{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T01:19:46Z","timestamp":1790644786857,"version":"4.1.0"},"reference-count":50,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T00:00:00Z","timestamp":1692057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Hydroxyapatite deposition disease (HADD) represents a multifaceted condition characterized by the accumulation of hydroxyapatite crystals in soft tissues, leading to subsequent inflammation and discomfort. The intricate etiology of HADD is the subject of this comprehensive review, which encompasses an in-depth analysis of the four proposed pathogenic mechanisms and a deliberation on the predisposing factors that instigate the development of this disease. In order to provide a thorough understanding of the disease\u2019s progression, this manuscript delineates the stages of HADD\u2014those preceding calcification, occurring during calcification, and following calcification\u2014in meticulous detail. This chronology forms the basis of a complete portrayal of the evolution of HADD. Moreover, this review encompasses an examination of the radiological findings associated with HADD, furnishing an extensive discourse on imaging characteristics. The potential of HADD to mimic other diseases, thereby posing diagnostic challenges, is also articulated. The discourse continues with an investigation of HADD\u2019s differential diagnosis. This section furnishes a robust framework for distinguishing HADD from other conditions based on imaging results. To enrich the understanding of this diagnostic process, case studies illustrating real-world applications are provided. An overview of treatment modalities for HADD, including both conservative and interventional approaches, forms the concluding discussion. The pivotal role of imaging specialists in the diagnosis and management of HADD is emphasized, highlighting their vital contribution to image-guided procedures and disease monitoring.<\/jats:p>","DOI":"10.3390\/diagnostics13162678","type":"journal-article","created":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T11:09:44Z","timestamp":1692097784000},"page":"2678","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Hydroxyapatite Deposition Disease: A Comprehensive Review of Pathogenesis, Radiological Findings, and Treatment Strategies"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8796-4923","authenticated-orcid":false,"given":"Tarek","family":"Hegazi","sequence":"first","affiliation":[{"name":"Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1148\/radiology.134.3.6243783","article-title":"Hydroxyapatite deposition disease","volume":"134","author":"Bonavita","year":"1980","journal-title":"Radiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"965","DOI":"10.2214\/ajr.181.4.1810965","article-title":"Osseous involvement in calcific tendinitis: A retrospective review of 50 cases","volume":"181","author":"Flemming","year":"2003","journal-title":"Am. J. Roentgenol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"108653","DOI":"10.1016\/j.ejrad.2019.108653","article-title":"Calcium hydroxyapatite deposition disease: Imaging features and presentations mimicking other pathologies","volume":"120","author":"Hongsmatip","year":"2019","journal-title":"Eur. J. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s11739-019-02235-9","article-title":"Hydroxyapatite deposition disease: A common disease in an uncommon location","volume":"15","author":"Benvenuto","year":"2020","journal-title":"Intern. Emerg. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1016\/j.jse.2015.02.024","article-title":"Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: Clinical and radiologic analysis of 1219 patients","volume":"24","author":"Louwerens","year":"2015","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1148\/radiographics.10.6.2175444","article-title":"Calcium hydroxyapatite deposition disease","volume":"10","author":"Hayes","year":"1990","journal-title":"RadioGraphics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1515\/bmte.2001.46.3.69","article-title":"Bedeutung der exakten Fokussierung extrakorporaler Sto\u00dfwellen (ESWT) bei der Therapie der Tendinitis calcarea. Eine prospektive randomisierte Studie\u2014Importance of Accurately Focussing Extracorporeal Shock Waves in the Treatment of Calcifying Tendinitis. A Prospective Randomized Study","volume":"46","author":"Haake","year":"2001","journal-title":"Biomed. Eng. Biomed. Tech."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.carj.2009.06.008","article-title":"Calcific tendinitis: A pictorial review","volume":"60","author":"Siegal","year":"2009","journal-title":"Can. Assoc. Radiol. J."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Oliva, F., Via, A.G., and Maffulli, N. (2012). Physiopathology of intratendinous calcific deposition. BMC Med., 10.","DOI":"10.1186\/1741-7015-10-95"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1001\/jama.1941.02820220019004","article-title":"Calcium deposits in the shoulder and subacromial bursitis: A survey of 12,122 shoulders","volume":"116","author":"Bosworth","year":"1941","journal-title":"J. Am. Med. Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1001\/archsurg.1939.01200140063006","article-title":"Calcification of the supraspinatus tendon: Cause, pathologic picture and relation to the scalenus anticus syndrome","volume":"39","author":"Bishop","year":"1939","journal-title":"Arch. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"183","DOI":"10.5435\/00124635-199707000-00001","article-title":"Calcific tendinopathy of the rotator cuff: Pathogenesis, diagnosis, and management","volume":"5","author":"Uhthoff","year":"1997","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_13","first-page":"164","article-title":"Calcifying tendinitis: A new concept of its pathogenesis","volume":"118","author":"Uhthoff","year":"1976","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1002\/1529-0131(200003)43:3<576::AID-ANR14>3.0.CO;2-A","article-title":"The mechanism of formation of bony spurs (enthesophytes) in the Achilles tendon","volume":"43","author":"Benjamin","year":"2000","journal-title":"Arthritis Rheum."},{"key":"ref_15","first-page":"606","article-title":"Does erroneous differentiation of tendon-derived stem cells contribute to the pathogenesis of calcifying tendinopathy?","volume":"124","author":"Rui","year":"2011","journal-title":"Chin. Med J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1136\/ard.48.3.211","article-title":"Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: A controlled study","volume":"48","author":"Drimis","year":"1989","journal-title":"Ann. Rheum. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jse.2006.06.007","article-title":"Calcific tendinitis: Natural history and association with endocrine disorders","volume":"16","author":"Harvie","year":"2007","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1136\/ard.35.3.213","article-title":"Periarthritis of the shoulder. I. Aetiological considerations with particular reference to personality factors","volume":"35","author":"Wright","year":"1976","journal-title":"Ann. Rheum. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1111\/j.1399-0039.1987.tb01571.x","article-title":"Increased frequency of HLA-A1 in calcifying tendinitis","volume":"29","author":"Sengar","year":"1987","journal-title":"Tissue Antigens"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/S0950-3579(89)80009-3","article-title":"Calcifying tendinitis","volume":"3","author":"Uhthoff","year":"1989","journal-title":"Bailliere\u2019s Clin. Rheumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1136\/emermed-2013-203387","article-title":"Plain radiographic evidence of stages of calcifying tendinitis of supraspinatus tendon of shoulder","volume":"32","author":"Reddy","year":"2015","journal-title":"Emerg. Med. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s10140-007-0626-9","article-title":"Acute calcific periarthritis of the hand and wrist: A series and review of the literature","volume":"14","author":"Doumas","year":"2007","journal-title":"Emerg. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s13244-018-0619-0","article-title":"Radiological identification and analysis of soft tissue musculoskeletal calcifications","volume":"9","author":"Freire","year":"2018","journal-title":"Insights Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1007\/s002560000278","article-title":"Atypical calcific tendinitis with cortical erosions","volume":"29","author":"Kraemer","year":"2000","journal-title":"Skelet. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"967","DOI":"10.2214\/ajr.149.5.967","article-title":"Calcific tendinitis in unusual sites associated with cortical bone erosion","volume":"149","author":"Hayes","year":"1987","journal-title":"Am. J. Roentgenol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1007\/s00330-006-0428-6","article-title":"MR arthrography in calcific tendinitis of the shoulder: Diagnostic performance and pitfalls","volume":"17","author":"Zubler","year":"2007","journal-title":"Eur. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s10195-015-0367-6","article-title":"Calcific tendinitis of the rotator cuff: State of the art in diagnosis and treatment","volume":"17","author":"Merolla","year":"2016","journal-title":"J. Orthop. Traumatol."},{"key":"ref_28","unstructured":"Abreu, M.R., and Recht, M. (2017). Musculoskeletal Diseases 2017\u20132020: Diagnostic Imaging, Springer."