Acute calcific tendinitis of the pectoralis major insertion associated with cortical bone erosion

Dürr, Hans Roland; Lienemann, Andreas; Silbernagl, H.; Nerlich, Andreas G.; Refior, H. J.

doi:10.1007/s003300050277

Cited by 35 publications

(16 citation statements)

References 10 publications

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“…The predilection for these sites remained unchanged in later reports of isolated cases and small series, which included 7 humeral locations (pectoralis major insertion) and 14 femoral locations (gluteus maximus insertion) across 8 publications [11][12][13][14][15][16][17][18], and in other examples illustrated in review articles and book chapters [6,7,19,20]. It largely predominated in Flemming's series too (9 humeral locations at the pectoralis major insertion and 19 femoral locations in the proximal femoral linea aspera) [1] and was also present in our series, which included 2 humeral diaphyses at the pectoralis major insertion (Fig.…”

Section: Cortical Erosionsmentioning

confidence: 86%

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Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series

et al. 2015

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Calcium hydroxyapatite crystal deposition is a common disorder, which sometimes causes acute pain as calcifications dissolve and migrate into adjacent soft tissue. Intraosseous calcium penetration has also been described. We illustrate the appearance of these lesions using a series of 35 cases compiled by members of the French Society of Musculoskeletal Imaging (Société d'Imagerie Musculo-Squelettique, SIMS). The first group in our series (7 cases) involved calcification-related cortical erosions of the humeral and femoral diaphyses, in particular at the pectoralis major and gluteus maximus insertions. A second group (28 cases) involved the presence of calcium material in subcortical areas. The most common site was the greater tubercle of the humerus, accompanying a calcifying tendinopathy of the supraspinatus. In addition, an extensive intramedullary diffusion of calcium deposits was observed in four of these cases, associated with cortical erosion in one case and subcortical lesions in three cases. Cortical erosions and intraosseous migration of calcifications associated with calcific tendinitis may be confused with neoplasm or infection. It is important to recognize atypical presentations of hydroxyapatite deposition to avoid unnecessary investigation or surgery.

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Section: Cortical Erosionsmentioning

confidence: 86%

“…The resultant inflammatory response may produce focal hypervascularity, leading to local bone resorption. The erosions may also be due to the mechanical pulling effect at the tendon insertion [1,3,14]. It is essential to note that the remodeling may include zones of chondroid metaplasia.…”

Section: Cortical Erosionsmentioning

confidence: 98%

Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series

et al. 2015

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“…4,12 In most reported case studies, painfulness may also occur due to bone or cortical erosion. 10,14,17 Another phenomenon that causes shoulder pain is sudden inflammation that produces an aggressive inflammatory reaction with inflammatory cell accumulation, excessive edema and increasing intratendineous pressure. 6,15 This reaction leads to severe pain that certain researchers have attributed to secondary impingement resulting from increased tendon size or to the rupture of Western Undergraduate Research Journal STUDENTS IN THE FIELD deposits into the subacromial space or the bursa.…”

Section: Discussionmentioning

confidence: 99%

Infraspinatus and Teres Minor Tendon Calcification with Severe Pain

2017

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Calcific tendinitis is an extremely common shoulder disorder which affects 2.7 to 10.3% of the adult population. However, clear details regarding the formation of calcific tendinitis have only been found recently, and its pathology still under debate. In this report, we present a case of calcific tendinitis affect both the infraspinatus and the teres minor tendon with both X-ray and ultrasound findings. Calcific tendinitis at the infraspinatus is rare (around 8.4% in all rotator cuff calcific tendinitis), and no separate case report on calcific tendinitis has been reported in the teres minor region in the preceding several years, therefore, the rarity of reporting this case was considered.4 We assume that additional case reports can help to further improve our understanding regarding infraspinatus and teres minor tendon calcification.

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“…Injuries to the pectoralis major tendon are rare and occur most often at the site of insertion 7,8 . Tears as well as calcific tendinitis are the most common pathological findings of the pectoralis tendon [9][10][11] whereas chronic avulsion injuries more frequently involve the deltoid tendon inserting at the humerus or the gluteus maximus tendon at the femur 12,13 . Histologically, the reactive nature of the lesion was confirmed and a primary or secondary bone tumor could be ruled out with certainty.…”

Section: Discussionmentioning

confidence: 99%

Enthesopathy of the pectoralis major tendon mimicking osteoid osteoma. A case report with an unfortunate series of events

Baumhoer

Jundt

Lenze

et al. 2015

MLTJ

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IntroductionTendons, aponeuroses and fasciae transfer the forces developed by muscle activity to bone and are firmly attached at both the periosteum and the cortical bone by extrinsic collagen fibers 1 . Summarized under the term entheses, these bone-soft tissue interfaces are especially prone to mechanical injuries that are well documented in a number of sports. As a consequence of repetitive biomechanical stress affecting the periosteal anchorage, extensive reactive new bone formation can occur and clinically as well as radiologically mimic neoplastic disease. We present a case of an enthesopathy of the pectoralis major tendon that was initially regarded suspicious for a metastasis, then, during radiological workup, proved difficult to distinguish from an osteoid osteoma and eventually was resected. The report illustrates the difficulties in assessing enthesopathies with unusual presentations and the potential complications of avoidable partial resections of cortical bone. Case reportA 50-year-old woman with a history of localized breast cancer (TNM classification: pT1c, pN0, cM0, G2) that was resected and treated with additional adjuvant radiotherapy three years ago, underwent a 99 m Technetium DPD bone scintigraphy due to chronic back pain to assess bone metastasis. While the spine was unremarkable, the left proximal humerus showed a focal uptake of the radioisotope on the whole body scan and the spot view of the left upper arm (Fig. 1). Specifically asked for symptoms she complained about minor pain in this region. Due to clinically suspected metastatic breast cancer, radiographs and a magnetic resonance (MR) imaging were acquired. The externally rotated anteroposterior radiograph of the left proximal humerus showed a focal juxtacortical osteolysis of 8 x 5 mm with a central calcification of the lateral cortex and a concomitant uniform smooth, non-aggressive periosteal reaction (Fig. 2). Corresponding to the radiographs, the MR images revealed a 5 x 4 mm lesion adjacent to the anterolateral humeral cortex with increased signal intensity on the T2-weighted fat saturated images, intermediate signal intensity on the T1-weighted images and enhancement after contrast administration (Fig. 3 A-D). The cortex underneath the lesion was slightly thinned, neither bone nor soft tis- SummaryBackground: we present the case of an enthesopathy at the proximal humerus which was initially -due to the clinical history and a positive bone scintigraphy -regarded suspicious for metastatic breast cancer in a 50-year-old woman. Case report: after complementing radiographs and a magnetic resonance (MR) examination exhibiting a focally contrast enhancing juxtacortical osteolysis of the humerus, a metastasis seemed radiologically unlikely, but besides a traction-related periosteal reaction of the pectoralis major tendon an unusual osteoid osteoma could not unequivocally be ruled out. Although radiological follow-up was recommended the patient insisted on a surgical resection that was performed subsequently and confirmed an enthesopa...

show abstract

Acute calcific tendinitis of the pectoralis major insertion associated with cortical bone erosion

Cited by 35 publications

References 10 publications

Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series

Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series

Infraspinatus and Teres Minor Tendon Calcification with Severe Pain

Enthesopathy of the pectoralis major tendon mimicking osteoid osteoma. A case report with an unfortunate series of events

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