Acute calcific supraspinatus tendinitis in a three-year-old child.

A previously healthy three-year-old boy presented with a 72-hour history of general malaise and refusal to move the right arm. There was no history of injury or of previous symptoms in the limb. On examination, he was unhappy and withdrawn, holding the right arm securely across his stomach with his left hand. He was apyrexial when first seen in the accident department but two hours later his temperature was 38.6#{176} Celsius. There was localised tenderness around the right shoulder and radiographs showed a large, amorphous calcific deposit in the subacromial region with inferior subluxation of the head of the humerus (Fig. 1). His haemoglobin was 1 1.5 g/dl, the white cell count 12.4 x 109/1 and the ESR 43 mm in the first hour. The urea and electrolyte values were normal. Under general anaesthesia, a wide-bore needle was inserted into the subacromial space and two millilitres of a white toothpaste-like material was aspirated. Because of the size of the calcium deposit, the subacromial space was explored through a short deltoid-splitting incision. An encapsulated white calcareous deposit was dissected from the subacromial space with a small piece of the tendon to which it was attached. There was no sign of infection and inspection of the shoulder joint through a short incision in the superior capsule showed no effusion and a normal appearance despite the subluxation seen on radiographs. Antibiotics were not given and although the arm was rested in a sling, this was rapidly discarded by the child and normal shoulder movements were regained after 14 days. Immediate Gram stain of the excised material showed no organisms, and cultures (aerobic, anaerobic and for mycobacteria and yeasts) were all negative. The serum calcium, phosphate and alkaline phosphatase and all investigations of renal function including ultrasound scanning were normal. Histology of the tendon and calcium deposit was reported as being consistent with calcific supraspinatus tendinitis. Discussion. Calcific supraspinatus tendinitis is common in middle-aged patients and is often assumed to be