Abstract
The tendons of the longus colli muscle are prone to the development of tendinitis. Longus colli tendinitis is usually caused either by repetitive trauma to the musculotendinous apparatus or by the deposition of calcium hydroxyapatite crystals. This crystal deposition usually occurs in the superior fibers of the musculotendinous apparatus and is easily identified on a lateral plain radiograph of the neck. The onset of longus colli tendinitis is generally acute, and it is often misdiagnosed as acute pharyngitis or retropharyngeal abscess because the acute onset of retropharyngeal pain is frequently accompanied by a mild elevation in temperature and leukocytosis. Longus colli tendinitis is most often seen in the third to sixth decades of life. Referred pain from the inflamed longus colli muscle to the anterior and posterior neck often occurs. Initial treatment of the pain and functional disability associated with longus colli tendinitis includes a combination of nonsteroidal antiinflammatory drugs (NSAIDs) or cyclooxygenase-2 inhibitors. Local application of heat and cold and deep sedative massage may also be beneficial. For patients who do not respond to these treatment modalities, injection of the superior portion of the tendon with local anesthetic and steroid is a reasonable next step.
Keywords
longus colli tendinitis, longus colli muscle, calcium hydroxyapatite crystals, retropharyngeal pain, local anesthetic, dysphagia
ICD-10 CODE M65.20
The Clinical Syndrome
The tendons of the longus colli muscle are prone to the development of tendinitis. Longus colli tendinitis is usually caused either by repetitive trauma to the musculotendinous apparatus or by the deposition of calcium hydroxyapatite crystals. This crystal deposition usually occurs in the superior fibers of the musculotendinous apparatus and is easily identified on a lateral plain radiograph of the neck. The onset of longus colli tendinitis is generally acute, and it is often misdiagnosed as acute pharyngitis or retropharyngeal abscess because the acute onset of retropharyngeal pain is frequently accompanied by a mild elevation in temperature and leukocytosis. Longus colli tendinitis is most often seen in the third to sixth decades of life.
Signs and Symptoms
The pain of longus colli tendinitis is constant and severe and is localized to the retropharyngeal area. It is made worse by swallowing ( Fig. 19.1 ). The patient may complain of acute anterior neck pain in addition to the pain on swallowing. Referred pain from the inflamed longus colli muscle to the anterior and posterior neck often occurs ( Fig. 19.2 ). A mild fever is often present, as is mild leukocytosis. Intraoral palpation of the superior attachment of the muscle usually reproduces the symptoms.
Testing
Plain radiographs are indicated for all patients who present with retropharyngeal pain. Characteristic amorphous calcification of the superior attachment of the musculotendinous unit just below the anterior arch of atlas is highly suggestive of longus colli tendinitis ( Fig. 19.3 ). Computed tomographic scanning may further delineate the problem ( Fig. 19.4 ). The finding of a smooth, linear prevertebral fluid collection is considered pathognomonic for this disease ( Fig. 19.5 ). Unlike in a retropharyngeal or prevertebral abscess, the wall of the fluid-containing structure does not enhance. Additional testing may be indicated, including a complete blood count, erythrocyte sedimentation rate, and complete blood chemistry tests, in patients suspected of suffering from longus colli tendinitis.
