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Delbello F, Spinnato P, Aparisi Gomez MP. Calcific Tendinopathy Atypically Located Outside the Rotator Cuff: A Systematic Review. Curr Med Imaging 2024; 20:e100423215585. [PMID: 37038296 DOI: 10.2174/1573405620666230410091749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/24/2023] [Accepted: 02/20/2023] [Indexed: 04/12/2023]
Abstract
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.
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Affiliation(s)
- Federica Delbello
- Department of Rehabilitation Medicine, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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2
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Siag K, Mazzawi S, Paker M, Biener R, Ghanayim R, Lumelsky D. Acute longus colli tendinitis and otolaryngology. Braz J Otorhinolaryngol 2020; 88:351-357. [PMID: 33342696 PMCID: PMC9422725 DOI: 10.1016/j.bjorl.2020.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/20/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Kfir Siag
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel.
| | - Salim Mazzawi
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
| | - Miki Paker
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
| | - Roy Biener
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
| | - Rami Ghanayim
- Emek Medical Center, Department of Otolaryngology Head and Neck Surgery, Afula, Israel
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Draghi F, Cocco G, Lomoro P, Bortolotto C, Schiavone C. Non-rotator cuff calcific tendinopathy: ultrasonographic diagnosis and treatment. J Ultrasound 2020; 23:301-315. [PMID: 31197633 PMCID: PMC7441123 DOI: 10.1007/s40477-019-00393-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/31/2019] [Indexed: 12/13/2022] Open
Abstract
Calcific tendinopathy is a condition that is related to the deposition of calcium, mostly hydroxyapatite crystals, within the tendons. The shoulder and the hip are commonly affected joints, but calcific tendinopathy may occur in any tendon of the body. While there is an extensive literature on the ultrasound diagnosis of calcific tendinopathy of the shoulder, there are only sporadic reports on other sites. This review combines the experience of our centers and a thorough analysis of the literature from the last 45 years (1972-2017) in order to highlight the localizations beyond the rotator cuff, their ultrasound characteristics and therapeutic possibilities.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Giulio Cocco
- Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
| | - Pascal Lomoro
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Chandra Bortolotto
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy.
| | - Cosima Schiavone
- Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
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Ulloa N, Gill J, Childress J. Acute Calcific Tendonitis of the Longus Colli: An Uncommon Cause of Neck Pain in the Emergency Department. Cureus 2020; 12:e9295. [PMID: 32832292 PMCID: PMC7437099 DOI: 10.7759/cureus.9295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The longus colli muscle has three major parts that originate and insert in the upper cervical and thoracic spine. It is a weak flexor of the neck, and when contracted also serves to rotate the neck to the ipsilateral side. It is innervated by the anterior rami of the C2-C6 spinal nerves and receives its blood supply from the anterior cervical and inferior thyroid arteries. In a post motor vehicle collision (MVC) patients presenting weeks later, the physician has to ensure there is no subacute fracture. Clinically, these patients present with severe anterior neck pain that will often be described as a deep pain. A 43-year-old female with a past medical history of diabetes and prior surgical history of a tonsillectomy and uvulectomy presented with sudden onset of sore throat that woke her up from sleep at 3:00 am. Associated with the sore throat, she had hoarseness of her voice, difficulty breathing and felt that her throat was closing. She forced herself to vomit and then felt better. She denied any fevers or chills. Later, the patient mentioned that she had chronic neck pain from a prior accident and had been told that she has C5-C6 stenosis. About a week prior, she had been involved in another MVC and had some neck pain after that. Significantly, she was also on lisinopril for her hypertension (HTN). She was tolerating secretions, protecting her airway and no gross inflammation was noted on physical exam. On labs, there was no leukocytosis noted. Soft tissue neck X-ray