Retropharyngeal tendinitis

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.

Acute longus colli tendinitis and otolaryngology

INTRODUCTION

Acute longus colli tendinitis is caused by calcium hydroxyapatite deposition in the tendon of the longus colli muscle with subsequent inflammation. The calcifications are commonly located at the superior oblique portion at the level of the C1-C2 vertebrae. The typical clinical presentation consists of acute neck pain, odynophagia, and painful limitation of neck range of motion.

OBJECTIVES

We will describe this disease with three that cases presented to our institution and compare the findings on imaging studies.

METHODS

We retrospectively reviewed the clinical data, radiological features, and laboratory reports of three patients diagnosed with acute longus colli tendinitis. Computed tomography and plain radiographs were reviewed and compared by a single radiologist. A contemporary review of the literature was conducted using PubMed (Medline), Embase, and Cochrane library databases.

RESULTS

Computed tomography showed greater sensitivity for the detection of the pathognomonic calcification than plain radiographs and facilitated the exclusion of other more severe conditions by following a systematic interpretation composed of five key elements. Plain radiographs showed non-specific signs of prevertebral soft tissue swelling and a decreased cervical lordotic curve. However, no calcification was identified on plain radiographs. The literature review revealed 153 articles containing 372 cases. Surgical or invasive procedures were mentioned in 13.7% of publications and were performed in 28 patients.

CONCLUSIONS

Acute longus colli tendinitis can mimic the clinical presentation of more severe conditions that the otolaryngologist may be required to evaluate, such as infectious, traumatic, and neoplastic diseases. Knowledge of this entity, with its pathognomonic imaging findings, can prevent misdirected medical therapy and unnecessary invasive procedures.

Calcific retropharyngeal tendinitis: a frequently missed diagnosis. Case report

Neck pain is a common presentation in emergency departments that requires the exclusion of serious underlying pathological entities. Acute calcific retropharyngeal tendinitis is a rare and underrecognized cause of atraumatic neck pain and stiffness. Although this entity has been reported previously, it is often poorly recognized and is often confused with other more serious lesions, such as infectious, traumatic, and neoplastic conditions. Clinically, it can be very difficult to distinguish from these three disorders, and a definitive diagnosis can only be established using imaging studies. A knowledge of the characteristic clinical spectrum and, most importantly, its imaging features is crucial for making the correct diagnosis of this uncommon cause of neck pain. The authors present their experience with one case to highlight the characteristic findings of this disorder on plain radiography, computed tomography, and magnetic resonance imaging.

[Retropharyngeal tendinitis. Differential diagnosis in the management of acute neck pain]

Neck pain is frequent and can be a symptom of numerous differential diagnoses with quite different diagnostic and therapeutic consequences. A 37-year-old woman reported acute neck pain aggravated by movements of the cervical spine and head and by swallowing. Clinical examination showed pronounced neck stiffness. T2-weighted MRI demonstrated high-intensity edema and effusion localized prevertebrally in the area of the superior part of the longus colli muscle. Computed tomography of this region demonstrated prevertebral calcification leading to the diagnosis of retropharyngeal tendinitis. Nonsteroidal antiphlogistic drugs led to rapid improvement of clinical signs and symptoms. Retropharyngeal tendinitis should be considered in patients with acute neck pain.

Acute calcific retropharyngeal tendinitis. Clinical presentation and pathological characterization

Acute calcific retropharyngeal tendinitis is an underrecognized cause of pain and stiffness in the neck associated with odynophagia and retropharyngeal soft-tissue swelling. We report on five patients in whom an initial misdiagnosis of this entity as a retropharyngeal or nasopharyngeal abscess, a neoplasm, or a fracture-dislocation of the cervical spine led to interventions such as admission to the hospital and parenteral administration of antibiotics. An open biopsy was performed in one patient because of a suspected neoplasm. Evaluation of the tissue specimen with routine and polarized light microscopy, scanning electron microscopy, and energy-dispersive spectrometry demonstrated a foreign-body inflammatory response to deposited crystals of hydroxyapatite. In all five patients, the correct diagnosis was established only after retrospective review of the radiographic studies by a physician who was familiar with acute calcific retropharyngeal tendinitis. The computed tomographic findings of acute calcific retropharyngeal tendinitis are distinctive and consist of prevertebral calcification localized to the insertion of an edematous tendon of the longus colli muscle. Symptomatic relief was provided with anti-inflammatory and analgesic medications. The symptoms resolved, without sequelae, within one to two weeks for all of the patients. We hope that an increased awareness of hydroxyapatite deposition in the tendon of the longus colli muscle will result in improved early diagnosis of acute calcific retropharyngeal tendinitis.

Calcific tendonitis of the longus colli muscle: a cause of atraumatic neck pain

Retropharyngeal calcific tendonitis is a not-infrequent cause of atraumatic neck pain. Two patients presented with neck pain and stiffness, one with associated dysphagia. Cervical spine radiographs showed calcification anterior to the dens, establishing the diagnosis of calcific tendonitis of the longus colli muscle. Treatment with analgesics and antiinflammatory agents brought relief of symptoms within one week. A review of the literature shows that these patients had courses similar to those in previously reported cases.

Calcific tendinitis of the longus colli muscle

Facility in the evaluation of the cervical prevertebral soft tissues should be a skill of any otolaryngologist. Tendinitis of the longus colli muscle mimics more serious disease processes of the prevertebral cervical region that the otolaryngologist may be required to evaluate. It has, however, received little attention in otolaryngological literature. Five cases from the Massachusetts Eye and Ear Infirmary are presented. Calcific tendinitis of the longus colli muscle is an easily recognized clinical and radiological syndrome. Characteristic features include cervical pain, dysphagia, and distinctive radiographs. The pathognomonic lateral neck film reveals prevertebral soft tissue swelling and an amorphous radiodensity anterior to the C-1 and C-2 vertebral bodies. Symptoms usually manifest over a few days and resolve benignly within 2 weeks.