Atypical calcific tendinitis involving the long biceps tendon: A rare cause of hemiplegic shoulder pain.

Abstract

Calcific tendinitis is commonly found in the rotator cuff; however, it is very rare in the long biceps tendon (LBT). Furthermore, calcific tendinitis involving the LBT in the hemiplegic shoulder after a stroke has not been previously reported. We present a case of a 63-year-old man who suffers from a stroke and atypical calcific tendinitis involving the LBT as a rare cause of hemiplegic shoulder pain. The patient had experienced intractable pain in the right hemiplegic shoulder for more than 6 months with a waxing and waning course. Marked tenderness to palpation was present at the biceps tendon adjacent to the bicipital groove. Ultrasound (US) and computed tomography revealed a long, blade-shaped, circumscribed, cloudy and irregular dense calcific deposit in the LBT site, distal to the bicipital groove. The patient underwent US-guided corticosteroid injection at the posterior intra-articular joint. The symptoms failed to resolve; we injected an additional corticosteroid into the biceps tendon sheath adjacent to the calcific deposit. This procedure provided satisfactory relief, and follow-up US revealed mild diminution of the calcification through absorption. This is the first report on atypical calcific tendinitis involving the LBT causing hemiplegic shoulder pain after a stroke.