Osseous Involvement in Calcific Tendinitis: A Retrospective Review of 50 Cases

Abstract

Calcific tendinitis presenting with osseous destruction, marrow changes, and soft-tissue calcifications may be confused with neoplasm both radiologically and pathologically. Recognition of the atypical presentation of this common disease may prevent unnecessary biopsy.

Treatment of bone marrow lesions (bone marrow edema)

“…One study reported that MRI showed positive marrow edema in 36% of cases, whereas isotope scans revealed uptake in 100% of cases. 30 …”

Intramuscular migration of calcium hydroxyapatite crystal deposits involving the rotator cuff tendons of the shoulder: report of 11 patients

“…Homogeneous, well-defined deposits that are contained within the tendon and cause minimal symptoms are observed in the formative and resting phases. In the resorptive phase, however, the deposits grow in size, become ill-defined, and often migrate to the adjacent tissues [1,9], where they may extend beneath or within the overlying bursa, erode into the underlying bone [10,11] or, as described in this report, migrate medially within the tendon substance to the myotendinous junction of the corresponding rotator cuff muscle. The dispersion of hydroxyapatite crystals into neighboring tissues triggers an acute inflammatory response with severe pain and tenderness that is frequently seen with MRI as bursal fluid, soft tissue edema, or marrow edema about intraosseous deposits.…”

Migration of calcium deposits into subacromial–subdeltoid bursa and into humeral head as a rare complication of calcifying tendinitis: sonography and imaging

“…A rare complication of this condition is the migration of calcium deposits from tendon fibers, usually of the supraspinatus, to the subacromial space, into the subacromial-subdeltoid bursa (2) or into the humeral greater tuberosity (6,7,8,9), which is responsible for the intense acute shoulder pain and functional disability. This complication shows a typical US, radiographic, CT and MR imaging presentation, described in this article, which is important to know to make the correct diagnosis and avoid unnecessary invasive tests or aggressive surgery.…”

“…Intraosseous migration of tendon calcifications is another rare painful complication of calcifying tendinitis that has been described in the literature, not only in the shoulder [6][7][8], but also in other tendon insertions such as the pectoralis major, glutei maximus and medius, adductor magnus and deltoid insertions [9]. The pathomechanism is still unknown, but seems to be mediated by acute inflammation and local vasculature changes at the tendon insertion and by mechanical effects of the muscle traction causing bone destruction.…”