Atypical calcific tendinitis with cortical erosions

Objective. To present and discuss six cases of calcific tendinitis in atypical locations (one at the insertion of the pectoralis major and five at the insertion of the gluteus maximus). Patients and results. All cases were associated with cortical erosions, and five had soft tissue calcifications. The initial presentation was confusing and the patients were suspected of having infection or neoplastic disease. Conclusion. Calcific tendinitis is a self-limiting condition. It is important to recognize the imaging features of this condition to avoid unnecessary investigation and surgery. Received: 2 May 2000 Revision requested: 8 June 2000 Revision received: 31 July 2000 Accepted: 8 August 2000     

Calcific tendinitis of the gluteus maximus tendon (Gluteus maximus tendinitis)

Seven cases of calcific tendinitis of the gluteus maximus tendon are presented. Awareness of the precise anatomic location of the calcific deposit is essential for the accurate diagnosis of this uncommon site of tendinitis. Clinically, the presenting complaint is that of pain. In some instances, however, the patients are asymptomatic and the calcification is an incidental finding.     

Calcific tendinitis of the gluteus medius tendon with bone marrow edema mimicking metastatic disease

A case of calcific tendinitis of the gluteus medius is presented. This report describes a patient with a history of breast cancer who had the combination of amorphous calcifications in the gluteus medius tendon and the MR finding of conspicuous bone marrow edema in the adjacent greater trochanter, prompting concern for metastatic disease. We present images from radiography, bone scanning, CT, and MR imaging. The unusual combination of findings in these studies should be considered conclusive for calcific tendinitis, and should not be confused with malignancy.     

髂胫束松解治疗臀肌挛缩症

目的为了寻求治疗臀肌挛缩症更加简单、安全、有效的手术方法,了解该病的发病因素和股骨大转子部髂胫束的病变情况。背景目前大部分作者认为臀肌挛缩症是臀部肌肉注射引起并与患者遗传因素有关的一种疾病,治疗方法多采用臀部切口,对臀大肌、臀中肌、臀小肌中的挛缩组织进行松解,以改善患侧髋关节的内收与内旋。此方法切口大、出血多、创伤大,有损伤坐骨神经和术后引起髋外展肌无力的危险。方法作者采取于股骨大转子部“Z”字形切断髂胫束的方法,使臀部紧张组织松弛,缓解患者症状。术后随访了连续治疗的33例患者,随访时间1～6年半,平均2.6年。结果本文所采取的手术方法操作简单、出血少,无严重合并症,所有病人手术效果均满意,是治疗该症较理想的方法之一,并发现创伤也是造成该症的另一因素。强调手术时彻底松解紧张的髂胫束和部分紧张的臀大肌止点是手术成功的关键。     

Osseous involvement in calcific tendinitis: a retrospective review of 50 cases

OBJECTIVE: The purpose of this study was to describe the spectrum of radiologic and pathologic manifestations of calcific tendinitis involving bone. MATERIALS AND METHODS: We retrospectively reviewed 50 cases of calcific tendinitis involving underlying bone. Clinical data reviewed included patient age and sex and lesion location. Images reviewed included radiographs (n = 44), CT scans (n = 13), MRIs (n = 16), and bone scintigrams (n = 13). Radiologic examinations were evaluated for the presence of cortical erosion, periosteal reaction, and marrow extension. Pathology confirmation was available in 37 cases. RESULTS: The average age of patients was 50 years (range, 16-82 years), with 29 female patients (58%). Calcific tendinitis with associated bone involvement was seen most commonly in the femur (40%) and the humerus (40%). Concretions were most commonly solid-appearing (50%). Cortical erosion was the most common manifestation of osseous involvement (78% of cases). Marrow involvement was shown in 18 (36%) of 50 cases. Marrow extension was most commonly seen in the lesser and greater tuberosities of the humerus, which accounted for 61% (11/18) of cases. Focal increased radionuclide uptake was seen in 13 (100%) of 13 cases. CONCLUSION: Calcific tendinitis presenting with osseous destruction, marrow changes, and soft-tissue calcifications may be confused with neoplasm both radiologically and pathologically. Recognition of the atypical presentation of this common disease may prevent unnecessary biopsy.     

Tendon abnormalities mimicking metastatic disease in patients with prostate cancer

We present plain x-ray examination, bone scintigraphy, computed tomography, and magnetic resonance imaging of 2 patients diagnosed with prostate cancer who complained of hip pain. Bone scintigraphy was suggestive for metastases. Further radiologic investigation revealed benign etiologies for the hip pain; calcific tendinitis of the vastus lateralis and tendonosis of the gluteus medius tendon were visualized.     

