Calcific Tendinitis of the Supraspinatus Tendon in an Infant

Calcific tendinitis of the supraspinatus tendon in adults is common, but it is extremely rare in children. This report presents an unusual case of a 2-year-old boy with calcific tendinitis of the supraspinatus tendon. A mother brought her 2-year-old son to our hospital with a fever and severe left shoulder pain. Examination revealed a temperature of 38.6°C accompanied by a swollen shoulder with extreme pain and restricted movement. The radiographs of his left shoulder showed a large radio-opacity in the subacrominal region, and magnetic resonance imaging showed an elongated T1 and T2 hypointense signal above the supraspinatus tendon. Although these images were suggestive of calcific tendinitis of the supraspinatus tendon, we performed an open biopsy and resection in order to differentiate between a suspected diagnosis of calcific tendinitis, which is incredibly rare within pediatric patients, and infection or a soft tissue tumor. Finally, calcific tendinitis of the supraspinatus tendon was diagnosed by pathologic experiment and successfully treated, with complete resolution of pain and movement. Because only four other pediatric cases of calcific tendinitis of the supraspinatus tendon have ever been reported, there is a lack of information on the diagnostic process, management, and treatment of such a condition in young patients. Calcific tendinitis of the supraspinatus tendon still should be considered when encountering cases with typical findings even if the patient is a child.

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Restriction of Passive Glenohumeral Abduction Combined With Normal Passive External Rotation Is a Diagnostic Feature of Calcific Tendinitis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117752907 ◽

2018 ◽

Vol 6 (2) ◽

pp. 232596711775290 ◽

Cited By ~ 2

Author(s):

Anna Jungwirth-Weinberger ◽

Christian Gerber ◽

Glenn Boyce ◽

Thorsten Jentzsch ◽

Simon Roner ◽

...

Keyword(s):

Range Of Motion ◽

External Rotation ◽

Adhesive Capsulitis ◽

Salient Feature ◽

Supraspinatus Tendon ◽

Calcific Tendinitis ◽

Diagnostic Feature ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Standardized Protocol

Background: Passive glenohumeral range of motion may be characteristically limited to specific shoulder pathologies. While pain associated with loss of range of passive external glenohumeral rotation is recognized as a salient feature in adhesive capsulitis, restriction of glenohumeral range of motion in calcific tendinitis of the supraspinatus tendon has never been studied. Hypothesis: On the basis of clinical observation, we hypothesized that calcific tendinitis of the supraspinatus tendon is associated with loss of passive glenohumeral abduction without loss of external rotation. Study Design: Cohort study; Level of evidence, 3. Methods: Ranges of passive glenohumeral rotation and abduction, which are measured with a standardized protocol in our institution, were retrospectively reviewed and compared for patients diagnosed with either adhesive capsulitis or calcific tendinitis of the supraspinatus tendon. A total of 57 patients met the inclusion criteria for the calcific tendinitis, and 77 met the inclusion criteria for the adhesive capsulitis group. Results: When compared with the contralateral, unaffected shoulder, glenohumeral abduction in the calcific tendinitis group was restricted by a median of 10° (interquartile range [IQR], –20° to –5°) as opposed to glenohumeral external rotation, which was not restricted at all (median, 0°; IQR, 0° to 0°). The adhesive capsulitis group showed a median restriction of glenohumeral abduction of 40° (IQR, –50° to –30°) and a median restriction of passive glenohumeral external rotation of 40° (IQR, –60° to –30°). Conclusion: Calcific tendinitis of the supraspinatus does not typically cause loss of external rotation but is frequently associated with mild isolated restriction of abduction. This finding can be used to clinically differentiate adhesive capsulitis from calcific tendinitis.

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Clinical manifestation of malignant lymphomas of the head and neck region

Otolaryngologia Polska ◽

10.5604/01.3001.0010.7192 ◽

2017 ◽

Vol 71 (6) ◽

pp. 14-21 ◽

Cited By ~ 1

Author(s):

Katarzyna Bojanowska-Poźniak ◽

Wioletta Pietruszewska

Keyword(s):

