1
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Atilano L, Martin N, Iglesias G, Martin JI, Mendiola J, Aiyegbusi A, Bully P, Rodriguez-Palomo M, Andia I. Sonographic pathoanatomy of greater trochanteric pain syndrome. J Ultrasound 2024; 27:501-510. [PMID: 38082193 PMCID: PMC11333682 DOI: 10.1007/s40477-023-00836-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/11/2023] [Indexed: 08/21/2024] Open
Abstract
AIMS To identify and highlight pertinent US features that could serve as imaging biomarkers to describe different patient phenotypes, within Great Trochanteric Pain Syndrome (GTPS) clinical diagnosis. MATERIALS AND METHODS Using ultrasound we evaluated eighty-eight clinically diagnosed patients with GTPS, for tendon matrix changes and calcium deposits in the gluteus medius (superoposterior and lateral aspects) and in the gluteus minimus. Peritrochanteric examination included fascia lata, trochanteric bursa, cortical irregularities and the presence of enthesophytes. The association of pathological changes with pain and functionality was evaluated using multivariate regression models. RESULTS Out of the 88 patients, 86 examinations (97.7%) detected gluteus medius tendinopathy, and 54 patients (61.4%) had gluteus minimus tendinopathy in addition. Calcium deposits were present in 97.7% of patients, associated with tenderness (p = 0.009), and most often located in the gluteus medius rather than in the gluteus minimus (p = 0.014); calcifications were associated with tendon thickness (p = 0.042), hypoechogenicity (p = 0.005) and the presence of partial tears (p = 0.030). Bursa swelling occurred in 36 patients (40.9%); multivariate regression models predicted less pain in patients with bursa distension (p = 0.008) and dysfunction in patients with gluteal muscle atrophy (p = 0.001) and loss of fibrillar pattern in the gluteus medius (p = 0.002). CONCLUSION GTPS involves both degenerative calcifying gluteal tendinopathy and alterations in the peritrochanteric space associated with physical function and pain. The severity of GTPS can be assessed using ultrasound imaging biomarkers.
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Affiliation(s)
- Leire Atilano
- Interventional Unit, Radio-Diagnostic Service, Cruces University Hospital, 48903, Barakaldo, Spain
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Nerea Martin
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
- Department of Orthopedic Surgery, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Gotzon Iglesias
- Interventional Unit, Radio-Diagnostic Service, Cruces University Hospital, 48903, Barakaldo, Spain
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Jose Ignacio Martin
- Interventional Unit, Radio-Diagnostic Service, Cruces University Hospital, 48903, Barakaldo, Spain
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Josu Mendiola
- Interventional Unit, Radio-Diagnostic Service, Cruces University Hospital, 48903, Barakaldo, Spain
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Ayoola Aiyegbusi
- Department of Physiotherapy, Faculty of Clinical Sciences College of Medicine, University of Lagos, Lagos, Nigeria
| | - Paola Bully
- Methodological and Statistical Consulting, Sopuerta, Spain
| | - Manuel Rodriguez-Palomo
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
- Department of Orthopedic Surgery, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Isabel Andia
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain.
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2
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Tran S, North T, Hackel JG. Calcific tendinitis of gluteus maximus insertion. Radiol Case Rep 2024; 19:3748-3751. [PMID: 38983307 PMCID: PMC11231496 DOI: 10.1016/j.radcr.2024.05.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 07/11/2024] Open
Abstract
Calcific tendinitis, classified as enthesopathy, is a self-limiting disease that rarely involves the tendons of the gluteus maximus. We discuss a 52-year-old woman with a 1-year history of localized, reproducible posterolateral pain of her left hip, which was previously treated with steroid injection to her left greater trochanteric bursa without significant pain relief. Plain radiography and magnetic resonance imaging of the left hip revealed abnormal edema and calcifications at the insertion of the gluteus maximus tendon to the gluteal tuberosity, corresponding to the area of maximal tenderness on examination. This case report contributes to the growing medical literature for the rare presentation of calcific tendinitis of gluteus maximus insertion and reinforces the importance of the patient history, focused physical examination with special testing, and pertinent imaging for proper diagnosis and management.
