1
|
Delbello F, Spinnato P, Aparisi Gomez MP. Calcific Tendinopathy Atypically Located Outside the Rotator Cuff: A Systematic Review. Curr Med Imaging 2024; 20:e100423215585. [PMID: 37038296 DOI: 10.2174/1573405620666230410091749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/24/2023] [Accepted: 02/20/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND AND PURPOSE Calcific tendinopathy is a common cause of painful shoulder easily identified with ultrasound or conventional radiography. Although the rotator cuff is by far the most common location of the disease and diagnostic or treatment strategies are well known in clinical practice, a lack of awareness characterizes the assessment of the other sites affected by this condition; consequently, the risk of underestimating the prevalence of atypical non-rotator cuff calcific tendinopathy is high. This may lead to expensive or invasive diagnostic exams and/or inappropriate treatment, whereas the condition is usually self-limited. The present study aims at analysing the frequency of calcific tendinitis in uncommon sites, in order to fill a gap in knowledge and awareness regarding non-rotator cuff calcific tendinopathy, thus avoiding improper clinical choices and helping to identify this condition. METHODS This systematic review was conducted following the PRISMA guidelines. We performed a search on Pubmed and Scopus databases concerning atypically sited extra-rotator cuff calcific tendinopathy published since 1950. RESULTS The research found a total of 267 articles and 793 non-rotator cuff cases of calcific tendinopathy registered. The spine (213 – 26.86%), foot and ankle (191 – 23.95%), and hip (175 – 22.06%) appeared to be the most common sites of calcific tendinopathy after the rotator cuff, whereas the longus colli C1-C2 (204 – 25.72%), Achilles (173 – 21.81%), and rectus femori (61 – 7.69%) were the most commonly affected tendons. CONCLUSION A better awareness of this condition in several different sites of the body than the rotator cuff could avoid unnecessary choices both in assessment and treatment.
Collapse
Affiliation(s)
- Federica Delbello
- Department of Rehabilitation Medicine, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | | |
Collapse
|
2
|
Albano D, Coppola A, Gitto S, Rapisarda S, Messina C, Sconfienza LM. Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls. Radiol Med 2020; 126:608-619. [PMID: 33151457 PMCID: PMC8007494 DOI: 10.1007/s11547-020-01300-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022]
Abstract
Rotator cuff calcific tendinopathy (RCCT) is a very common condition, characterized by calcium deposition over fibrocartilaginous metaplasia of tenocytes, mainly occurring in the supraspinatus tendon. RCCT has a typical imaging presentation: in most cases, calcific deposits appear as a dense opacity around the humeral head on conventional radiography, as hyperechoic foci with or without acoustic shadow at ultrasound and as a signal void at magnetic resonance imaging. However, radiologists have to keep in mind the possible unusual presentations of RCCT and the key imaging features to correctly differentiate RCCT from other RC conditions, such as calcific enthesopathy or RC tears. Other presentations of RCCT to be considered are intrabursal, intraosseous, and intramuscular migration of calcific deposits that may mimic infectious processes or malignancies. While intrabursal and intraosseous migration are quite common, intramuscular migration is an unusual evolution of RCCT. It is important also to know atypical regions affected by calcific tendinopathy as biceps brachii, pectoralis major, and deltoid tendons. Unusual presentations of RCCT may lead to diagnostic challenge and mistakes. The aim of this review is to illustrate the usual and unusual imaging findings of RCCT that radiologists should know to reach the correct diagnosis and to exclude other entities with the purpose of preventing further unnecessary imaging examinations or interventional procedures.
