Presentation
Excruciating right shoulder pain with associated local increased temperature. Has had corticosteroid injection done by the GP three days ago. Septic joint?
Patient Data
Globular calcification surrounding the greater tuberosity most likely represents calcium hydroxyapatite deposition within the supraspinatus tendon, with signs of rupture into the subacromial space or into the bursa. The glenohumeral joint is normally aligned with no erosive changes identified. The acromioclavicular joint is normal.
There is echogenic material within the supraspinatus tendon that appears to track down along the greater tuberosity, forming an extra tendinous pouch with compressible and mobile debris. Correlation with the radiographs, where it is shown to be dense, makes it highly concerning for a ruptured calcific bursitis.
Case Discussion
This case illustrates classic calcific tendinitis involving the supraspinatus tendon, and subacromial bursitis due to rupture of the calcium hydroxyapatite deposits into the subacromial space/bursa.
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