Migration of calcium deposit over the biceps brachii muscle, a rare complication of calcific tendinopathy: Ultrasound image and treatment

Abstract

Calcific tendinopathy is characterized by the deposition of calcium, mostly hydroxyapatite crystals, in tendons. Women are more frequently affected than men, with prevalence in the fourth and fifth decades of life. This condition has been reported between 2.5 and 7.5% of healthy shoulders in adults, but other tendons may also be affected. A complication of this condition is the migration of calcium deposits from tendons, usually the supraspinatus, into the subacromial-subdeltoid bursa. We reported a rare complication of calcific tendinopathy, that is, calcium deposits migrated from the long head of the biceps tendon over the proximal tract of the biceps brachii muscle. Keywords Shoulder • Ultrasound • Tendon • Calcific tendinopathy Sommario La tendinopatia calcifica è caratterizzata dalla deposizione di calcio, per lo più cristalli di idrossiapatite, nei tendini. Le donne sono più frequentemente colpite rispetto agli uomini, con una prevalenza nella quarta e quinta decade di vita. Questa condizione è stata riportata tra il 2,5% e il 7,5% delle spalle sane negli adulti, ma può interessare anche altri tendini. Una complicanza di questa condizione è la migrazione dei depositi di calcio dai tendini, di solito dal tendine sovraspinato alla borsa sub-acromion-deltoidea. Abbiamo riportato un caso di tendinopatia calcifica migrata dal tendine capo lungo del bicipite brachiale sopra al tratto prossimale del muscolo bicipite brachiale, rara complicanza della tendinopatia calcifica.

Ultrasound imaging of bone fractures

“…We strongly suggest performing a local sono-palpation over the bone irregularity in the attempt to exactly reproduce the pain usually complained by the patient [ 58 ]. Indeed, the aforementioned simple maneuver can be useful in clinical practice to optimize the differential diagnosis between pathological bony abnormalities and normal findings [ 59 ]. On the other hand, if the target anatomical area to assess is very painful reducing the compliance of the patient to the ultrasound examination, a large amount of gel (the “suspension technique”) can be used to avoid physical contact between the ultrasound probe and the skin.…”

“…On the other hand, if the target anatomical area to assess is very painful reducing the compliance of the patient to the ultrasound examination, a large amount of gel (the “suspension technique”) can be used to avoid physical contact between the ultrasound probe and the skin. Likewise, in the presence of doubtful/ambiguous sonographic findings, the comparative ultrasound examination [ 59 , 60 ] of the healthy vs. painful side can be considered an essential phase of the assessment.…”

Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls

“…The bicipital anchor and the distal myotendinous junction seem to be the two most vulnerable sites [66]. It has been described from case series and case reports as calcific opacities at plain radiographs or as inhomogeneous hyperechoic mass at US located along the anterior aspect of the proximal third of the biceps brachii muscle [66,67]. Calcifications at the origin of long head of the biceps, such as biceps anchor or biceps labral complex, have been less described in literature and generally present an ovoid shape, with their position close to the upper glenoid being unchanged during external or internal rotation of the humerus [66,68,69].…”

Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review

“…The most commonly described patterns are intratendinous, sub-bursal, intrabursal, intramuscular, intraosseous and intraarticular migrations ( Figure 1 D) [ 2 , 3 ]. Interfascial migration of softly hydrated calcification slipping from the originating tendon over the superficial fascia of biceps brachii muscle was also described [ 6 ]. An intra-articular migration has never been demonstrated by imaging modalities; however, several authors have reported the frequent onset of shoulder stiffness after arthroscopy for calcific tendinopathy—postulating the irritation of the glenohumeral capsule by residual calcium debris as the possible mechanism [ 7 ].…”