Collapse
Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy.
| | - Alessandra Coppola
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, 20122, Milan, Italy
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
| | - Santi Rapisarda
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
| |
Collapse
|
3
|
Draghi F, Cocco G, Lomoro P, Bortolotto C, Schiavone C. Non-rotator cuff calcific tendinopathy: ultrasonographic diagnosis and treatment. J Ultrasound 2020; 23:301-315. [PMID: 31197633 PMCID: PMC7441123 DOI: 10.1007/s40477-019-00393-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/31/2019] [Indexed: 12/13/2022] Open
Abstract
Calcific tendinopathy is a condition that is related to the deposition of calcium, mostly hydroxyapatite crystals, within the tendons. The shoulder and the hip are commonly affected joints, but calcific tendinopathy may occur in any tendon of the body. While there is an extensive literature on the ultrasound diagnosis of calcific tendinopathy of the shoulder, there are only sporadic reports on other sites. This review combines the experience of our centers and a thorough analysis of the literature from the last 45 years (1972-2017) in order to highlight the localizations beyond the rotator cuff, their ultrasound characteristics and therapeutic possibilities.
Collapse
Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Giulio Cocco
- Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
| | - Pascal Lomoro
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Chandra Bortolotto
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy.
| | - Cosima Schiavone
- Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
| |
Collapse
|
4
|
Pauchet A, Falticeanu A, Lebecque O. Adductor Insertion Avulsion Syndrome with Proximal Femoral Shaft Stress Fracture: Not Only Found in Young Athletes. J Belg Soc Radiol 2020; 104. [PMID: 32405612 PMCID: PMC7207251 DOI: 10.5334/jbsr.2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The adductor insertion avulsion syndrome, also called “thigh splints,” is usually considered a sports injury, causing thigh and groin pain. It is related to chronic traction stress of the adductor muscles at their insertion site along the posterior margin of the proximal and mid-femoral diaphysis, and it can get complicated by stress fracture. We report the case of a 64-year-old woman—significantly older than previously reported cases—with a history of complete functional loss of the right hip following intensive physiotherapy and a final diagnosis of adductor insertion avulsion syndrome.
Collapse
|
5
|
Low SBL, Toms AP. Calcification of the linea aspera: A systematic narrative review. Eur J Radiol Open 2019; 6:101-105. [PMID: 30815518 PMCID: PMC6378843 DOI: 10.1016/j.ejro.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 08/01/2018] [Accepted: 12/12/2018] [Indexed: 11/04/2022] Open
Abstract
Calcification at the linea aspera is a differential for hip/thigh pain. Imaging should commence with plain radiographs, and also include the distal femur. Smaller calcific deposits can be obscured on anteroposterior projection, necessitating additional views. Calcific tendo-enthesopathy is associated with osteolysis but no soft tissue mass.
This review aims to consolidate the published demographics, clinical and radiological features of calcific tendonitis affecting the linea aspera. Using the PRISMA protocol, 55 clinical cases were extracted from 19 shortlisted papers. In a patient presenting with thigh and/or hip pain, radiologic evaluation should commence with plain radiographs; subsequent cross-sectional imaging, if necessary. Our review of the literature indicates that calcific tendonitis can be safely diagnosed when intratendinous calcification is observed in the region of the linea aspera with cortical erosion but no discrete soft tissue mass.
Collapse
Affiliation(s)
- Samantha Bee Lian Low
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, United Kingdom
| | - Andoni Paul Toms
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, United Kingdom
| |
Collapse
|
6
|
Affiliation(s)
- Sangoh Lee
- Royal National Orthopaedic Hospital NHS Trust, London, UK.
| | - Asif Saifuddin
- Royal National Orthopaedic Hospital NHS Trust, London, UK
| |
Collapse
|
7
|
Van Damme K, De Coster L, Mermuys K, Van den Eeckhaut A, Walgraeve N, De Geeter F. Bone scan findings in calcific tendinitis at the gluteus maximus insertion: some illustrative cases. Radiol Case Rep 2017; 12:168-174. [PMID: 28228904 PMCID: PMC5310380 DOI: 10.1016/j.radcr.2016.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 12/30/2022] Open
Abstract
We describe the bone scan and single-photon emission computed tomography/computed tomography findings in calcific tendinitis of the gluteus maximus and discuss its pathophysiology. Although this tendinopathy is mostly self-limiting, awareness of this disease is important for 2 reasons. First, it may explain acute hip symptoms in patients in the resorptive phase of the calcifications. Second, it should be considered as a differential diagnosis for bone scan hot spots in the vicinity of the gluteus maximus tendon and for cortical erosion seen in that region on X-rays or CT.
