Calcific tendinitis at the biceps brachii insertion of a child: A case report

Autor: Kenso Kozuki, Kazuaki Sakamoto
Rok vydání: 2002
Předmět:
Zdroj: Journal of Shoulder and Elbow Surgery. 11:88-91
ISSN: 1058-2746
DOI: 10.1067/mse.2002.119854
Popis: CASE REPORT A young boy (aged 3 years 11 months) felt pain in his left wrist after a minor fall. His parents consulted a doctor in the emergency department on the same day and were told that there were no significant findings in the boy’s forearm or wrist after plain radiography. The pain dissipated quickly. However, after a few days, it recurred and spread to the anterior aspect of the proximal forearm, and range of motion of the forearm and elbow was restricted. The boy’s parents consulted an orthopaedic doctor, and plain radiography found an abnormality of the elbow. Fifteen days after the first episode, the patient was referred to our hospital for further treatment with a bone tumor diagnosis. On physical examination, there was neither tumor mass nor local heat over his left forearm or elbow. However, there was tenderness found in the anterior region of the radial head and neck. Forearm and elbow examination revealed a restricted range of motion with 27° of pronation, 68° of supination, and –30° of extension, but full flexion (Figure 1). Plain radiography showed a round, clear margin and faint calcific shadow with uniform density located between the proximal radius and ulna (Figure 2). Computed tomography showed a crescent-shaped, highdensity shadow with its concave side facing the radius (Figure 3). Upon laboratory examination, only mild leukocytosis was found. The family history and personal history of this patient were unremarkable. Sixteen days after his visit to our hospital, simple excision was scheduled, based on the tentative diagnosis of benign bone tumor. In surgery, a 4-cm longitudinal incision was made on the anterior aspect of the proximal forearm starting from just under the cubital fossa and continuing along the lateral border of the biceps tendon. On deep dissection, the brachioradialis muscle and a superficial branch of the radial nerve were retracted radially, and the radial artery with concomitant veins was retracted ulnarly after ligation of recurrent vessels. The biceps tendon was exposed and showed spindle-like swelling at its insertion to the radial tuberosity. Milky effusion and white granules spouted on longitudinal incision of the epitenon, thus confirming the diagnosis of calcific tendinitis (Figure 4). Calcium deposition extended up to the posterior side of the radius along the tendon surface. Complete excision of the calcium deposit was confirmed by intraoperative radiography. Pathologic examination of the excised tissue showed an amorphous deposition of calcium both in the tenosynovial sheath and in the intratendinous tissue with foreign body reaction (Figure 5). Biopsy of the radial tuberosity showed normal bone tissue. One year later, elbow and forearm function was normal Calcific tendinitis at the biceps brachii insertion of a child: A case report
Databáze: OpenAIRE
Externí odkaz: