How to Treat Calcific Tendonitis: 3 Steps to Remove Calcium Deposits Without Surgery

Medically reviewed by Dr. Jeffrey Peng, MD — Board-Certified Sports Medicine Physician

Published: February 26, 2026 | Last Updated: February 26, 2026

If you have been told to just live with calcific tendonitis — or to keep getting cortisone shots until you are "ready for surgery" — you have probably noticed the pain always comes back. That is because most conventional treatments only mask symptoms without addressing the underlying calcium deposit. The good news is there is a better approach. In my practice, I use a three-step protocol that breaks down the calcium, stimulates true tendon healing, and rebuilds strength — all without surgery.

What Is Calcific Tendonitis?

Calcific tendonitis (also known as calcific tendinopathy) is a condition in which calcium crystals deposit inside a tendon. It occurs when a tendon fails to heal properly after repeated microinjury. Instead of laying down normal collagen fibers during the repair process, some of the cells involved in tissue repair begin depositing calcium hydroxyapatite crystals within the tendon substance.

This process most commonly affects the rotator cuff tendons of the shoulder, but it can also develop in tendons around the hip, elbow, knee, wrist, and ankle. As the calcium deposits harden and enlarge, they irritate the surrounding tissue and trigger a persistent inflammatory response. That inflammation is what causes the deep, sharp pain that makes everyday activities — lifting your arm, sleeping on your side, or gripping objects — so uncomfortable.

Why Cortisone Shots and Physical Therapy Alone May Not Be Enough

Physical therapy and targeted exercises can improve mobility and strengthen the muscles that support the affected joint. However, in many cases, these interventions do not break down the calcium deposit itself. The calcification remains in place, continuing to irritate the tendon and cause recurring pain cycles.

Cortisone injections can temporarily reduce inflammation and provide short-term pain relief, but they do not dissolve the calcium or promote tendon healing. In fact, repeated cortisone injections have been associated with tendon weakening over time. To truly resolve calcific tendonitis, you need to address all three components of the problem: break down the calcium deposit, stimulate proper tendon healing, and progressively rebuild tendon strength.

The 3-Step Approach to Treating Calcific Tendonitis

Step 1: Break Up the Calcium Deposit

The first step is to physically disrupt and remove the calcium deposit. There are two primary methods I use, depending on the size, consistency, and chronicity of the calcification.

Option A: Ultrasound-Guided Needle Barbotage and Lavage

Barbotage is a minimally invasive procedure in which a needle is inserted directly into the calcium deposit under real-time ultrasound guidance. Sterile saline is then injected through the needle to loosen and fragment the calcium, and the softened material is aspirated (flushed out) through the same needle. This effectively removes much of the calcium, relieving the mechanical pressure and chemical irritation inside the tendon.

A randomized controlled trial published in The American Journal of Sports Medicine found that ultrasound-guided barbotage produced significantly better clinical and radiographic outcomes at one year compared to corticosteroid injection alone. Patients in the barbotage group demonstrated greater pain relief, improved shoulder function scores, and larger reductions in calcification size — with a mean treatment effect of 20.5 points in favor of barbotage on the Constant Shoulder Score.

Option B: Ultrasound-Guided Percutaneous Needle Tenotomy

For larger or more chronic calcium deposits that have become densely hardened, I often use ultrasound-guided percutaneous needle tenotomy. This is a quick, in-office procedure that uses a specialized needle device to mechanically break apart the hardened calcium under precise ultrasound guidance.

Disrupting the calcified tissue triggers a controlled inflammatory response that boosts local blood flow and releases growth factors — essentially jump-starting the healing cascade. We are clearing out the damaged, calcified tissue and creating the right biological environment for regeneration.

A 2023 meta-analysis in European Radiology that pooled data from 35 studies and over 1,600 patients found that percutaneous ultrasound-guided needle tenotomy led to significant and sustained pain relief, improved tendon function, and very low complication rates. Pain improvements were most pronounced after three months and continued through long-term follow-up (Shomal Zadeh et al., Eur Radiol, 2023; DOI: 10.1007/s00330-023-09657-2).

