Hydroxyapatitic Bursitis

A patient (65) comes  due to terrible pains of the shoulder lasting for two days. They occurred after an increasing  exertion when he was lifting a heavy object during his work in the garden. The patient talks about an acute origin of a terrible pain during several seconds. This pain is still getting worse, and an oedema occurred gradually on the medial side of the glenohumeral articulation the second day. He cannot sleep at night because of the pains, antirheumatics or Tramal, which he got from the general practitioner, do not help.

Objective Finding

View

An oedema in the area of the medial part of the glenohumeral articulation, palpably much painful.

Motility and extensions of the movement

Complex movements of the shoulder girdle

are painful, an elevation in the flexion, and the abduction is possible till 30 degrees, then the patient is not able to overcome the pain.

Isolated movements in the glenohumeral articulation

an outer rotation, abduction, flexion are possible only around 30 degrees.

Movements against resistance

strength

it does not seem to be restricted, but an examination is not possible because of soresness.

soresness

an isometric contraction is painful in the directions of the flexion, inner and outer rotation, and abduction (abduction of m. supraspinatus).

Ultrasound Finding

apabulx.jpg (28704 bytes) 

 picture and scheme of hydroxyapatitic bursitis longitudinally

videoclip of hydroxyapatitic bursitis longitudinally

 

apabutX.jpg (29433 bytes)

picture and scheme of hydroxyapatitic bursitis transversally

videoclip of hydroxyapatitic bursitis transversally

 

 

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X-ray picture of hydroxyapatitic bursitis

Aspiration of Bursitis

2 ml of chalk white substance, culturally negative

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Macroscopic appearance of a artrocentesis of a hydroxyapatitic bursa.<

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Microscopic finding of hydroxyapatitic bursitis a artrocentesis of hydroxyapatitic bursitis dyed with Alizarin red paint S, red spots are the loci of hydroxyapatite.

Dyeing of the artrocentesis with Alizarin red paint S, and photo documentation was made by dr. Galinova, Rheumatology, Na Slupi 4, manager K. Pavelka.

X-ray Diffraction

Given sample, according to powdered X-ray analysis, can be determined as a hydroxyapatite. For the interpretation a card number 9-432 of a file for minerals published in JOINT COMMITTEE ON POWDER DIFFRACTION DTANDARDS. L 601 PARK LINE, SWARTHMORE, PENNSYLVANIA 19081. U.S.A. was used.

It was made in the laboratory of geochemistry, mineralogy and natural resources of  Science Faculty UK, Albertov 6. Prague 2, X-ray was made and interpreted by RNDr. Alexej Zdimera17, manager of the institute : Doc. RNDr. Emil Jelinek, in Praque 18.2.1997.

Conclusion

Hydroxyapatitic bursitis

Commentary

Anamnestic and clinical picture shows eventual tendinitis of the long head of the biceps or a rupture of muscles of the rotator cuff. A finding was a surprise for us. It was proved again that a definitive diagnosis can be determined only on the basis of the analysis of the artrocentesis.

17 we thank very much for the interpretation and providing of the documentation (author)