Abstract
Objective
The intent of the study is to describe an unusual pattern of intramuscular migration of calcific deposits related to hydroxyapatite deposition disease (HADD) involving the rotator cuff, to illustrate the characteristic imaging features of this phenomenon, and to discuss the clinical significance of such migration.
Materials and methods
A series of cases of intramuscular accumulation of calcium hydroxyapatite crystals collected over a 7-year period at multiple hospitals within the same academic institution were retrospectively reviewed.
Results
The patient group was composed of seven men and four women, ranging in age from 51 to 79 years, with a mean age of 63 years. All subjects presented with acute shoulder pain. The majority of subjects reported the spontaneous onset of the symptoms (64 %), while others reported weight lifting (27 %) and a fall on the arm (9 %) as the mechanisms of injury. The right shoulder was affected in 73 % of the subjects. The supraspinatus was the most commonly affected muscle (82 %), followed by the infraspinatus muscle (36 %).
Conclusions
Knowledge of the imaging features of intramuscular migration of hydroxyapatite deposits is important in order to avoid the erroneous diagnosis of other causes of muscle edema and inflammation such as myotendinous injury, myositis, subacute denervation, and neoplasm.
Similar content being viewed by others
References
Hayes CW, Conway WF. Calcium hydroxyapatite deposition disease. Radiographics. 1990;10:1031–48.
Hayes CW, Rosenthal DI, Plata MJ, Hudson TM. Calcific tendinitis in unusual sites associated with cortical bone erosion. Am J Roentgenol. 1987;149:967–70.
Kachewar SG, Kulkarni DS. Calcific tendinitis of the rotator cuff: a review. J Clin Diagnostic Res. 2013;7:1482–5.
Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis, and management. J Am Acad Orthop Surg. 1997;5:183–91. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10797220.
Bosworth BM. Examination of the shoulder for calcium deposits. J Bone Jt Surg. 1941;23:567–77.
Mileto A, Gaeta M. Calcific tendonitis of supraspinatus simulating acute brachial neuritis (Parsonage-Turner syndrome). Clin Radiol. 2011;66:578–81. Available at: http://dx.doi.org/10.1016/j.crad.2011.01.001.
Rui YF, Lui PPY, Chan LS, Chan KM, Fu SC, Li G. Does erroneous differentiation of tendon-derived stem cells contribute to the pathogenesis of calcifying tendinopathy? Chin Med J. 2011;124:606–10.
Oliva F, Via A, Maffulli N. Physiopathology of intratendinous calcific deposition. BMC Med. 2012. p. 95. Available at: http://www.biomedcentral.com/1741-7015/10/95
Cho NS, Lee BG, Rhee YG. Radiologic course of the calcific deposits in calcific tendinitis of the shoulder: does the initial radiologic aspect affect the final results? J Shoulder Elb Surg. 2010;19:267–72.
Sola WC, Drake GN, Ramos CH, Gomes A, Gartsman GM. Calcific tendinitis of the rotator cuff associated with intraosseous loculation: two case reports. J Shoulder Elb Surg. 2009;18:e6–8.
Flemming DJ, Murphey MD, Shekitka KM, Temple HT, Jelinek JJ, Kransdorf MJ. Osseous involvement in calcific tendinitis: a retrospective review of 50 cases. Am J Roentgenol. 2003;181:965–72.
Kassarjian A, Torriani M, Ouellette H, Palmer WE. Intramuscular rotator cuff cysts: association with tendon tears on MRI and arthroscopy. Am J Roentgenol. 2005;185:160–5.
Jim YF, Hsu HC, Chang CY, Wu JJ, Chang T. Coexistence of calcific tendinitis and rotator cuff tear: an arthrographic study. Skeletal Radiol. 1993;22:183–5.
Hsu H-C, Wu J-J, Jim Y-F, Chang C-Y, Lo W-H, Yang D-J. Calcific tendinitis and rotator cuff tearing: a clinical and radiographic study. J Shoulder Elb Surg. 1994;3:159–64. Available at: http://dx.doi.org/10.1016/S1058-2746(09)80095-5.
Gotoh M, Higuchi F, Suzuki R, Yamanaka K. Progression from calcifying tendinitis to rotator cuff tear. Skelet Radiol. 2003;32:86–9.
Ramon FA, Degryse HR, De Schepper AM, Van Marck EA. Calcific tendinitis of the vastus lateralis muscle. Skelet Radiol. 1991;20:21–3.
Taneja AK, Kattapuram SV, Chang CY, Simeone FJ, Bredella MA, Torriani M. MRI findings of rotator cuff myotendinous junction injury. Am J Roentgenol. 2014;203:406–11. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25055277.
Lunn JV, Castellanos-Rosas J, Tavernier T, Barthélémy R, Walch G. A novel lesion of the infraspinatus characterized by musculotendinous disruption, edema, and late fatty infiltration. J Shoulder Elb Surg. 2008;17:546–53.
Walch G, Nové-Josserand L, Liotard JP, Noël E. Musculotendinous infraspinatus ruptures: an overview. Orthop Traumatol Surg Res. 2009;95:463–70.
Helms CA, Martinez S, Speer KP. Acute brachial neuritis (Parsonage-Turner syndrome): MR imaging appearance—report of three cases. Radiology. 1998;207:255–9.
Fritz RC, Helms CA, Steinbach LS, Genant HK. Suprascapular nerve entrapment: evaluation with MR imaging. Radiology. 1992;182:437–44.
Beltran J, Rosenberg ZS. Diagnosis of compressive and entrapment neuropathies of the upper extremity: value of MR imaging. Am J Roentgenol. 1994;163:525–31.
Yanny S, Toms AP. MR patterns of denervation around the shoulder. Am J Roentgenol. 2010;195:W157–63.
May DA, Disler DG, Jones EA, Balkissoon AA, Manaster BJ. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. Radiographics. 2000;20(1):S295–315.
Conflict of Interest
The authors declare that they have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pereira, B.P.G., Chang, E.Y., Resnick, D.L. et al. Intramuscular migration of calcium hydroxyapatite crystal deposits involving the rotator cuff tendons of the shoulder: report of 11 patients. Skeletal Radiol 45, 97–103 (2016). https://doi.org/10.1007/s00256-015-2255-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-015-2255-9