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Calcific periarthritis of the proximal medial collateral ligament. (a) Rounded, amorphous calcification adjacent to the adductor tubercle (short arrow). (b) Calcifications (arrowhead) lie deep to the origin of the superficial band of the medial collateral ligament with mild adjacent soft tissue and minimal adjacent bone marrow edema.
Source publication
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 l...
Citations
... In the majority of the articles included, female subjects were the most affected (>75%) 1,2,4,[6][7][8][9]19,21,23,25,[28][29][30]32,33,[36][37][38][39][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]58,59 and the subjects' age was reported between 30 and 60 years of age (>85%). 1-4,6-9,19-22, 27-30,33,34,36-40,42-56,58,59 Only in six studies, the individuals' age fell outside this range, with two children, 23,24 three subjects who were over sixty 28,30,32 and one 29year-old individual. ...
... 31 In 30 studies, the reported symptoms were unilateral (20 right shoulders) 7,[19][20][21][22]24,26,31,32,39,44,46,[49][50][51][52][53]56 and 10 left shoulders, 23,25,[27][28][29][30]44,49,50,52 and in three studies the symptoms were present bilaterally. 34,36,44 Nine of them specified that the subjects' dominant shoulder was affected. 8,20,22,26,31,42,46,47 Pain was mostly defined as acute, recent, severe, 2,4,6,8,19,23,24,26,28,29,31,33,[35][36][37]42,43,49,[51][52][53]55 with a spontaneous and sudden onset [20][21][22][23][27][28][29][30][31][32]50,51 and which occurred during the night. ...
... 34,36,44 Nine of them specified that the subjects' dominant shoulder was affected. 8,20,22,26,31,42,46,47 Pain was mostly defined as acute, recent, severe, 2,4,6,8,19,23,24,26,28,29,31,33,[35][36][37]42,43,49,[51][52][53]55 with a spontaneous and sudden onset [20][21][22][23][27][28][29][30][31][32]50,51 and which occurred during the night. 1,2,4,20,22,26,31,32,35,42,44,48,51 However, in some articles, the subjects' pain was described as chronic 4,22,30,32,33,36,[39][40][41][42][43][44]46,48,50,51,55 and moderate 1,36,38,43,51 . ...
Introduction
The main goal of this scoping review is to highlight the clinical features of subjects with rotator cuff calcific tendinopathy (RCCT), in order to identify and map this condition clinical criteria, and thus to be able to hypothesize such pathology before imaging investigations.
Methods
Four databases were consulted up to January 2023. The obtained results were reported following the PRISMA-ScR and the Joanna Briggs Institute reviewer's manual was used as guideline for conducting the review. No time and geographical restrictions were applied.
Results
A total of 851 records have been identified, with 50 studies meeting the inclusion criteria. Subjects with RCCT mostly reported nightly, acute and severe pain with spontaneous onset. Symptoms were mostly unilateral. Subjects were mostly women aged between 30 and 60. Deficit in active and passive range of motion was reported, mainly during abduction and forward flexion. Endocrine and metabolic disorders were described as comorbidity, in particular diabetes and thyroid disorders.
Conclusion
In this scoping review, the most relevant RCCT clinical features were detected. These clinical criteria, predictive for shoulder RCCT, can be crucial to help all clinicians suspect this musculoskeletal disease early and with certainty, thus allowing for an appropriate and prompt diagnosis path.
Level of evidence
III.
... When individuals present with acute symptomatic HADD following minor trauma, there is a possibility that HADD's calcifications may be misinterpreted as avulsion fragments. Nevertheless, avulsion fractures typically display a linear or incompletely corticated appearance, contrasting with HADD calcification's more ambiguous or homogeneous display [35]. ...
... In situations where HADD affects the longus colli muscle at the cervical spine, patients might also experience neck stiffness, odynophagia (painful swallowing), and dysphagia (difficulty swallowing). In rare instances, the swelling accompanying HADD in this region can lead to airway compromise [35]. ...
... These calcifications are calcium apatite crystal deposits within and around connective tissues, a defining feature of HADD. In radiographic images, these calcifications often exhibit an amorphous, nebulous appearance, differing considerably from the linear or incompletely corticated appearance of avulsion fragments typically seen in traumatic injuries [35]. ...
