Calcific shoulder can be divided into different categories depending on the stage and type of calcium deposits:

1. Formation phase:
   • In this phase, calcium deposits form in the tendons. Patients often do not notice any discomfort.
2. Resting stage:
   • The deposits are stable but can cause irritation and mild pain.
3. Resorption phase:
   • The calcium is broken down by the body, which is often associated with severe pain.
4. Post-calcification phase:
   • The tissue heals, and the discomfort subsides.

The exact causes of calcific tendinitis are not fully understood, but several factors are discussed:

• Reduced blood flow to the tendons:
  • Restricted blood supply to the rotator cuff can promote degenerative changes leading to the formation of calcium deposits.
• Overuse and microtrauma:
  • Repeated stress or minor injuries to the tendons can encourage the development of calcific deposits.
• Metabolic disorders:
  • Conditions such as diabetes mellitus or thyroid problems increase the risk of calcific tendinitis.
• Hormonal influences:
  • Changes in hormone levels, especially in women, could promote the development.

The symptoms of a calcific shoulder vary depending on the stage of the disease and individual progression:

• Pain:
  • Acute or chronic pain in the shoulder, especially at night or during overhead activities.
• Movement restrictions:
  • Difficulty lifting the arm or moving it behind the back.
• Tenderness:
  • Pain when touching the shoulder or during certain movements.
• Signs of inflammation:
  • During the resorption phase, swelling, warmth, and redness often occur.

The diagnosis of calcific shoulder involves a combination of medical history, clinical examination, and imaging techniques:

- Medical history:

- The doctor inquires about the course of symptoms, possible triggering factors, and the intensity of pain.

- Clinical examination:

- Tests to check mobility and provoke pain, such as the Neer test or the Hawkins-Kennedy test.

- Imaging techniques:

- X-ray: Clear depiction of calcium deposits in the tendons.

- Ultrasound: Assessment of soft tissue changes and size of the calcifications.

- MRI: Detailed depiction of the tendons and exclusion of other conditions such as rotator cuff tears.

Conservative Therapy

In most cases, calcific shoulder can be successfully treated without surgery:

• Medication Therapy:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief and anti-inflammation.
• Physiotherapy:
  • Exercises to improve shoulder mobility and strengthen the muscles.
• Shock Wave Therapy:
  • Breaking up calcific deposits with high-energy sound waves to promote resorption.
• Injections:
  • Cortisone injections to reduce inflammation and pain.

Surgical Therapy

In severe or therapy-resistant cases, surgical intervention may be necessary:

• Needling:
  • Puncturing and flushing out the calcific deposits under ultrasound guidance.
• Arthroscopic Removal:
  • Minimally invasive removal of calcific deposits and treatment of accompanying injuries. 

The following measures are helpful in preventing a calcific shoulder:

1. Regular exercise: Joint-friendly sports such as swimming or yoga promote circulation and mobility.
2. Avoiding overstrain: Limiting repetitive movements and overhead work.
3. Strengthening the shoulder muscles: Targeted exercises to stabilize the rotator cuff.
4. Early treatment: Consult a doctor promptly at the first signs of shoulder pain.