Fact-sheet: Calcific tendinitis - periarthritis
- Calcific tendinopathy
- Hydroxyapatite deposition disease
Updated on 09/08/2020 at 3:15 PM
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Definition
Disease of uncertain pathogenesis resulting in periarticular and/or intra-articular deposits mainly composed of carbonated apatite, hence the term hydroxyapatite crystal deposition disease
Clinical features
- Most often asymptomatic: incidental finding
- Acute tendinopathy: pain of inflammatory rhythm +/- swelling if the calcification is superficial (hands, feet...). Guarded posture of the Upper limb in cases of shoulder involvement (most frequent location)
- Chronic pain: particularly common in the shoulder, as it may cause subacromial impingement (superficial surface of the supraspinatus tendon) or anterior impingement (subscapularis tendon).
- Acute arthritis (Milwaukee shoulder +++)
- Chronic destructive arthropathy
Locations (in order of frequency): shoulder, Hip, Knee, Elbow, wrist, spine (longus colli muscle) ...
Laboratory findings
Inflammatory syndrome common in cases of acute involvement
Radiography
- Tendinous calcification typically amorphous, well-defined, round or oval, with sharp margins, of variable size
- During resorption, calcifications become poorly defined and less dense (fluffy appearance).
- Possible migration:
x into an adjacent bursa
x into the adjacent joint, with possible chronic arthropathy
x into the adjacent bone (intraosseous resorption): erosion
Ultrasound
- Hyperechoic +/- shadowing, rounded tendinous calcification
- During resorption, underlying tendinopathy is seen with hyperemia on Doppler and fragmentation of the calcification.
CT
No indication.
Tendinous calcification, +/- dense depending on the stage of disease, bone erosions in cases of intraosseous resorption
MRI
No indication.
- Tendinous calcification hypointense on T1 and T2
- T2 hyperintensity of the underlying tendon, bone, or soft tissue during the resorption phase
- Possible joint effusion or Bursitis
Management
->Symptomatic treatment +++: - NSAIDs - Ice - rest - corticosteroid injection -> Ultrasound-guided needle lavage-aspiration -> Ultrasound physiotherapy -> Lithotripsy -> Surgical excision as a last resort.
Classification
3 types of calcifications:
- Type A: dense, homogeneous calcification with sharp margins
- Type B: dense, septated, polylobulated or fragmented calcification with sharp margins
- Type C: inhomogeneous calcification with ill-defined/scalloped margins
Differential diagnosis
- Osteoarthritis with osteophytes
- CPPD crystal arthropathy
- Neurogenic osteoarthropathy
- Tumoral lesion
- Hemophilic arthropathy