Calcific tendinitis (ruptured)

Case contributed by Bruno Di Muzio
Diagnosis almost certain

Presentation

Excruciating right shoulder pain with associated local increased temperature. Has had corticosteroid injection done by the GP three days ago. Septic joint?

Patient Data

Age: 40 years
Gender: Female
  • Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Right shoulder radiographs

Globular calcification surrounding the greater tuberosity most likely represents calcium hydroxyapatite deposition within the supraspinatus tendon, with signs of rupture into the subacromial space or into the bursa. The glenohumeral joint is normally aligned with no erosive changes identified. The acromioclavicular joint is normal.

Shoulder ultrasound

ultrasound

There is echogenic material within the supraspinatus tendon that appears to track down along the greater tuberosity, forming an extra tendinous pouch with compressible and mobile debris. Correlation with the radiographs, where it is shown to be dense, makes it highly concerning for a ruptured calcific bursitis. 

Case Discussion

This case illustrates classic appearances of calcific tendinitis involving the supraspinatus tendon with due to rupture of the calcium hydroxyapatite deposits into the subacromial space/bursa.

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