Elbow Swelling with Calcifications: Diagnosis and Management

Differential Diagnosis

The American College of Radiology recommends beginning with plain radiographs immediately to differentiate between calcific tendonitis, heterotopic ossification, loose bodies, and septic arthritis, with the latter requiring urgent arthrocentesis if clinical signs of infection are present 1, 2
Heterotopic ossification shows mature bone formation with swelling and limited range of motion, according to the American College of Radiology 1, 3
Loose bodies with calcification cause mechanical symptoms, such as locking or catching, with intermittent swelling, as reported by the American College of Radiology 1, 3

The American College of Radiology states that plain radiographs of the elbow are the first-line study, identifying soft tissue calcifications, heterotopic ossification, loose bodies, fractures, and osteochondral lesions 1, 4, 2
Comparing radiographs with the contralateral asymptomatic elbow is recommended when findings are subtle, according to the American College of Radiology 1, 4
The American College of Radiology suggests performing image-guided arthrocentesis with synovial fluid analysis when infection cannot be excluded 2

The American College of Radiology recommends conservative management for calcific tendonitis, including NSAIDs, ice application, relative rest, and counterforce bracing, as outlined by Praxis Medical Insights 6
For heterotopic ossification, the American College of Radiology advises CT elbow to define extent and maturity of ossification, followed by conservative management with NSAIDs and gentle range-of-motion exercises 5, 3
In cases of septic arthritis, immediate arthrocentesis with culture and empiric IV antibiotics pending culture results are necessary, as stated by Praxis Medical Insights 2

Over-reliance on corticosteroid injections may lead to tendon rupture, according to Praxis Medical Insights 6
Ordering MRI before plain radiographs is not recommended, as MRI is less sensitive for calcifications, as reported by the American College of Radiology 3
Failing to exclude septic arthritis when swelling is acute with systemic signs is a common pitfall, as stated by Praxis Medical Insights 2
Complete immobilization can lead to muscle atrophy and joint stiffness, according to Praxis Medical Insights 6