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"7","DOI":"10.7863\/jum.1995.14.1.7","article-title":"Sonographic findings of rotator cuff calcifications","volume":"14","author":"Farin","year":"1995","journal-title":"J. Ultrasound Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"289","DOI":"10.7863\/jum.2002.21.3.289","article-title":"Evaluation of calcific tendonitis of the rotator cuff: Role of color Doppler ultrasonography","volume":"21","author":"Chiou","year":"2002","journal-title":"J. Ultrasound Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jbspin.2010.01.012","article-title":"Assessment of calcific tendonitis of rotator cuff by ultrasonography: Comparison between symptomatic and asymptomatic shoulders","volume":"77","author":"Berthelot","year":"2010","journal-title":"Jt. Bone Spine"},{"key":"ref_32","first-page":"186","article-title":"Rotator cuff calcific tendinopathy: From diagnosis to treatment","volume":"89","author":"Chianca","year":"2018","journal-title":"Acta Biomed."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"585","DOI":"10.5301\/HIP.2012.10347","article-title":"Gluteal Tumoral Calcinosis","volume":"22","author":"Liuzza","year":"2012","journal-title":"HIP Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1007\/s00256-015-2165-x","article-title":"Intraosseous migration of tendinous calcifications: Cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series","volume":"44","author":"Malghem","year":"2015","journal-title":"Skelet. Radiol."},{"key":"ref_35","first-page":"4801474","article-title":"Calcium Apatite Deposition Disease: Diagnosis and Treatment","volume":"2016","author":"Beckmann","year":"2016","journal-title":"Radiol. Res. Pract."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1001\/jama.1955.02950220016005","article-title":"Acute calcium deposits in the hand","volume":"157","author":"Carroll","year":"1955","journal-title":"J. Am. Med. Assoc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jse.2009.07.008","article-title":"Radiologic course of the calcific deposits in calcific tendinitis of the shoulder: Does the initial radiologic aspect affect the final results?","volume":"19","author":"Cho","year":"2010","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/0002-9610(58)90436-7","article-title":"Methods and results in the treatment of 2,580 painful shoulders: With special reference to calcific tendinitis and the frozen shoulder","volume":"95","author":"Harmon","year":"1958","journal-title":"Am. J. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/PHM.0000000000000190","article-title":"Gluteus maximus calcific tendonosis: A rare cause of sciatic pain","volume":"94","author":"Singh","year":"2015","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_40","first-page":"567","article-title":"Calcific tendinitis of the shoulder","volume":"34","author":"Hurt","year":"2003","journal-title":"Orthop. Clin."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1177\/0363546513487066","article-title":"Calcific tendinitis of the rotator cuff: A randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids","volume":"41","author":"Selten","year":"2013","journal-title":"Am. J. Sport. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"542","DOI":"10.7326\/M13-1982","article-title":"High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: A systematic review","volume":"160","author":"Bannuru","year":"2014","journal-title":"Ann. Intern. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1016\/j.jse.2014.06.036","article-title":"Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy","volume":"23","author":"Kim","year":"2014","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/S1058-2746(98)90180-X","article-title":"Arthroscopic treatment of calcific tendinitis of the shoulder","volume":"7","author":"Jerosch","year":"1998","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.arthro.2006.01.012","article-title":"Arthroscopic Treatment of Chronically Painful Calcifying Tendinitis of the Supraspinatus Tendon","volume":"22","author":"Seil","year":"2006","journal-title":"Arthrosc. J. Arthrosc. Relat. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"707","DOI":"10.5435\/JAAOS-22-11-707","article-title":"Calcific tendinitis of the rotator cuff: Management options","volume":"22","author":"Suzuki","year":"2014","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.CDR.0000753128.93798.99","article-title":"Calcific Tendinosis: What the General Radiologist Needs to Know","volume":"44","author":"Hussain","year":"2021","journal-title":"Contemp. Diagn. Radiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1148\/radiol.2212000830","article-title":"Calcific Shoulder Tendinitis: Treatment with Modified US-guided Fine-Needle Technique","volume":"221","author":"Aina","year":"2001","journal-title":"Radiology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e486","DOI":"10.1016\/S2589-7500(20)30160-6","article-title":"Artificial intelligence in medical imaging: Switching from radiographic pathological data to clinically meaningful endpoints","volume":"2","author":"Oren","year":"2020","journal-title":"Lancet Digit. Heal."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"137","DOI":"10.4103\/ijri.IJRI_256_18","article-title":"Artificial intelligence in radiology\u2014Are we treating the image or the patient?","volume":"28","author":"Sm","year":"2018","journal-title":"Indian J. Radiol. 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