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Affiliation(s)
- Steven Tran
- Physical Medicine and Rehabilitation, HCA Florida West Hospital Graduate Medical Education, 8383 N Davis Hwy, Pensacola, FL 32514, USA
| | - Taylor North
- Andrews Institute for Orthopaedics and Sports Medicine, 1040 Gulf Breeze Parkway, Gulf Breeze, FL 32561, USA
| | - Joshua G Hackel
- Andrews Institute for Orthopaedics and Sports Medicine, 1040 Gulf Breeze Parkway, Gulf Breeze, FL 32561, USA
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3
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Gessl I, Sakellariou G, Wildner B, Filippou G, Mandl P, D'Agostino MA, Navarro-Compán V. Systematic literature review to inform the EULAR recommendations for the use of imaging in crystal-induced arthropathies in clinical practice. Ann Rheum Dis 2024; 83:1208-1224. [PMID: 38702175 DOI: 10.1136/ard-2023-225247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To summarise current data regarding the use of imaging in crystal-induced arthropathies (CiAs) informing a European Alliance of Associations for Rheumatology task force. METHODS We performed four systematic searches in Embase, Medline and Central on imaging for diagnosis, monitoring, prediction of disease severity/treatment response, guiding procedures and patient education in gout, calcium pyrophosphate dihydrate deposition (CPPD) and basic calcium phosphate deposition (BCPD). Records were screened, manuscripts reviewed and data of the included studies extracted. The risk of bias was assessed by validated instruments. RESULTS For gout, 88 studies were included. Diagnostic studies reported good to excellent sensitivity and specificity of dual-energy CT (DECT) and ultrasound (US), high specificity and lower sensitivity for conventional radiographs (CR) and CT. Longitudinal studies demonstrated sensitivity to change with regard to crystal deposition by US and DECT and inflammation by US and structural progression by CR and CT. For CPPD, 50 studies were included. Diagnostic studies on CR and US showed high specificity and variable sensitivity. There was a single study on monitoring, while nine assessed the prediction in CPPD. For BCPD, 56 studies were included. There were two diagnostic studies, while monitoring by CR and US was assessed in 43 studies, showing a reduction in crystal deposition. A total of 12 studies with inconsistent results assessed the prediction of treatment response. The search on patient education retrieved two studies, suggesting a potential role of DECT. CONCLUSION This SLR confirmed a relevant and increasing role of imaging in the field of CiAs.
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Affiliation(s)
- Irina Gessl
- Division of Rheumatology, Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Garifallia Sakellariou
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | | | - Georgios Filippou
- Rheumatology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Peter Mandl
- Division of Rheumatology, Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Maria Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
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4
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Mitsutake R, Takakuwa M, Tanino H, Ito H. Administration of Cimetidine for Calcific Tendinitis of the Rectus Femoris: Five Cases. Cureus 2024; 16:e61002. [PMID: 38910668 PMCID: PMC11194018 DOI: 10.7759/cureus.61002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Calcific tendinitis of the rectus femoris is rare. This clinical report presents five cases of management of calcific tendinitis of the rectus femoris. Between July 2018 and March 2023, five patients visited our institution, where they were treated for calcific tendinitis of the rectus femoris. All patients presented with severe acute hip pain. Radiographs, computed tomography, magnetic resonance imaging, and an ultrasound examination of the hip showed calcification outside the joint, suggesting calcific tendinitis of the rectus femoris. All patients were orally administered 200 mg cimetidine and nonsteroidal anti-inflammatory drugs twice daily. A pain-free status was achieved in 2 weeks on average. Calcium deposits disappeared in three patients and decreased in two. Symptoms did not recur. Furthermore, no recurrence or enlargements in calcium deposits were observed. It appears to be an effective treatment for calcific tendinitis of the rectus femoris; however, the underlying mechanisms of action of cimetidine on calcific tendinitis have not yet been elucidated in detail.
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Affiliation(s)
- Ryo Mitsutake
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, JPN
| | - Masayuki Takakuwa
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, JPN
- Department of Orthopaedic Surgery, Takakuwa Orthopaedic Nagayama Clinic, Asahikawa, JPN
| | - Hiromasa Tanino
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, JPN
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, JPN
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5
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Al-Khudairi R, Maris A, Khurram R, Tsamados S, Farrant J, Armstrong TM. Gluteus medius calcific tendonitis as a cause of severe anterior hip pain. Radiol Case Rep 2024; 19:1004-1007. [PMID: 38226051 PMCID: PMC10788367 DOI: 10.1016/j.radcr.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 01/17/2024] Open
Abstract
Calcific tendinopathy in the gluteus medius is uncommon and sporadically reported. It may be asymptomatic or present with acute or chronic pain. Pain is usually isolated to the lateral hip overlying the gluteal muscles or greater trochanter. We present a rare case of gluteus medius calcific tendonitis as a cause of severe anterior hip pain. Given the atypical local and clinical presentation these can be often misdiagnosed as septic arthritis or fracture which may lead to overtreatment and even unnecessary surgery. This article will detail the clinical presentation, imaging findings, and clinical course following treatment. This will facilitate the clinician in making a timely diagnosis and establishing an effective treatment course.