Collapse
Affiliation(s)
- Karel Van Damme
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
| | - Liesbeth De Coster
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
| | - Koen Mermuys
- Department of Radiology, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
| | - Anja Van den Eeckhaut
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
| | - Natascha Walgraeve
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
| | - Frank De Geeter
- Department of Nuclear Medicine, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende Belgium, Ruddershove 10, Brugge 8000, Belgium
| |
Collapse
|
8
|
Abstract
Calcium apatite deposition disease (CADD) is a common entity characterized by deposition of calcium apatite crystals within and around connective tissues, usually in a periarticular location. CADD most frequently involves the rotator cuff. However, it can theoretically occur in almost any location in the musculoskeletal system, and many different locations of CADD have been described. When CADD presents in an unexpected location it can pose a diagnostic challenge, particularly when associated with pain or swelling, and can be confused with other pathologic processes, such as infection or malignancy. However, CADD has typical imaging characteristics that usually allows for a correct diagnosis to be made without additional imaging or laboratory workup, even when presenting in unusual locations. This is a review of the common and uncommon presentations of CADD in the appendicular and axial skeleton as well as an updated review of pathophysiology of CADD and current treatments.
Collapse
|
9
|
Malghem J, Omoumi P, Lecouvet F, Vande Berg B. Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series. Skeletal Radiol 2015; 44:1403-12. [PMID: 25975184 DOI: 10.1007/s00256-015-2165-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 02/02/2023]
Abstract
Calcium hydroxyapatite crystal deposition is a common disorder, which sometimes causes acute pain as calcifications dissolve and migrate into adjacent soft tissue. Intraosseous calcium penetration has also been described. We illustrate the appearance of these lesions using a series of 35 cases compiled by members of the French Society of Musculoskeletal Imaging (Société d'Imagerie Musculo-Squelettique, SIMS). The first group in our series (7 cases) involved calcification-related cortical erosions of the humeral and femoral diaphyses, in particular at the pectoralis major and gluteus maximus insertions. A second group (28 cases) involved the presence of calcium material in subcortical areas. The most common site was the greater tubercle of the humerus, accompanying a calcifying tendinopathy of the supraspinatus. In addition, an extensive intramedullary diffusion of calcium deposits was observed in four of these cases, associated with cortical erosion in one case and subcortical lesions in three cases. Cortical erosions and intraosseous migration of calcifications associated with calcific tendinitis may be confused with neoplasm or infection. It is important to recognize atypical presentations of hydroxyapatite deposition to avoid unnecessary investigation or surgery.
