Keywords:
Tissue characterisation, Education, Teleradiology, MR, Musculoskeletal system, Musculoskeletal soft tissue
Authors:
I. Bayram, E. Erturer; Istanbul/TR
DOI:
10.1594/essr2017/P-0173
Background
Biceps tendinitis is inflammation of the tendon around the long head of the biceps muscle.
Biceps tendinosis is caused by degeneration of the tendon from athletics requiring overhead motion or from the normal aging process (1).
Calcific tendinitis is a painful condition related to deposition of hydroxyapatite crystals; it favors large joints.
The shoulder,
specifically the tendons of the rotator cuff and the insertion of the long head of the biceps on the superior glenoid rim,
is a well-recognized location for this abnormality.
Calcific tendinitis accounts for 40-45% of patients with shoulder pain (2).
It is most often located at the insertion of the supraspinatus tendon on the greater tuberosity (2-5),
followed by the other three tendons of the rotator cuff.
Calcification at the long head of biceps's origin on the superior glenoid labrum has been well described in previous publications (2,
4,
6,
7).
However,
a more distal site near the junction of the tendon and muscle has rarely been noted in the literature.
Approximately the tendon muscle junction to be adjacent to the junction of the upper and middle thirds of the humerus.
This location corresponds roughly to the site of calcific tendinitis observed in the extra-articular biceps (on average,
6.6 cm below the lesser tuberosity).
Tendinitis of the long head of the biceps brachii is cited as a frequent cause of shoulder pain (8).
It may occur as an isolated entity (3,
6,
9),
but often coexists with rotator cuff tears and/or the impingement syndrome (10- 12).
The major radiographic differential diagnoses of calcific tendinitis of the extra-articular part of the tendon of the long head of the biceps are other soft-tissue densities that project below the tuberosity of the humerus,
specifically,
calcific bursitis and loose bodies trapped in the biceps tendon sheath. The calcium collection within the bursa,
unlike calcific tendinitis of the long head of the biceps,
is teardrop shaped,
more proximal in position,
and does not change with rotation.
A more difficult differential diagnosis comprises loose bodies that become trapped in the biceps tendon sheath.
The source of the loose bodies (degenerative arthritis or a Bankart deformity) was evident on the routine plain films (13).