Acute calcific tendinitis of the pectoralis major insertion associated with cortical bone erosion

A case of calcific tendinitis of the pectoralis major insertion with cortical bone erosion is presented. Clinical and laboratory findings showed a significant inflammatory reaction. Both CT and MR images demonstrated the extent of the lesion providing additional information on the dimensions of inflammatory soft tissue and bone marrow reaction. Biopsy was performed and histology revealed the typical features of calcification, inflammation and giant cell reaction. Received 19 December 1996; Revision received 19 February 1997; Accepted 24 February 1997     

MRI diagnosis of contracture of the gluteus maximus muscle

OBJECTIVE: The objective of our study was to describe MRI features of contracture of the gluteus maximus muscle after providing a retrospective review of the MRI studies of 21 patients. CONCLUSION: Gluteal contracture manifests characteristic features on MRI, including an intramuscular fibrotic cord extending to the thickened distal tendon with atrophy of the gluteus maximus muscle and posteromedial displacement of the iliotibial tract. In advanced cases, medial retraction of the muscle and its tendon results in a depressed groove at the muscle-tendon junction and external rotation of the proximal femur. Clinical correlation and meticulous physical examination may confirm the MR diagnosis.     

Inflammation of vertebral bone associated with acute calcific tendinitis of the longus colli muscle

We present a case of acute retropharyngeal calcific tendinitis with characteristic findings on radiographic, computed tomography, and magnetic resonance imaging (MRI). To our knowledge, this is the first acute retropharyngeal calcific tendinitis report having inflammation of both the vertebra itself and the longus colli muscle diagnosed on MRI. In patients with neck pain, acute retropharyngeal calcific tendinitis should be kept in mind in the differential diagnosis, even if these patients had vertebral pathological signals on MRI.     

Calcifying tendinitis of the rotator cuff with cortical bone erosion

Calcifying tendinitis occurs most commonly in the rotator cuff tendons, particularly involving the supraspinatus tendon insertion, and is often asymptomatic. Cortical erosion secondary to calcifying tendinitis has been reported in multiple locations, including in the rotator cuff tendons. We present a pathologically proven case of symptomatic calcifying tendinitis involving the infraspinatus tendon with cortical erosion with correlative radiographic, CT, and MR findings. The importance of considering this diagnosis when evaluating lytic lesions of the humerus and the imaging differential diagnosis of calcifying tendinitis and cortical erosion are discussed.An erratum to this article can be found at     

Calcific tendinitis of the long head of the biceps brachii distal to the glenohumeral joint: plain film radiographic findings

Calcific tendinitis is a painful condition related to deposition of hydroxyapatite crystals; it favors large joints. The shoulder, specifically the tendons of the rotator cuff and the insertion of the long head of the biceps on the superior glenoid rim, is a well-recognized location for this abnormality. The purpose of this article is to describe a second site of calcific tendinitis of the biceps, distal to the joint and corresponding to the junction of the tendon and muscle. Radiographs in 119 cases of calcific tendinitis of the shoulder, obtained between 1980 and 1988, were reviewed. Twenty had calcific tendinitis in the region of the tendon of the long head of the biceps (nine at the glenoid insertion and 11 adjacent to the humeral shaft). All 11 patients with calcific tendinitis at the more distal site had a small, homogeneous deposit adjacent to the proximal humeral shaft. The densities in these 11 cases followed the normal course of the tendon of the long head of the biceps and were therefore medial to the proximal humeral shaft on the internal rotation view, lateral to the proximal humeral shaft on the external rotation view, and anterior to the proximal humeral shaft on the axillary projection. The major differential diagnosis of calcific tendinitis of the tendon of the long head of the biceps is loose bodies trapped in the biceps tendon sheath. Although the position of the soft-tissue densities in these two entities is similar, loose bodies have an appearance of bone, and their source (degenerative arthritis or recurrent dislocations) is usually apparent. A site of calcific tendinitis distal to the glenohumeral joint that is detectable on plain films is reviewed. Accurate diagnosis depends on understanding the anatomy of the tendon of the long head of the biceps brachii. The clinical charts of the 11 patients also are summarized, with emphasis on the association between the roentgen finding and bicipital tendinitis and impingement syndrome.     

Muscle contributions to propulsion and braking during walking and running: Insight from external force perturbations

There remains substantial debate as to the specific contributions of individual muscles to center of mass accelerations during walking and running. To gain insight, we altered the demand for muscular propulsion and braking by applying external horizontal impeding and aiding forces near the center of mass as subjects walked and ran on a treadmill. We recorded electromyographic activity of the gluteus maximus (superior and inferior portions), the gluteus medius, biceps femoris, semitendinosus/membrinosus, vastus medialis, lateral and medial gastrocnemius and soleus. We reasoned that activity in a propulsive muscle would increase with external impeding force and decrease with external aiding force whereas activity in a braking muscle would show the opposite. We found that during walking the gastrocnemius and gluteus maximus provide propulsion while the vasti are central in providing braking. During running, we found that the gluteus maximus, vastus medialis, gastrocnemius and soleus all contribute to propulsion.     

