Impingement · Calcific tendinitis · Vienna
Pain when lifting the arm, a shoulder that wakes you at night – behind it is often an impingement (a pinched rotator cuff beneath the acromion) or a calcific shoulder (calcium deposits in the tendon). The good news: both usually settle without surgery – with shockwave therapy, targeted physiotherapy and a clear stepwise plan.
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In calcific tendinitis, calcium deposits form in the rotator cuff tendons – most often in the supraspinatus tendon. Why this happens is not fully understood; reduced blood supply within the tendon plays a role. Typical: sudden, sometimes very intense pain episodes, pain when lifting the arm and at night.
Important to know: a calcific deposit is not a "stone" that must always be removed. Many deposits dissolve by themselves – and treatment can actively support exactly that process.
In impingement syndrome the rotator cuff is pinched in the narrow space between the humeral head and the acromion. The classic signs: a painful arc when lifting the arm to the side, pain with overhead work and – like the calcific shoulder – night pain when lying on the affected side.
Both conditions overlap and are examined together: clinical tests, ultrasound and X-ray; an MRI if tendon damage is suspected.
The vast majority of calcific shoulders and impingements settle without an operation. The plan:
Focused shockwave therapy is one of the best-studied treatments for the calcific shoulder: it can break up the deposit and stimulate its natural resorption – usually 3–5 sessions, about a week apart, directly in my practice. Physiotherapy corrects the mechanics that caused the pinching.
In an acute, highly painful phase a targeted injection calms the inflammation quickly – so that physiotherapy and shockwave can do their work.
Only when pain persists despite 3–6 months of consistent conservative treatment, the deposit is large, or imaging shows accompanying tendon damage: arthroscopic removal of the calcium and, where useful, widening of the space beneath the acromion – a small keyhole procedure, usually outpatient.
Shoulder pain that lasts longer than a few weeks, night pain, or noticeable loss of strength should be clarified – not least to distinguish impingement and calcific shoulder from a rotator cuff tear or a frozen shoulder, which are treated differently.
The earlier the correct diagnosis, the shorter the path back to a pain-free shoulder – and the smaller the chance that an operation ever becomes necessary.
Why patients with shoulder pain come to me
No – the vast majority of calcific shoulders do not need surgery. Shockwave therapy, targeted physiotherapy and, for acute inflammation, injections dissolve the calcium deposit in many cases; not infrequently it even disappears on its own. Arthroscopy only becomes sensible once conservative treatment has been fully tried for months and symptoms persist.
In impingement the rotator cuff is pinched beneath the acromion – typical are pain when lifting the arm to the side (painful arc) and night pain. Treatment is conservative at first, with physiotherapy and, where needed, injections.
Focused shockwave therapy is one of the best-studied treatments for calcific shoulder: it can break up the calcium deposit and stimulate its natural resorption. Usually 3–5 sessions about a week apart are needed.
When pain persists despite consistent conservative treatment over 3–6 months, the calcium deposit is large, or imaging shows accompanying tendon damage. Arthroscopic calcium removal or widening of the space beneath the acromion is a small procedure, usually outpatient.
If surgery is needed: for office work usually about 1 week, for physical work 4–6 weeks. Conservative treatment (shockwave, injection) generally causes no time off work at all.
For an operation, supplementary (Sonderklasse) insurance generally covers all costs – with direct billing. Practice treatments such as shockwave or injections are billed as private-physician services; with outpatient supplementary cover, I help with the submission.
Most calcific shoulders and impingements settle without surgery – let's find out what your shoulder needs. In English, without pressure.
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