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Volume 13 Journal of Orthopaedics Trauma Surgery and Related Research
ISSN: 1897-2276 Orthopedics 2018
March 08-09, 2018
March 08-09, 2018 London, UK
10th International Conference on
Orthopedics, Trauma and Rheumatology
Acute calcific tendonitis at the pectoralis major attachment: A benign cause of red flag signs
Christian Gray Stephens
Royal National Orthopaedic Hospital, UK
Introduction &Aim: Acute calcific tendonitis at the pectoralis major insertion is rarely reported in the radiology literature, but not in
the orthopedic 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.
Investigation: 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.
Result: 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 6-weekly 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.
Conclusion: Both orthopedic 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.
Biography
Christian Gray Stephens, MB BChir, MA (hons) (Cantab) is a Research Fellow at Royal National Orthopaedic Hospital, Stanmore. He attended Medical school at
Cambridge University. He took his foundation training in Cambridge shire before undertaking a research fellowship in RNOH, Stanmore. He is interested in Trauma
& Orthopaedics, sarcoma and joint reconstruction.
Christian Gray Stephens, J Orthop Trauma Surg Rel Res 2018, Volume 13