THE CLINICAL SYNDROME

• Tendinitis is a condition that frequently occurs in the tendons that are associated with the longus colli muscle.

• In most cases, the condition known as longus colli tendinitis is brought on by either the deposition of calcium hydroxyapatite crystals or by recurrent stress to the musculotendinous apparatus.

• On a lateral plain radiograph of the neck, this crystal deposition will typically be found in the superior fibers of the musculotendinous apparatus. It is quite easy to spot.

• The onset of longus colli tendinitis is typically sudden, and because the acute onset of retropharyngeal pain is frequently accompanied by a mild elevation in temperature and leukocytosis, it is frequently misdiagnosed as acute pharyngitis or retropharyngeal abscess.

• This is because the acute onset of retropharyngeal pain is often mistaken for acute pharyngitis.

• Longus collitendinitis is most commonly seen in patients between the ages of 30 and 60 years old.

SIGNS AND SYMPTOMS

• The pain caused by longus colli tendinitis is consistent and strong, and it is centered around the region of the retropharynx.

• Swallowing makes the condition even more uncomfortable.

• In addition to the discomfort experienced when swallowing, the patient may also report acute pain in the front of the neck.

• When the longus colli muscle in the back of the neck becomes inflamed, it frequently causes referred pain in the front and back of the neck.

• There is frequently the presence of a mild fever, as well as a minor leukocytosis.

• When the symptoms are present, intraoral palpation of the superior attachment of the muscle will typically bring them on.

TESTING

• When a patient comes in complaining of retropharyngeal pain, it is necessary to take plain radiographs of their neck.

• It is quite likely that longus colli tendinitis is present when there is characteristic amorphous calcification of the superior attachment of the musculotendinous unit right below the anterior arch of the atlas.

• The issue might be more clearly defined after undergoing computed tomographic scanning. It is regarded to be pathognomonic for this condition to find a smooth, linear prevertebral fluid collection.

• The wall of the fluid-containing structure does not thicken like it would in a retropharyngeal or prevertebral abscess. This is in contrast to other types of abscesses.

• In patients who are thought to be suffering from longus colli tendinitis, further testing, such as a complete blood count, an erythrocyte sedimentation rate, and a full blood chemistry profile, may be recommended.

DIFFERENTIAL DIAGNOSIS

• Acute pharyngitis or retropharyngeal abscess are two conditions that are sometimes misdiagnosed as longus colli tendonitis.

• On occasion, the patient is found to have an early peritonsillar abscess upon further examination.

• Because to the delay in diagnosis, the patient may be forced to undergo antibiotic treatment that is not essential and, on occasion, surgical draining of the so-called "abscess."

• When dealing with certain clinical scenarios, it is important to take into account the possibility of primary or secondary malignancies involving this anatomic region.

TREATMENT

• The initial treatment for the pain and functional handicap associated with longus colli tendinitis consists of a combination of nonsteroidal antiinflammatory medications (NSAIDs) or cyclooxygenase-2 inhibitors. This treatment is intended to alleviate the inflammation and pain caused by the condition.

• A thorough sedative massage, as well as the administration of heat and cold to the affected area, may also be therapeutic.

• An injection of a local anesthetic and steroid into the superior section of the tendon is a reasonable next step for patients who do not respond to these therapy techniques.

• Only if the practitioner is absolutely convinced that there is no latent infection present in this anatomic location should they ever attempt giving such an injection.

• The use of ultrasound to guide the needle could make placement of the needle easier while reducing the risk of injury to nearby structures, such as the thyroid gland, the carotid artery, the jugular vein, and the exiting cervical nerve roots.

COMPLICATIONS AND PITFALLS

• Longus colli tendinitis is a painful ailment that can be difficult to identify in a timely manner.

• Another common mistake in the treatment of longus colli tendinitis is to mistake it for another disease that requires more intensive therapy (e.g., retropharyngeal abscess or peritonsillar abscess).

• In many cases, the only thing that is required is prompt treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and reassurance.

• In more difficult cases, immediate symptom relief can nearly always be achieved with injection of a local anesthetic and steroid combination.

• If the clinically relevant anatomy is carefully considered before using this injection technique, then its application does not provide any safety concerns.

• In order to prevent infection, sterile technique must be utilized, and universal precautions must be taken in order to lessen the likelihood that the operator would be put in harm's way.

• If pressure is applied to the injection site soon after the injection, this can help reduce the risk of complications such as ecchymosis and hematoma formation. There is also the potential that the injection itself will cause injury to the tendon.

• If a tendon that is already severely inflamed or has been damaged in the past is given an injection directly, there is a risk that it will rupture. This problem can typically be avoided if the therapist employs a cautious approach and ceases injections as soon as they encounter strong resistance.

• Patients should be made aware of the chance that they may experience a temporary increase in pain after receiving an injection, as this affects approximately one quarter of all patients.