Tendinopatía cálcica: etiopatogenia y evaluación por imágenes / Calcific tendinitis: aetiopathogenesis and imaging evaluation

Resumen: La tendinopatía cálcica es causada por el depósito patológico de cristales de hidroxiapatita de calcio en los tendones y es una causa común de dolor en las articulaciones. Afecta más frecuentemente al hombro y la cadera, con hallazgos característicos en imágenes; sin embargo, cualquier tendón puede estar involucrado. Ocasionalmente, la tendinopatía cálcica puede simular patología agresiva, como infección o neoplasia, especialmente en RM. Fisiotpatológicamente, las calcificaciones provendrían de una diferenciación anormal de las células madre del tendón, que comienzan a producir calcio, aunque todavía no es del todo claro. Los radiólogos deben estar familiarizados con los hallazgos de las imágenes para distinguir la tendinopatía cálcica de procesos más agresivos. La aspiración y lavado guiado bajo ecografía es una técnica útil realizada por el radiólogo para el tratamiento de casos sintomáticos. La familiaridad con estos procedimientos y su apariencia en imágenes es un aspecto importante en el manejo de esta enfermedad. El propósito de esta revisión es analizar la etiopatogenia de la tendinopatía cálcica, la evaluación con imágenes en los sitios de presentación más comunes y también en los menos frecuentes, así como el papel que desempeña la ecografía en el tratamiento de la patología.

Abstract: Calcific tendinitis is caused by abnormal deposition of calcium hydroxyapatite crystals in tendons and is a common cause of joint pain. The disease typically affects the shoulder and hip, with characteristic imaging findings; however, any tendon can be involved. Occasionally, calcific tendinitis can mimic aggressive disorders, such as infection and neoplasm, especially on MRI. Apparently, the calcifications come from an abnormal differentiation of the tendon stem cells, which begin to produce calcium. Radiologists should be familiar with the imaging findings to distinguish calcific tendinitis from more aggressive processes. Image-guided percutaneous needle aspiration is a useful technique performed by the radiologist for the treatment of symptomatic cases. Being familiar with these processes and their imaging appearance is an important aspect in the management of this common disease. The purpose of this review is to analyze the pathogenesis of calcium tendinopathy, the evaluation of images in both the most common and less frequent presentation sites, as well as the role played by ultrasound in the treatment of pathology.

The Evaluation of the Short-Term Voice Outcome of Injection Laryngoplasty Using Two Types of Calcium Hydroxylapatite (Radiesse versus Facetem) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Radiesse® is a widely used calcium hydroxyapatite (CaHA) injection material used for vocal fold injection. Recently, a new CaHA injection material (Facetem ®) which complements the structural disadvantages of Radiesse has been developed and released in the market. The aim of this study is to compare the efficacy and short-term voice outcome of these two CaHA materials. SUBJECTS AND METHOD: A retrospective analysis was performed for 70 patients with unilateral vocal fold paralysis who underwent vocal fold injection using CaHA materials. Acoustic voice analysis, maximal phonation time (MPT), voice handicap index (VHI), and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale were evaluated between Radiesse and Facetem injection group. RESULTS: Both groups showed a signifcant improvement of MPT, VHI, and G, B, A scale after injection. The Facetem group showed similar voice improvement as the Radiesse group, where pre- and postoperatively objective and subjective voice evaluation results were compared. CONCLUSION: Our study reveals that there is no significant difference in efficacy and nor any short-term vocal improvement between Radiesse and Facetem. Therefore, the use of Facetem as CaHA injection material could be considered as an alternative material for patients with unilateral vocal cord paralysis.

Novel Hybrid Hydroxyapatite Spacers Ensure Sufficient Bone Bonding in Cervical Laminoplasty

