CASE 103
By: Dr. Aliya Sarhan Al Barwani
HISTORY: 42 years old female patient with sever shoulder pain for 1 week.
What are the findings?
What is the diagnosis?
What is the name of this crystals?
FINDINGS:
Dense globular calcifications along the course of Supraspinatus tendon close to the greater tuberosity. No adjacent osseous erosion.
DIAGNOSIS:
Calcific tendinitis.
Crystal name: Hydroxyapatite crystal deposition disease (HADD).
PEARLS AND DISCUSSION:
Is a self-limiting disease seen in middle age adults. The crystals commonly deposit along Supraspinatus tendon 80%. It has four stages:
· Pre-calcifi: asymptomatic.
· Calcific: Symptomatic.
· Resorpative: Most symptomatic.
· Post-calcific: Mainly patient complain of movement restriction and less pain.
MRI: The crystal is low in signal in T1WI and T2WI and calcification may bloom in T2*.
Treatment: Oral analgesia/anti-inflammatory medication.
Mineral aspiration and subacromial local anaesthesia/steroid injection (Barbotage) under ultrasound guidance:
· Is mainly done during the calcific and resporbtion stages (Symptomatic stages).
· Mineral aspiration is performed by irrigating the calcification with normal saline and to dilute the calcium then aspirate it. This procedure is done with either single or double needle technique.
· The subacromial space is then approached and steroid is injected away from the Supraspinatus tendon.
FURTHER READING:
1. Giovanni Serafini, MD, Luca M. Sconfienza. Rotator Cuff Calcific Tendonitis: Short-term and 10-year Outcomes after Two-Needle US-guided Percutaneous Treatment— Nonrandomized Controlled Trial. Radiology. (2009)
2. Rima Aina, MD, Etienne Cardinal. Calcific Shoulder Tendinitis: Treatment with Modified US-guided Fine-Needle Technique. Radiology. (2001)
3. Donald J. Flemming, Mark D. Murphey. Osseous Involvement in Calcific Tendinitis: A Retrospective Review of 50 Cases. AJR (2003)
