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  • Writer's pictureRobin R Varghese, PT.

Acute calcific periarthritis(ACP)

Let us understand Acute calcific periarthritis.

  • Acute calcific periarthritis (ACP) is another term for periarthritis

  • It is a painful condition that occurs when calcium crystals build around the joints or in the soft tissues surrounding the joint.(1)

  • Acute calcific periarthritis (ACP) is a self-limiting, monoarticular, peri-articular process of dystrophic mineral deposition and adjacent inflammation.(2)

  • 'Peri' means that the swelling is around the joint, not inside the joint itself.

  • Calcium crystals occur naturally in the body and help make our bones and teeth strong. However, some people have too many calcium crystals which may get deposited in other parts of the body Eg. -in a tendon,( one of the strong cords that attach our muscles to our bones– this is referred to as calcific tendonitis) -in a bursa, (a fluid-filled sac that acts like a cushion which allows muscles, tendons and ligaments to glide smoothly over our bones as we move.)

  • Sometimes, the crystals can leave the tendon, or ‘shed’, into the soft tissue surrounding the joint. When this happens the hard, sharp crystals can(3) rub against the tendons and muscles and lead to pain and swelling(1). This is known as calcific periarthritis.

  • This condition most commonly affects tendons that help the shoulders move, but it can also affect the hips, hands and other parts of the body.

  • Once shedding starts, the crystals usually continue to shed until they've all gone. The crystals don't usually re-form in the same place.

  • However, if you have an attack of calcific periarthritis in one shoulder then you may be more likely to get it in the other shoulder. And some people go on to have attacks in other parts of the body too.(3)

  • Relapse of acute calcific periarthritis is uncommon. Symptoms reduce in severity within 4–7 days and self resolve in 3–4 weeks.(2)


The primary symptoms of periarthritis are:

  • pain

  • swelling

  • stiffness 

  • tenderness

  • pain that makes it difficult to move the affected joint or limb

  • pain that is worse when you move the affected joint

  • pain that gets worse at night

  • pain that makes it difficult to sleep

  • reduced range of motion

  • Muscle weakness

The phases of ACP

There are four phases of ACP .

  • Precalcific phase (phase 1)

It is characterized by metaplasia of collagen fibers of the tendon into fibrocartilage.

  • Formative phase (phase 2),

It is characterized by the formation of calcified appetite crystals which is mediated by chondrocytes.

  • Resorptive phase (phase 3),

The accumulation of leukocytes, lymphocytes and giant cells results in formation of a calcium granuloma.

  • Post calcific phase (phase 4)

It is characterized by formation of new capillaries and collagen fibers(2).


Treatments, such as NSAIDs, aspiration, and steroid injections, shockwave treatment, or even surgery can help manage symptoms until periarthritis resolves.

Else it is a self resolving condition.(1)

Physical therapy treatment:

Physical therapy plays an important role in the treatment for joints that are stiff and painful. The goal is to stretch and strengthen the joint, reduce pain, and regain lost movement. The following measures help in relieving the symptoms as well as in regaining flexibility and strength of the muscles and joints that are affected:

  • Ice

  • Rest

  • Mobility exercises

  • Well- balanced diet

  • Strengthening exercises

  • Periarthritis vs Arthritis(1)

Did you know?

  • Acute calcific periarthritis has a high rate of misdiagnosis as it may clinically mimic other pathology. The most commonly misdiagnoses include infective and inflammatory processes, arthropathies or less likely neoplasia. This condition has specific imaging findings which allows differentiation from other disorders when combined with the clinical presentation. Prompt diagnosis results in appropriate management and reduces the likelihood of unnecessary diagnostic and therapeutic procedures.(2)

They say:

  • Local hypoxia in critical areas of the tendon, ligament or capsule, due to poor blood flow induced by mechanical, metabolic or other factors, is postulated as the cause of calcium deposition(2)

Periarthritis and Arthritis.

  • There are notable differences between periarthritis and regular arthritis. One of the primary differences is that periarthritis affects the area around a joint, while arthritis affects the joint itself.

  • Additionally, arthritis is a chronic condition that gets worse over time. Periarthritis is a temporary condition that resolves after a few years.(1)

At Valley Healing Hands, we provide the best Physical Therapy treatment for Acute Calcific Periarthritis. We provide an atmosphere for our patients with a one on one ratio for the best quality of care needed for maximum outcomes and return to regular routine. Our physical therapist are highly qualified and will plan an individualized treatment routine, customized to your specific needs. Our patients are highly satisfied with our services. You can learn about what they have to say about us here and get connected to us here. Our patients love us and you too will! We can get you back in the game!!!


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