From the Guidelines
Longus colli tendinitis is a condition characterized by inflammation of the longus colli muscle in the neck, typically caused by calcium deposits in the tendon, presenting with sudden onset of severe neck pain, stiffness, difficulty swallowing, and sometimes low-grade fever. The condition is often mislabeled as "tendonitis" due to the common misconception that symptomatic tendon injuries are inflammatory, when in fact most patients have chronic symptoms suggesting a degenerative condition that should be labeled as "tendinosus" or "tendinopathy" 1.
Key Features
- The natural history of the condition is gradually increasing load-related localized pain coinciding with increased activity 1.
- Examination should include thorough inspection to assess for swelling, asymmetry, and erythema of involved tendons; range-of-motion testing; palpation for tenderness; and examination maneuvers that simulate tendon loading and reproduce pain 1.
- Plain radiography, ultrasonography, and magnetic resonance imaging can be helpful if the diagnosis remains unclear 1.
Treatment
- Treatment primarily involves managing symptoms with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 7-14 days 1.
- Muscle relaxants such as cyclobenzaprine (5-10mg three times daily) may help with muscle spasms.
- Applying ice packs for 15-20 minutes several times daily during the first 48 hours, followed by heat therapy, can provide relief.
- Most cases resolve spontaneously within 1-2 weeks with conservative management.
- Patients should seek medical attention if symptoms worsen or don't improve after a few days of treatment to rule out more serious conditions like infection or vertebral artery dissection. The condition occurs when calcium hydroxyapatite crystals deposit in the tendon of the longus colli muscle, triggering an inflammatory response, and is considered a self-limiting condition 1.
From the Research
Definition and Characteristics of Longus Colli Tendinitis
- Longus colli tendinitis is an uncommon aseptic inflammatory condition that affects the prevertebral longus colli tendon, which is a muscle that courses anteriorly from the level of the C1 to T3 vertebrae 2.
- It is characterized by acute neck pain, neck stiffness, and dysphagia or odynophagia, and can be misdiagnosed as other life-threatening conditions, including retropharyngeal abscess or meningitis 2, 3, 4, 5.
Symptoms and Diagnosis
- The symptoms of longus colli tendinitis typically consist of acute neck pain and stiffness with or without dysphagia, and can also include odynophagia, headache, and torticollis 3, 4, 5.
- The diagnosis is established by imaging findings on CT and MRI, which show prevertebral effusion and calcific deposition in the longus colli tendon 2, 4, 5.
- Awareness of this rare, benign, and self-limiting disease entity with characteristic radiologic findings is essential for early diagnosis and to avoid unnecessary medical and surgical interventions 4.
Treatment and Prognosis
- Longus colli tendinitis is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, and most patients show complete resolution of symptoms within 1 week 3, 4, 5.
- In some cases, treatment with corticosteroid injections and acupotomy may be necessary, and can lead to immediate relief of symptoms and complete resolution within 1 week 6.
- It is important for physicians to be aware of the existence of longus colli tendinitis and its variable radiographic appearance to avoid misdiagnosis and unnecessary interventions 2, 3, 4, 5, 6.