Evidence checked 26 October 2026. General information, not a personal diagnosis.
Why is my shoulder so painful, and what is the calcium on my X-ray?
Calcific tendinopathy, also called calcific tendonitis, is a shoulder disorder in which deposits of calcium crystals form in one or more rotator cuff tendons. It can cause pain in the upper arm and shoulder, reduced range of movement, stiffness and weakness. The exact cause is unknown [1].
Shoulder pain that will not settle? Ask about a consultation, email team@thewellnesslondon.com or call 020 3951 3429. Assessment comes before any decision about treatment.
At a glance
- NICE states that most cases resolve in time without treatment. Early on, painkillers and anti-inflammatory medicines are used for symptoms, then physiotherapy if symptoms persist. Steroid injection, lavage (needle washout of the deposit) or surgery are other options [1].
- A 2023 BMJ sham-controlled trial of 220 adults with symptoms for at least three months found no benefit from ultrasound-guided lavage with a steroid injection compared with sham treatment, and no study procedure was superior to sham at 24 months [2].
- NICE says the evidence on shockwave therapy efficacy is inadequate, so it should only be used in the context of research [3].
- PRP is not a proven stand-alone way to dissolve calcium deposits. Research combining PRP with needling cannot establish that PRP alone removes calcium [4].
How is it diagnosed?
Diagnosis is usually based on the history, examination and imaging. NICE describes ultrasound guidance being used to assist some procedures [1]. Similar shoulder problems such as rotator cuff disease and frozen shoulder can feel alike, so a proper assessment matters before choosing treatment.
Will it go away on its own?
NICE states most cases resolve in time without treatment [1]. That is a reason to avoid rushing into procedures when pain is manageable.
What does the evidence say about each treatment?
Physiotherapy. NICE lists physiotherapy when symptoms persist [1]. A plan should reflect pain, movement and function rather than an X-ray alone. The BMJ trial gave every group a home exercise programme, so it cannot tell us how exercise compares with no exercise [2].
Lavage. In the 2023 BMJ trial, ultrasound-guided lavage with steroid did not beat sham lavage on the Oxford Shoulder Score at four months (difference 0.2, 95% CI -2.3 to 2.8), and at 24 months none of the study procedures was superior to sham. No serious adverse events were reported. All participants also did a home exercise regimen [2]. This does not show lavage never helps anyone, but it argues against assuming that removing the deposit is what relieves symptoms.
Shockwave. NICE describes shockwave therapy as a non-invasive treatment that passes short acoustic pulses through the skin, and reports no major short-term safety concerns, but judges efficacy evidence inadequate and recommends use only in research [3].
Steroid injection. NICE lists it as an option when symptoms persist [1]. In the BMJ trial, sham lavage with steroid did not differ significantly from sham alone on the primary outcome at four months [2].
Surgery. NICE lists surgery among treatment options [1].
We are not recommending a particular procedure here. The honest summary is that the evidence is mixed, the condition often improves on its own, and people differ in what they need.
Does PRP work for calcific tendinitis?
PRP is not listed in NICE's description of usual treatment options [1]. A double-blind trial of 80 adults compared PRP with corticosteroid after both groups had needle aspiration of the calcium deposit. PRP had worse early clinical scores at six weeks, some advantages at six months, and comparable outcomes at one and two years. There were more complications in the PRP group, including frozen shoulder, although the difference was not statistically significant [4].
This is not a trial of PRP alone against placebo. It does not prove that PRP dissolves calcium or that it should be routine treatment. Findings from a combined procedure also need to be considered alongside the larger sham-controlled lavage trial. Ask what diagnosis is being treated, what improvement is realistic and why the proposed procedure is preferable to continued rehabilitation or observation.
What should I ask before agreeing to a procedure?
- Is the calcium deposit likely to explain my symptoms, or could another shoulder problem be contributing?
- What would a sensible period of symptom control and rehabilitation involve?
- Is this treatment supported by controlled trials for my diagnosis, or mainly by experience with another tendon problem?
- What are the risks, recovery restrictions, full cost and alternatives if I do not have it?
- If shockwave is suggested, how does that fit NICE's research-only recommendation?
Bring any existing scan report and a list of treatments already tried. Tell the clinician about recent injury, night pain, weakness, fever and medicines or medical conditions that affect treatment choices. A consultation should explain uncertainty, not promise a cure from the appearance of an X-ray.
When should I get this checked?
If shoulder pain has lasted more than a few weeks, is waking you at night or is limiting movement. Seek urgent medical help for sudden shoulder pain with chest pain, breathlessness or sweating, or for a hot, red, swollen joint with fever.
Next step
To discuss your symptoms, ask about a consultation, email team@thewellnesslondon.com or call 020 3951 3429. Assessment comes before any decision about treatment.
Frequently asked questions
Does the calcium go away? NICE states most cases resolve in time without treatment [1].
Can PRP dissolve the calcium? PRP alone has not been shown to dissolve calcium in the evidence discussed here. The PRP trial combined it with needle aspiration, so it cannot answer that question on its own [4].
Is shockwave recommended? NICE says it should only be used in the context of research, because efficacy evidence is inadequate [3].
This article is general information and does not replace personal medical advice. Individual outcomes vary.
References
- NICE. Extracorporeal shockwave therapy for calcific tendinopathy in the shoulder (HTG645), section 2: the condition, current treatments and procedure. https://www.nice.org.uk/guidance/htg645/chapter/2-The-condition-current-treatments-and-procedure
- Moosmayer S, Ekeberg OM, Hallgren HB, et al. Ultrasound guided lavage with corticosteroid injection versus sham lavage with and without corticosteroid injection for calcific tendinopathy of shoulder: randomised double blinded multi-arm study. BMJ. 2023;383:e076447. https://www.bmj.com/content/383/bmj-2023-076447
- NICE. Extracorporeal shockwave therapy for calcific tendinopathy in the shoulder (HTG645), section 1: recommendations; last reviewed 9 November 2022. https://www.nice.org.uk/guidance/htg645/chapter/1-Recommendations
- Oudelaar BW et al. Efficacy of adjuvant platelet-rich plasma after needle aspiration for rotator cuff calcific tendinitis: randomised trial with two-year follow-up. Am J Sports Med. 2021;49:873-882. https://pubmed.ncbi.nlm.nih.gov/33566629/