Abstract
Calcific tendinitis is a potentially symptomatic disorder characterized by calcium deposits in the substance of the tendon. Although this condition can occur in any tendinous tissue throughout the human body, calcium deposition commonly occurs at tendon insertions near the bone–tendon junction. The musculotendinous junction of the deltoid muscle has peculiarly dense intramuscular tendons to which muscle fibers attach obliquely to create muscular strength. Given that the intramuscular tendons themselves, which form the consecutive part from the insertion, are subjected to unpredictable stress load or microtrauma similar to tendon insertions, it is reasonable to assume that calcific tendinitis could also occur at the intramuscular tendons. Here we report a case of chronic symptomatic calcium deposition in the lateral part of the deltoid muscle between the origin and the insertion, which was eventually surgically removed and confirmed as intramuscular calcific tendinitis.
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Depalma AF, Kruper JS. Long-term study of shoulder joints afflicted with and treated for calcific tendinitis. Clin Orthop. 1961;20:61–72.
Kim MS, Kim IW, Lee S, Shin SJ. Diagnosis and treatment of calcific tendinitis of the shoulder. Clin Shoulder Elb. 2020;23(4):210–6.
Oliva F, Via AG, Maffulli N. Physiopathology of intratendinous calcific deposition. BMC Med. 2012;10:95.
Albano D, Coppola A, Gitto S, Rapisarda S, Messina C, Sconfienza LM. Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls. Radiol Med. 2021;126(4):608–19.
Merolla G, Singh S, Paladini P, Porcellini G. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment. J Orthop Traumatol. 2016;17(1):7–14.
Hayes CW, Conway WF. Calcium hydroxyapatite deposition disease. Radiographics. 1990;10(6):1031–48.
Becciolini M, Bonacchi G, Galletti S. Intramuscular migration of calcific tendinopathy in the rotator cuff: ultrasound appearance and a review of the literature. J Ultrasound. 2016;19(3):175–81.
Kalaycı CB, Kızılkaya E. Calcific tendinitis: intramuscular and intraosseous migration. Diagn Interv Radiol. 2019;25(6):480–4.
Pereira BPG, Chang EY, Resnick DL, Pathria MN. Intramuscular migration of calcium hydroxyapatite crystal deposits involving the rotator cuff tendons of the shoulder: report of 11 patients. Skelet Radiol. 2016;45(1):97–103.
Stirma GA, Chaves DH, Belangero PS, Andreoli CV, de Castro Pochini AC, Ejnisman B. Arthroscopic treatment of an unusual intramuscular calcium hydroxyapatite crystal deposit on the rotator cuff. Arthrosc Tech. 2019;8(10):e1093–7.
Kachewar SG, Kulkarni DS. Calcific tendinitis of the rotator cuff: a review. J Clin Diagn Res. 2013;7(7):1482–5.
Louwerens JKG, Veltman ES, van Noort A, van den Bekerom MPJ. The effectiveness of high-energy extracorporeal shockwave therapy versus ultrasound-guided needling versus arthroscopic surgery in the management of chronic calcific rotator cuff tendinopathy: a systematic review. Arthroscopy. 2016;32(1):165–75.
Suzuki K, Potts A, Anakwenze O, Singh A. Calcific tendinitis of the rotator cuff: management options. J Am Acad Orthop Surg. 2014;22(11):707–17.
Moser T, Lecours J, Michaud J, Bureau NJ, Guillin R, Cardinal É. The deltoid, a forgotten muscle of the shoulder. Skelet Radiol. 2013;42(10):1361–75.
Goldman AB. Calcific tendinitis of the long head of the biceps brachii distal to the glenohumeral joint: plain film radiographic findings. AJR Am J Roentgenol. 1989;153(5):1011–6.
Almedghio S, Garneti N. The acute and chronic presentation of gluteus medius calcific tendinitis- a case report of two. J Orthop Case Rep. 2014;4(4):48–50.
Park SY, Jin W, Lee SH, Park JS, Yang DM, Ryu KN. Acute retropharyngeal calcific tendinitis: a case report with unusual location of calcification. Skeletal Radiol. 2010;39(8):817–20.
Williams AA, Stang TS, Fritz J, Papp DF. Calcific tendinitis of the gluteus maximus in a golfer. Orthopedics. 2016;39(5):e997-1000.
Uhthoff HK, Sarkar K, Maynard JA. Calcifying tendinitis: a new concept of its pathogenesis. Clin Orthop Relat Res. 1976;118(118):164–8.
Vidavsky N, Kunitake J, Estroff LA. Multiple pathways for pathological calcification in the human body. Adv Healthc Mater. 2021;10(4): e2001271.
Brukner P, Cook JL, Purdam CR. Does the intramuscular tendon act like a free tendon? Br J Sports Med. 2018;52(19):1227–8.
Lorne E, Gagey O, Quillard J, Hue E, Gagey N. The fibrous frame of the deltoid muscle. Its functional and surgical relevance. Clin Orthop Relat Res. 2001;386(386):222–5.
Brukner P, Connell D. “Serious thigh muscle strains”: beware the intramuscular tendon which plays an important role in difficult hamstring and quadriceps muscle strains. Br J Sports Med. 2016;50(4):205–8.
Garrett WE Jr, Nikolaou PK, Ribbeck BM, Glisson RR, Seaber AV. The effect of muscle architecture on the biomechanical failure properties of skeletal muscle under passive extension. Am J Sports Med. 1988;16(1):7–12.
Archambault JM, Jelinsky SA, Lake SP, Hill AA, Glaser DL, Soslowsky LJ. Rat supraspinatus tendon expresses cartilage markers with overuse. J Orthop Res. 2007;25(5):617–24.
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 Elbow Surg. 2010;19(2):267–72.
Kwee RM, Kwee TC. Calcified or ossified benign soft tissue lesions that may simulate malignancy. Skelet Radiol. 2019;48(12):1875–90.
Freire V, Moser TP, Lepage-Saucier M. Radiological identification and analysis of soft tissue musculoskeletal calcifications. Insights Imaging. 2018;9(4):477–92.
Holobinko JN, Damron TA, Scerpella PR, Hojnowski L. Calcific myonecrosis: keys to early recognition. Skelet Radiol. 2003;32(1):35–40.
Rowland F, Call C, Mujtaba B, Amini B, Wang WL. Calcified leiomyoma of the deltoid: pathophysiology and imaging review. Skelet Radiol. 2019;48(4):625–8.
Noel E, Carillon Y, Gaillard T, Bouvier M. Needle aspiration irrigation in calcifying tendinitis of rotator cuff. In: Gazielly DF, Gleyze PT, editors. The Cuff. Paris: Elsevier; 1997. p. 152–7.
Tillander B, Franzén LE, Karlsson MH, Norlin R. Effect of steroid injections on the rotator cuff: an experimental study in rats. J Shoulder Elbow Surg. 1999;8(3):271–4.
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Yoshida, Y., Yoshida, A. Chronic intramuscular calcific tendinitis of the deltoid muscle. Skeletal Radiol 52, 1251–1256 (2023). https://doi.org/10.1007/s00256-022-04203-5
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DOI: https://doi.org/10.1007/s00256-022-04203-5