showed reversal of the cervical lordosis, degenerative and erosive changes at C4-C5 and C5-C6, and thickening of the prevertebral soft tissues. She obtained a CT of the neck and cervical spine that showed osteophyte complexes at C4-C5 and C5-C6, as well as calcific tendonitis of the longus colli with a moderate amount of prevertebral free fluid. Neurosurgery was consulted from the ED who recommended getting an MRI of the neck, and consulting ENT as well. ENT happened to be in the ED and performed a bedside laryngoscopy that showed edema of the left arytenoid with full functionality of the vocal cords, and no signs of airway compromise. The patient was started on steroids, antibiotics, H2 blockers, and the ACE-inhibitor was discontinued due to suspected angioedema per ENT. She was also admitted to the ICU for airway monitoring. The MRI of the neck again showed calcific tendonitis of the longus colli with moderate prevertebral fluid. Meanwhile, the patient had complete resolution of her symptoms in 24 hours and she was cleared from both neurosurgery and ENT to be discharged. Acute calcific tendonitis is due to the deposition of calcium hydroxyapatite, which can cause significant pain and edema. In terms of calcific tendonitis of the longus colli muscle, this condition is frequently misdiagnosed and continues to be a challenge, especially in the emergency department. The differential diagnosis is diverse in etiology and severity, ranging from meningitis and retropharyngeal abscess to vertebral fracture and muscle strain.
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Affiliation(s)
- Nicolas Ulloa
- Emergency Medicine, Aventura Hospital and Medical Center, Aventura, USA
| | - Jaskirat Gill
- Emergency Medicine, Aventura Hospital and Medical Center, Aventura, USA
| | - John Childress
- Emergency Medicine, Aventura Hospital and Medical Center, Aventura, USA
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Yamamoto N, Watari T, Kawasaki K, Matsui Y, Ozaki T. Acute Calcific Retropharyngeal Tendinitis with Eggshell-like Calcification: Case Report and Literature Review on Time-course Changes in Imaging Findings. Cureus 2020; 12:e7611. [PMID: 32399345 PMCID: PMC7213671 DOI: 10.7759/cureus.7611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Acute calcific retropharyngeal tendinitis is a rare disease, and few studies have reported the radiological findings of its time-course in detail. These radiological findings vary according to the calcific stage. We report a case of acute calcific retropharyngeal tendinitis with eggshell-like calcification detected on follow-up computed tomography (CT). We also review pertinent literature on calcific retropharyngeal tendinitis, with a focus on time-course changes in imaging findings. A 54-year-old Japanese woman presented with acute severe neck pain. She also had a limited range of motion in the rotation of her neck and moderate pain and discomfort during swallowing. Plain radiographs of the cervical spine showed no apparent abnormality. CT revealed massive retropharyngeal calcification in front of the C1-C2 vertebrae. The patient was diagnosed with acute calcific retropharyngeal tendinitis and treated with a soft collar and non-steroidal anti-inflammatory drugs. Two weeks later, the neck pain and dysphagia improved. At the one-month follow-up, CT showed residual marginal calcification, which was diminishing in size, suggesting eggshell-like calcification. We believe that although the eggshell calcification appearance is extremely rare, it is important to note this atypical presentation of acute calcific retropharyngeal tendinitis.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopedic Surgery, Unnan City Hospital, Unnan, JPN
| | - Takashi Watari
- Department of Internal Medicine, Postgraduate Clinical Training Center, Shimane University Hospital, Izumo, JPN
| | - Keisuke Kawasaki
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Takamatsu, JPN
| | - Yuzuru Matsui
- Department of Orthopedic Surgery, Unnan City Hospital, Unnan, JPN
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, JPN
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Suh B, Eoh J, Shin J. Clinical and Imaging Features of Longus Colli Calcific Tendinitis: An Analysis of Ten Cases. Clin Orthop Surg 2018; 10:204-209. [PMID: 29854344 PMCID: PMC5964269 DOI: 10.4055/cios.2018.10.2.204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/26/2018] [Indexed: 11/17/2022] Open
Abstract