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Affiliation(s)
| | | | - Ruhaid Khurram
- Royal Free Hospital NHS Trust, Pond St, London, NW3 2QG UK
| | | | - Joanna Farrant
- Royal Free Hospital NHS Trust, Pond St, London, NW3 2QG UK
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6
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Delbello F, Spinnato P, Aparisi Gomez MP. Calcific Tendinopathy Atypically Located Outside the Rotator Cuff: A Systematic Review. Curr Med Imaging 2024; 20:e100423215585. [PMID: 37038296 DOI: 10.2174/1573405620666230410091749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/24/2023] [Accepted: 02/20/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND AND PURPOSE Calcific tendinopathy is a common cause of painful shoulder easily identified with ultrasound or conventional radiography. Although the rotator cuff is by far the most common location of the disease and diagnostic or treatment strategies are well known in clinical practice, a lack of awareness characterizes the assessment of the other sites affected by this condition; consequently, the risk of underestimating the prevalence of atypical non-rotator cuff calcific tendinopathy is high. This may lead to expensive or invasive diagnostic exams and/or inappropriate treatment, whereas the condition is usually self-limited. The present study aims at analysing the frequency of calcific tendinitis in uncommon sites, in order to fill a gap in knowledge and awareness regarding non-rotator cuff calcific tendinopathy, thus avoiding improper clinical choices and helping to identify this condition. METHODS This systematic review was conducted following the PRISMA guidelines. We performed a search on Pubmed and Scopus databases concerning atypically sited extra-rotator cuff calcific tendinopathy published since 1950. RESULTS The research found a total of 267 articles and 793 non-rotator cuff cases of calcific tendinopathy registered. The spine (213 – 26.86%), foot and ankle (191 – 23.95%), and hip (175 – 22.06%) appeared to be the most common sites of calcific tendinopathy after the rotator cuff, whereas the longus colli C1-C2 (204 – 25.72%), Achilles (173 – 21.81%), and rectus femori (61 – 7.69%) were the most commonly affected tendons. CONCLUSION A better awareness of this condition in several different sites of the body than the rotator cuff could avoid unnecessary choices both in assessment and treatment.
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Affiliation(s)
- Federica Delbello
- Department of Rehabilitation Medicine, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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7
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An QJ, Qin DA. "Torch fire sign" for acute calcific tendinitis of gluteus medius on MRI. Int J Surg 2022; 102:106666. [PMID: 35562004 DOI: 10.1016/j.ijsu.2022.106666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Qi-Jun An
- Department of Orthopedics, Shanxi Provincial People's Hospital, Taiyuan, 030012, Shanxi, China
| | - De-An Qin
- Department of Orthopedics, Shanxi Provincial People's Hospital, Taiyuan, 030012, Shanxi, China.
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8
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Chua E, Shah D. Hydroxyapatite crystal deposition disease around the hip: a rare cause of piriformis syndrome and ischiofemoral impingement. BJR Case Rep 2022; 7:20210075. [PMID: 35300243 PMCID: PMC8906143 DOI: 10.1259/bjrcr.20210075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/31/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022] Open
Abstract
Hydroxyapatite crystal deposition disease (HADD) around the hip is typically described involving the gluteal tendons. However, HADD can occur in any location and result in varied clinical presentations. Even with small deposits, symptoms can be significant and imaging findings may appear aggressive, mimicking infection and malignancy particularly when in an atypical location. We illustrate cases of both common and rare locations of HADD around the hip, in particular presenting as greater trochanteric pain syndrome, piriformis syndrome and ischiofemoral impingement. The latter two manifestations have not been previously described in the literature. Low signal deposits were identified on MRI at the greater trochanter (gluteus medius tendon), proximal piriformis (adjacent to the sciatic nerve), and quadratus femoris (in the ischiofemoral space), respectively. Associated inflammatory changes with tendinopathy, bursitis and oedema were also demonstrated. The patient with piriformis syndrome underwent steroid injections and shockwave therapy with significant symptom improvement. HADD should be within the differential diagnosis for hip pain and nerve compression syndromes. Knowledge of tendon anatomy and correlation with radiographs or CT, even after MRI, is crucial in recognising unusual manifestations and preventing unnecessary investigation. Therefore, we review the spectrum of imaging features of HADD, as well as the current evidence on its management, to confidently diagnose this condition.