Both barbotage and tenotomy are performed entirely under local anesthetic, typically take less than 20 minutes, involve minimal downtime, and are usually covered by insurance — making them excellent alternatives to surgery for achieving long-term relief and genuine tendon healing.

Step 2: Stimulate Tendon Healing with Platelet-Rich Plasma (PRP)

Once the calcium deposits are broken down, the next step is to optimize the tendon's healing response. This is where platelet-rich plasma (PRP) plays a critical role.

PRP is prepared from a small sample of your own blood. The blood is processed in a centrifuge to concentrate the platelets, which contain a dense payload of growth factors — including platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β), and vascular endothelial growth factor (VEGF). These bioactive proteins regulate inflammation, stimulate collagen synthesis, and recruit the progenitor cells responsible for tendon repair.

Injecting PRP directly into the treated tendon immediately after barbotage or tenotomy provides a concentrated biological signal for the body to rebuild strong, healthy tissue rather than scar. It transforms the area we just cleared into an active healing zone.

Clinical evidence strongly supports this combined approach. A 2025 network meta-analysis published in Orthopaedic Surgery reviewed 19 randomized controlled trials involving over 1,100 patients with calcific rotator cuff tendinopathy. The study found that PRP ranked highest (85% probability) for improving shoulder function and was among the most effective interventions for long-term pain relief — outperforming corticosteroid injections, shockwave therapy, and barbotage alone (Moggio et al., Orthop Surg, 2025; DOI: 10.1111/os.70175).

Because PRP uses your own cells, there is no risk of allergic reaction or rejection, no synthetic drugs are involved, and recovery is straightforward. When paired with barbotage or tenotomy, PRP amplifies the body's regenerative response — turning a chronic, degenerative process into one that can finally heal.

Step 3: Structured Rehabilitation

The final — and often underestimated — step is structured rehabilitation. The goal in treating calcific tendonitis is to stimulate genuine tendon healing by first removing the calcium and then using PRP to amplify the repair response. Once new tendon fibers begin forming, controlled mechanical loading becomes essential. Skipping this phase is one of the main reasons patients relapse or never fully recover.

Rehabilitation typically begins with gentle range-of-motion exercises — such as pendulums, wall slides, and light resistance band work — to restore flexibility and reduce post-procedure stiffness. From there, we progressively introduce strengthening exercises that target the muscles supporting the affected joint, including the rotator cuff and scapular stabilizers for shoulder cases.

The most important principle is slow, consistent loading. The exercise intensity should be sufficient to stimulate collagen remodeling without placing excessive stress on the healing tendon. This progressive loading allows collagen fibers to realign along lines of mechanical stress, making the tendon structurally stronger and more resilient against future injury.

Research consistently demonstrates that structured exercise after procedures such as tenotomy or PRP injection leads to significantly better long-term outcomes compared with rest or anti-inflammatory medications alone.

Why This 3-Step Approach Works

When you combine all three steps — breaking down the calcium, repairing the tendon with PRP, and rebuilding strength through rehabilitation — you are addressing the problem at its source rather than masking symptoms. This protocol treats the calcification, promotes biological healing, and restores mechanical function. It is a comprehensive, evidence-based approach that helps prevent the pain from coming back.

In my experience treating patients with calcific tendonitis in the San Francisco Bay Area, this three-step protocol has consistently delivered lasting results for patients who had previously been told there was nothing left to try short of surgery.

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Schedule a Consultation

If you are dealing with calcific tendonitis and want to explore non-surgical treatment options, Dr. Jeffrey Peng can help. Request an appointment at our sports medicine clinic in Campbell, California to discuss whether barbotage, tenotomy, and PRP may be right for you.

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About the Author

Dr. Jeffrey Peng, MD is a board-certified sports medicine and family medicine physician practicing in the San Francisco Bay Area. He specializes in non-surgical orthopedic treatments using orthobiologics and ultrasound-guided minimally invasive techniques for osteoarthritis, tendinopathies, and musculoskeletal disorders. Dr. Peng completed his residency and sports medicine fellowship training at Stanford. He is an active faculty member at Stanford, where he trains the next generation of physicians.