Learning objectives
Describe the imaging findingsassociated with hydroxyapatite deposition in particular the association of reactive myositis
Describe the pathogenesis of hydroxyapatite deposition and associated acute tendinitis
Discuss treatment options related to the condition
Background
Hydroxyapatite deposition (HAD) is a common condition predominantly seen in the rotator cuff tendons.
It has been described in association with metabolic disorders such as diabetes and thyroid disease.
The pathogenesis is uncertain and different theories have been proposed [1].
In our review we aim to discuss the condition of hydroxyapatite deposition while focussing on the less described appearance of associated myositis.
Epidemiology:
The shoulder joint is most commonly affected by HAD and while 3% of the population may be asymptomatic,
7% will present with...
Imaging findings OR Procedure Details
Our case series looks at four unusual presentations of HAD affecting the origin of the peroneus longus at the fibular head,
the longus colli muscle,
common extensor origin in the elbow and the gluteus medius tendon in the hip.
Almost any tendon in the body is susceptible to HAD.
The supraspinatus tendon in the shoulder is the most commonly affected.
The hip joint is one of the more reported sites.
Calcific deposits may be seen in any of the peri-articular tendons and more commonly the...
Conclusion
HAD is a self-limiting condition and often resolves spontaneously within 2 weeks of symptoms.
In view of this the first measures would be conservative. Anti-inflammatory medication together with off loading of the tendon in question would be the first treatment of choice [5].
In the case of acute tendinitis of the longus colli immobilisation in a soft collar is sometimes advisory [6].
When conservative treatment fails non-surgical therapeutic options such as extracorporeal shock wave therapy,
steroid injection and needle aspiration of deposits may be required...
References
Grases F,
Muntaner-Gumbernat L,
Vilchex-Mira M et al (2015) Characterisation of Deposits in Patients With Calcific Tendinopathy of the Supraspinatus.
Role of Phytate and Osteopontin.
J Orthop Res 9999:1–8
Bruno P.
G.
Pereira,
Eric Y.
Chang,
Donald L.
Resnick,
Mini N.
Pathria (2016) Intramuscular migration of calcium hydroxyapatite crystal deposits involving the rotator cuff tendons of the shoulder: report of 11 patients.
Skeletal Radiol 45:97-103
Hayes,
C W,
and W F Conway (2013) Calcium Hydroxyapatite Deposition Disease.
RadioGraphics 10 (6): 1031–48.
Malghem,
Jacques,
Patrick Omoumi,...
Personal Information
Christine Azzopardi
Consultant Musculoskeletal Radiologistat the Nuffield Orthopaedic Centre- Oxford University Hospitals
For questions and/or comments about this poster,
please contact me at:
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