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Affiliation(s)
- Elise Chua
- Department of Radiology, London North West University Healthcare NHS Trust, London, United Kingdom
| | - Dhiren Shah
- Department of Radiology, London North West University Healthcare NHS Trust, London, United Kingdom
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9
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Yang W, Xu Q, Liu X, Bakhshi P, Wang H, Shao Z, Meng C, Huang W. Arthroscopic Treatment of Calcific Tendinitis of Gemellus Superior and Gemellus Inferior: A Case Report and Literature Review. Orthop Surg 2022; 14:621-627. [PMID: 35156309 PMCID: PMC8926998 DOI: 10.1111/os.13186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Wen‐bo Yang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Qian‐kun Xu
- Department of Orthopaedic Surgery Central Hospital of Hefeng County Enshi China
| | - Xing‐huang Liu
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Prapti Bakhshi
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Hong Wang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Zeng‐wu Shao
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Chun‐qing Meng
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Wei Huang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Department of Orthopaedic Surgery Central Hospital of Hefeng County Enshi China
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10
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Catapano M, Robinson DM, Schowalter S, McInnis KC. Clinical evaluation and management of calcific tendinopathy: an evidence-based review. J Osteopath Med 2022; 122:141-151. [PMID: 35119231 DOI: 10.1515/jom-2021-0213] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/29/2021] [Indexed: 11/15/2022]
Abstract
Calcific tendinopathy (CT) is an important musculoskeletal condition most commonly seen in the shoulder girdle, accounting for 10-42% of all shoulder pain. Despite the high prevalence within the shoulder region, CT has been demonstrated in many tendons throughout the axial and appendicular skeleton. Unlike degenerative tendinopathies, CT appears to be a self-limiting condition that affects otherwise-healthy tendon with deposition of calcium hydroxyapatite crystals between healthy tenocytes. In patients with functionally limiting symptoms or pain, the clinical course may be accelerated through a multitude of treatments including physical therapy and pain management, extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage (UGPL), and operative debridement. Currently, the most efficacious and frequently utilized treatment for shoulder CT is UGPL due to its ability to effectively reduce calcium burden and pain while limiting soft-tissue damage. However, more evidence regarding the treatment and course of CT is needed before determining the most appropriate treatment at all potential sites of CT.
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Affiliation(s)
- Michael Catapano
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
| | - David M Robinson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
| | - Kelly C McInnis
- Department of Physical Medicine and Rehabilitation and Division of Sports Medicine, Massachusetts General Hospital and Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA
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11
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Caterson HC, McGill NW, Brown W. Acute calcific periarthritis of the hip joint. Intern Med J 2021; 51:1756-1757. [PMID: 34664372 DOI: 10.1111/imj.15526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Hugh C Caterson
- Rheumatology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Neil W McGill
- Rheumatology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Wendy Brown
- Radiology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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12
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Robinson DM, Schowalter S, McInnis KC. Update on Evaluation and Management of Calcific Tendinopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00317-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Su CA, Ina JG, Raji Y, Strony J, Philippon MJ, Salata MJ. Endoscopic Treatment of Calcific Tendinitis of the Gluteus Maximus: A Case Report. JBJS Case Connect 2021; 11:e20.00974-e20.976. [PMID: 34033592 DOI: 10.2106/jbjs.cc.20.00974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Calcific tendinitis of the gluteus maximus is a rare condition with poorly described operative treatment options. We present a 51-year-old man with chronic left posterolateral hip pain because of gluteus maximus calcific tendinitis that was refractory to conservative treatment. Endoscopy was pursued given the severity and chronicity of his symptoms. The patient remains asymptomatic without recurrence. CONCLUSION This is the first description of endoscopic management of calcific tendinitis of the gluteus maximus. This is a minimally invasive, efficacious option for management of this pathology.
