Trapezius calcific tendinosis

Case contributed by Dr Ashesh Ishwarlal Ranchod

Presentation

The patient presents with neck, right shoulder and right upper limb pain, with no significant trauma history.

Patient Data

Age: 25 years
Gender: Female

Right humerus

x_ray

There is right trapezius calcific tendinosis with a calcific deposit overlying the posterior superior acromion (middle trapezius) just lateral to the acromioclavicular joint.There is mild reduced acromiohumeral joint space with a type II acromial profile. X-rays are otherwise unremarkable.

ultrasound

Dynamic right shoulder ultrasound confirmed focal trapezius calcific tendinosis superolateral to the normal right acromioclavicular joint. This measured 12.7 x 5.2 mm in diameter. This was exquisitely tender on ultrasound palpation and likely accounted for pain and presentation.

Ultrasound was further normal with no sonographic right shoulder abnormalities.

Case Discussion

Trapezius muscle calcific tendinosis is an extremely rare finding. This patient was offered localized aspiration of the mineral deposit and injection of local anesthetic and steroid as treatment. She has not returned for the offered treatment.

In general, poor posture is often a cause of trapezius muscle strain and associated symptoms. Stress, accidental and non-accidental muscle injury, muscle overuse, and external pressure(heavy backpack/ shoulder bags and even tight bra straps) represent additional causes of trapezius strain and symptoms. In this instance, the patient was an educator and no obvious aggravating cause was found.

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