Collapse
Affiliation(s)
- Jacques Malghem
- Département de radiologie et d'imagerie médicale, Université Catholique de Louvain, Cliniques St- Luc, Avenue Hippocrate 10, B-1200, Bruxelles, Belgium,
| | | | | | | |
Collapse
|
10
|
Paik NC. Acute calcific tendinitis of the gluteus medius: an uncommon source for back, buttock, and thigh pain. Semin Arthritis Rheum 2014; 43:824-9. [PMID: 24393625 DOI: 10.1016/j.semarthrit.2013.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 11/29/2013] [Accepted: 12/06/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study was conducted to describe the imaging features and clinical manifestations in acute calcific tendinitis (CaT) of the gluteus medius muscle (GMe). METHODS A retrospective analysis was conducted, aimed at six patients with acute calcific tendinitis of the gluteus medius muscle (CaT-GMe), who were seen between January 2011 and December 2012. Clinical presentations, radiologic data (radiography, CT, and MRI), and laboratory reports were all subject to review. RESULTS All patients presented with pain and decreased range of motion (ROM) at the hip. Two of the six patients experienced pain in the anterolateral thigh and groin, with antalgic gait (anterior group). The other four complained of low back, buttock, and posterolateral thigh pain, accompanied by difficulty in standing and antalgic gait (posterior group). Edema within the GMe or effusion surrounding the muscle was regularly identified on MRIs. Calcific deposits were conspicuous in the gluteus medius tendon attachments to the lateral (anterior group) and superoposterior (posterior group) facets of the greater trochanter on radiography, CT, or MRI. Complete resolution of symptoms was uniformly achieved in 5-10 days with conservative management. CONCLUSIONS Acute CaT-GMe should be considered in any patient suffering lateral hip pain (with either groin or low back pain) and ROM limitation. Images of the hip characteristically show edema of the gluteus medius and calcifications lateral or superior to the greater trochanter.
Collapse
|
11
|
Paik NC, Lim CS, Jang HS. Tendinitis of Longus Colli: Computed Tomography, Magnetic Resonance Imaging, and Clinical Spectra of 9 Cases. J Comput Assist Tomogr 2012; 36:755-61. [DOI: 10.1097/rct.0b013e318269880c] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Abstract
Rotator cuff pathology is a common cause of shoulder pain, and imaging plays a major role in the management of shoulder problems. General radiography may be useful as an initial screening test particularly in trauma and arthritis. Musculoskeletal ultrasound and magnetic resonance imaging are the most suitable modalities for the investigation of the rotator cuff, having high sensitivities and specificities for full-thickness tears. Musculoskeletal ultrasound and magnetic resonance imaging are less accurate in the detection of partial-thickness tears with greater observer variability. This article reviews the normal and pathologic imaging features of the rotator cuff and highlights the potential usefulness and limitations of various imaging modalities in the assessment of the tendon and the potential impact of imaging findings on clinical patient care.
Collapse
|
13
|
|
14
|
Tamangani J, Davies A, James S, Christie-large M. Calcific tendonitis of the adductor brevis insertion. Clin Radiol 2009; 64:940-3. [DOI: 10.1016/j.crad.2009.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 01/12/2009] [Accepted: 01/22/2009] [Indexed: 11/17/2022]
|
15
|
Abstract
Gluteus maximus tendonitis with its clinical and imaging patterns has been described in radiologic, orthopedic, and rheumatology texts and journals. Image-guided treatment, however, is not a familiar approach and has only been described in one case report in the English literature to the best of our knowledge. We present 4 patients with calcific tendonitis of the gluteus maximus who presented with excruciating pain in the posterior upper thigh with limitation of daily activities. The diagnosis was based on the characteristic radiologic appearances of calcifications in the tendon with cortical bone erosion and muscle edema. Treatment was with image-guided (fluoroscopy or computed tomography) injection of a local anesthetic and corticosteroid. All patients were pain-free on follow up.
Collapse
Affiliation(s)
- Hema Nalini Choudur
- Department of Radiology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada.
| | | |
Collapse
|
16
|
Abstract
OBJECTIVE The shoulder is the most common location for calcific tendonitis. Presentation of calcific tendonitis at other sites is unusual and may lead to diagnostic difficulty. DESIGN AND PATIENTS We report a case of calcific tendonitis of the pectoralis major insertion and describe the CT and MRI findings. RESULTS AND CONCLUSION The presence of an associated cortical defect at the site of tendon insertion may lead to the incorrect diagnosis of neoplastic process.
