What are the clinical presentation and exam findings of deltoid tendons calcification?

Clinical Presentation and Exam Findings of Deltoid Tendons Calcification

Deltoid tendon calcification presents with severe shoulder pain, localized tenderness, and decreased range of motion, with calcium deposits visible on imaging at either the acromial insertion site or within the intramuscular tendons of the deltoid muscle.

Clinical Presentation

Deltoid tendon calcification is characterized by:

• Severe shoulder pain, often acute in onset 1
• Pain that may be activity-related and chronic 2
• Localized tenderness over the affected area of the deltoid muscle 1
• Various degrees of decreased range of motion 2
• Pain that may worsen with specific shoulder movements, particularly elevation 1
• Symptoms that can occur without associated trauma 1

Physical Examination Findings

During examination, the following findings may be present:

• Localized tenderness on palpation of the deltoid muscle, particularly at the:
  • Anterior acromial insertion site 1
  • Lateral part of the deltoid muscle between origin and insertion 3
• Localized edema or swelling 2
• Pain with active and passive range of motion tests 1
• Limited shoulder mobility, especially during elevation 1
• Possible associated subdeltoid bursitis 4

Diagnostic Approach

To properly diagnose deltoid tendon calcification:

1. Plain radiography:

   • First-line imaging modality 5
   • Should include weight-bearing axial views 6
   • Calcium deposits may be visible at the acromial insertion site or within the deltoid muscle 1
   • Arm elevation during imaging may improve visualization of calcium deposits 1

2. Ultrasonography:

   • Highly sensitive for detecting calcium deposits 1
   • Can help differentiate between calcification in the deltoid versus rotator cuff tendons 1
   • Standard scans should include:
     • Anterior transverse scan in neutral position 5
     • Anterior transverse scan in maximal internal rotation 5
     • Lateral longitudinal scan in neutral position 5

3. Advanced imaging (when needed):

   • CT scan for more detailed evaluation 6
   • MRI without IV contrast to assess associated soft tissue pathology 6

Clinical Pitfalls and Considerations

• Deltoid tendon calcification can be easily overlooked as clinicians typically focus on rotator cuff calcification 1
• The condition may coexist with subdeltoid bursitis, which can complicate the clinical picture 4
• Calcific deposits can occur at both the tendon insertion sites and within the intramuscular tendons of the deltoid 3
• Calcium deposits may spontaneously disappear over time, with complete resolution of symptoms 1
• The clinical presentation may vary depending on whether the calcification is in the formative or resorptive phase 7
• Careful palpation of the entire deltoid muscle is essential, as calcification can occur at atypical sites 1

Examination Technique

For proper examination of suspected deltoid tendon calcification:

• Position the patient in a sitting position 5
• Examine with the elbow flexed at 90° 5
• Place the hand in supination on top of the patient's thigh 5
• Perform dynamic examination with active and passive external and internal rotation of the humerus 5
• Carefully palpate the entire deltoid muscle, particularly focusing on areas of tenderness 1
• Assess for limited range of motion in all planes 2