Background Longus colli calcific tendinitis (LCCT) exhibits characteristic clinical features; thus, misidentification can be avoided once it is learned. There is a lack of reports on this disease. In this study, we analyzed the imaging and clinical features of LCCT in 10 patients. Methods We retrospectively reviewed the radiolographic findings, laboratory data and clinical features of 10 patients diagnosed with LCCT between January 2015 and June 2017. All patients were treated with medical treatment consisting of intravenous methylprednisolone 125 mg twice and oral nonsteroidal anti-inflammatory drug administration. Results On clinical findings, all 10 patients complained of severe posterior neck pain and cervical motion limitation. Odynophagia was present in nine patients. The mean time from symptom onset to hospital visit was 2.9 days. The mean time to symptom relief was 4.6 days. Of the 10 patients, three patients were admitted through the emergency room. There were five patients in the medical records who were transferred from another hospital. On the laboratory data, the mean value of C-reactive protein and erythrocyte sedimentation rate were 2.08 mg/dL (reference range, < 0.30 mg/dL) and 36.9 mm/hr (reference range, < 20 mm/hr), respectively. Leukocytosis was found in only two patients and fever was not present all patients. On radiographic findings, calcification was present on computed tomography images of all patients. The calcification was located at the lower part of the C1 arch, except for one case where calcification occurred in the anterolateral aspect of the C4–5 disc space. The mean value of the retropharyngeal space was 7.2 mm. Conclusions LCCT, a rare disease, has characteristic radiographic findings and clinical features. Understanding such characteristics of this disease can prevent unnecessary testing and misdiagnosis.
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Affiliation(s)
- Bogun Suh
- Spine Center and Department of Orthopaedic Surgery, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - Jaehyung Eoh
- Spine Center and Department of Orthopaedic Surgery, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - Jihoon Shin
- Spine Center and Department of Orthopaedic Surgery, Pohang Semyeong Christianity Hospital, Pohang, Korea
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Alamoudi U, Al-Sayed AA, AlSallumi Y, Rigby MH, Taylor SM, Hart RD, Trites JRB. Acute calcific tendinitis of the longus colli muscle masquerading as a retropharyngeal abscess: A case report and review of the literature. Int J Surg Case Rep 2017; 41:343-346. [PMID: 29145108 PMCID: PMC5686463 DOI: 10.1016/j.ijscr.2017.10.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 11/25/2022] Open
Abstract
The longus colli muscle is situated on the anterior surface of C1-C2 disk space. Calcific tendinitis of the longus colli muscle is a reactive self-limiting inflammatory response to the subacute deposition of calcium hydroxyapatite crystals on the tendon of the muscle. The clinical presentation is usually mistaken with other serious conditions, such as a retropharyngeal abscess, disk herniation, neck tumor or trauma. The importance of recognizing this pathology lies in preventing its misdiagnosis and mismanagement. This condition is usually managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs).
Introduction Acute calcific longus colli tendinitis, also known as retropharyngeal or acute calcific prevertebral tendinitis, is a reactive self-limiting inflammatory response to acute or subacute deposition of amorphous calcium hydroxyapatite crystals in the tendons of the longus colli muscle, anterior to the C1–C2 disk space. Case presentation A 53-year-old man presented with a complaint of neck pain and odynophagia over a few days. Blood test findings showed mild leukocytosis and elevated C-reactive protein level. Computed tomography findings showed mild edematous prevertebral thickening involving the retropharyngeal space, predominantly on the left side, with no appreciable surrounding peripheral enhancement. A small amount of linear calcification/ossification involving the superior fibers of the left longus colli muscle, anterior to the C1 arch were also noted. Discussion The patient’s presentation could be easily misdiagnosed as a retropharyngeal abscess. However, the presence of subtle findings on CT would lead to the correct diagnosis. The management of this condition is mainly with nonsteroidal anti-inflammatory drugs. Conclusion This study presents the characteristic radiological features of retropharyngeal calcific tendinitis. These features are subtle and could be missed. Once an accurate diagnosis is made, treatment with nonsteroidal anti-inflammatory drugs is indicated. The purpose of this case report is to highlight this rare condition’s diagnosis and management.
