Question
A 42 year old woman wakes with severe shoulder pain and cannot lift her arm. There has been no injury.
- What is the diagnosis and what are its stages?
- What is the natural history?
- What are the treatment options?
Answer
Diagnosis
- Calcific tendinopathy of supraspinatus from calcium hydroxyapatite deposition
- Most often in women aged 30 to 50
- Uhthoff stages are precalcific, calcific (formative, resting and resorptive) and postcalcific
- The resorptive phase is the most painful
- Gartner type III deposits are cloudy and likely to resorb
- Ultrasound shows the deposit and guides treatment
Natural history
- Most deposits resolve spontaneously
- Rupture of the deposit into the subacromial bursa causes acute severe pain
- Symptoms can recur during resorption
Treatment
- Analgesia, physiotherapy and subacromial steroid injection
- Ultrasound guided barbotage
- Extracorporeal shockwave therapy
- Arthroscopic removal for symptoms beyond 6 months
- Surgical results are good when the deposit is fully removed
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.