Calcific tendinitis in unusual sites associated with cortical bone erosion

Abstract

Five cases of calcific tendinitis with radiographic evidence of cortical bone erosion are presented. All five cases arose at unusual sites: two at the pectoralis major insertion on the proximal humerus,two at the insertion of the gluteus maximus, and one at the insertion of the adductor magnus. Biopsy was performed in four cases and revealed areas of histiocytic infiltration, amorphous spherules of calcification, and areas of giant cell reaction extending into the cortex.To our knowledge, calcific tendinitis presenting with radiographic evidence of bone erosion has not been reported previously.

Abnormal ossified structures around the hip joint and its clinical implications

“…19 Hayes et al reported five cases of calcific tendinitis with radiographic evidence of cortical bone erosion. 20 Wepfer et al reported three cases of gluteus maximus tendinitis, apparently none of which showed bone destruction. 21 Goldenberg and Leventhal reported calcified deposits near the greater trochanter (5 to 4%).…”

Synovium and Capsule

“…Crystal deposition may be identifi ed on MR imaging due to intra-articular foreign bodies, calcifi ed tendons insertions, cartilage destruction, and subchondral cysts and erosions. In some cases, deposition near the origin or insertion of tendons may simulate a malignant bone neoplasm [ 41 ].…”

Sonography of bone and bone‐related diseases of the extremities

“…Rotator cuff tears, arthritis, and rarely calcific tendinitis may cause periarticular bone erosion, which may reflect repetitive pressure, stress, or traction force on the insertion site of tendons or local hyperemia due to inflammation. [25][26][27] These bone changes sometimes may have an MSUS appearance similar to that of fractures. Because a stress fracture may be chronic, a focally thick hyperechoic callus commonly overlies the cortical interruption at the fracture site, a finding that may contribute to diagnosis in conjunction with the findings on radiographs.…”

“…[37][38][39]53 Miscellaneous and Soft Tissue Lesions Affecting the Bone Abnormalities of the bone and soft tissues, especially in the articular and periarticular regions, may cause changes in the bone surface; these are seen in arthritides, intra-articular loose bodies, rotator cuff tears, habitual dislocation of the shoulder (eg, Hill-Sachs' lesion of the shoulder), Osgood-Schlatter disease, and calcific tendinitis. 1,[6][7][8][9][10][25][26][27]60 Surface contours of the bone may in rare cases also be changed by bursitis, periosseous ganglia, myositis ossificans, giant cell tumors of the tendon sheath, and various juxtacortical soft tissue tumors. Therefore, bone abnormalities found during assessment of the soft tissues or joints, and vice versa, should be incorporated in differential diagnosis, as should information from radiography and other imaging studies.…”