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Affiliation(s)
- Uthman Alamoudi
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada; Department of Otolaryngology, Hail University, Hail, Saudi Arabia.
| | - Ahmed A Al-Sayed
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada; Department of Otorhinolaryngology - Head & Neck Surgery, Department of Otolaryngology, King Saud University, Riyadh, Saudi Arabia
| | - Yasser AlSallumi
- Department of Radiology, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada; Department of Medical Imaging, Department of Radiology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Matthew H Rigby
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - S Mark Taylor
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Robert D Hart
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Jonathan R B Trites
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada
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Kim YJ, Park JY, Choi KY, Moon BJ, Lee JK. Case reports about an overlooked cause of neck pain: calcific tendinitis of the longus colli: Case reports. Medicine (Baltimore) 2017; 96:e8343. [PMID: 29145245 PMCID: PMC5704790 DOI: 10.1097/md.0000000000008343] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
STUDY DESIGN Case description. OBJECTIVE Acute calcific tendinitis of the longus colli muscle is a rare clinical entity that causes severe neck pain. This entity is not well recognized due to its nonspecific presentation such as acute neck pain, neck stiffness, and odynophagia. The importance of this disease with a review of the literature is presented. SUMMARY OF BACKGROUND DATA Acute calcific tendinitis of the longus colli muscle is an inflammatory condition caused by deposition of calcium hydroxyapatite in the superior oblique tendon fibers of the longus colli muscle. It can be misdiagnosed as other life-threatening conditions including retropharyngeal abscess, resulting in unnecessary medical or surgical interventions. METHODS We retrospectively reviewed the clinical data, radiological features, and laboratory reports of 8 patients who were diagnosed with acute calcific tendinitis of the longus colli muscle and seen at our institution between April 2008 and March 2015 in this article. We describe the clinical presentation, diagnosis, and treatment of acute calcific tendinitis of the longus colli muscle. RESULTS There were 5 men and 3 women who ranged in age from 41 to 49 years (mean age: 44.5 years). The associated symptoms included neck pain, stiffness, odynophagia, and headache. The duration of symptoms varied from 2 days to 1 week. All patients showed calcific deposition inferior to the anterior arch of the atlas, and prevertebral effusion extending from C1 to C4. All patients were treated with NSAIDs and immobilization with a cervical brace, and most patients showed complete resolution of symptoms within 1 week. CONCLUSION We report 8 cases of acute calcific tendinitis of the longus colli, and describe the symptoms and radiological findings in detail. Awareness of this rare, benign, and self-limiting disease entity with characteristic radiologic findings is essential for early diagnosis and to avoid unnecessary medical and surgical interventions.
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Boardman J, Kanal E, Aldred P, Boonsiri J, Nworgu C, Zhang F. Frequency of acute longus colli tendinitis on CT examinations. Emerg Radiol 2017; 24:645-651. [PMID: 28744692 PMCID: PMC5681978 DOI: 10.1007/s10140-017-1537-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022]
Abstract
Purpose We attempted to determine the frequency of acute longus colli tendinitis on diagnostic CT imaging performed at a large multicenter health care system. By correlating with the pre-imaging clinical information, we investigated which patient presentations should lead the radiologist to increased suspicion for this condition. Methods Images from a total of 8101 adult CT examinations of the neck and cervical spine performed over a 3-month period were evaluated by researchers independent of the original clinical report. Clinical information available at the time of imaging was reviewed and assigned to one of five categories. Frequency of the condition was calculated by sex and clinical presentation. This retrospective study with waiver of consent and waiver of HIPPA was approved by our IRB. Results Nine positive scans were found for an overall frequency of 1.1 per 1000 examinations. The frequency was significantly higher (11.4 per thousand) on scans performed of patients presenting without history of recent trauma, concern for tumor, suspected postoperative complication, or clinical signs of infection localized to the neck. Although frequency in males was higher than in females, this did not reach statistical significance. In no positive or negative case was longus colli tendinitis considered in the pre-imaging documentation. Conclusions Findings of acute longus colli tendinitis on CT examination generally occur in the absence of prior mention of this condition in the medical record. The radiologist should be particularly alert for this diagnosis when a patient presents with rapid-onset neck pain without a clear history of recent trauma or other etiologies.
