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Hydroxyapatite Deposition Disease
Eva M. Escobedo, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Hydroxyapatite deposition disease (HADD)
          • Synonyms

            • Calcific tendonitis/tendinitis, calcific tendinopathy, calcific bursitis, calcific periarthritis
          • Definitions

            • Broad spectrum of musculoskeletal pathology due to calcium hydroxyapatite crystal deposition
              • Primary HADD includes calcific tendonitis and bursitis
              • Secondary hydroxyapatite related to underlying disease; not further discussed in this section
                • End-stage renal disease
                • Collagen vascular disease
                • Vitamin D intoxication
                • Tumoral calcinosis

          IMAGING

          • General Features

            • Imaging Recommendations

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Albano D et al: Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls. Radiol Med. 126(4):608-19, 2021
                                            2. Cipolletta E et al: The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis. Osteoarthritis Cartilage. 29(5):619-32, 2021
                                            3. Lawande MA et al: MRI findings in calcific deposits in and around shoulder: atypical locations beyond supraspinatus. Clin Radiol. 75(8):579-85, 2020
                                            4. Beckmann NM et al: Incidence of rotator cuff tears in the setting of calcific tendinopathy on MRI: a case controlled comparison. Skeletal Radiol. 48(2):245-50, 2019
                                            5. Hongsmatip P et al: Calcium hydroxyapatite deposition disease: Imaging features and presentations mimicking other pathologies. Eur J Radiol. 120:108653, 2019
                                            6. Chianca V et al: Rotator cuff calcific tendinopathy: from diagnosis to treatment. Acta Biomed. 89(1-S):186-96, 2018
                                            7. Becciolini M et al: Intramuscular migration of calcific tendinopathy in the rotator cuff: ultrasound appearance and a review of the literature. J Ultrasound. 19(3):175-81, 2016
                                            8. Greis AC et al: Evaluation and nonsurgical management of rotator cuff calcific tendinopathy. Orthop Clin North Am. 46(2):293-302, 2015
                                            9. Lanza E et al: Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting. Eur Radiol.25(7):2176-83, 2015
                                            10. Louwerens JK et al: Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. J Shoulder Elbow Surg. 24(10):1588-93, 2015
                                            11. Malghem J et al: Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series. Skeletal Radiol. 44(10):1403-12, 2015
                                            12. Del Castillo-González F et al: Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study. Muscles Ligaments Tendons J. 4(4):407-12, 2014
                                            13. Gabra N et al: Retropharyngeal calcific tendinitis mimicking a retropharyngeal phlegmon. Case Rep Otolaryngol. 2013:912628, 2013
                                            14. Torbati SS et al: Acute calcific tendinitis of the wrist. J Emerg Med. 44(2):352-4, 2013
                                            15. Ogon P et al: Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulder. Arthritis Rheum. 60(10):2978-84, 2009
                                            16. Serafini G et al: Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial. Radiology. 252(1):157-64, 2009
                                            17. Farid N et al: Miscellaneous conditions of the shoulder: anatomical, clinical, and pictorial review emphasizing potential pitfalls in imaging diagnosis. Eur J Radiol. 68(1):88-105, 2008
                                            18. Fodor D et al: Crystal-associated synovitis- ultrasonographic feature and clinical correlation. Ortop Traumatol Rehabil. 10(2):99-110, 2008
                                            19. Carlson AP et al: Disorders of tumoral calcification of the spine: illustrative case study and review of the literature. J Spinal Disord Tech. 20(1):97-103, 2007
                                            20. Choi MH et al: Imaging features of crystal-induced arthropathy. Rheum Dis Clin North Am. 32(2):427-46, viii, 2006
                                            21. Devauchelle-Pensec V et al: Performance of hand radiographs in predicting the diagnosis in patients with early arthritis. J Rheumatol. 33(8):1511-5, 2006
                                            22. Duey RE et al: Carpal tunnel syndrome resulting from hydroxyapatite deposition. Curr Probl Diagn Radiol. 35(6):261-3, 2006
                                            23. Feydy A et al: Cervical spine and crystal-associated diseases: imaging findings. Eur Radiol. 16(2):459-68, 2006
                                            24. Bui-Mansfield LT et al: Magnetic resonance appearance of bone marrow edema associated with hydroxyapatite deposition disease without cortical erosion. J Comput Assist Tomogr. 29(1):103-7, 2005
                                            25. Kuroda H et al: A case of probable hydroxyapatite deposition disease (HADD) of the hip. Magn Reson Med Sci. 3(3):141-4, 2004
                                            26. Garcia GM et al: Hydroxyapatite crystal deposition disease. Semin Musculoskelet Radiol. 7(3):187-93, 2003
                                            27. Molloy ES et al: Hydroxyapatite deposition disease of the joint. Curr Rheumatol Rep. 5(3):215-21, 2003
                                            28. Pay S et al: Calcium pyrophosphate dihydrate and hydroxyapatite crystal deposition in the joint: new developments relevant to the clinician. Curr Rheumatol Rep. 5(3):235-43, 2003
                                            29. Hayes CW et al: Calcium hydroxyapatite deposition disease. Radiographics. 10(6):1031-48, 1990
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Hydroxyapatite deposition disease (HADD)
                                                    • Synonyms

