Calcific Tendinopathy of the Gluteus Medius Mimicking Lumbar Radicular Pain Successfully Treated With Barbotage: A Case Report

Extracorporeal Shockwave Therapy for Tendinopathies Around the Hip and Pelvis: A Systematic Review

Background: Tendinopathies affecting the hip and pelvis include proximal hamstring tendinopathy (PHT), gluteal tendinopathy (greater trochanteric pain syndrome [GTPS]), and calcific tendinopathy (CT). Extracorporeal shockwave therapy (ESWT) is a noninvasive treatment described for the management of lower-extremity tendinopathies. Purpose: We sought to synthesize the evidence on ESWT used in the treatment of hip/pelvis tendinopathies, including protocols, outcomes, and safety. Methods: A comprehensive search of PubMed/Medline, EMBASE, and Cochrane Library databases was performed on November 1, 2024, for studies reporting ESWT data for hip/pelvis tendinopathies. Study design, population, and ESWT-related data (protocols, outcomes, and safety) were extracted. Results: Eighteen studies were included; 9 reported on GTPS, 7 on CT, and 5 on PHT. Most ESWT protocols (72% [n = 13]) implemented 3 to 4 weekly sessions and delivered 2000 to 3000 pulses/session (83% [n = 15]). Eleven studies used radial ESWT and 7 used focused ESWT. ESWT significantly improved pain and functional outcomes for GTPS, CT, and PHT in 17 level-I to level-V studies; only 1 level-V study showed no improvement. Six studies showed superior outcomes post-ESWT vs conservative treatment (PHT/GTPS), sham ESWT (GTPS), ultrasound therapy (GTPS/CT), or corticosteroid injection (GTPS). One study showed comparable outcomes between ESWT and eccentric exercise (GTPS). Two studies reported no outcome differences between radial ESWT and "minimal-dose" ESWT (GTPS) or combined ESWT (PHT). All studies assessing pain showed improvement from 0.5 to 27 months post-ESWT. Six of 18 studies reported adverse events, including increased pain and skin irritation (overall rate: 12% [n = 65/557]). Conclusions: The results of this systematic review suggest that ESWT may be safe and effective for hip/pelvis tendinopathies. Future research using validated outcome measures and ESWT parameters will aid in treatment optimization.

Gluteus medius calcific tendonitis as a cause of severe anterior hip pain

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.

Calcific Tendinopathy Atypically Located Outside the Rotator Cuff: A Systematic Review

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.

Endoscopic treatment for calcific tendinitis of the gluteus medius: A case report and review

Tendon calcification is a common disease, with the shoulder rotator cuff being the most common site. However, calcific tendinitis of the gluteus medius has rarely been reported. This study reports the case of a 64-year-old woman diagnosed with calcific tendinitis of the gluteus medius and experiencing right lateral hip pain with no apparent trigger. After unsuccessful conservative treatment, hip endoscopy was performed on this patient, allowing for a clear view of a “toothpaste-like” lesion in the gluteus medius tendon. A shaver was used to remove the lesion. After 8 weeks and 14 months of follow-up, the patient could return to regular daily and social activities. This study shows that endoscopic surgery can lead to effective, rapid recovery and minimally invasive clinical outcomes in patients with tendon calcification near the hip joint.

Bilateral gluteus medius and minimus calcific tendonitis in a patient with previous bilateral calcific tendonitis of the shoulder: A case report

Calcific tendonitis of the gluteus medius and minimus tendons is a rare complication of hydroxyapatite deposition disease, with bilateral involvement even more so. Although patients can be asymptomatic, there is often an acute-on-chronic presentation of pain. We present a case of bilateral calcific tendonitis of the gluteus medius and minimus tendons on a background of previous bilateral rotator cuff calcific tendonitis in a middle-aged woman. This patient's long-standing history of multi-focal involvement required a multidisciplinary approach between orthopedics, rheumatology, and musculoskeletal radiology for optimal management, requiring different treatment options for different affected sites.

Non-rotator cuff calcific tendinopathy: ultrasonographic diagnosis and treatment

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.

Ultrasonographic evaluation of the effect of extracorporeal shock wave therapy on calcific tendinopathy of the rectus femoris tendon: A case report

BACKGROUND

Calcific tendinopathy denotes calcific deposits in a specific tendon. It is also known as calcifying tendinitis, calcifying periarticulitis, or periarticular apatite deposition disease. Recently, extracorporeal shock wave therapy (ESWT) has been reported to be effective in relieving and treating pain in calcific tendinopathy.

CASE SUMMARY

A 36-year-old female patient suffered from left hip joint pain for six months. The pain was increased during abduction of the hip, waking, and jumping. B-mode ultrasonography was performed by a physiatrist with an L12-5 linear transducer. A single session of ESWT was given in the marking area under ultrasound guidance at 4 Hz, 2500 shots with intensity of stimulation using energy of 0.1 mJ/mm2. The hip pain of the patient slowly decreased within 4 wk after starting the ESWT. After six weeks of ESWT, her hip pain was completely resolved. However, the size of calcification showed almost no reduction in simple radiography at the final follow-up.

CONCLUSION

Ultrasonography is a very good modality not only for diagnosing calcified tendinitis by classical appearance, but also for evaluating the effect of ESWT during the follow-up period.