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Affiliation(s)
- Charles A Su
- Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jason G Ina
- Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Yazdan Raji
- Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - John Strony
- Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Michael J Salata
- Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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14
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Zhang BQ, An MY, Gao F, Li CB, Wei Q, Hu B, Yuan W, Lu M, Liu YF, Liu YJ. Clinical Outcomes of Hip Arthroscopy for Hip Labrum Calcification in Young and Middle-Aged Patients. Orthop Surg 2021; 13:1244-1253. [PMID: 33943016 PMCID: PMC8274186 DOI: 10.1111/os.12998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/07/2021] [Accepted: 02/25/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the methods and outcomes of hip arthroscopy for hip labrum calcification, and to discuss the clinical, imaging, and intraoperative findings of hip labrum calcification. METHODS This is a therapeutic case series study. From January 2015 to June 2018, 15 patients who met the inclusion and exclusion criteria were followed up for at least 2 years for an analysis on the outcomes of arthroscopy in the treatment of hip labrum calcification and the clinical, imaging, and intraoperative findings of the patients. There were eight males and seven females, with an average age of 38.9 ± 8.8 years (range, 23-50 years). The visual analog scale (VAS), the modified Harris hip score (mHSS), and the international hip outcome tool (iHOT-12) were used to evaluate the outcomes of surgery. RESULTS A total of 15 patients were followed up for at least 2 years (28.1 ± 2.9 months). The average calcified volume was 118.0 mm3 (range, 19.4-609.2 mm3 ) and calcified volume was related to the preoperative hip function score. Thirteen patients had pain in the groin area (86.7%). Labrum calcifications were located (according to the clock distribution) as follows: 14 patients were anterior and superior (11:00-3:00); 12 cases of femoroacetabular impingement (FAI) were observed during operation, including five cases of pincer type, two cases of cam type, and five cases of mixed type. VAS pain score means were 7.73 ± 1.28 before surgery, decreasing to 2.0 ± 0.89 and 1.73 ± 0.79 at 1 and 2 years post-surgery, respectively. mHSS scores were 57.40 ± 6.23 before surgery and 82.10 ± 4.76 and 83.18 ± 4.07, 1 and 2 years post-surgery, respectively; iHOT-12 mean score pre-surgery was 37.67 ± 4.85, increasing to 67.64 ± 5.30 and 72.18 ± 4.49, 1 and 2 years post-surgery, respectively. Compared with preoperative values, postoperative VAS, mHSS, and iHOT-12 scores were significantly improved (P < 0.01); iHOT-12 scores also significantly decreased from 1 to 2 years postoperatively (P = 0.034). No patient had complications. CONCLUSION Hip arthroscopy is an effective method for the treatment of hip labrum calcification. The size of calcification influenced preoperative symptoms and function. Long-term irritation from FAI may be one important cause of labrum calcification.
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Affiliation(s)
- Bai-Qing Zhang
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Ming-Yang An
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Feng Gao
- Department of Sports Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Chun-Bao Li
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Qi Wei
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Bo Hu
- Department of Orthopaedics, Beijing Chaoyang Integrative Medicine Emergency Medical Center, Beijing, China
| | - Wei Yuan
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Ming Lu
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Yu-Feng Liu
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Yu-Jie Liu
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
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15
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Draghi F, Cocco G, Lomoro P, Bortolotto C, Schiavone C. Non-rotator cuff calcific tendinopathy: ultrasonographic diagnosis and treatment. J Ultrasound 2020; 23:301-315. [PMID: 31197633 PMCID: PMC7441123 DOI: 10.1007/s40477-019-00393-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/31/2019] [Indexed: 12/13/2022] Open
Abstract
Calcific tendinopathy is a condition that is related to the deposition of calcium, mostly hydroxyapatite crystals, within the tendons. The shoulder and the hip are commonly affected joints, but calcific tendinopathy may occur in any tendon of the body. While there is an extensive literature on the ultrasound diagnosis of calcific tendinopathy of the shoulder, there are only sporadic reports on other sites. This review combines the experience of our centers and a thorough analysis of the literature from the last 45 years (1972-2017) in order to highlight the localizations beyond the rotator cuff, their ultrasound characteristics and therapeutic possibilities.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Giulio Cocco
- Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
| | - Pascal Lomoro
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Chandra Bortolotto
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy.
| | - Cosima Schiavone
- Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
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Henry S, Small T, Cottle D. Unusual presentation of calcific tendinitis of the iliopsoas tendon in a 28‐year‐old female. ANZ J Surg 2019; 89:E398-E399. [DOI: 10.1111/ans.14671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/12/2018] [Accepted: 04/04/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Sonia Henry
- St Vincent's Hospital Sydney New South Wales Australia
| | - Timothy Small
- St Vincent's Hospital Sydney New South Wales Australia
| | - David Cottle
- St Vincent's Hospital Sydney New South Wales Australia
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Abstract
The most common types of calcium-containing crystals that are associated with joint and periarticular disorders are calcium pyrophosphate dihydrate (CPP) and basic calcium phosphate (BCP) crystals. Several diverse but difficult-to-treat acute and chronic arthropathies and other clinical syndromes are associated with the deposition of these crystals. Although the pathogenic mechanism of calcium crystal deposition is partially understood, much remains to be investigated, as no drug is available to prevent crystal deposition, permit crystal dissolution or specifically target the pathogenic effects that result in the clinical manifestations. In this Review, the main clinical manifestations of CPP and BCP crystal deposition are discussed, along with the biological effects of these crystals, current therapeutic approaches and future directions in therapy.
