Medical Imaging Analysis Report

1. Radiological Findings

Based on the provided X-ray, CT, and MRI images, the main findings are as follows:

• A localized abnormal density/signal is observed in the soft tissues near the proximal humeral metaphysis in the left upper arm, suggesting calcific lesions in the tendon or its attachment site.
• X-ray findings: A dense shadow, with relatively clear margins, is seen on the lateral proximal humerus. It may exhibit a “comet tail” appearance, indicating calcium salt deposition in the tendon or its attachment point.
• MRI findings: A localized signal abnormality in the corresponding area. On the T2-weighted sequence, there is mild indentation of the cortical bone or periosteal reaction, but no obvious soft tissue mass. Only mild changes in the bone marrow signal are noted, suggesting possible slight bone involvement or reactive bone marrow edema.
• CT findings: Local calcification and localized cortical erosion are further confirmed. The lesion is closely related to surrounding soft tissues and the tendon, with no obvious soft tissue mass.

Overall imaging findings are more consistent with calcific changes at the tendon or tendon attachment site. Although there is mild reactive bone change, there is no clear evidence of aggressive bone destruction.

2. Potential Diagnoses

Considering the patient’s history (a 53-year-old female with a history of malignant melanoma, currently presenting with left upper arm pain and normal blood tests) and the imaging findings, the possible diagnoses or differential diagnoses include:

1. Calcific Tendonitis:
   This is the most likely consideration. Lesions often occur in the shoulder tendons, with imaging showing localized calcium deposits within the tendon or at the attachment site, possibly appearing as clumps or with a “comet tail” sign. CT may show mild cortical changes or minimal bone marrow reaction, usually without a significant soft tissue mass.
2. Tumoral Lesion (e.g., Chondrosarcoma or Metastasis):
   Given the patient’s history of malignant melanoma, metastasis or a primary chondrosarcoma must be excluded. Typically, malignant lesions demonstrate more pronounced bone destruction, soft tissue masses, and bone marrow infiltration. Current imaging does not reveal obvious signs of invasiveness or soft tissue masses, but it remains in the differential.
3. Tendon Avulsion Changes:
   If there was trauma or avulsion at the tendon insertion, X-ray or CT might show bone fragments or local calcification. However, there is no clear history of trauma, and the pain appears spontaneously, which makes avulsive changes less likely.

3. Final Diagnosis

Taking into account the patient’s age, symptom characteristics (non-traumatic, chronic pain with restricted mobility), past medical history (despite melanoma, current blood tests and imaging show no obvious signs of malignancy), and the radiological findings (localized tendon calcification, mild cortical bone reaction, absence of a significant soft tissue mass or extensive bone destruction), the most likely diagnosis is:

Calcific Tendonitis.

If there is still concern, consideration may be given to monitoring lesion stability or performing a biopsy/puncture if necessary to rule out malignancy. However, based on the current information, a benign lesion is more strongly suggested.

4. Treatment Plan and Rehabilitation

According to the standard management principles of calcific tendonitis and the patient’s situation, possible treatment and rehabilitation plans are as follows:

1. Conservative Treatment:
   
   • Oral nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation.
   • During the acute inflammatory phase, short-term reduced activity or immobilization may be considered as needed.
   • Physical therapy: Hot compresses, physiotherapy, and ultrasound therapy to help relieve local pain and promote resolution of inflammation.
2. Injection Therapy (if applicable):
   When conservative treatment is less effective and inflammation recurs, image-guided local corticosteroid injection or other minimally invasive interventions (e.g., shock wave therapy, needle aspiration/irrigation of the calcific deposit) may be considered to reduce inflammatory response.
3. Surgical Treatment:
   For patients who do not respond to conservative measures or have large calcifications severely affecting function, surgical removal of the calcific deposit may be considered. However, most patients improve with systematic conservative treatment.

Rehabilitation and Exercise Prescription Recommendations:

• Early Phase (Acute Phase):
  Frequency (F): 1–2 times per day with light activities
  Intensity (I): Low intensity, avoid excessive pulling on the painful area
  Time (T): 5–10 minutes each session, gradually increasing
  Type (T): Passive or assisted range-of-motion exercises (e.g., gentle arm swings, finger wall-climbing)
  Progression (P): Increase range of motion and frequency as pain subsides
• Middle Phase (Repair Phase):
  Frequency: Muscle strength and joint mobility exercises 3–4 times per week
  Intensity: Moderate intensity, some resistance training (e.g., elastic band)
  Time: 20–30 minutes each session, including local heat or physiotherapy
  Type: Isometric exercises for the shoulder joint and upper limb muscles, gradually increasing load
  Progression: Monitor range of motion and pain weekly, and increase training intensity accordingly
• Late Phase (Functional Consolidation Phase):
  Frequency: At least 3 times per week, can be incorporated into daily exercise
  Intensity: Medium to high intensity, gradually increasing based on individual tolerance
  Time: 30–45 minutes per session, including warm-up, core exercises, and cool-down
  Type: Gradually return to normal activities and sports, possibly adding upper limb functional exercises (e.g., rowing machine, light resistance training)
  Progression: Adjust intensity based on functional assessments to further strengthen or maintain training and prevent recurrence

Throughout the rehabilitation process, closely monitor the patient’s pain and functional improvement. If there is marked increase in pain or other discomfort, timely medical evaluation is necessary. For patients with fragile bones or insufficient cardiopulmonary function, exercise intensity should be individualized to ensure safety.

Disclaimer: This report is based on the analysis of current data and is provided for clinical reference only. It cannot replace an in-person consultation or the final opinion of a professional physician. Please combine the patient’s actual condition with professional advice for diagnosis and treatment.