Muscle contributions to propulsion and braking during walking and running: Insight from external force perturbations

There remains substantial debate as to the specific contributions of individual muscles to center of mass accelerations during walking and running. To gain insight, we altered the demand for muscular propulsion and braking by applying external horizontal impeding and aiding forces near the center of mass as subjects walked and ran on a treadmill. We recorded electromyographic activity of the gluteus maximus (superior and inferior portions), the gluteus medius, biceps femoris, semitendinosus/membrinosus, vastus medialis, lateral and medial gastrocnemius and soleus. We reasoned that activity in a propulsive muscle would increase with external impeding force and decrease with external aiding force whereas activity in a braking muscle would show the opposite. We found that during walking the gastrocnemius and gluteus maximus provide propulsion while the vasti are central in providing braking. During running, we found that the gluteus maximus, vastus medialis, gastrocnemius and soleus all contribute to propulsion.     

The influence of gluteus maximus on transverse plane tibial rotation

There is a common clinical belief that transverse plane tibial rotation is controlled by the rearfoot. Although distal structures may influence the motion of the tibia, transverse plane tibial rotation could be determined by the proximal hip musculature. Cadaver studies have identified gluteus maximus as having the largest capacity for external rotation of the hip. This study was therefore undertaken to investigate the effect of gluteus maximus on tibial motion. Kinematic data were collected from the foot and tibia along with EMG data from gluteus maximus for 17 male subjects during normal walking. A number of kinematic parameters were derived to characterise early stance phase. Gluteus maximus function was characterised using RMS EMG and EMG on/off times. No differences in muscle timing were found to be associated with any of the kinematic parameters. In addition, no differences in gluteal activation levels were found between groups of subjects who had different amounts of tibial rotation. However, there was a significant difference (p < 0.001) in gluteus maximus activation when groups were defined by the time taken to decelerate the tibia (time to peak internal velocity). Specifically, subjects with greater gluteus maximus activity had a lower time to decelerate the tibia. We suggest that a high level of gluteus maximus activity results in a larger external torque being applied to the femur, which ultimately leads to a more rapid deceleration of the tibia.     

Hip muscle activity in male football players with hip-related pain; a comparison with asymptomatic controls during walking

ObjectivesCompare muscle activity between male football players with and without hip-related pain. Morphological and intra-articular features of hip-related pain are proposed pre-cursors to hip osteoarthritis. Altered muscle activity is a feature of severe hip osteoarthritis, but it is not known whether differences exist earlier in the pathological spectrum.DesignCross-sectional;SettingUniversity laboratory;ParticipantsForty-two male football players with hip-related pain; and 19 asymptomatic controls.Main outcome measuresHip muscle activity (Gluteus maximus, gluteus medius, tensor facia latae, adductor longus and rectus femoris) was recorded during walking using surface electromyography (EMG).ResultsMen with hip-related pain had sustained rectus femoris activity prior to toe-off (47–51% of the gait cycle) (p = 0.01, ES = 0.51) unlike controls who had reduced activity. In men with severe hip-related pain, gluteus maximus EMG was sustained into mid-stance (12–20% of the gait cycle) (F = 6.15, p < 0.01) compared to controls.ConclusionsDifferences in rectus femoris and gluteus maximus activity were identified between male footballers with and without hip-related pain. The pattern of gluteus maximus EMG relative to peak, approaching mid-stance in severe hip-related pain, is consistent with observations in severe hip osteoarthritis. This supports the hypothesis that symptom severity may influence muscle activity across the spectrum of hip degeneration.     

Calcific tendinitis of the neck

When a calcific deposit in the shoulder, hip or elbow ruptures, it results in severe pain and tenderness. Few clinicians are aware that the longus colli muscle of the neck is also subject to acute tendinitis. When it occurs, the pain and spasm mimic infectious spondylitis or meningitis. Four patients are presented with acute tendinitis of the longus colli muscle and the classic radiographic findings of soft-tissue swelling and amorphous calcium deposits in the tendon.     

A Survey of Overuse and Traumatic Hip and Pelvic Injuries in Athletes

In brief: Two hundred and twenty-two hip and pelvic injuries in 204 patients (114 men and 90 women) were retrospectively assessed at a general sports medicine clinic over a two-year period. The three most common bone injuries were sacroiliitis, pelvic and femoral neck stress fractures, and osteitis pubis. The three most common soft-tissue injuries were gluteus medius strain/tendinitis, trochanteric bursitis, and hamstring strain. Running, fitness classes, and racket sports were the most commonly involved activities. Overuse accounted for 82.4% of injuries and trauma 17.6%. Treatment consisted of modified activity, local muscle rehabilitation, physiotherapy, oral anti-inflammatory medication, infrequent corticosteroid injection, orthoses and/or heel lifts, change of footwear, and gradual reintroduction of the specific sport.     

