Acute severe neck pain and dysphagia following cervical maneuver: diagnostic approach

Calcific Tendinopathy Atypically Located Outside the Rotator Cuff: A Systematic Review

BACKGROUND AND PURPOSE

Calcific tendinopathy is a common cause of painful shoulder easily identified with ultrasound or conventional radiography. Although the rotator cuff is by far the most common location of the disease and diagnostic or treatment strategies are well known in clinical practice, a lack of awareness characterizes the assessment of the other sites affected by this condition; consequently, the risk of underestimating the prevalence of atypical non-rotator cuff calcific tendinopathy is high. This may lead to expensive or invasive diagnostic exams and/or inappropriate treatment, whereas the condition is usually self-limited. The present study aims at analysing the frequency of calcific tendinitis in uncommon sites, in order to fill a gap in knowledge and awareness regarding non-rotator cuff calcific tendinopathy, thus avoiding improper clinical choices and helping to identify this condition.

METHODS

This systematic review was conducted following the PRISMA guidelines. We performed a search on Pubmed and Scopus databases concerning atypically sited extra-rotator cuff calcific tendinopathy published since 1950.

RESULTS

The research found a total of 267 articles and 793 non-rotator cuff cases of calcific tendinopathy registered. The spine (213 – 26.86%), foot and ankle (191 – 23.95%), and hip (175 – 22.06%) appeared to be the most common sites of calcific tendinopathy after the rotator cuff, whereas the longus colli C1-C2 (204 – 25.72%), Achilles (173 – 21.81%), and rectus femori (61 – 7.69%) were the most commonly affected tendons.

CONCLUSION

A better awareness of this condition in several different sites of the body than the rotator cuff could avoid unnecessary choices both in assessment and treatment.

Differentiation of retropharyngeal calcific tendinitis and retropharyngeal abscess: a case series and review of the literature

Introduction

Retropharyngeal calcific tendinitis (RCT) is a self-limiting aseptic inflammation of the tendon of the longus colli muscle, which can be clinically and radiologically misdiagnosed as abscess formation. This is a particular challenge for ENT specialists. However, articles about RCT are highly underrepresented in ENT journals and existing articles in ENT journals almost exclusively report overtreatment.

Methods

This study presents five patients, in which the diagnosis of RCT was delayed and of which one patient underwent incision and draining of a suspected retropharyngeal abscess under general anesthesia. In addition, the literature on the reported cases of RCT, between 1990 and 2020 was reviewed. For each case, epidemiological characteristics, complaints on presentation, symptoms, imaging and laboratory finding and treatment were summarized and compared to our own findings.

Results

In all the five patients, the correct diagnosis was delayed. One patient underwent incision and draining of a suspected RA under general anesthesia. All patients received antibiotic treatment. The literature review revealed a total of 116 reported cases of RCT. A total of 99 CT scans and 72 MRI showed soft tissue swelling in 89.6% and calcifications in 91.4% of the cases, 6.9% received invasive treatment.

Conclusion

This article emphasizes the importance of knowledge about RCT and its management to avoid invasive and potentially harmful treatment. The focus in establishing the correct diagnosis of RCT is the identification and correct interpretation of clinical symptoms together with the specific radiological findings.

Electronic supplementary material

The online version of this article (10.1007/s00405-020-06057-w) contains supplementary material, which is available to authorized users.

Retropharyngeal Calcific Tendonitis in a Patient Seeking Chiropractic Care for Neck Pain: A Case Report

Objective

The purpose of this report is to describe the evaluation and treatment of a patient initially presenting for chiropractic care of neck pain (NP) who was subsequently diagnosed with retropharyngeal calcific tendonitis (RCT).

Clinical Features

A 53-year-old woman presented to a chiropractic office with severe idiopathic NP, loss of cervical mobility, and intermittent painful swallowing. She had a motor vehicle accident 6 months before with NP that resolved within a week without treatment. A brief examination and some manual palliative care were attempted by the chiropractor. Two days later, the patient developed severe NP and fever, sought emergency medical care on her own, and requested the chiropractor meet her at the hospital. The emergency physicians initially considered an infection, and antibiotics were provided along with oxycodone and naproxen sodium for pain. After advanced (computed tomography) imaging, RCT was diagnosed, and she was discharged the next day.

Interventions and Outcome

After being diagnosed, the patient's primary care provider prescribed prednisone and physical therapy. After 3 weeks, the patient stated her pain continued and she went for chiropractic care and was treated for mechanical neck pain with manipulation, manual muscle treatment, postural training, and rehabilitative exercises.

Conclusion

Practitioners should recognize the clinical presentation of RCT, order appropriate computed tomography imaging, and implement effective treatments. Although uncommon, RCT should be considered in patients with NP, limited mobility, and painful swallowing.

Longus colli tendinitis. A review of literature and case series

Purpose: To increase the awareness of longus colli tendinitis (LCT) among spine specialists and to present a practical overview of diagnostic and treatment options, so that unnecessary interventions are avoided. Five sample cases from a German spine center will also be presented.

Methods: Literature review and case series. A PubMed search was performed in May 2015, and the articles found were reviewed for clinical presentation, investigations, and treatment. The frequency of publication of LCT cases and the specialty of journals were also noted. Recent cases treated in our institution were also reviewed. The clinical findings, investigations, and therapeutic interventions were summarized.

Results: The PubMed search from May 2015 found 104 articles, published over 51 years, on the topic of LCT. Only four were published in spine journals. A review of this literature yielded a total of 242 cases. The classic clinical triad included neck pain, limitation of movements, and swallowing complaints. C-reactive Protein (CRP) values were available in 21 cases (mean 23.66 mg/dL). A contrast-enhanced computed tomography (CT) scan was the best diagnostic modality. LCT is usually a self-limiting condition, but non-steroidal anti-inflammatory drugs (NSAIDs) may help alleviate discomfort. Five cases of LCT were diagnosed and treated in our center over the past three years.

Conclusions: LCT, which is uncommon and has non-specific symptoms, is often referred to spine centers. Spine specialists should be aware of its clinical presentation and radiographic findings in order to avoid unnecessary interventions. The condition is self-limiting and can be treated conservatively.

Neck pain and dysphagia associated to disc protrusion and reduced functional stability: A case report

BACKGROUND

Deglutition dysfunction like dysphagia may be associated with cervical symptoms.

FINDINGS

A young female complained of pain on the neck and swallowing dysfunction that was reduced by means of isometric contraction of cervical muscles. Magnetic resonance imaging revealed an anterior C5-C6 disc protrusion associated with a lesion of the anterior longitudinal ligament. Barium radiograph showed a small anterior cervical osteophyte at C6 level and dynamic X-ray excluded anatomical instability. The treatment included manual therapy and active exercises to improve muscular stability.

CONCLUSIONS

Diagnostic hypothesis was a combination of cervical disc dysfunction associated with C6 osteophyte and reduced functional stability.