Hospital For Special Surgery: Ultrasound of the Month - Case 28

Clinical History •

65 year old female with skiing injury 2 years ago and gradual development of right buttock and posterior thigh pain

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Hip radiographs were obtained and following interpretation ultrasound was requested

Ultrasound of the Month – Case 28

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Ultrasound of the Month – Case 28

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Ultrasound of the Month – Case 28

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Ultrasound of the Month – Case 28

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Ultrasound of the Month – Case 28

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Diagnosis:

Calcific tendinosis of the proximal hamstring tendons

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Ultrasound-Guided Treatment •

Under direct ultrasound visualization, an 18 gauge needle (arrows) was advanced into the largest focus of calcification. Aspiration of cloudy particulate calcific material was performed followed by lavage aspiration of additional calcium. The remaining shell of calcification was fenestrated with the needle.

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Sterile preparation of the area is important.

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Under continuous sonographic guidance, an 18 gauge needle is advanced into the center of the calcification.

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Aspiration may yield calcific material.

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Lavage is then performed with anesthetic and saline, creating a cavity in the center of the calcification and removing any additional calcification.

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After all calcification is removed, the peripheral shell of the calcification is fenestrated with the needle.

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Finally, a preparation of long-acting anesthetic and cortisone is injected around the calcification to provide long-term relief of discomfort.

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Ultrasound of the Month – Case 28

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Discussion •

Calcific tendinosis represents the deposition of calcium hydroxyapatite within a tendon.

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The most commonly seen and treated location of calcific tendinosis is the rotator cuff of the shoulder.

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Calcific tendinosis may develop in any tendon and has been encountered not infrequently in the extensor carpi ulnaris, gluteus medius, rectus femoris, and longus colli tendons.

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Treatment •

Treatment options include percutaneous ultrasound-guided lavage aspiration, surgery, extracorporeal shock wave therapy, and conservative management

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As in this case, ultrasound-guided lavage aspiration is often the treatment of choice as it allows rapid removal of calcific material and fragmentation of the remaining calcification, with often rapid symptomatic improvement

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