Lower extremity kinetics and muscle activation during gait are significantly different during and after pregnancy compared to nulliparous females

BackgroundLow back, pelvic, and lower extremity pain are common during and after pregnancy. Understanding differences in mechanics between pregnant and non-pregnant females is a first step toward identifying potential pathological mechanisms. The primary purpose of this study was to compare joint kinetics and muscle activation during gait between females during and after pregnancy to nulliparous females.MethodsTwenty pregnant females completed testing on three occasions (second trimester, third trimester, and post-partum), while 20 matched, nulliparous controls were tested once. Motion capture, force data, and surface electromyography were averaged across seven trials during gait. Lower extremity kinematics, lower extremity moments and work normalized to pre-pregnancy body mass, work distribution, and peak and average muscle activation amplitude were calculated. Independent t-tests were conducted between pregnant and nulliparous females at each time point.ResultsCompared to controls, peak hip abductor moments were greater throughout and after pregnancy. Females in second trimester also demonstrated greater sagittal negative ankle work and greater percent contribution of the ankle and smaller percent contribution of the hip to negative work. Compared to controls, during third trimester there were greater knee abductor, ankle plantarflexor, and ankle dorsiflexor moments and greater work at the ankle and total work. Several moment and work variables continued to be elevated post-partum compared to controls. Gluteus maximus muscle activation amplitude was smaller in second trimester and post-partum compared to controls.SignificanceWhile overall joint demands were greater during and after pregnancy, there was a smaller relative sagittal utilization of the hip early in pregnancy and smaller gluteus maximus muscle amplitude during second trimester and post-partum. Because the gluteus maximus muscle contributes to force closure and dynamic stability of the low back and pelvis, relative gluteus maximus disuse, concurrent with increased joint loads, could potentially contribute to pain during and after pregnancy.     

Hip abductor muscle activity during walking in individuals with gluteal tendinopathy

The external hip adduction moment during walking is greater in individuals with gluteal tendinopathy (GT ) than pain‐free controls. Although this likely represents a greater demand on the hip abductor muscles implicated in GT , no study has investigated activation of these muscles in GT . For this purpose, fine wire electrodes were inserted into the segments of the gluteus minimus and medius muscles, and surface electrodes placed on the tensor fascia lata, upper gluteus maximus, and vastus lateralis muscles of eight individuals with, and eight without, GT . Participants underwent six walking trials. Individual muscle patterns were compared between groups using a wavelet‐based linear effects model and muscle synergy analysis performed using non‐negative matrix factorization to evaluate muscle activation patterns, within‐ and between‐participant variability. Compared to controls, individuals with GT exhibited a more sustained initial burst of the posterior gluteus minimus and middle gluteus medius muscle segments. Two muscle synergies were identified; Synergy‐1 activated in early‐mid stance and Synergy‐2 in early stance. In GT participants, posterior gluteus minimus and posterior gluteus medius and tensor fascia lata contributed more to Synergy‐1 active during the period of single leg support. Participants with GT exhibited reduced within‐participant variability of posterior gluteus medius and reduced between‐participant variability of anterior gluteus minimus and medius and upper gluteus maximus. In conclusion, individuals with GT exhibit modified muscle activation patterns of the hip abductor muscles during walking, with potential relevance for gluteal tendon loading.     

Detection of exercise load‐associated differences in hip muscles by texture analysis

We examined whether specific physical exercise loading is associated with texture parameters from hip muscles scanned with magnetic resonance imaging (MRI). Ninety‐one female athletes representing five distinct exercise‐loading groups (high‐impact, odd‐impact, low‐impact, nonimpact and high‐magnitude) and 20 nonathletic female controls underwent MRI of the hip. Texture parameters were computed from the MRI images of four hip muscles (gluteus maximus, gluteus medius, iliopsoas and obturator internus). Differences in muscle texture between the athlete groups and the controls were evaluated using Mann‐Whitney U‐test. Significant (P < 0.05) textural differences were found between the high‐impact (triple and high jumpers) and the control group in gluteus medius, iliopsoas and obturator internus muscles. Texture of the gluteus maximus, gluteus medius and obturator internus muscles differed significantly between the odd impact (soccer and squash players) and the control group. Textures of all studied muscles differed significantly between the low impact (endurance runners) and the controls. Only the gluteus medius muscle differed significantly between the nonimpact (swimmers) and the controls. No significant difference in muscle texture was found between the high‐magnitude (powerlifters) and the control group. In conclusion, MRI texture analysis provides a quantitative method capable of detecting textural differences in hip muscles that are associated with specific types of long‐term exercise loadings.