Tendinitis calcarea

Calcific
tendinitis of the longus colli muscles: Schmerzen, C-reaktives Protein erhöht. Leukozyten nicht erhöht. Man erkennt schon in der Röntgenaufnahme ein kräftiges Kalkdepot ventral des C2 unter dem vorderen Atlasbogen. Recht kräftige Kontrastmittelaufnahme, was nicht unbedingt typisch ist und die Differentialdiagnose eines retropharyngealen Abszess bedenken lässt.
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Tendinitis
calcarea hier vor allem des Musculus infraspinatus mit sehr kräftigen, scholligen Depots. Links MRT axial PDW SPAIR, die auch das Ödem der Sehne bis in den Muskel zeigt. Rechts Röntgen.
Wikipedia •
Verkalkungen
in den Sehnen von M. infraspinatus (dorsal) und M. subscapularis (ventral)
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Tendinitis
calcarea infraspinatus
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Tendinitis
calcarea in der Sehne sowie im Muskelbauch des Subscapularis, weit nach medial reichend.
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Verkalkungen
in den Sehnen von M. infraspinatus (dorsal) und M. subscapularis (ventral)
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X-ray of a
right shoulder with calcific deposits (Calcific tendinitis)
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Hydroxyapatite
deposition disease • Rotator cuff barbotage (ultrasound-guided) - Ganzer Fall bei Radiopaedia
Roberts, D. Rotator cuff barbotage (ultrasound-guided). Case study, Radiopaedia.org. (accessed on 06 Nov 2022) https://doi.org/10.53347/rID-75291 • CC by-nc-sa 3.0 (modified)
Tendinitis
calcarea Schultergelenk mit kräftigem, scholligem Depot im Ansatzbereich der Supraspinatussehne.
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Hydroxyapatite
deposition disease • Calcific tendinitis of the infraspinatus tendon - Ganzer Fall bei Radiopaedia
Saber, M. Calcific tendinitis of the infraspinatus tendon. Case study, Radiopaedia.org. (accessed on 06 Nov 2022) https://doi.org/10.53347/rID-87256 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

Calcific tendinitis (or calcific tendonitis) is a self-limiting condition due to the deposition of calcium hydroxyapatite within tendons, usually of the rotator cuff. It is a common presentation of the hydroxyapatite crystal deposition disease (HADD).

Epidemiology

Typically this condition affects middle-aged patients between the ages of 30 and 60, with a slight predilection for women .

Clinical presentation

The condition passes through four stages :

  • pre-calcific
    • asymptomatic
    • fibrocartilaginous metaplasia (see below)
  • calcific or formative
    • symptoms are variable from none to pain on movement
  • resorptive
    • most symptomatic
    • pain due to extravasation of calcium hydroxyapatite into adjacent tissues, especially subacromial bursa, causing calcific bursitis
    • pain typically lasts two weeks
  • post-calcific
    • variable symptomatology
    • some restriction of movement common
    • may last months

    • Pathology

    Calcific tendinitis results from the deposition of calcium hydroxyapatite within the substance of a tendon and is thought to be due to decreased oxygen tension, leading to fibrocartilaginous metaplasia and secondary mineralization .

    Location

    This condition most frequently affects the rotator cuff of the shoulder .

    However, the condition may occur anywhere in the body with the hip and knee being the other most common locations .

    Radiographic features

    Plain radiograph

    Calcific deposits are usually visualized as homogeneous hyperdensity with variable morphology, but typically globular/amorphous with smooth or ill-defined margins.

    Ultrasound

    Features of calcific tendinitis on ultrasound may include :

    • a curvilinear/ovoid calcification with acoustic shadowing
    • capsular soft tissue swelling
    MRI
    • T1
      • hypointense homogeneous signal
      • adjacent tendon may be thickened
      • some enhancement surrounding deposit may be seen
    • T2
      • hypointense calcium deposits
      • hyperintense signal may be present peripherally due to edema
      • hyperintense subacromial-subdeltoid bursal fluid
    • T2*: calcifications may bloom

    Treatment and prognosis

    Controversial and difficult to measure due to the inherent variability of the symptoms and the self-limiting nature of the disease. Potential treatments include :

    • oral analgesic/anti-inflammatory medication
    • subacromial local anesthetic/steroid injection
    • aspiration of mineralized material
    • ultrasound therapy

    Differential diagnosis

    In the shoulder consider:

    • incidental calcification: seen in 2.5-20% of 'normal' healthy shoulders
    • degenerative calcification
      • seen in previously torn tendons
      • generally smaller
      • slightly older individuals
    • loose bodies
      • associated chondral defect
      • associated secondary osteoarthritis
    Siehe auch:
    und weiter:
    Assoziationen und Differentialdiagnosen zu Tendinitis calcarea:
    periartikuläre
    Verkalkungen
    Wikipedia •
    Hydroxylapatit-Ablagerungserkrankung
     
    Wikipedia • CC BY-SA 3.0 de
    kalzifizierende
    Tendinitis des Musculus longus colli
    Wikipedia • CC BY-SA 4.0
    Tendinosis
    calcarea der Rotatorenmanschette
    Wikipedia • CC-BY-SA-3.0
    Bursa
    subacromialis
    Wikipedia • Public domain
    Rotatorenmanschette
     
    Wikipedia • Public domain
    Tendinitis
     
    Wikipedia • CC BY-SA 4.0
    Tendinitis
    calcarea Musculus infraspinatus
    Wikipedia • CC BY-SA 4.0
    frozen
    shoulder
    Wikipedia • CC BY-SA 3.0
    Milwaukee-Schulter
     
    www.eurorad.org • CC by-nc-sa-4.0
    Tendinitis
    calcarea Musculus supraspinatus
    Wikipedia • CC BY-SA 4.0