Upper limb symptoms and signs
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
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.
Orthopaedics
Keith Hopcroft in Instant Wisdom for GPs, 2017
Calcific tendonitisIn the absence of trauma, sudden incapacitating shoulder pain may well be calcific tendinitis. The patient is often in agony with disturbed sleep. X-ray will reveal calcification in the rotator cuff. Treatment consists initially of an ultrasound guided steroid injection into the calcific deposit.Ulnar nerve problemsThe ulnar nerve can be trapped at the elbow (cubital tunnel syndrome) or at the wrist (Guyon's canal compression). Numbness on the dorsal and volar ulnar side of the hand suggests compression at the elbow, while numbness only on the volar side suggests compression in Guyon's canal. Urgent referral is required if the patient has motor features. Early motor symptoms involve the hand feeling clumsy due to weakness in the intrinsic muscles – affecting intricate activities such as doing up buttons or shoe laces, writing and picking up fine objects. Late signs, such as muscle wasting, may be irreversible, so refer early.Popeye biceps rupturePopeye biceps sign with pain and bruising distally on the front of the elbow may indicate a distal biceps rupture. Repair should ideally be performed within 10 to 14 days. Biceps are the main forearm supinator, so this movement will be most affected. Popeye sign with tenderness at the front of the shoulder is a proximal long head of biceps rupture – not an urgent referral. Often, surgery is not needed as this injury tends to occur in older patients and causes fewer problems.Missed scaphoid fractureA social goalkeeper blocking a shot is a common mechanism for scaphoid fracture and should always be taken seriously when presenting with wrist pain. Look out for a restricted range of movement, especially extension, with pain and swelling in the anatomical snuffbox plus pain on telescoping the thumb.Iliotibial band syndromeThis condition often affects runners, causing pain on the lateral aspect of the knee. It is caused by inflammation of the iliotibial band, which connects the iliac crest of the pelvis to the lateral proximal tibia. The ITB rubs over the lateral femoral condyle at the knee during flexion and extension, causing pain. This is often well localised but can radiate up the lateral aspect of the thigh. Treatment usually involves activity modification and physiotherapy.
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.
Applying a clinical decision-making model to a patient with severe shoulder pain ultimately diagnosed as neuralgic amyotrophy
Published in Physiotherapy Theory and Practice, 2022
Marie-Eve Pepin, Derek Chan
With still a large list of possible diagnosis, the PT tried to cluster signs and symptoms to discover a pattern. Clustering signs and symptoms is a process common with advanced clinicians when facing complex clinical scenarios (May, Withers, Reeve, and Greasley, 2010). Sudden and severe onset of acute shoulder pain with weakness was consistent with NA, but normal sensation was not. Pain laying down was consistent with congestive heart failure and pulmonary or visceral involvement, but no other symptoms indicated systemic involvement. Rapid onset of pain for no apparent reason, rapidly increasing in intensity, sharp pain felt with movement (especially abduction), and decreased strength and ROM were all consistent with acute bursitis or calcific tendinitis. However, the patient denied aggravating or recent changes in activities and did not respond to NSAIDs. Weakness and shoulder pain could be related to the severe pain or to peripheral nerve insults but there was no trauma or causative factors to implicate nerve injuries.
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.
Related Knowledge Centers
- Calcium Phosphate
- Infraspinatus Muscle
- Subscapularis Muscle
- Supraspinatus Muscle
- Radiography
- Rotator Cuff
- Physical Examination
- NONsteroidal Anti-Inflammatory Drug
- Physical Therapy
- Subacromial Bursa