Hydroxyapatite deposition disease (HADD) represents a multifaceted condition characterized by the accumulation of hydroxyapatite crystals in soft tissues, leading to subsequent inflammation and discomfort. The intricate etiology of HADD is the subject of this comprehensive review, which encompasses an in-depth analysis of the four proposed pathogenic mechanisms and a deliberation on the predisposing factors that instigate the development of this disease. In order to provide a thorough understanding of the disease’s progression, this manuscript delineates the stages of HADD—those preceding calcification, occurring during calcification, and following calcification—in meticulous detail. This chronology forms the basis of a complete portrayal of the evolution of HADD. Moreover, this review encompasses an examination of the radiological findings associated with HADD, furnishing an extensive discourse on imaging characteristics. The potential of HADD to mimic other diseases, thereby posing diagnostic challenges, is also articulated. The discourse continues with an investigation of HADD’s differential diagnosis. This section furnishes a robust framework for distinguishing HADD from other conditions based on imaging results. To enrich the understanding of this diagnostic process, case studies illustrating real-world applications are provided. An overview of treatment modalities for HADD, including both conservative and interventional approaches, forms the concluding discussion. The pivotal role of imaging specialists in the diagnosis and management of HADD is emphasized, highlighting their vital contribution to image-guided procedures and disease monitoring.
... [5] e greater trochanter, where the gluteal tendons insert, is the most frequently involved site. [6] HADD, however, can develop in any tendon or muscle. e flexor and extensor tendons of the hand can also be involved; the most frequent location is where the flexor carpi ulnaris (FCU) tendon attaches to the pisiform bone. ...
Hydroxyapatite deposition disease (HADD) can affect any location of the body and present with a variety of clinical symptoms. Here, we describe three unusual sites of involvement of HADD around the hip as well as the wrist joint. Magnetic resonance imaging along with computed tomography correlation was performed in these cases, which demonstrated the calcific deposits as well as their associated soft-tissue inflammatory changes. Its imaging findings can look very aggressive and empowering, similar to infection or even malignancy. This makes this entity a great mimicker. Through these cases, we emphasize the need to think about HADD in places other than the classical shoulder girdle and always keep it on the differential list.
... Calcific tendinitis in the fingers has rarely been reported. Due to its low incidence and atypical clinical manifestations, calcific tendonitis in the fingers is usually misdiagnosed as flexor sheath infection, tenosynovitis, septic arthritis, fracture, cellulitis, or gout (3)(4)(5). Such misdiagnoses have resulted in unnecessary antibiotic treatment and surgery. ...
... The effects of conservative treatment can be insufficient however, and the condition is prone to relapse. When conservative treatment is ineffective, or the symptoms persist, surgery can be considered (5,6). ...
... Postoperative histopathological examination revealed calcium hydroxyapatite deposition with necrosis of surrounding tissue. Calcific tendinitis is a self-limiting disease, but both conservative treatment and surgical treatment have been successfully utilized (5,30). Conventional treatment methods involve immobilization in conjunction with aspirin or non-steroidal anti-inflammatory medications, with the aim of reducing pain and relieving symptoms. ...
Background
Calcific tendonitis rarely occurs in the fingers, and it is easily misdiagnosed. Herein we describe the case of a patient with multiple calcific lesions within the flexor digitorum superficialis and the extensor digitorum tendons of the distal interphalangeal joints of the right index finger, and the surgical treatment of those lesions.
Case presentation
The patient was a 66-year-old man who reported pain and swelling in his right index finger for one year. He was diagnosed with chronic calcific tendonitis based on his symptoms and radiology images. He was successfully treated surgically, and histopathological examination confirmed the diagnosis. After one month, the patient had healed well, and there was no recurrence.
Conclusions
This is the first report of a patient suffering from chronic calcific tendonitis in a finger who failed conservative treatment and was successfully treated with surgery. The outcome demonstrates that surgical debridement can yield a good outcome in patients with chronic calcific tendonitis.
... It is a subset of the broader disease process called hydroxyapatite crystal deposition disease (HADD). A clinical distinction from the more common subsets of HADD such as calcific tendinitis and calcific bursitis is that calcific periarthritis favors distal extremities and small joints such as fingers and toes [1]. The typical demographic is middle-aged women. ...
... Acute hydroxyapatite deposits appear as fluffy, amorphous, and illdefined periarticular calcifications. Chronic or long-standing deposits have a well-defined and homogenous appearance [1]. Calcific periarthritis rarely affects underlying bone as it does in the case presented. ...
... Calcification of the tendon most commonly occurs in the shoulder, causing rotator cuff pain, but calcification can also be found on other tendon sites such as hip, spine, patella, and Achilles [1]. Calcific tendinitis of the hand and wrist are extremely rare, occurring only 2.4% of calcification deposits in the tendon [2]. ...