Head And Neck ◽

Hodgkin Lymphoma ◽

Young Patients ◽

Neck Region ◽

Lymphoid Cells ◽

Diagnostic Process ◽

Malignant Neoplasms ◽

Malignant Lymphomas ◽

Head And Neck Region ◽

Medical University

Introduction: Malignant lymphoma (ML) is a neoplasm caused by clonal expansion of undifferentiated B, T and NK-lymphoid cells. WHO classification divides lymphomas into two main types, i.e. Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL), with numerous subtypes. The majority of MLs are localized in lymph nodes, but extranodal locations are also possible. MLs represent approximately 3-5% of all malignant neoplasms in Poland, but their incidence has been increasing in recent years, especially in young patients. The objective of the study was to evaluate clinical manifestations and diagnostic process in patients with malignant lymphomas of the head and neck region as diagnosed in the Department of Otorhinolaryngology of the Medical University of Lodz in years 2013-2017. Material and method: 30 patients diagnosed with malignant lymphomas of the head and neck region at the Departbadament of Otorhinolaryngology of the Medical University of Lodz in 2013-2017. Results: The study group consisted of 8 cases of nodal lymphomas and 22 cases of extranodal lymphomas. In 29 cases B-cell lymphomas were diagnosed. The most common symptoms included lymphadenopathy or neck tumor. Other symptoms were associated with the location of tumors in particular body organs. The diagnosis was based on histopathological examination of biopsy (needle or surgical) samples. Conclusion: Malignant lymphomas should be taken into account during differential diagnosis of the tumor or lymphadenopathy of the neck. The diagnosis is difficult because of the nonspecificity of symptoms and the need for interdisciplinary cooperation of many specialists.

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Stroke Care in Young Patients

Stroke Research and Treatment ◽

10.1155/2013/715380 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

L. Tancredi ◽

F. Martinelli Boneschi ◽

M. Braga ◽

I. Santilli ◽

C. Scaccabarozzi ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Clinical Care ◽

Young Patients ◽

Stroke Care ◽

Diagnostic Process ◽

Consecutive Series ◽

Digital Subtraction ◽

Vascular Risk ◽

Pfo Closure

The aims of this study were (i) to evaluate the clinical features of a consecutive series of young patients with ischemic stroke and (ii) to assess the changes in the clinical management of these patients over the study period. All consecutive cases of young adults aged 16 to 44 years, with ischemic stroke, that were admitted between 2000 and 2005 in 10 Italian hospitals were included. We retrospectively identified 324 patients. One or more vascular risk factors were present in 71.5% of the patients. With respect to the diagnostic process, an increase in the frequency of cerebral noninvasive angiographic studies and a decrease in the use of digital subtraction angiography were observed (P<0.001andP=0.03, resp.). Undetermined causes decreased over 5-year period of study (P<0.001). The diagnosis of cardioembolism increased. Thrombolysis was performed for 7.7% of the patients. PFO closure (8%) was the most frequently employed surgical procedure. In conclusion, the clinical care that is given to young patients with ischemic stroke changed over the study period. In particular, we detected an evolution in the diagnostic process and a reduction in the number of undetermined cases.

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Transmastoid Repair of Temporal Meningoencephaloceles and Cerebrospinal Fluid Otorrhea

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1052 ◽

2011 ◽

Vol 3 (1) ◽

pp. 31-41 ◽

Cited By ~ 2

Author(s):

Werner Garavello ◽

Lorenzo Gaini ◽

Diego Zanetti

Keyword(s):

Cerebrospinal Fluid ◽

Temporal Bone ◽

Process Management ◽

Diagnostic Process ◽

Mastoid Cavity ◽

Tegmen Tympani ◽

Surgical Options ◽

Conductive Hearing ◽

Transmastoid Approach ◽

Csf Leaks

ABSTRACT This paper reviews the diagnosis and treatment of temporal bone meningoencephaloceles, defined as the herniation of meninges or brain tissue into empty spaces within the temporal bone, i.e. tympanic or mastoid cavity, through the tegmen tympani or antri respectively. It also describes the current methods of control of cerebrospinal fluid (CSF) leaks, which commonly present as serous otorrhea or rhinorrhea in addition to a variety of symptoms, such as conductive hearing loss. Imaging is the mainstay of the diagnostic process. Management of the condition is surgical, and this review outlines the surgical options with special emphasis on the transmastoid approach and the materials applicable for repair of the bony dehiscences.

