Discussion

Subtle calcification can be seen in the triceps tendon, revealing calcific tendinitis. Although calcific tendinitis most frequently affects the shoulder, it may affect other joints as well, with the triceps tendon of the elbow being the second most commonly affected site. Typical presentation is rapid onset of severe pain — many times patients are tearful because if it — with no explanation. Women are affected more often than men and usually are between 30 and 60 years of age at onset. In this case presentation, the onset of pain was slower than normal.

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Radiographic images usually show calcification within an extensor tendon. After more serious conditions are ruled out, pain management and immobilization are initiated. The patient may be discharged with return precautions and follow-up with an orthopedist. Refractory cases may benefit from steroid injection or ultrasound-guided needle lavage. Symptoms typically resolve in 1 to 2 weeks, even without treatment, and long-term prognosis is good.

The patient’s symptoms improved over the next 2 weeks, and she did not require follow-up care.

Table. Calcific Tendinitis

DescriptionSudden, severe joint pain without trauma
Occurs in women aged 30 to 60 years
ImagingRadiographs show calcification
Commonly Affected Anatomic SitesShoulder
Triceps tendon at olecranon insertion      
Achilles tendon
TreatmentNonsteroidal anti-inflammatory drugs
Opioids
Immobilization
Steroid injection or ultrasound-guided needle lavage

Reference

Pregerson DB. Emergency Medicine 1-Minute Consult Pocketbook. EMresource.org. 2017;5.

This article originally appeared on Clinical Advisor