Chronic calcific periarthritis of the elbow treated by cimetidine administration: Five cases

Administration of Cimetidine for Calcific Tendinitis of the Rectus Femoris: Five Cases

Calcific tendinitis of the rectus femoris is rare. This clinical report presents five cases of management of calcific tendinitis of the rectus femoris. Between July 2018 and March 2023, five patients visited our institution, where they were treated for calcific tendinitis of the rectus femoris. All patients presented with severe acute hip pain. Radiographs, computed tomography, magnetic resonance imaging, and an ultrasound examination of the hip showed calcification outside the joint, suggesting calcific tendinitis of the rectus femoris. All patients were orally administered 200 mg cimetidine and nonsteroidal anti-inflammatory drugs twice daily. A pain-free status was achieved in 2 weeks on average. Calcium deposits disappeared in three patients and decreased in two. Symptoms did not recur. Furthermore, no recurrence or enlargements in calcium deposits were observed. It appears to be an effective treatment for calcific tendinitis of the rectus femoris; however, the underlying mechanisms of action of cimetidine on calcific tendinitis have not yet been elucidated in detail.

TNFα-dependent mTOR activity is required for tenotomy-induced ectopic ossification in mice

INTRODUCTION

Ectopic ossifications often occur in skeletal muscles or tendons following local trauma or internal hemorrhage, and occasionally cause severe pain that limits activities of daily living. However, mechanisms underlying their development remain unknown.

MATERIALS AND METHODS

The right Achilles tendon in 8-week-old female or male mice was dissected. Some mice were injected intraperitoneally either with phosphate-buffered saline, dimethyl sulfoxide, cimetidine, rapamycin, celecoxib or loxoprofen for 10 weeks. One week after surgery, immunohistochemical analysis was performed for mTOR, TNFα or F4/80. Ten weeks after surgery, ectopic ossification at the tenotomy site was detected by 3D micro-CT.

RESULTS

Ectopic ossification was seen at dissection sites in all wild-type mice by dissection of the Achilles tendon. mTOR activation was detected at dissection sites, and development of ectopic ossification was significantly inhibited by administration of rapamycin, an mTOR inhibitor, to wild-type mice. Moreover, administration of the histamine 2 blocker cimetidine, which reportedly inhibits ectopic ossification in tendons, was not effective in inhibiting ectopic ossification in our models. TNFα-expressing F4/80-positive macrophages accumulate at dissection sites and that ectopic ossification of the Achilles tendon dissection was significantly inhibited in TNFα-deficient mice in vivo. Ectopic ossification is significantly inhibited by administration of either celecoxib or loxoprofen, both anti-inflammatory agents, in wild-type mice. mTOR activation by Achilles tendon tenotomy is inhibited in TNFα-deficient mice.

CONCLUSION

The TNFα-mTOR axis could be targeted therapeutically to prevent trauma-induced ectopic ossification in tendons.

Clinical evaluation and management of calcific tendinopathy: an evidence-based review

Calcific tendinopathy (CT) is an important musculoskeletal condition most commonly seen in the shoulder girdle, accounting for 10-42% of all shoulder pain. Despite the high prevalence within the shoulder region, CT has been demonstrated in many tendons throughout the axial and appendicular skeleton. Unlike degenerative tendinopathies, CT appears to be a self-limiting condition that affects otherwise-healthy tendon with deposition of calcium hydroxyapatite crystals between healthy tenocytes. In patients with functionally limiting symptoms or pain, the clinical course may be accelerated through a multitude of treatments including physical therapy and pain management, extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage (UGPL), and operative debridement. Currently, the most efficacious and frequently utilized treatment for shoulder CT is UGPL due to its ability to effectively reduce calcium burden and pain while limiting soft-tissue damage. However, more evidence regarding the treatment and course of CT is needed before determining the most appropriate treatment at all potential sites of CT.

Calcific Tendonitis of the Elbow in an Adult - A Case Report and Review of the Literature

Introduction:

Calcific tendonitis occurs most commonly in the shoulder, and it is a rare entity in other parts including the elbow. We report a symptomatic case of calcific tendonitis of common extensor origin of the non-dominant elbow in a young female.

Case Presentation:

A 39-year-old female (right hand dominant) presented with the left elbow pain for the past 1 year. The diagnosis was achieved by radiography and confirmed by histopathology. Her pain did not respond to conservative treatment of analgesics, physiotherapy, and elbow support and a local steroid injection. She, therefore, underwent surgical exploration of the elbow, under general anesthesia. There was white-colored paste like a collection within the common extensor tendon origin, with dystrophic calcification of the tendon. The histology of the excised tissue revealed focal nodular aggregates of plump fibroblasts and osteoclastic giant cells around microcalcific foci. Large areas of fibrosis and calcific nodular deposits seen suggestive of calcific tendonitis.

Conclusion:

Calcific tendonitis is not a common condition around elbow joint. The diagnosis may be delayed due to its rarity. Hence, a high degree of suspicion in the absence of trauma, along with relevant investigations, leads to a definitive diagnosis and treatment. A review of literature also becomes important since it is not a day-to-day case.