                                                      • Calcific tendonitis/tendinitis, calcific tendinopathy, calcific bursitis, calcific periarthritis
                                                    • Definitions

                                                      • Broad spectrum of musculoskeletal pathology due to calcium hydroxyapatite crystal deposition
                                                        • Primary HADD includes calcific tendonitis and bursitis
                                                        • Secondary hydroxyapatite related to underlying disease; not further discussed in this section
                                                          • End-stage renal disease
                                                          • Collagen vascular disease
                                                          • Vitamin D intoxication
                                                          • Tumoral calcinosis

                                                    IMAGING

                                                    • General Features

                                                      • Imaging Recommendations

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Albano D et al: Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls. Radiol Med. 126(4):608-19, 2021
                                                                                      2. Cipolletta E et al: The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis. Osteoarthritis Cartilage. 29(5):619-32, 2021
                                                                                      3. Lawande MA et al: MRI findings in calcific deposits in and around shoulder: atypical locations beyond supraspinatus. Clin Radiol. 75(8):579-85, 2020
                                                                                      4. Beckmann NM et al: Incidence of rotator cuff tears in the setting of calcific tendinopathy on MRI: a case controlled comparison. Skeletal Radiol. 48(2):245-50, 2019
                                                                                      5. Hongsmatip P et al: Calcium hydroxyapatite deposition disease: Imaging features and presentations mimicking other pathologies. Eur J Radiol. 120:108653, 2019
                                                                                      6. Chianca V et al: Rotator cuff calcific tendinopathy: from diagnosis to treatment. Acta Biomed. 89(1-S):186-96, 2018
                                                                                      7. Becciolini M et al: Intramuscular migration of calcific tendinopathy in the rotator cuff: ultrasound appearance and a review of the literature. J Ultrasound. 19(3):175-81, 2016
                                                                                      8. Greis AC et al: Evaluation and nonsurgical management of rotator cuff calcific tendinopathy. Orthop Clin North Am. 46(2):293-302, 2015
                                                                                      9. Lanza E et al: Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting. Eur Radiol.25(7):2176-83, 2015
                                                                                      10. Louwerens JK et al: Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. J Shoulder Elbow Surg. 24(10):1588-93, 2015
                                                                                      11. Malghem J et al: Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series. Skeletal Radiol. 44(10):1403-12, 2015
                                                                                      12. Del Castillo-González F et al: Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study. Muscles Ligaments Tendons J. 4(4):407-12, 2014
                                                                                      13. Gabra N et al: Retropharyngeal calcific tendinitis mimicking a retropharyngeal phlegmon. Case Rep Otolaryngol. 2013:912628, 2013
                                                                                      14. Torbati SS et al: Acute calcific tendinitis of the wrist. J Emerg Med. 44(2):352-4, 2013
                                                                                      15. Ogon P et al: Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulder. Arthritis Rheum. 60(10):2978-84, 2009
                                                                                      16. Serafini G et al: Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial. Radiology. 252(1):157-64, 2009
                                                                                      17. Farid N et al: Miscellaneous conditions of the shoulder: anatomical, clinical, and pictorial review emphasizing potential pitfalls in imaging diagnosis. Eur J Radiol. 68(1):88-105, 2008
                                                                                      18. Fodor D et al: Crystal-associated synovitis- ultrasonographic feature and clinical correlation. Ortop Traumatol Rehabil. 10(2):99-110, 2008
                                                                                      19. Carlson AP et al: Disorders of tumoral calcification of the spine: illustrative case study and review of the literature. J Spinal Disord Tech. 20(1):97-103, 2007
                                                                                      20. Choi MH et al: Imaging features of crystal-induced arthropathy. Rheum Dis Clin North Am. 32(2):427-46, viii, 2006
                                                                                      21. Devauchelle-Pensec V et al: Performance of hand radiographs in predicting the diagnosis in patients with early arthritis. J Rheumatol. 33(8):1511-5, 2006
                                                                                      22. Duey RE et al: Carpal tunnel syndrome resulting from hydroxyapatite deposition. Curr Probl Diagn Radiol. 35(6):261-3, 2006
                                                                                      23. Feydy A et al: Cervical spine and crystal-associated diseases: imaging findings. Eur Radiol. 16(2):459-68, 2006
                                                                                      24. Bui-Mansfield LT et al: Magnetic resonance appearance of bone marrow edema associated with hydroxyapatite deposition disease without cortical erosion. J Comput Assist Tomogr. 29(1):103-7, 2005
                                                                                      25. Kuroda H et al: A case of probable hydroxyapatite deposition disease (HADD) of the hip. Magn Reson Med Sci. 3(3):141-4, 2004
                                                                                      26. Garcia GM et al: Hydroxyapatite crystal deposition disease. Semin Musculoskelet Radiol. 7(3):187-93, 2003
                                                                                      27. Molloy ES et al: Hydroxyapatite deposition disease of the joint. Curr Rheumatol Rep. 5(3):215-21, 2003
                                                                                      28. Pay S et al: Calcium pyrophosphate dihydrate and hydroxyapatite crystal deposition in the joint: new developments relevant to the clinician. Curr Rheumatol Rep. 5(3):235-43, 2003
                                                                                      29. Hayes CW et al: Calcium hydroxyapatite deposition disease. Radiographics. 10(6):1031-48, 1990