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Affiliation(s)
- Geraldine M McCarthy
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. .,Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Aisling Dunne
- School of Biochemistry and Immunology and School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Abstract
PURPOSE OF REVIEW Basic calcium phosphate (BCP) crystals are associated with two important musculoskeletal syndromes. Deposition of BCP crystals in tendons, bursae, and other soft tissues around joints causes calcific periarthritis, whereas intra-articular BCP crystals contribute to osteoarthritis and cause the highly destructive arthritis known as Milwaukee Shoulder Syndrome. The epidemiology and natural history of these syndromes are poorly understood, and because the pathogenesis remains unclear, few targeted therapies are available. I will review new developments in this field. RECENT FINDINGS I will discuss a case collection of calcific periarthritis of the hip, and evidence-based management strategies for shoulder calcific periarthritis that might be applied to calcific periarthritis at other locations. I will summarize several recent articles addressing mechanisms of crystal formation and identifying pathways through which BCP crystals produce tissue damage and explore some newly identified risk factors for pathologic mineralization. SUMMARY We are making slow, but steady progress in understanding the clinical presentation of calcific periarthritis in sites other than the shoulder. A growing appreciation of the mechanisms through which BCP crystals mediate tissue damage should lead to the development of novel management strategies for these common musculoskeletal syndromes.
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Moraux A, Balbi V, Cockenpot E, Vandenbussche L, Miletic B, Letartre R, Khalil C. Sonographic Overview of Usual and Unusual Disorders of the Rectus Femoris Tendon Origins. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1543-1553. [PMID: 28857221 DOI: 10.1002/jum.14352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/22/2017] [Indexed: 06/07/2023]
Abstract
Rectus femoris muscle proximal injuries are not rare conditions. The proximal rectus femoris tendinous anatomy is complex and may be affected by traumatic, microtraumatic, or nontraumatic disorders. A good knowledge of the proximal rectus femoris anatomy allows a better understanding of injury and disorder patterns. A new sonographic lateral approach was recently described to assess the indirect head of the proximal rectus femoris, hence allowing for a complete sonographic assessment of the proximal rectus femoris tendons. This article will review sonographic features of direct, indirect, and conjoined rectus femoris tendon disorders.
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Affiliation(s)
- Antoine Moraux
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Vincent Balbi
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Eric Cockenpot
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Laurent Vandenbussche
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Bruno Miletic
- Nord Genou, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Romain Letartre
- Nord Genou, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Chadi Khalil
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
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Kimura H, Iwamoto T, Oki S, Matsumura N, Nakamura M, Matsumoto M, Sato K. Chronic calcific periarthritis of the elbow treated by cimetidine administration: Five cases. J Orthop Surg (Hong Kong) 2018; 25:2309499017717193. [PMID: 28659055 DOI: 10.1177/2309499017717193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Calcific periarthritis or calcific tendinitis occurs most frequently in the shoulder and rarely in the elbow. Cimetidine was previously reported to be effective for chronic calcific periarthritis of the shoulder. Here, we present five patients with chronic calcific periarthritis of the elbow treated by administration of cimetidine; there were six affected elbows in these five patients. Although all patients had been treated with nonsteroidal anti-inflammatory drugs for at least 3 months, their symptoms were not relieved. All patients took oral administration of cimetidine 400 mg daily. The pain was completely relieved in an average of 1.8 months after the administration of cimetidine, and the calcification of the elbow disappeared in an average of 5.1 months. During the follow-up period, there were no symptoms suggesting a recurrence. Although the detailed mechanism of action of cimetidine on periarticular calcifications remains to be understood, cimetidine appears to be a potential therapeutic agent for chronic calcific periarthritis.
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Affiliation(s)
- Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Sato
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Klontzas ME, Vassalou EE, Zibis AH, Karantanas AH. Hydroxyapatite deposition disease around the hip: outcomes of CT-guided treatment. Diagn Interv Radiol 2017; 22:466-70. [PMID: 27537854 DOI: 10.5152/dir.2016.15616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Hydroxyapatite deposition disease (HADD) around the hip joint is a self-limiting condition usually treated conservatively. The aim of the present study is to directly compare the outcomes of CT-guided and conservative treatments in cases of refractory hip HADD. METHODS Two groups of patients with refractory hip HADD were prospectively constructed from a pool of 484 patients referred for greater trochanter pain syndrome, based on the presence of calcifications around the hip and the failure of conservative treatment. Study group included 22 hips, which underwent CT-guided barbotage and steroid injection treatment, whereas control group consisted of 28 hips that were treated conservatively. Evaluation of the outcome of both groups was performed over a one-year follow-up period with the use of a score measuring clinical improvement in terms of pain and functional impairment. RESULTS Three weeks after the initiation of treatment, study group exhibited significantly higher scores compared with the control group (P < 0.001). Improvement scores of the control group were similar to the study group after three months of treatment (P > 0.1). CONCLUSION CT-guided treatment provides relief of debilitating symptoms in the acute phase.
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Affiliation(s)
- Michail E Klontzas
- Department of Radiology, Medical School, University of Crete and the Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece.