... Appearance of the calcification on radiographs depends on the phase of tendinitis. Acute condition of calcific tendinitis shows a fluffy, ill-defined and inhomogeneous appearance, whereas a better defined, and homogenous calcification are usually seen in a more chronic condition [1]. Measurement of calcification usually ranges between 2 and 10 mm. ...
Introduction:
Calcification in the tendon (Calcific Tendinitis) occurs commonly in the shoulder, but this condition can happen in other tendon sites. Calcific tendinitis of the hand and wrist occurs rarely, which causes unfamiliarity toward the disease. With the symptoms mimicking other causes, misdiagnosis often happens. This can cause ineffective and over treatment.
Case report:
A 51-year-old man presented with a 2-week-pain on his right wrist with localized erythema and tenderness on physical examination. Imaging with ultrasound and X-ray shows calcification on the flexor carpi ulnaris tendon. Patient was treated with splinting for 2 weeks and NSAID for pain management and was free of pain afterwards.
Conclusion:
Calcific tendinitis mimics the symptoms of various causes. The ability to differentiate this entity to other differential diagnosis leads to an effective and precise treatment.
... "Hydroxyapatite deposition disease" (HADD) ist eine gut bekannte Entität und kann theoretisch in jeder Sehne des Körpers vorkommen. Am häufigsten sind hiervon jedoch die Schulter und die Hüfte betroffen [3]. Die abgelagerten Hydroxyapatitkristalle verursachen dabei eine Entzündungsreaktion im Körper, was zu einem periinflammatorischen Ödem führt und auch von systemischen Reaktionen (z. ...
... Die genaue Ätiologie der HADD ist jedoch nicht abschließend belegt. So stützen einige Autoren die Theorie der zellvermittelten Entzündungsreaktion, wohingegen andere Autoren eher von auslösenden Mikrotraumen, degenerativen Prozessen oder genetischer Prädisposition ausgehen [3]. ...
Zusammenfassung
Atraumatische Nackenschmerzen sind ein häufiger Vorstellungsgrund für Patienten in der Notaufnahme. Für die behandelnden Ärzte ist dabei der Ausschluss möglicherweise lebensbedrohlicher Erkrankungen, wie Spondylodiszitis, retropharyngealer Abszess oder Meningitis, oft eine große Herausforderung. In dieser Kasuistik wird der seltene Fall der retropharyngealen Tendinitis vorgestellt, einer wenig bekannten und dadurch sicherlich unterdiagnostizierten Entität. Sie ist charakterisiert durch einen stark reduzierten Bewegungsumfang der HWS, erhöhte Infektparameter und einen pathognomonischen MRT-Befund.
Zusätzlich zur Fallpräsentation soll im Rahmen eines kurzen Reviews die Charakteristik der retropharyngealen Tendinitis noch genauer dargestellt werden. So ist es das Ziel dieser Arbeit, die behandelnden Ärzte für dieses Krankheitsbild zu sensibilisieren, um in Zukunft falsche bzw. unnötige Therapien zu vermeiden.
... 1 It predominantly affects people between 40 and 60 years age group with women being more often affected than men. 2 It is most commonly described in the shoulder followed by hip. 1,3 Involvement of the wrist and hand is less common. Strong clinical suspicion with radiographic evidence of calcification leads to correct diagnosis. ...
... 5 MRI and the clinical history also help exclude other differential possibilities such as infection and trauma. 3,6 Being a self-limiting condition, a conservative approach is considered ideal for management. 4,7,8 In some cases, however, there is excessive pain which impacts the quality of life. ...
... It is a well-known and common painful condition most often seen in the shoulder. 1,3 The condition also occurs in multiple other locations all over the body but is often missed or misdiagnosed due to the lack of awareness. It has been described at many small joints of the hand and wrist involving both the flexor and extensor tendons, most common location being insertion of flexor carpi ulnaris tendon at pisiform. ...
Aim To demonstrate the role of radiographs and ultrasound (USG) in the diagnosis of calcific tendinitis and periarthritis in the wrist and hand and the efficacy of USG-guided barbotage for its management.
Materials and Methods A retrospective chart review was performed in six patients who presented with acute-onset pain in the wrist and hand varying from 3 days to 2 weeks. Four patients had tenderness over pisiform and two patients had pain along the lateral aspect of the wrist and thumb. Radiographs and USG revealed calcific focus corresponding to the site of pain. USG-guided calcific barbotage and injection was performed for the same and pain relief was assessed immediately and through telephonic follow-up at 6 months using subjective satisfaction score. Data were analyzed using Microsoft Excel 2013.