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Intra-articular venous malformations of the knee: a diagnostic challenge

Pediatric Rheumatology ◽

10.1186/s12969-021-00640-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Federico Diomeda ◽

Maria Santaniello ◽

Giulia Bracciolini ◽

Angelo Ravelli ◽

Adele Civino

Keyword(s):

Early Recognition ◽

Young Patients ◽

Clinical Manifestations ◽

Case Series ◽

Venous Malformations ◽

Mri Imaging ◽

Diagnostic Challenge ◽

Complete Excision ◽

Hyperintense Signal ◽

Hypointense Signal

Abstract Background Intra-articular venous malformations (IAVM) are rare benign vascular anomalies that usually affect young patients and most common locate in the knee. The terminology of these lesions is still ill-defined, as they are often termed in the literature as synovial hemangiomas. Early diagnosis can be difficult, because they usually present with nonspecific clinical manifestations that are similar those of other rheumatic diseases, especially juvenile idiopathic arthritis (JIA). Case series We conducted a retrospective analysis of five pediatric patients admitted to our units for recurrent swelling of the knee, and compared their characteristics with those of literature reports. The average age at first symptom and time from onset to diagnosis was 3.9 years (range 18 months-7 years) and 3.5 years (range 1-7 years), respectively. In our patients, an initial misdiagnosis of JIA, bleeding disorder or traumatic arthropathy was made. On MRI imaging, the features of the lesion were similar in all patients, and were marked by isointense-to-hypointense signal in T1-weighted images, and hyperintense signal in T2-weighted images. When performed, arthrocentesis led to aspiration of bloody fluid. The diagnosis was confirmed with a biopsy and histopathologic assessment in all patients. Open surgery enabled complete excision of the mass and was followed by stable remission over time in all cases. Conclusions Our report highlights the challenges that may be posed by the detection of knee IAVM and the frequent long delay between onset of symptoms and diagnosis. The key elements for early recognition include careful assessment of patient history, demonstration of bloody fluid on arthrocentesis, and proper interpretation of MRI scanning.

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Sonographic and MRI Presentation of Geyser Sign in Rotator Cuff Tears

Indian Journal of Musculoskeletal Radiology ◽

10.25259/ijmsr_58_2020 ◽

2021 ◽

Vol 0 ◽

pp. 1-3

Author(s):

Amandeep Singh ◽

Aaina Devgan ◽

Jasmin Khatana ◽

Gauravdeep Singh

Keyword(s):

Rotator Cuff ◽

Ganglion Cyst ◽

Incidental Finding ◽

Supraspinatus Tendon ◽

Rotator Cuff Tears ◽

Left Shoulder ◽

Full Thickness ◽

Ac Joint ◽

Benign Process

Limited cases of rotator cuff tears with acromioclavicular (AC) degeneration in association with cystic swelling or ganglion cyst have been described till date. The “geyser radiographic sign” was originally described by Craig in 1984. Its significance was to document a tear in the articular capsule of the AC joint in the setting of a chronic full-thickness tear of the rotator cuff, which gave the appearance of a geyser arising from the subacromial bursa as radiographic contrast tracked through the AC joint to project superiorly from the shoulder. An 82-year-old male presented with pain on rest in the left shoulder and with difficulty in overhead abduction from last few months. MRI showed near complete full-thickness tear of supraspinatus tendon with retraction of the tendon and reduced bulk of the supraspinatus muscle with associated superior subluxation of humerus with AC arthropathic changes causing ganglion cyst and incidental finding of superior labrum anterior and posterior tear. AC cysts are further divided into Type 1 and Type 2. Repeated aspirations of these masses are not advised, as they often recur and repeated attempts at aspiration may lead to formation of a draining fistula. MRI geyser sign is highly suggestive of a benign process, which suggests underlying rotator cuff pathology.

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Calcification of the Anterior Acromial Insertion of the Deltoid Muscle

Case Reports in Orthopedics ◽

10.1155/2020/8895801 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Kiminori Yukata ◽

Ashish Suthar ◽

Yutaka Suetomi ◽

Kazuhiro Yamazaki ◽

Kazuteru Doi ◽

...

Keyword(s):

Rotator Cuff ◽

Conservative Management ◽

Insertion Site ◽

Deltoid Muscle ◽

Calcific Tendinitis ◽

Plain Radiography ◽

Left Shoulder ◽

Relieve Pain ◽

Calcium Deposits

A 45-year-old man presented with severe left shoulder pain that was not associated with trauma. Plain radiography with the arm in an elevated position and ultrasonography demonstrated calcium deposits at the anterior acromial insertion site of left deltoid muscle. Conservative management could successfully relieve pain. At the 3-year follow-up, the calcification completely disappeared. To the best of our knowledge, calcium deposits at the acromial insertion site of the deltoid have not been reported in the literature. Clinicians who suspect calcific tendinitis but do not observe calcification around the rotator cuff should carefully palpate and examine other sites, such as the deltoid origin, and use ultrasonography or radiography.

