Intramuscular migration of calcific tendinopathy in the rotator cuff: ultrasound appearance and a review of the literature

Abstract

Calcific tendinopathy of the shoulder is a common condition caused by calcium hydroxyapatite crystals, affecting the tendons of the rotator cuff. Among uncommon complication, one is the migration of the calcium in the subacromion-subdeltoid bursa. More rare is the intraosseous migration. We present four cases of an even more rare condition, not well described in literature yet, the intramuscular migration of calcium.Keywords Calcific tendinopathy Á Intramuscular migration Á Shoulder pain Á Ultrasound Á Calcium hydroxyapatite crystal deposition disease Á Rotator cuff Riassunto La tendinopatia calcifica della spalla è una condizione comune causata da cristalli di idrossiapatite di calcio, che colpisce i tendini della cuffia dei rotatori. Tra le complicanze non comuni, una è la migrazione di calcio nella borsa subacromion-subdeltoidea. Più rara è la migrazione intraossea. Presentiamo quattro casi di una condizione ancora più rara, poco descritta in letteratura, la migrazione intramuscolare di calcio.

Ultrasound Appearance of the Migration of Tendon Calcifications

“…Other sites may be involved, and intramuscular migration of CTe is probably under‐recognized (Figure ). Ultrasound results require a correlation with clinical findings; other imaging modalities may be helpful to confirm the diagnosis …”

“…Ultrasound‐guided palpation reproduces and increases local pain, thus supporting the diagnosis. A positive history of CTe facilitates the diagnosis …”

“…Intramuscular migration of CTe is a rare condition, mainly involving the rotator cuff (Figure ) . Pereira et al hypothesized that calcium deposits may migrate through delaminating intrasubstance tendon tears, although they could not demonstrate this.…”

“…Pereira et al hypothesized that calcium deposits may migrate through delaminating intrasubstance tendon tears, although they could not demonstrate this. Ultrasound can effectively depict the intramuscular migration of calcium deposits because the hyperechoic calcifications can be easily visualized surrounded by the hypoechoic muscle (Figure ) . Doppler imaging typically shows hyperemia surrounding the calcification in the acute and painful phase (Figure ); the finding is likely related to muscular inflammation and edema, which can be shown by MRI .…”

Arthroscopic Treatment of an Unusual Intramuscular Calcium Hydroxyapatite Crystal Deposit on the Rotator Cuff

“…The most affected tendon is the supraspinatus (80%), followed by the infraspinatus (15%), subscapular (5%), and teres minor. The most common region of the affected supraspinatus is usually the “critical area,” 1.5 cm medial to the insertion in the greater tuberosity, which has low vascularization 1, 2…”