Results Four patients with tenderness over pisiform had flexor carpi ulnaris calcific tendinitis and two patients with pain along the lateral aspect of the wrist and thumb had first metacarpophalangeal calcific periarthritis and abductor pollicis brevis calcific tendinitis on radiographs as well as USG. In post-USG-guided calcific barbotage and injection, all patients had significant immediate and 6 months delayed relief in symptoms with excellent satisfaction scores.
Conclusion Acute calcific tendinitis/periarthritis is a benign and self-limiting inflammatory condition. Radiographs are extremely helpful in identifying calcific focus. Ultrasonography in experienced hands is the best modality to identify, confirm the symptomatic calcific focus, and perform USG-guided intervention. USG-guided calcific barbotage is the simplest, quickest, and effective way to treat this condition and avoid compromised functional capacity.
... 4 After the shoulder, the hip is the second most frequently involved site, seen in 5% of adults with calcific tendinitis. 5 Although almost always described around the insertion of the gluteal tendons on the greater trochanter and/or gluteal tuberosity, 6 HADD can occur in any tendon or muscle and hence have a variety of clinical manifestations. ...
Hydroxyapatite crystal deposition disease (HADD) around the hip is typically described involving the gluteal tendons. However, HADD can occur in any location and result in varied clinical presentations. Even with small deposits, symptoms can be significant and imaging findings may appear aggressive, mimicking infection and malignancy particularly when in an atypical location.
We illustrate cases of both common and rare locations of HADD around the hip, in particular presenting as greater trochanteric pain syndrome, piriformis syndrome and ischiofemoral impingement. The latter two manifestations have not been previously described in the literature.
Low signal deposits were identified on MRI at the greater trochanter (gluteus medius tendon), proximal piriformis (adjacent to the sciatic nerve), and quadratus femoris (in the ischiofemoral space), respectively. Associated inflammatory changes with tendinopathy, bursitis and oedema were also demonstrated. The patient with piriformis syndrome underwent steroid injections and shockwave therapy with significant symptom improvement.
HADD should be within the differential diagnosis for hip pain and nerve compression syndromes. Knowledge of tendon anatomy and correlation with radiographs or CT, even after MRI, is crucial in recognising unusual manifestations and preventing unnecessary investigation. Therefore, we review the spectrum of imaging features of HADD, as well as the current evidence on its management, to confidently diagnose this condition.
... The relationship between CaT and RC tear is controversial given the differing findings in the literature [8,12]. Studies published as early as the 1950s demonstrated that RC tears in the presence of CaT are rare [13][14][15][16][17]. Conversely, both older and very recent studies report that RC tears are not uncommon with CaT [9,[18][19][20][21][22]. ...
Objectives
To compare the incidence of rotator cuff (RC) tears on shoulder ultrasounds of patients with RC calcific tendinopathy (CaT) to that of a control group without CaT.Method
In this retrospective case-control study, 50 shoulder ultrasounds of patients with CaT were compared independently by 2 musculoskeletal radiologists to 50 patients from a control group without CaT to catalog the number and type of RC tears. RC tears in the CaT group were further characterized based on location, into tears in the specific tendon(s) containing calcium versus all tendon tears.ResultsRC tears were diagnosed in 38% (19/50) of the control group (16 full-thickness) as compared to 22% (11/50) with CaT (6 full-thickness). The fewer full-thickness tears in the CaT group (12%, 6 of 50) compared to that in the control group (32%, 16 of 50) was statistically significant (P = 0.016, odds ratio 0.29). Only 7 of the 11 tears in the CaT group were in a calcium-containing tendon (3 full-thickness). The fewer calcium-containing tendon tears compared to tears in the control group was also statistically significant (P = 0.006, odds ratio 0.27). Furthermore, the fewer full-thickness calcium-containing tendon tears (6%, 3/50) compared to full-thickness tears in the control group (32%, 16/50) were yet more statistically significant (P = 0.001, odds ratio 0.14).Conclusions
In patients with shoulder pain and CaT, we observed a decreased number of RC tears and especially calcium-containing tendon tears, as compared to similar demographic patients with shoulder pain but without CaT.
Key Points
• Patients with rotator cuff calcific tendinopathy have few rotator cuff tears, especially full-thickness tears, compared to a control group without calcific tendinopathy.
• The tendons containing the calcium hydroxyapatite deposition were the least likely to have a rotator cuff tear.
• Future studies could evaluate if calcium hydroxyapatite deposition provides a protective mechanism against rotator cuff tears.
• Musculoskeletal ultrasound is more sensitive than MRI in the evaluation of rotator cuff calcific tendinopathy.
