk factors for poor outcome<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Usually a self-limiting condition that resolves spontaneously<\/li>\n\n\n\n<li>May take weeks, months or years to resolve<\/li>\n\n\n\n<li>Those with endocrine disease\/ biological contributing factors may respond more poorly to conservative measures<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Other considerations<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Consider red flags relating to the shoulder as the signs &amp; symptoms associated with acute calcific tendinopathy often mimic malignant pain.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Dystrophic calcification may occur within a non-viable and poorly vascularised rotator cuff or in those with cuff tears; this is common to see with other signs of degenerative change and may not be the primary cause of symptoms, especially in older patients.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Incidental calcification can be found in 2.5-20% of &#8216;normal&#8217; healthy shoulders on imaging.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Loose bodies: associated chondral defect; associated secondary osteoarthritis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Differential diagnoses<\/strong> Main differential diagnosis is Rotator Cuff Related Shoulder Pain. Patient history\/ story\/ onset is key in distinguishing.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>P.A &amp; M.A \u2013 16-7-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who can refer: <\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners <\/li>\n\n\n\n<li>Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP <a href=\"https:\/\/services.nhslothian.scot\/musculoskeletal\/where-to-find-us\/\" target=\"_blank\" rel=\"noreferrer noopener\">Where To Find Us \u2013 Musculoskeletal Physiotherapy<\/a>)<\/li>\n\n\n\n<li>Secondary care consultants and associated teams<\/li>\n\n\n\n<li>MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes <a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Integrated Shoulder &amp; Elbow Service<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who and How to refer:<\/h4>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><thead><tr><th>Condition<\/th><th>Referral Type<\/th><th>Referral destination and process<\/th><\/tr><\/thead><tbody><tr><td><strong>Suspected septic arthritis\/ septic bursitis<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected facture or dislocation<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected acute distal biceps rupture<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected acute traumatic rotator cuff tear in the younger patient<\/strong><\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow &amp; Shoulder<\/td><\/tr><tr><td><strong>Suspected malignancy\/ tumour specific to shoulder*<\/strong><\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow &amp; Shoulder<\/td><\/tr><tr><td><strong>Suspected inflammatory condition<\/strong><\/td><td>&nbsp;<\/td><td>Consider referral to <strong>Rheumatology<\/strong> \u2013 see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Rheumatology.<\/a><\/td><\/tr><tr><td><strong>Suspected neurological condition<\/strong><\/td><td>&nbsp;<\/td><td>Consider referral to <strong>Neurology<\/strong> \u2013 see&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Neurology.<\/a><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">* <em>Please also see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/sarcoma\/\" target=\"_blank\" rel=\"noreferrer noopener\">Sarcoma \u2013 RefHelp<\/a>. If clinical assessment leads to a very strong suspicion of suspected underlying malignancy, with no specific localising signs or symptoms to suggest a specific underlying primary, consider recommendations and referral options&nbsp;detailed on <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-radiology\/gpaccesstoctforsuspectedcancernoclinicallyobviousprimary\/\" target=\"_blank\" rel=\"noreferrer noopener\">GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) \u2013 RefHelp<\/a><\/em><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients who have the presence of significant red flags\/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition &#8211; see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/serious-shoulder-and-elbow-conditions-red-flags\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/serious-shoulder-and-elbow-conditions-red-flags\/\" target=\"_blank\" rel=\"noreferrer noopener\">serious shoulder &amp; elbow conditions<\/a><\/li>\n\n\n\n<li>Age &lt;16<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Other considerations<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is key to distinguish a traumatic rotator cuff tear in the younger patient (typically &lt;65) as this is a red flag and requires urgent referral to Orthopaedics.&nbsp;&nbsp;Atraumatic degenerative rotator cuff tears can occur in older patients. In these cases, patients usually experience pain and weakness in the absence of significant trauma.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">For further information see associated sections<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>Link to NHS Lothian patient internet site including patient information resources \u2013&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/ises\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/ISES\/Pages\/default.aspx<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page shoulder &nbsp;problems&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/shoulder-problems\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/shoulder-problems<\/a><\/li>\n\n\n\n<li>Link to NHS Inform shoulder problems- Patient self help guide&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/self-help-guides\/self-help-guide-shoulder-pain\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/self-help-guides\/self-help-guide-shoulder-pain<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page elbow problems&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/elbow-problems\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/elbow-problems<\/a><\/li>\n\n\n\n<li>Link to intranet site NHS Lothian Integrated Shoulder and Elbow Service&nbsp;<a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Patient resources NHS Lothian MSK Self Help Resources Webpage Definition Calcific tendinopathy (or calcific tendonitis) refers to a build up of calcium within a viable and well vascularised rotator cuff tendon, most often the supraspinatus tendon. Typical signs and symptoms Formative phase: may extend from 1 to 6 years and is usually asymptomatic. Resorptive phase:<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4425,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[900,1414],"class_list":["post-14441","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-shoulder-calcific-tendinopathy","category-https-apps-nhslothian-scot-refhelp-shoulder-conditions"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/shoulder-elbow\/https-apps-nhslothian-scot-refhelp-shoulder-conditions\/https-apps-nhslothian-scot-refhelp-shoulder-calcific-tendinopathy\/\" rel=\"tag\">Shoulder calcific tendinopathy<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/shoulder-elbow\/https-apps-nhslothian-scot-refhelp-shoulder-conditions\/\" rel=\"tag\">Shoulder conditions<\/a>","rttpg_excerpt":"Patient resources NHS Lothian MSK Self Help Resources Webpage Definition Calcific tendinopathy (or calcific tendonitis) refers to a build up of calcium within a viable and well vascularised rotator cuff tendon, most often the supraspinatus tendon. Typical signs and symptoms Formative phase: may extend from 1 to 6 years and is usually asymptomatic. Resorptive phase:","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14441","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=14441"}],"version-history":[{"count":4,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14441\/revisions"}],"predecessor-version":[{"id":28995,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14441\/revisions\/28995"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4425"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=14441"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=14441"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}