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Frizziero A, Vittadini F, Pignataro A, Gasparre G, Biz C, Ruggieri P, Masiero S. Conservative management of tendinopathies around hip. Muscles Ligaments Tendons J 2016; 6:281-292. [PMID: 28066732 DOI: 10.11138/mltj/2016.6.3.281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The anatomy of hip is widely complex and several anatomical structures interact and contribute to its functioning. For position and role, hip and the surrounding tendons, which have their insertion around, are overstressed and often overloaded, especially in athletes. This could lead to the developing of several tendinopathies, among which the differential diagnosis is often complicated. Many conservative treatments are used in clinical practice, while actually, no defined conservative protocol is recommended. METHODS This is a review article. The aim of this manuscript is to evaluate the current evidences about the effectiveness of conservative management in hip tendinopathies. CONCLUSION Conservative treatment is effective in the management of hip tendinopathies and may be considered the first-line approach for patients affected. However, there is lack of evidences about which is the most effective treatment. Exercise therapy seems to provide long-term pain relief, but the literature is still lacking about the correct type, dose, posology, intensity of exercise prescribed. Further studies about different local approaches, as PRP or hyaluronic acid injections, may be encouraged. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Antonio Frizziero
- Department of Physical Medicine And Rehabilitation, University of Padua, Italy
| | - Filippo Vittadini
- Department of Physical Medicine And Rehabilitation, University of Padua, Italy
| | - Andrea Pignataro
- Department of Physical Medicine And Rehabilitation, University of Padua, Italy
| | - Giuseppe Gasparre
- Department of Physical Medicine And Rehabilitation, University of Padua, Italy
| | - Carlo Biz
- Department of Surgery, Onchology, Gastroentherology DiSCOG, University of Padua, Italy
| | - Pietro Ruggieri
- Department of Surgery, Onchology, Gastroentherology DiSCOG, University of Padua, Italy
| | - Stefano Masiero
- Department of Physical Medicine And Rehabilitation, University of Padua, Italy
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Beckmann NM. Calcium Apatite Deposition Disease: Diagnosis and Treatment. Radiol Res Pract 2016; 2016:4801474. [PMID: 28042481 PMCID: PMC5155096 DOI: 10.1155/2016/4801474] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/24/2016] [Indexed: 02/08/2023] Open
Abstract
Calcium apatite deposition disease (CADD) is a common entity characterized by deposition of calcium apatite crystals within and around connective tissues, usually in a periarticular location. CADD most frequently involves the rotator cuff. However, it can theoretically occur in almost any location in the musculoskeletal system, and many different locations of CADD have been described. When CADD presents in an unexpected location it can pose a diagnostic challenge, particularly when associated with pain or swelling, and can be confused with other pathologic processes, such as infection or malignancy. However, CADD has typical imaging characteristics that usually allows for a correct diagnosis to be made without additional imaging or laboratory workup, even when presenting in unusual locations. This is a review of the common and uncommon presentations of CADD in the appendicular and axial skeleton as well as an updated review of pathophysiology of CADD and current treatments.
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Affiliation(s)
- Nicholas M. Beckmann
- Department of Diagnostic and Interventional Imaging, UT Health, Houston, TX, USA
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Williams AA, Stang TS, Fritz J, Papp DF. Calcific Tendinitis of the Gluteus Maximus in a Golfer. Orthopedics 2016; 39:e997-e1000. [PMID: 27337668 DOI: 10.3928/01477447-20160616-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/08/2016] [Indexed: 02/03/2023]
Abstract
Calcific tendinitis is a relatively rare condition in which calcium is inappropriately deposited in tendons, resulting in a local inflammatory reaction that can cause severe symptoms in certain cases. The cause of this disease process is not completely understood, although repetitive microtrauma likely plays a role in its development. Although the disorder most often involves the rotator cuff, it can affect other structures throughout the body, such as the tendons about the ankle and hip-including the rectus femoris and gluteus maximus. Nonoperative management typically involves using an anti-inflammatory medication and activity modification and can be augmented with formal physical therapy and modalities. Although nonoperative management provides adequate relief for many patients, sometimes operative debridement of the calcific deposit with or without repair of the involved tendon is required. The authors report an unusual case of calcific tendinitis of the gluteus maximus insertion in a golfer. The patient had tried nonoperative treatment for approximately 2 years with no real relief, and a recent exacerbation of the pain was significantly delaying his return to sport. Although plain radiographs did not show abnormalities, magnetic resonance imaging showed a calcific deposit in the insertion of the gluteus maximus tendon. After discussing further treatment options with the patient, the decision was made to remove the deposit and repair the insertion. He recovered completely and was able to return to play. The frequency, pathogenesis, and treatment of this condition are discussed in this case report, as well as the possible link to golf in this patient. [Orthopedics.2016; 39(5):e997-e1000.].
