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Calcific Tendinitis

Calcific tendinitis of the shoulder (CTS) is an aseptic inflammatory condition characterized by calcium salt deposits within degenerative shoulder tendons.

Disease Overview

Calcific tendinitis of the shoulder (CTS) is an aseptic inflammatory condition characterized by calcium salt deposits within degenerative shoulder tendons. This condition frequently causes shoulder pain and restricted mobility, with the supraspinatus tendon being the most commonly affected site.

Typical Symptoms and Associated Factors

CTS predominantly affects individuals in the 40 to 50 age group. The condition is self-limiting, and many cases resolve spontaneously or respond to conservative treatment.

Clinician palpating a patient's shoulder to localize tendon tenderness

Professional Evaluation

The diagnosis is based on clinical examination and imaging. Plain radiographs can demonstrate apatite calcium deposits, except during the pre-calcification phase. Ultrasound or MRI may be selected according to specific clinical needs to better localize the position of the calcification relative to the tendon.

Clinician marking the affected shoulder area during a professional evaluation

Conservative Management

Initial treatment includes conservative measures such as rest, oral non-steroidal anti-inflammatory drugs, and physical therapy. For patients who do not respond to initial conservative treatment, ultrasound-guided percutaneous lavage (barbotage) may be considered as a minimally invasive option.

Applying coupling gel to the shoulder area during treatment preparation

ESWT: Potential Mechanisms and Limitations of Evidence

Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive treatment that uses a device to deliver controlled, short-duration acoustic shock waves through the skin to the affected area. The exact mechanisms by which this therapy may exert effects on tendinopathy have not been fully elucidated.

A 2023 systematic review and meta-analysis of randomized controlled trials comparing operative and non-operative interventions for chronic calcific tendinitis found that the pooled mean VAS improvement for ESWT was −3.83 (95% CI −5.38, −2.27), and the pooled mean Constant-Murley score improvement was 18.30 (95% CI 10.95, 25.66). Both surgical and non-surgical approaches may produce clinically significant improvements in function and pain, and the authors concluded that attempting ultrasound-guided puncture or ESWT as first-line treatment is reasonable. In the UK, the National Institute for Health and Care Excellence (NICE) concluded that the safety evidence for ESWT for calcific tendinopathy of the shoulder shows no major short-term safety concerns, but the efficacy evidence is insufficient. NICE recommends that this procedure be used only within a research setting.

Extracorporeal shock wave therapy being applied to the shoulder tendon

Contact with SHOCKIS

Clinicians and procurement professionals evaluating shock wave therapy systems for calcific tendinitis of the shoulder should consider device-specific characteristics and the applicable regulatory status in their respective regions. The evidence summarized above reflects the broader ESWT literature and does not constitute validation of any specific SHOCKIS product for any particular indication. If you wish to discuss how SHOCKIS can support your clinical or procurement needs, our team is welcome to hear from you.

Clinical Workflow Checklist

  1. 01CLINICAL ASSESSMENT

    Review patient history, symptoms, and contraindications.

  2. 02TARGET AREA IDENTIFICATION

    Identify the treatment area through clinical examination and appropriate imaging when needed.

  3. 03TREATMENT SETUP

    Select treatment parameters according to clinical assessment, device instructions, and patient tolerance.

  4. 04SHOCKWAVE APPLICATION

    Apply coupling gel and deliver treatment while monitoring patient response.

  5. 05POST-TREATMENT CARE

    Clean the treatment area and applicator, and provide appropriate aftercare guidance.

Safety Information

The information below describes conditions and reactions generally associated with extracorporeal shock wave therapy. It does not replace the instructions for use of the specific SHOCKIS device. Clinicians must verify applicability against the current device labeling and their own clinical judgment.

Contraindications & Precautions

Shock wave therapy should not be applied, or should be applied only with particular caution, in the following situations:

  1. Known hemorrhagic disorders or coagulation dysfunction
  2. Thrombosis in or adjacent to the intended treatment area
  3. Severe cognitive impairment or psychiatric illness
  4. Implanted pacemakers or other active electronic implants
  5. Tumors located in the treatment area
  6. Pregnancy, particularly the lower abdominal region
  7. Ruptured or severely injured tendons and fasciae, as well as regions containing the brain, spinal cord, large blood vessels, or major nerve trunks
  8. Regions containing abdominal organs, especially lung tissue
  9. Bone defects exceeding 2 cm
  10. Joint fluid leakage
  11. Growing pains in pediatric patients

Any other condition deemed unsuitable by the treating physician.

Potential Adverse Reactions

The following reactions may occur at or near the treatment site:

  1. Local hematoma, ecchymosis, or petechiae
  2. Temporary intensification of pain shortly after treatment
  3. Local numbness, needle-like sensation, or hypoesthesia
  4. High-energy extracorporeal shock wave therapy may cause local nerve or vascular injury

These reactions are generally transient and typically resolve within approximately one week without special treatment.

References
  1. [1] Moggio L, Marotta N, de Sire A, et al. Efficacy of Conservative Approaches on Pain Relief and Function in Patients With Rotator Cuff Calcific Tendinopathy: Which Is the Best Option? A Systematic Review and Network Meta-Analysis. Orthop Surg. 2025;17(11):3048-3066. DOI: 10.1111/os.70175. PMID: 41002287.
  2. [2] Yao Y, Yang G, Jiang S, et al. Treatments for rotator cuff calcific tendinitis: a systematic review and network meta-analysis of randomized-controlled trials. EFORT Open Rev. 2025;10(7):520-533. DOI: 10.1530/EOR-2024-0078. PMID: 40591667.
  3. [3] Angileri HS, Gohal C, Comeau-Gauthier M, 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):1746-1760. DOI: 10.1016/j.jse.2023.03.017. PMID: 37080421.
  4. [4] National Institute for Health and Care Excellence. Extracorporeal shockwave therapy for calcific tendinopathy in the shoulder. HealthTech guidance 645. Published 09 November 2022.

FAQ

Common professional questions.

Is imaging useful for calcific tendinitis?

Imaging may help confirm the location and characteristics of a calcium deposit as part of clinical assessment.

Are radial and focused shockwave systems equivalent?

No. They generate and deliver energy differently, so published evidence and product indications must be interpreted by technology type.

Does every calcium deposit require treatment?

No. Clinical significance depends on symptoms and professional assessment.

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