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Affiliation(s)
- John Boardman
- Radiology Suite, 201 East Wing, 200 Lothrop St, Pittsburgh, PA 15213 USA
| | - Emanuel Kanal
- Radiology Suite, 201 East Wing, 200 Lothrop St, Pittsburgh, PA 15213 USA
| | - Patrick Aldred
- Radiology Suite, 200 Lothrop St, Pittsburgh, PA 15213 USA
| | - Joseph Boonsiri
- Department of Neuroradiology, NYU, 660 First Ave., 2nd Floor, New York, NY 10016 USA
| | | | - Feng Zhang
- Department of Radiology Education, Stanford University Medical Center, 300 Pasteur Dr., H1330, MC:5621, Stanford, CA 94305-5621 USA
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Shawky A, Elnady B, El-Morshidy E, Gad W, Ezzati A. Longus colli tendinitis. A review of literature and case series. SICOT J 2017; 3:48. [PMID: 28664844 PMCID: PMC5492790 DOI: 10.1051/sicotj/2017032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 05/09/2017] [Indexed: 12/05/2022] Open
Abstract
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.
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Affiliation(s)
- Ahmed Shawky
- Department of Orthopedics and Trauma Surgery, Assiut University Hospitals, 71111 Assiut, Egypt - Spine Center, Helios Klinikum Erfurt, Nordhaeuser street 74, 99089 Erfurt, Germany
| | - Belal Elnady
- Department of Orthopedics and Trauma Surgery, Assiut University Hospitals, 71111 Assiut, Egypt
| | - Essam El-Morshidy
- Department of Orthopedics and Trauma Surgery, Assiut University Hospitals, 71111 Assiut, Egypt
| | - Wael Gad
- Department of Orthopedics and Trauma Surgery, Assiut University Hospitals, 71111 Assiut, Egypt
| | - Ali Ezzati
- Spine Center, Helios Klinikum Erfurt, Nordhaeuser street 74, 99089 Erfurt, Germany
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Patel TK, Weis JC. Acute neck pain in the ED: Consider longus colli calcific tendinitis vs meningitis. Am J Emerg Med 2017; 35:943.e3-943.e4. [PMID: 28139306 DOI: 10.1016/j.ajem.2017.01.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/25/2017] [Indexed: 10/20/2022] Open
Abstract
Presented here is a rare cause of severe neck pain - acute longus colli calcific tendinitis - in a 54year old man who presented to the emergency department. The neck pain is due to inflammation caused by calcium hydroxyapatite crystal deposition in the tendons on the longus colli muscles. This is non-infectious. The gold standard for diagnosis is a CT neck which best shows the calcifications in the anterior vertebral column of C1-C4, where the tendons of these muscles insert bilaterally. Longus colli calcific tendinitis is not life-threatening and patients will make a full recovery after treatment with NSAIDs. However, this condition is often confused with life-threatening conditions such as infection (meningitis or retropharyngeal abscess), intracranial hemorrhage, trauma, herniation of cervical discs, or malignancy (Estimable et al. (2015) [1]). Symptoms associated with calcific tendinitis of the longus colli muscle are non-specific and include mild fever, moderate-severe headache, neck pain, and drastically reduced range of motion of the neck. More specific symptoms are the presence of dysphagia and odynophagia. Lab findings usually are significant for mild leukocytosis, and elevated ESR and CRP. Awareness of this condition by E.D. physicians can avoid unnecessary invasive interventions, increased costs, and delays that result from incorrect diagnosis and treatment. This is a unique case in which a patient who was afebrile with a normal ESR was worked up for meningitis and an intracranial process, and also empirically treated for meningitis before finally being diagnosed with acute calcific tendinitis of the longus colli muscle in the E.D.
