Retropharyngeal tendinitis (or falhgrens syndrome) explained
Tendonitis is defined by the National Health Service (NHS) as the swelling of a thick cord tendon that is attached to a muscle to a bone which can cause joint pain and stiffness.
Retropharyngeal tendinitis is defined as an unfamiliar but not extremely rare condition that causes intense neck pain and headache. It is often misdiagnosed as retropharyngeal abscess, infectious spondylitis, traumatic injury, meningitis, or even cervical artery dissection and therefore be over-treated with invasive procedures. The diagnosis is made radiographically by prevertebral soft tissue swelling and a nearly pathognomonic amorphous calcification in front of the first and second cervical vertebrae Retropharyngeal tendonitis can be managed conservatively without surgery.
What causes retropharyngeal tendinitis
Retropharyngeal Calcific tendonitis is caused by an aseptic inflammatory process in the longus Colli tendon, prompted by displacement of calcium hydroxyapatite crystal. The pathogenesis of crystal deposition in these fibers remains unclear, although repetitive trauma, ischemia, necrosis, and genetic predisposition have been suggested as possible causes.
The diagnosis is made radiographically by prevertebral soft tissue swelling and a nearly pathognomonic amorphous calcification anterior to C1-C2. Retropharyngeal Calcific tendonitis can be managed without surgery.
Symptoms are usually extremely intense over a few days. This pain is described as sharp or pulsating, or also as dull and heavy sometimes, often radiating into the back of the head. As a result, there is a painful restriction in the movement of the neck.
Common symptoms of Retropharyngeal Calcific tendonitis are
- Odynophagia: Odynophagia is a disorder that makes swallowing feels painful. The pain can be experienced when swallowing food, saliva, or liquid, in the throat, esophagus, or mouth
- Neck stiffness: A stiff neck may become painful when a person tries to move their neck or head and it is mainly characterized by difficulty moving the neck and its soreness when trying to turn the head to the side
- Other symptoms include headaches, increased body temperature, limited movement of the neck without fever, or severely increased white blood cell count (WBC)
Acute retropharyngeal calcific tendinitis is a limited disease that spontaneously resolves after one to two weeks. Research has suggested that a short course of non-steroidal anti inflammatory drugs (NSAIDs) and immobilization with a soft cervical collar can relieve symptoms. Additional medications, such as prednisolone or opioids can be suggested in cases of severe pain.
Retropharyngeal tendinitis radiology
Radiographically, it is shown as edema of the retropharyngeal soft tissues and calcium deposits. RCT is usually a self-limiting condition and its formation mechanism has not yet been fully understood, often resolving within one to two weeks.
What to do
RCT does not require surgical treatment, and an accurate diagnosis can initiate prompt treatment. In centers where imaging is readily available, a CT scan should be performed to confirm the diagnosis to initiate prompt treatment. Non-steroidal anti-inflammatory drugs and corticosteroids can accelerate the healing process. Opioids can be used if there is persistent pain.
Question: Is retropharyngeal tendonitis life-threatening?
Answer: It frequently presents as an emergency because it can mimic more serious disorders.
Question: Can you ever fully recover from retropharyngeal tendonitis?
Answer: Retropharyngeal tendinitis tends to disappear spontaneously when treated with drugs.
Question: What age group is most likely to develop retropharyngeal tendonitis?
Answer: Retropharyngeal tendinitis typically affects adults aged between 30 and 60 years
Question: Does calcific tendonitis go away?
Answer: Retropharyngeal calcific tendonitis eventually resolves on its own in most cases.
Can it be extremely painful?
Retropharyngeal Calcific tendonitis can be extremely painful. It commonly presents with vague symptoms such as 94% of neck pain, 27% of difficulty swallowing, 45% of limited movement, 42% of stiffness, and 45% of painful swallowing.
Is retropharyngeal tendinitis rare?
Yes, it is. It is also known as calcific tendinitis of the longus Colli muscle, a relatively rare entity that is mostly incorrectly diagnosed or ignored which results in unnecessary treatment and interventions which include unnecessary antibiotic therapy and specialty consults.
Though RCT is rare, doctors should be aware of its diagnosis and consider it as a differential diagnosis for symptoms such as the sudden onset of neck stiffness and pain, odynophagia, restricted neck movement or opening of the mouth . CT scans should be performed in centers where imaging is readily available to confirm the diagnosis to initiate prompt treatment. Radiological imaging helps to avoid dangerous and unnecessary interventions that may lead to serious adverse events. A prompt diagnosis of RCT helps to reduce symptoms sooner which reduces the duration of a hospital stay.
- Hartley J. Acute cervical pain associated with retropharyngeal calcium deposit. A case report. J Bone Joint Surg Am. 1964; 46: 1753- 1754.
- Eastwood JD, Hudgins PA, Malone D. Retropharyngeal effusion in acute calcific prevertebral tendinitis: Diagnosis with CT and MR imaging. AJNR Am J Neuroradiol. 1998; 19: 1789- 1792.
- Kupferman TA, Rice CH, Gage-White L. Acute prevertebral calcific tendinitis: A nonsurgical cause of prevertebral fluid collection. Ear Nose Throat J. 2007; 86: 164- 166.
- Fahlgren H. Retropharyngeal tendinitis. Cephalalgia. 1986; 6: 169- 174.
- Artenian DJ, Lipman JK, Scidmore GK, Brant-Zawadzki M. Acute neck pain due to tendonitis of the longus colli: CT and MRI findings. Neuroradiology. 1989; 31: 166- 169.
- Chung T, Rebello R, Gooden EA. Retropharyngeal calcific tendinitis: Case report and review of literature. Emerg Radiol. 2005; 11: 375- 380.
- Kuhn J, Harzheim A, Hartmann-Klosterkoetter U, Bewermeyer H. Acute calcifying prevertebral tendinitis of the M. longus colli as a rare cause of intense neck and occipital lobe pain-a radiological imaging diagnosis. Rofo. 2005; 177: 577- 579.
- Ring D, Vaccaro AR, Scuderi G, Pathria MN, Garfin SR. Acute calcific retropharyngeal tendinitis. Clinical presentation and pathological characterization. J Bone Joint Surg Am. 1994; 76: 1636- 1642.
- Prempreet Kaur Manjit Singh, Muhammad Irsyad Mohamed Noor, Rohaizam Jaafar, Amali Ahmad, Acute Retropharyngeal Calcific Tendonitis as a Rare Cause of Odynophagia and Neck Pain. Medeni Med J. 2021;36(1):75-79.