Episodic attacks of pain in the rotator cuff are typical in calcifying tendinitis.

Calcific deposits at the attachment area of the rotator cuff are responsible for these attacks, the pain often being caused by spontaneous efforts to disintegrate the calcifications. If the calcific deposit is very large, the high displacement volume can also cause considerable tension pain.
Those affected are often also seen to have a mechanical constriction (mechanical impingement) in which a synovial bursa swells as a result of inflammation, further compromising the range of motion in the confined area beneath the coracoacromial arch.

Extracorporeal shock waves frequently unhelpful

Extracorporeal shock wave treatments (ESWT) are often unsuccessful in calcifying tendinitis, especially when there are concomitant adhesions in the bursa in chronic conditions. An EWST can only shatter the calcific deposits; it cannot release the inflammatory adhesions in the bursa, which are often a significant concomitant of calcifying tendinitis. The same applies to the impingement, which quite often accompanies it or is actually causative. An EWST has some chance of success if the calcific deposits are homogeneous and chalk-like (radio-opaque) and if there is no concomitant mechanical impingement.

Arthroscopy: a gentle method of removing calcific deposits

Anti-inflammatory injections are sometimes helpful in providing short-term pain relief in calcifying tendinitis, but minimally invasive arthroscopic procedures are necessary in many cases for a lasting solution to the problem. Arthroscopy is not just a sure way of getting rid of the calcific deposits – it can also remove the highly inflamed bursa or its adhesions to the surrounding tissue, which are often part of the problem. The same applies to an associated impingement, which a precision decompression can easily eliminate. As the procedure is a simple one with arthroscopy, only a brief stay in hospital is normally required.