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Affiliation(s)
- Tyag K Patel
- Lehigh Valley Hospital Network, USF SELECT Medical Student Program, 1200 S Cedar Crest Blvd, Allentown, PA 18103, United States.
| | - James C Weis
- Lehigh Valley Healthy Network, Department of Orthopedic Surgery, 1200 S Cedar Crest Blvd, Allentown, PA, United States.
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12
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Zapolsky N, Heller M, Felberbaum M, Rose J, Steinberg E. Calcific Tendonitis of the Longus Colli: An Uncommon but Benign Cause of Throat Pain that Closely Mimics Retropharyngeal Abscess. J Emerg Med 2016; 52:358-360. [PMID: 27765436 DOI: 10.1016/j.jemermed.2016.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/09/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Nathan Zapolsky
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, New York, New York
| | - Michael Heller
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, New York, New York
| | - Mark Felberbaum
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, New York, New York
| | - Jeremy Rose
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, New York, New York
| | - Eric Steinberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, New York, New York
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13
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Joshi GS, Fomin DA, Joshi GS, Serano RD. Unusual case of acute neck pain: acute calcific longus colli tendinitis. BMJ Case Rep 2016; 2016:bcr-2016-216041. [PMID: 27257001 DOI: 10.1136/bcr-2016-216041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute calcific longus colli tendinitis (ACLCT), a very rare cause of severe neck pain, dysphagia and odynophagia, is often mistaken for other common causes of neck pain. However, prompt recognition of this uncommon presentation is important to prevent unnecessary medical and surgical intervention. A 46-year-old Caucasian man presented with a 1-day history of severe neck pain, headache and odynophagia. The patient was afebrile with stable vital signs, however, the laboratory data showed mildly elevated C reactive protein and erythrocyte sedimentation rate. The physical examination was remarkable for markedly reduced cervical range of motion. MRI revealed the pathognomonic findings of paravertebral oedema and calcification. The definitive diagnosis of ACLCT was made and the patient was successfully managed with a short course of oral steroid, benzodiazepine and aural acupuncture, with complete resolution of the condition within a week.
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Affiliation(s)
- Gunjan S Joshi
- Highland Neurology Center, Fayetteville, North Carolina, USA Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Daren A Fomin
- Highland Neurology Center, Fayetteville, North Carolina, USA Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Gargi S Joshi
- Highland Neurology Center, Fayetteville, North Carolina, USA
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14
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Oh JY, Lim JH, Kim YS, Kwon YE, Yu JY, Lee JH. Misconceived Retropharyngeal Calcific Tendinitis during Management of Myofascial Neck Pain Syndrome. Korean J Pain 2016; 29:48-52. [PMID: 26839671 PMCID: PMC4731552 DOI: 10.3344/kjp.2016.29.1.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 11/20/2022] Open
Abstract
Differential diagnosis of posterior neck pain is very challenging based on symptoms and physical examination only. Retropharyngeal calcific tendinitis is a rare and frequently misdiagnosed entity in various causes of neck pain. It results from calcium hydroxyapatite deposition in the longus colli muscle which is characterized by severe neck pain, painful restriction of neck movement, dysphagia, and odynophagia. We herein report a case of a patient with acute retropharyngeal calcific tendinitis, who complained of posterior neck pain, initially diagnosed and treated as a myofascial neck pain syndrome.
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Affiliation(s)
- Ji Youn Oh
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jin Hun Lim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Yong Seok Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Young Eun Kwon
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jae Yong Yu
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jun Hak Lee
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
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