Hydroxyapatite Crystal Deposition Disease of the Shoulder: A Review of Cases and Literature

• Main Authors: Reddy Ravikanth, Kanagasabai Kamalasekar, Manu Jacob Abraham, Ashok Alapati
• Format: Article
• Language: English
• Published: Thieme Medical and Scientific Publishers Pvt. Ltd. 2018-07-01
• Series: International Journal of Recent Surgical and Medical Sciences
• Subjects: hydroxyapatite deposition disease; milwaukee shoulder; ultrasound ablation therapy; magnetic resonance appearance
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1676663
• ISSN: 2455-7420; 2455-0949

Hydroxyapatite crystal deposition diseases (HADDs) are characterized by deposition of insoluble crystals within the joints and periarticular soft tissues, initiating inflammatory destructive reaction. Calcium hydroxyapatite (CHA) is the most common type of calcium in human bone and is also the most common pathologic calcification found in the body. There are three phases of the disease: silent, mechanical, and adhesive phases. The shoulder is the most common site of HADD. CHA crystals are non-birefringent in polarized light. Radiographic characteristics include homogenous, amorphous densities without trabeculations that are variable in size, ovoid, triangular, or linear. The first imaging modalities to identify calcific tendinitis (CT) were X-ray and ultrasound, as calcium deposits are readily identifiable on both. Treatment is chiefly conservative, including nonsteroidal anti-inflammatory drugs (NSAIDs), local heat application, and physiotherapy. Local corticosteroid injections may also be of benefit. When intra-articular, CHA crystals can cause joint destruction such as “ Milwaukee shoulder.” In the acute symptomatic phase of HADD, called acute calcific periarthritis, soft tissue and osseous edema can be present and needs to be differentiated from infection, tumor, and trauma.