STUDY DESIGN: Prospective observational study. PURPOSE: This prospective analysis aimed to evaluate the efficacy and bone-bonding rate of hybrid hydroxyapatite (HA) spacers in expansive laminoplasty. OVERVIEW OF LITERATURE: Various types of spacers or plates have been developed for expansive laminoplasty. METHODS: Expansive open-door laminoplasty was performed in 146 patients with cervical myelopathy; 450 hybrid HA spacers and 41 autogenous bone spacers harvested from the spinous processes were grafted into the opened side of each lamina. The patients were followed up using computed tomography (CT), and their bone-bonding rates for hybrid HA and autogenous spacers, bone-fusion rates of the hinges of the laminae, and complications associated with the implants were then examined. RESULTS: Clinical symptoms significantly improved in all patients, and no major complications related to the procedure were noted. The hybrid HA spacers exhibited sufficient bone bonding on postoperative CT. The hinges completely fused in over 95% patients within 1 year of the procedure. Only 4 spacers (0.9%) developed lamina sinking, and most expanded laminae maintained their positions without sinking or floating throughout the follow-up period. CONCLUSIONS: Hybrid HA spacers contributed to high bone-fusion rates of the spacers and hinges of the laminae, and no complications were associated with their use. Cervical laminoplasty with these spacers is safe and simple, and it yields sufficient fixation strength while ensuring sufficient bone bonding during the immediate postoperative period.

Efficacy of Calcium Hydroxyapatite in Vocal Fold Augmentation for Unilateral Vocal Fold Paralysis in Asian

BACKGROUND AND OBJECTIVES: This study aimed to evaluate efficacy and complication of injection laryngoplasty using calcium hydroxyapatite (CaHA) for unilateral vocal fold paralysis in Asian. MATERIALS AND METHODS: A prospective study was conducted on the adult patients with unilateral vocal fold paralysis from May 2015 through January 2016. Injection laryngoplasty was performed by one laryngologist. All patients underwent prospective voice evaluation using the subjective and objective comprehensive battery of assessments, before the procedure and after the procedure at 3 months, and 6 months. RESULTS: A total of 7 patients (5 males and 2 females) were included in this study. VHI-10 was significantly decreased after injection laryngoplasty, at postoperative 6 months (p=0.031), while VAS score and MDADI showed no difference. GRBAS scale gradually decreased in 3 months and 6 months follow-up without statistical significance. Acoustic analysis revealed that jitter, shimmer, and noise-to-harmonic ratio continuously decreased from the baseline at 3 months and 6 months, although statistical significance was not attained. In the aerodynamic analysis, maximal phonation time was gradually increased at 3months and 6 months with significant difference (p=0.016, 0.031, respectively). There was no side effect associated with the procedure. CONCLUSION: CaHA can be safely used in Asian patients and the onset of maximal efficacy seems to be slow than other studies with Caucasian patients.

An Assessment of Fate of CHA Blocks Used in the Cystic Lesions of Bone.

Background: The calcium phosphate system and in particular hydroxyapatite (CHA), has been the subject of intensive investigation. Although coralline hydroxyapatite is not inherently as strong as trabecular bone and does not exhibit plastic properties owing to the absence of a collagen matrix, with subsequent growth of native bone, it has been shown to become stronger but less stiff than autogenous graft material. Method: Thirty six cases of cystic lesions of long bones were curretted and filled with CHA blocks with or without autogenous cancellous bone chips between 2013 to 2014 with follow up duration ranging from 12 to 24 months. Filling by CHA blocks, mixing with autogenous bone grafts was done in osteoclastoma and fibrous dysplasia cases, while only CHA block filling was done in solitary bone cyst, aneurysmal bone cyst and fibroma cases. In all the cases, the diagnosis was made on the basis of clinical, radiological and histopathological examination. Both with and without pathological fractures cystic lesions were taken. Results: In the present study, 11 cases had pathological fracture. In our series, maximum cases were of osteoclastoma. Most of the cases were associated with pathological fracture. The pathological fractures united from 20-30 weeks time, Radiologically, the density of CHA blocks increased with the lapse of time. In our series, the longest follow up period was about 24 months and the shortest was of 12 months duration. 20 patients had excellent results with full functional, anatomical restoration without any pain and radiograph shows no recurrence, with healing of pathological fracture. While 2 patients had poor results they were not able to do activities of daily living, had pain and delayed healing. Conclusion: The CHA has favourable clinical result because of less adverse effects, biocompatibility to the tissue of the body, ease of manufacture, production and shape adjustment. Therefore, it is strongly suggested as a useful bone substitute.In our limited experience with coralline hydroxyapatite bone graft substitutes, we have encountered no significant complications related to implant themselves.