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Jo H, Kim G, Baek S, Park HW. Calcific Tendinopathy of the Gluteus Medius Mimicking Lumbar Radicular Pain Successfully Treated With Barbotage: A Case Report. Ann Rehabil Med 2016; 40:368-72. [PMID: 27152290 PMCID: PMC4855134 DOI: 10.5535/arm.2016.40.2.368] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/25/2015] [Indexed: 02/07/2023] Open
Abstract
We report a case of calcific tendinopathy of the gluteus medius initially misdiagnosed as a lumbar herniated intervertebral disc. It was successfully treated with barbotage under ultrasonographic guidance finally. A 56-year-old woman was referred to interventional pain clinic for right hip pain due to an L5-S1 disc herniation. Serial L5 and S1 spinal nerve root blocks and epidural steroid injections were administered. However, pain relief was sustained only for a very short period. Plain radiography of the right hip revealed a solid calcific nodule at adjacent to the insertion site of the gluteus medius tendon. Physical modalities and extracorporeal shock wave therapy failed to improve the pain. Therefore, we attempted ultrasound-guided barbotage of the calcification. Barbotage was performed twice serially and her pain was considerably improved. At 6-month follow-up, the calcification was completely resolved.
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Affiliation(s)
- Hannae Jo
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Gowun Kim
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Hee-Won Park
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
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Yi SR, Lee MH, Yang BK, Ahn YJ, Kwon J, Im SH, Lee YH. Characterizing the Progression of Varying Types of Calcific Tendinitis around Hip. Hip Pelvis 2015; 27:265-72. [PMID: 27536635 PMCID: PMC4972798 DOI: 10.5371/hp.2015.27.4.265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/03/2015] [Accepted: 11/08/2015] [Indexed: 01/20/2023] Open
Abstract
Purpose To assess the progression of clinical symptoms and disease course of calcific tendinitis in the hip region according to types of calcification. Materials and Methods Among patients with the hip pain, 28 patients (21 males and 7 females; mean age 51 years, range 32-74 years) showing calcified lesions in simple radiography without other possible sources of pain were analyzed retrospectively. Twelve patients displayed a symptom duration of less than three weeks (acute; average=1±0.9 week) and 16 displayed greater than three weeks (chronic; average=21.0±19.5 weeks). Lesions were classified as nodular (11, 39.3%), nodular-fragmented (13, 46.4%), or amorphous (4, 14.3%). Initial symptoms, progression of clinical features, radiological findings and prognosis were investigated and analyzed according to calcification type. Results In 15 patients (53.6%), lesions were located superior to the great trochanter. On average, the acute group was younger (44.58 vs. 55.44 years, P=0.006), suffered more (mean pain Numeric Rating Scale [NRS], 6.3 vs. 3.8; P<0.001), and recovered more (difference between initial and follow-up NRS, 5.1 vs. 2.63; <<0.001) than the chronic group. The mean length of initial lesions was longer in the acute group than the chronic group (15.8 vs. 9.1 mm, P=0.008). When compared to patients with distinctive margins (15, 53.6%), those with nondistinctive margins showed better improvement (difference between initial and follow-up NRS, 4.7 vs. 2.8; P=0.01) and more significant decrease in lesion size (difference between initial and follow-up length, 10.8 vs. 2.6 mm; P=0.003). Conclusion Calcific tendinitis occurring in the hip area displayed a variety of characteristics. Although complaining of more severe pain in the initial phase, patients with acute pain or calcific lesions with nondistinctive margins showed better symptom improvement when compared to their counterparts.
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Affiliation(s)
- Seung Rim Yi
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea
| | - Min Ho Lee
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea
| | - Bo Kyu Yang
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea
| | - Young Joon Ahn
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea
| | - Jieun Kwon
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea
| | - Se Hyuk Im
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea
| | - Ye Hyun Lee
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea
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A Case of Bilateral Acute Calcific Tendinitis of the Gluteus Medius, Treated by Ultrasound-guided Needle Lavage and Corticosteroid Injection. J Belg Soc Radiol 2015; 99:16-19. [PMID: 30039099 PMCID: PMC6032810 DOI: 10.5334/jbr-btr.810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Calcium hydroxyapatite deposition disease is a common pathology, most frequently located in the rotator cuff tendons of the shoulder, for which different therapeutic approaches are used. Ultrasound guided needle lavage and injection of anesthetic/corticosteroid is a well-known and extensively described treatment for calcific tendinits of the rotator cuff. We present a case of bilateral calcific tendinitis of the gluteus medius tendon, both sides successfully treated using ultrasound guided needle lavage of the deposits and injection of an anesthetic and corticosteroid. We propose to not only use this approach for rotator cuff tendons, but also for calcific tendinitis at other locations.
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