A 26-year-old female patient presented with complaints of acute onset of neck pain with right upper limb numbness and pain for 5 days. No history of trauma or fever.
A lateral radiograph of the cervical spine shows prevertebral soft tissue thickening at the level C1–C5 with a faint calcific density at C5–C6 level (Figure 1). Non-contrast computed tomography (NCCT) shows degenerative changes at C5–C6 levels with a focus of amorphous calcific deposition in the central fibres of right longus colli muscles (Figures 2a and 2b). Magnetic resonance imaging (MRI) shows T2 hyperintense prevertebral collection extending from C1–C5 levels. Increased IR/T2 signal with post-contrast enhancement is seen in the right longus colli muscle (Figures 3, 4 and 5).
Background
Acute calcific tendinitis of longus colli (ACTLC) is an uncommon aetiology for neck pain. It is also known as retropharyngeal or prevertebral tendinitis [1]. Incidence is low, often due to misdiagnosis. It is important to differentiate this condition from other infectious causes of neck pain to prevent unnecessary surgical intervention. Longus colli is a prevertebral muscle extending from the cervical to the upper thoracic vertebra. It has upper, central and lower fibres.
Pathophysiology
ACTLC muscle primarily involves the upper oblique fibres, and it is due to an inflammatory response to hydroxyapatite crystals. The inflammatory reaction results in tendinitis and, in a few cases, reactive fluid collection is seen in the retropharyngeal space. ACTLC falls into the spectrum of hydroxyapatite deposition disorder (HADD), which is due to the deposition of calcium in the periarticular and intraarticular region, commonly triggered by metabolic imbalances or secondary to repetitive trauma of head and neck or ischemia [4,6].
Clinical Perspective
This condition mostly affects adults of the age group 20 to 50 years without any gender predilection. Patients can present with acute or subacute onset of neck pain, odynophagia, low-grade fever and reduced range of neck movements. Clinical presentation is not related to the degree of calcification [1–3,5].
Imaging perspective
In X-ray, ACTLC typically manifests as a thickening of the prevertebral soft tissue with calcification located most commonly anterior to the C1–C3 vertebral bodies; however, tiny calcific foci can easily missed.
CT is the modality of choice, which shows amorphous calcification anterior to C1–C2 at the insertion site of the superior oblique tendon of longus colli. Retropharyngeal effusion can be seen as a hypodense prevertebral collection. However, in our case, amorphous calcific deposits were found at the central fibres of the longus colli muscle at the level of C5–C6 level.
MRI features include oedema of the longus colli tendon, retropharyngeal effusion and, rarely, marrow oedema of adjacent vertebrae. Absence of diffusion restriction and peripheral enhancement of prevertebral collection rules out the abscess. MRI is highly effective in identifying prevertebral oedema and effusions, although it is not as efficient as a CT scan in detecting calcifications [2,5].
Outcome
This is a self-limiting condition that resolves on its own over a few weeks. Conservative management with NSAIDS and corticosteroids has been the mainstay of treatment [7]. The symptoms usually subside in one to two weeks after starting treatment.
Acute calcific tendinitis of longus colli
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Based on the provided X-ray, CT, and MRI images, there is thickening of the prevertebral soft tissue in the cervical region, with evidence of irregular calcifications. Faint or patchy calcifications can be observed in the central fibrous area anterior to the C5-C6 vertebral bodies. The images also show edema of the corresponding muscles and tendons (indicated by relatively high signal intensity on MRI). In some cases, a small amount of fluid can be seen in the prevertebral or retropharyngeal spaces, but there is no clear evidence of abscess formation (such as ring enhancement or significant diffusion restriction).
Considering the patient’s “acute neck pain and right upper limb numbness for 5 days,” “no history of trauma or fever,” the imaging findings of “prevertebral soft tissue thickening with calcific deposits,” and the distinct inflammatory edema signs without typical abscess features, the most likely diagnosis is Acute Calcific Tendinitis of the Longus Colli (ACTLC).
1. Treatment Strategies:
• Conservative Treatment: Symptomatic use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or short-term corticosteroids to reduce local inflammation and pain.
• Observation and Follow-Up: ACTLC is typically a self-limiting condition and may resolve spontaneously within a few weeks. If significant symptom relief is not achieved or imaging shows no improvement, repeat imaging may be required to rule out other possible pathologies.
• Surgical Indications: Rare. Surgery is considered only if severe complications arise (e.g., associated infection or significant nerve compression).
2. Rehabilitation and Exercise Prescription:
• Acute Phase (1–2 weeks): Focus on resting the cervical spine. Use a neck brace or similar support, accompanied by low-intensity isometric exercises (slight flexion and extension movements without large rotational range). Perform about 1–2 sessions per day, each lasting 5–10 minutes, keeping intensity to a level that does not cause significant pain.
• Subacute Phase (2–4 weeks): Once pain subsides, gradually increase cervical range-of-motion exercises, such as gentle stretching and resistance exercises (using resistance bands or light weights). Conduct these sessions 3–4 times a week, each session 10–15 minutes, progressively increasing resistance.
• Strengthening Phase (4–8 weeks): Further enhance the strength and stability of cervical muscles, combined with shoulder and upper limb strengthening exercises (e.g., dumbbell external rotation, resistance band rowing). Frequency can be 3–5 times a week, each session 20–30 minutes. Increase intensity gradually based on individual tolerance.
• Personalization and Safety: For patients with cervical spine instability, low bone density, or reduced cardiopulmonary function, exercise modifications should be made under professional guidance. Avoid high-impact or high-load activities, and monitor progress to adjust exercise intensity accordingly.
Disclaimer: This report is for reference based on the provided information and does not replace in-person consultation or professional medical advice. If you have any concerns or if symptoms worsen, please seek prompt diagnosis and treatment from a specialist.
Acute calcific tendinitis of longus colli