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Acute Symptoms on Rotator Cuff Calcific Tendinitis is Effectively Relieved by Ultrasound Guided Percutaneous Needle Lavage Procedure: a Case Report

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00485 ◽

2019 ◽

Vol 7 (11_suppl6) ◽

pp. 2325967119S0048

Author(s):

Tommy Mandagi ◽

Nyoman Aditya Sindunata ◽

Prettysia Suvarly ◽

John Butarbutar

Keyword(s):

Rotator Cuff ◽

Shoulder Pain ◽

Acute Pain ◽

Corticosteroid Injection ◽

Calcific Tendinitis ◽

Left Shoulder ◽

Ultrasound Guided ◽

Good Outcome ◽

Limited Range Of Motion ◽

Infraspinatus Tendon

Introduction: Rotator cuff calcific tendinitis (RCCT) frequently manifests as acute shoulder pain during the acute resorptive phase. Pain typically worse at night and limited range of motion (ROM) with muscle spasm. Several treatment options have been proposed. In this case, a single needle ultrasound-guided percutaneous lavage (UGPL) combined with corticosteroid subdeltoid bursa injection (SDBI) with a good outcome. Case Presentation: A Female, 59 years old, presents with left RCCT acute pain (VAS 7/10) for 2 days and limited painful shoulder ROM. Inflammation and local tenderness found on the left shoulder, ultrasonography shows calcification in the left infraspinatus tendon with sub-deltoid bursa fluid. Patient in sitting position, ultrasound probe placed at long axis of infraspinatus tendon. Using a 23G needle 5 ml syringe, 1% lidocaine infiltrated until the needle penetrates the calcification site. Then a small amount of normal saline (NaCl) with lidocaine injected in a pulsating manner, observed until chalky matter backflows, mixed with NaCl in the syringe. Repeat this procedure until chalky backflow is minimal. Finally, 10 ml of Triamcinolone Acetonide 40 mg mixed with 2 ml lidocaine 2% SDBI using the same needle. Dramatic shoulder pain relieve (VAS 2/10) is immediately achieved after the procedure. One week follow up, the patient is pain-free and regains full ROM of her left shoulder. Discussion: Several methods are proposed for the treatment of acute RCCT, including corticosteroid injection and arthroscopy debridement. UPGL is an attractive option because it is minimally invasive, can be performed in-office setting, and pain relief is obtained immediately by decompressing and removing inflamed calcified sites. Conclusion: The treatment in acute pain RCCT using UGPL combined with corticosteroid SDBI provides a good outcome.

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Limitations in assessment of ER, PR, and HER2 status of breast cancer patients: Yangon experience.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e11078 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e11078-e11078

Author(s):

Yin Yin Mon

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Advanced Technology ◽

Molecular Profile ◽

Molecular Testing ◽

Breast Cancer Patients ◽

Financial Problem ◽

Lack Of Information ◽

Number Of Patients ◽

Her 2

e11078 Background: Management of breast cancer become individualized nowadays especially in developed countries. Molecular profile of breast cancer is essential to have this management. However, there are still limitations to examine such molecular profile in developing countries like Myanmar. Our aim in this study is to know the number of patients who underwent ER, PR and HER 2 status assessment among breast cancer patients in Myanmar and to analyze types of limitations for the molecular assessment in management of breast cancer. Methods: Total number of 823 breast cancer patients who registered from January 2009 to December 2011 at Medical Oncology Unit of Yangon General Hospital and two private oncology clinics were studied. Results: The age range from 19-80 years and mean age of 44.36 years. Among 823 breast cancer patients, ER, PR and HER 2 status were done in 134 patients (16.28% ) whereas 689 patients( 83.71% ) were not. 604 (87.66%) out of 689 patients who did not undergo profiling were due to financial problem. 60 patients (8.70 %) were found to have lack of information about molecular profiling although they were affordable . 25 patients (3.62 %) lost their tissue due to technological limitation Conclusions: Financial problem is the major limitation to get molecular profile for breast cancer patients in Myanmar. Patients need self expense to do advanced technology examinations in different health care system of our country. In this study we also found out that there was lack of information which leads not to undergo further investigations to some well to do patients. Overall, we believe that molecular technology support with reduced expense will help more patients in future to get better management in breast cancer in Myanmar. Besides, we need to provide update information about molecular testing in breast cancer to not only patients but also health professionals in our country.

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