Collapse
Affiliation(s)
- John Cahir
- Department of Radiology, The Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, and The Institute of Orthopaedics and Musculoskeletal Sciences, University College London, HA7 4LP, UK
| | | |
Collapse
|
17
|
Bui-Mansfield LT, Moak M. Magnetic resonance appearance of bone marrow edema associated with hydroxyapatite deposition disease without cortical erosion. J Comput Assist Tomogr 2005; 29:103-7. [PMID: 15665693 DOI: 10.1097/01.0000145861.13963.66] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors report the magnetic resonance (MR) appearance of bone marrow edema associated with hydroxyapatite deposition disease without cortical erosion. Hydroxyapatite deposition disease may have bone marrow edema on MR imaging without radiographic evidence of cortical erosion, mimicking the appearance of fracture, neoplasm, or infection. Awareness of this association can prevent unnecessary additional imaging evaluation or biopsy.
Collapse
Affiliation(s)
- Liem T Bui-Mansfield
- Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, TX 78324, USA.
| | | |
Collapse
|
18
|
Chan R, Kim DH, Millett PJ, Weissman BN. Calcifying tendinitis of the rotator cuff with cortical bone erosion. Skeletal Radiol 2004; 33:596-9. [PMID: 15160255 DOI: 10.1007/s00256-004-0770-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Revised: 02/17/2004] [Accepted: 02/18/2004] [Indexed: 02/02/2023]
Abstract
Calcifying tendinitis occurs most commonly in the rotator cuff tendons, particularly involving the supraspinatus tendon insertion, and is often asymptomatic. Cortical erosion secondary to calcifying tendinitis has been reported in multiple locations, including in the rotator cuff tendons. We present a pathologically proven case of symptomatic calcifying tendinitis involving the infraspinatus tendon with cortical erosion with correlative radiographic, CT, and MR findings. The importance of considering this diagnosis when evaluating lytic lesions of the humerus and the imaging differential diagnosis of calcifying tendinitis and cortical erosion are discussed.
Collapse
Affiliation(s)
- Roxanne Chan
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | | | | |
Collapse
|
19
|
Flemming DJ, Murphey MD, Shekitka KM, Temple HT, Jelinek JJ, Kransdorf MJ. Osseous involvement in calcific tendinitis: a retrospective review of 50 cases. AJR Am J Roentgenol 2003; 181:965-72. [PMID: 14500211 DOI: 10.2214/ajr.181.4.1810965] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the spectrum of radiologic and pathologic manifestations of calcific tendinitis involving bone. MATERIALS AND METHODS We retrospectively reviewed 50 cases of calcific tendinitis involving underlying bone. Clinical data reviewed included patient age and sex and lesion location. Images reviewed included radiographs (n = 44), CT scans (n = 13), MRIs (n = 16), and bone scintigrams (n = 13). Radiologic examinations were evaluated for the presence of cortical erosion, periosteal reaction, and marrow extension. Pathology confirmation was available in 37 cases. RESULTS The average age of patients was 50 years (range, 16-82 years), with 29 female patients (58%). Calcific tendinitis with associated bone involvement was seen most commonly in the femur (40%) and the humerus (40%). Concretions were most commonly solid-appearing (50%). Cortical erosion was the most common manifestation of osseous involvement (78% of cases). Marrow involvement was shown in 18 (36%) of 50 cases. Marrow extension was most commonly seen in the lesser and greater tuberosities of the humerus, which accounted for 61% (11/18) of cases. Focal increased radionuclide uptake was seen in 13 (100%) of 13 cases. CONCLUSION Calcific tendinitis presenting with osseous destruction, marrow changes, and soft-tissue calcifications may be confused with neoplasm both radiologically and pathologically. Recognition of the atypical presentation of this common disease may prevent unnecessary biopsy.
Collapse
Affiliation(s)
- Donald J Flemming
- Department of Radiology, National Naval Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA
| | | | | | | | | | | |
Collapse
|
20
|
Affiliation(s)
- Andrew Strokon
- Department of Orthopaedic Surgery, Concord Hospital, Sydney, Australia
| | | | | | | |
Collapse
|