Milwaukee Shoulder Syndrome in a Eldery Female Patient: A Case Report / 대한정형외과연구학회지

Milwaukee shoulder syndrome is a rare clinical entity that is a rapid destructive shoulder arthropathy associated with deposition of calcium hydroxyapatite crystals. It mainly affects elderly women. It is characterized by the presence of large amount of noninflammatory synovial fluid containing calcium hydroxyapatite crystals, a complete tear of the rotator cuff and progressive degenerative changes at the humeral head, leading to almost complete functional impairment. We present a case of a 65-year-old woman suffered by Milwaukee shoulder syndrome with literature view.

Aspectos de imagem na tendinite calcária pré-vertebral / Imaging findings in acute calcific prevertebral tendinitis

A tendinite calcária aguda pré-vertebral é uma condição benigna e rara que apresenta calcificação das fibras do músculo longo do pescoço com reação inflamatória local, sendo esta uma das formas de apresentação menos frequentes da doença por deposição de hidroxiapatita de cálcio. Manifesta-se com dor cervical aguda e/ou odinofagia, podendo ser erroneamente diagnosticada como abscesso retrofaríngeo, espondilodiscite ou alteração decorrente de trauma. Os achados radiológicos na tendinite calcária pré-vertebral são patognomônicos. O conhecimento de tais achados é muito importante, pois o correto diagnóstico possibilita a resolução precoce dos sintomas e evita intervenções desnecessárias em um paciente que apresenta afecção com boa resposta ao tratamento conservador.

Acute calcific prevertebral tendinitis is a benign and rare condition that presents calcification of the superior oblique fibers of longus colli muscle with local inflammatory reaction. Such condition is one of the less common presentations of calcium hydroxyapatite deposition disease. Clinical signs are usually acute neck pain and odynophagia, and it may be misdiagnosed as retropharyngeal abscess, spondylodiscitis or traumatic injury. The imaging findings in calcific prevertebral tendinitis are pathognomonic. The knowledge of such findings is extremely important to avoid unnecessary interventions in a patient presenting a condition with a good response to conservative treatment.

Absence of Hyper-Responsiveness to Methacholine after Specific Bronchial Provocation Tests in a Worker With Hydroxyapatite-Induced Occupational Asthma

Hydroxyapatite is commonly used as a filler to replace amputated bone or as a coating to promote bone ingrowth into prosthetic implants. Many modern implants, such as hip replacements and dental implants, are coated with hydroxyapatite. We report a patient with occupational asthma due to hydroxyapatite, proven by a specific inhalation challenge, who experienced an early asthmatic reaction after exposure to hydroxyapatite, without increased airway responsiveness to methacholine despite an increased eosinophil count in the peripheral blood. A 38-year-old male dental implant worker visited our allergy department for the evaluation of occupational asthma. He had treated dental implant titanium surfaces with hydroxyapatite for 1.5 years. One year after starting his employment, he noticed symptoms of rhinorrhea, paroxysmal cough, and chest tightness. His symptoms were aggravated during and shortly after work and subsided several hours after work. When he stopped working for 2 months because of his chest symptoms, he became asymptomatic. After restarting his work, his symptoms reappeared and were aggravated. A methacholine bronchial challenge test had a negative response. The following day, a specific bronchial provocation test with wheat powder was negative. On the third day, a specific bronchial provocation test with hydroxyapatite powder produced an early asthmatic response. On the fourth day, a methacholine bronchial challenge test was negative. Further studies are needed to evaluate the exact pathogenetic mechanism of hydroxyapatite-induced occupational asthma.

Acute Calcific Tendinitis of the Longus Colli Muscle in the Cervical Spine / 대한정형외과학회잡지

Acute calcific tendinitis of the longus colli muscle in the cervical spine is an uncommon benign condition caused by calcium hydroxyapatite deposition in its tendon and a subsequent inflammation. Clinical diagnosis is difficult because its incidence is rare and it can be misdiagnosed as retropharyngeal abscess, traumatic cervical spine injury, or infectious spondylitis. Therefore, a definitive diagnosis requires evaluation of the plain radiogram and a combination of CT and MR imaging. In this report we describe a case with calcific tendinitis of the longus colli muscle with satisfactory results after conservative treatment.

Calcific Tendinitis of the Longus Colli Muscle in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

No abstract available.