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Shoulder disorders
Published in Maneesh Bhatia, Tim Jennings, An Orthopaedics Guide for Today's GP, 2017
A severely painful shoulder joint that will barely move – think malignancy, infection or acute calcific tendonitis – or in the case of trauma fracture. Calcific tendonitis is not a red flag diagnosis, but the pain of calcific tendonitis (usually because the calcium is leaving the tendon) is extremely painful and can mimic the ‘nasty’ cases. An x-ray will help in the diagnosis. Note that bilateral morning stiffness suggests polymyalgia rheumatic (PMR).
Upper limb symptoms and signs
Published in Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse, Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse
In chronic calcific tendinitis, the patient may be symptomless, and the calcification may be an incidental finding on a shoulder X-ray. When the calcification is painful, it is generally less marked than in acute calcific tendinitis, and is more consistent with the presentation of an impingement.
Arthritis
Published in Harry Griffiths, Musculoskeletal Radiology, 2008
Here is yet another newly described condition; yet it really is not. Everyone has heard of calcific bursitis and calcific tendinitis, and for a long time the underlying cause of these two conditions was thought to be the calcium pyrophosphate crystals. However, that is not so. Hydroxyapatite is an essential component of bone, ligaments, synovium, and tendons. If a tendon becomes torn, hydroxyapatite crystals get released and, in normal people, actually help with the healing process. In fact, hydroxyapatite is used as a “glue” for porous coated joint prostheses, where it is actually sprayed onto the outside of the prosthesis to aid in fusion between it and the underlying bone. And yet, no one fully understands what goes wrong in some people; when the tendon tears, blood and hydroxyapatite get deposited into the joint space and, in some people, apparently an inflammatory response ensues, which leads to calcification (and the presence of calcium pyrophosphate crystals, incidentally). This process is usually painful and is clinically known as calcific tendonitis (Fig. 112).
Calcific tendinopathy of the rotator cuff: a review of operative versus nonoperative management
Published in The Physician and Sportsmedicine, 2020
Joseph Bechay, Cassandra Lawrence, Surena Namdari
Controversy remains regarding the optimal methods for surgical management of calcific tendinitis. There is debate about removing all deposits versus leaving some deposits or whether or not the created tendon defect should be repaired (Figure 5). In a study by Ark et. al [11]., the authors concluded that complete removal of the deposits is not necessary after 12 of 14 patients obtained significant pain relief with residual calcium deposits evident on postoperative radiographs. Repair of the defects created from removal of the deposits was not performed. Alternatively, Jerosch et. al [47]. suggested that complete removal of the deposits is necessary, but repair of defects afterward is not. In another study by Porcellini et. al. [48], 63 patients who underwent arthroscopic debridement by one surgeon were analyzed. It was deemed that complete removal of the deposits and repair of the defects is appropriate as Constant score was inversely related to the number and size of residual calcifications at 2 year follow up. The authors argued that repair of the defects decreases the chance of further propagation of the tear and aids in patient rehabilitation. Given the conflicting findings in the current literature, further research is necessary to evaluate the optimal surgical technique.
Apatite calcific periarthritis of the radial collateral ligament of the thumb: a case report and review of the literature
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Wassim Zribi, Mohamed Mokhtar Jmal, Ameur Abid, Mohamed Ben Jemaa, Nabil Krid, Mohamed Zribi, Hassib Keskes
Periarticular calcifications with hydroxyapatite deposits were described in 1966 by Mac Carthy and Gatter [1]. The pathogenesis of this rare disease is uncertain, but two hypotheses exist. There may be local stress as a response to local necrosis resulting from microtrauma, causing calcium deposition and inflammatory reaction [2–4] Uhthoff and all [5], however, have shown no evidence of inflammatory infiltration or scarring. were not seen in a series of 46 cases of calcific tendinitis treated surgically. They suggest that tendon hypoxia is the inciting event, with poor vascular perfusion caused by mechanical or metabolic problems, factors leading to tendon transformation into fibrocartilage where chondrocytes mediate calcium deposition.
Calcific tendonitis of the flexor pollicis longus tendon at the thumb interphalangeal joint in childhood
Published in Baylor University Medical Center Proceedings, 2021
Mimi Phan, Krista Birkemeier, Reshma George, Ricardo Garza-Gongora, Matthew Crisp, Bradley Trotter, Varan Haghshenas
Calcific tendonitis, a disease of calcium hydroxyapatite crystal deposition in tendons, most commonly presents as monoarticular pain in adults.1–4 Rarely, it may present in a child as acute digit pain with inflammatory features. It may be acute, chronic, or asymptomatic; however, acute calcific tendonitis is notable for swelling, erythema, pain, and potentially elevated laboratory inflammatory markers.3 The clinical presentation overlaps with other etiologies, such as infection, trauma, tenosynovitis, or septic arthritis.2,4–8 Appropriate workup and recognition of pediatric calcific tendonitis can allow for conservative management.