What question did this study set out to answer?

To examine the multifactorial mechanisms underlying shoulder calcific tendinopathy and discuss potential therapeutic approaches.

February 28, 2026Open Access

Pathogenesis of Shoulder Calcific Tendinopathy

Key Points

To examine the multifactorial mechanisms underlying shoulder calcific tendinopathy and discuss potential therapeutic approaches.
Review of literature on shoulder calcific tendinopathy
Analysis of risk factors and pathogenetic processes
Evaluation of recent therapeutic strategies targeting inflammation and calcium balance
Identified phenotypic changes in tenocytes linked to mechanical stress and metabolic factors
Highlighted roles of metalloproteinases and inflammatory mediators in disease development
Suggested new treatment options that modulate osteogenic differentiation and calcium homeostasis with positive preclinical outcomes

Abstract

Shoulder calcific tendinopathy is a common condition affecting adults and is has a higher incidence in women. This condition is due to a multifactorial process and is characterized by the deposition of hydroxyapatite crystals in the rotator cuff tendons. The disease shows a phenotypic transformation of tenocytes into chondrocyte-like cells, likely caused by metabolic and inflammatory changes and mechanical stress. Risk factors promoting this pathology include hyperlipidemia, advanced age, diabetes, female gender, and thyroid dysfunction. Recent studies highlight that metalloproteinases, oxidative stress, inflammatory mediators, bone morphogenetic proteins (BMPs), genetic and post-transcriptional alterations play a significant role in the pathogenesis of the disease. New therapeutic strategies are currently available that aim to modulate inflammation, osteogenic differentiation, and calcium homeostasis, showing promising results, especially in preclinical models. The aim of this review is to explore the different pathogenetic mechanisms and highlight future therapeutic developments for the treatment of shoulder calcification.

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