Sometimes similar shoulder pain to that caused by impingement (link) is actually caused by the build up of small (1-2cm) calcium deposits within the rotator cuff tendons. The exact cause of these deposits is unknown. They can cause no symptoms, or severe pain in the shoulder especially in the acute phase

Signs and Symptoms
You may experience only mild shoulder discomfort as calcium is deposited in the rotator cuff tendons, the pain can be severe and may disturb your sleep. This is often associated with shoulder stiffness.

Diagnosis
In addition to discussing your symptoms and examining you, an X-ray will be taken of your shoulder to exclude other shoulder conditions and confirm the presence of calcium deposits. Ultrasound scanning can be used to localize the deposit accurately. You may need further X-rays as the condition progresses to confirm resorbtion of the calcium.

Initial Treatment
Rest and anti-inflammatory medication such as ibuprofen may be sufficient to reduce symptoms. If the pain remains severe, an injection of local anaesthetic and steroid into the joint may be recommended.

Further Treatment
Shockwave therapy can be used as an initial treatment. During this treatment, high-energy sound waves are focused on the tendons to break down the calcium so it can be more easily and rapidly resorbed. Shockwave Therapy also promotes the breakdown of scar tissue and it encourages healing. Recent studies have confirmed its effectiveness in the treatment of calcific tendonitis.

Babotage Procedure – Under local anaesthetic and Ultrasound guidance the calcium can be aspirated. This can be combined with a steroid injection to help with the pain

Surgery – if symptoms persist and simple measures have not worked then Keyhole surgery can be performed to excise the calcium and deal with any other disorders around the shoulder. This will need to be combined with physiotherapy afterwards.