ISSN 2472-016X

Journal of Orthopedic Oncology
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  • Case Report   
  • J Orthop Oncol 2018, Vol 4(2): 127
  • DOI: 10.4172/2472-016X.1000127

Case Report: Acute Calcific Tendonitis at the Pectoralis Major Attachment-A Benign Cause of Red Flag Signs

Christian Gray Stephens1*, Boyd Goldie2 and Asif Saifuddin3
1Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
2The Holly Private Hospital, IG9 5HX, UK
3Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
*Corresponding Author : Christian Gray Stephens Research Fellow, MB BChir. Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK, Email: christian.graystephens@nhs.net

Received Date: Dec 20, 2018 / Accepted Date: Dec 31, 2018 / Published Date: Jan 07, 2019

Abstract

Introduction: Acute calcific tendonitis at the pectoralis major insertion is rarely reported in the radiology literature, but not in the Orthopaedic literature. We present a case that illustrates the typical findings with discussion from a shoulder surgeon, and a senior radiologist.

Case Study: A 60-year-old woman was woken at night with sudden onset left shoulder and arm pain. She was otherwise systemically well. Her shoulder range of motion was globally restricted. Past medical history included previous spinal surgery and a hepatitis A infection within the last year.

Plain radiographs of the shoulder and humerus were unremarkable save for a small an anterior proximal humeral protuberance at the junction of proximal third and distal two-thirds of the humeral shaft. Blood tests were unremarkable. CT and MRI imaging showed a calcific tendon with associated cortical defect, and surrounding inflammation.

Because of the sinister red flag symptoms (night pain) and suggestion of cortical erosion with periosteal reaction, the differential diagnosis list included sarcoma. For this reason, it was referred to the local sarcoma service. This was reviewed by a senior radiologist. The diagnosis of calcific tendonitis of pectoralis major calcific tendonitis was made. The decision was made by the Sarcoma MDT to not biopsy the lesion but instead review clinically with interval scan and safety netting.

On six week clinic follow up the patient’s symptoms had improved. Because of the knowledge regarding this potential diagnosis, unnecessary invasive diagnostic procedures (CT biopsy) or surgeries were avoided. Repeat MRI at three month showed resolution of changes.

Conclusion: Both Orthopaedic surgeons within sarcoma services and wider members of the multidisciplinary team should be aware of this diagnosis. This would help to prevent over investigation of benign self-limiting pathologies.

Keywords: Calcific tendonitis; Osteosarcoma; Sarcoma; Pectoralis major

Citation: Stephens CG, Goldie B, Saifuddin A (2019) Case Report: Acute Calcific Tendonitis at the Pectoralis Major Attachment–A Benign Cause of Red Flag Signs. J Orthop Oncol 4: 127. Doi: 10.4172/2472-016X.1000127

Copyright: © 2019 Stephens CG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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