| 제목 |
Calcific Tendinitis of Common Extensor Tendon Treated with US-guided Barbotage Combined with ESWT |
| 소속 |
Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Department of Physical and Rehabilitation Medicine1 |
| 저자 |
Chul-Hyun Park1*, Kyung Jae Yoon1, Joon-Youn Lee1, Jung-Sang Lee1, Yong-Taek Lee1† |
Introduction:
Calcific tendinitis is well-known for chronic refractory painful musculoskeletal condition. Ultrasonography (US)-guided barbotage, ESWT, or combined treatment has been previously reported to show therapeutic effect for the treatment of calcific tendinitis of shoulder. However, there have been few reports about the treatment of calcific tendinitis of common extensor tendon. We present a case of severe elbow pain with chronic intractable calcific tendinitis of common extensor tendon which was successfully managed with US-guided barbotage combined with extracorporeal shock-wave therapy (ESWT).
Case description:
Thirty-one year-old woman with chronic right lateral elbow pain for three years was referred to our hospital for surgical treatment after previous standard conservative managements and ESWT had failed. Tenderness was prominent over the right lateral epicondyle and the pain was aggravated by resisted wrist extension. Laboratory findings were normal. Plain x-ray and T2-weighted fat-suppressed magnetic resonance imaging (MRI) showed the curvilinear calcification around lateral epicondyle of elbow (Fig. 1 and Fig. 3). Numeric rating scale (NRS) was 7 and Roles-Maudsley score (RMS) was “poor” grade (Subjective 4-graded scale; excellent = no pain, full movement and activity; good = occasional discomfort, full movement and activity; fair = some discomfort after prolonged activity; poor = pain-limiting activities). The patient received US-guided barbotage and additional 3 sessions of ESWT (0.15 mJ/mm2, 600 shocks, 1 Hz, weekly).
After US-guided barbotage combined ESWT, pain and tenderness started to dramatically decrease (Fig. 2). NRS was 3 at one month follow-up after barbotage. At two-month follow-up, size of calcific deposit was decreased, but additional three sessions of ESWT were given to alleviate residual pain (NRS 3). At 4 months and 8 months follow-up, pain scores were NRS was 1, and RMS was good, respectively. At 12 months follow-up, pain scores were NRS 0, and RMS was excellent (Fig. 2). Calcific deposits nearly disappeared on X-ray at 12 month follow-up (Fig. 3).
Conclusion:
This is the first reported case, to our knowledge, of chronic intractable calcific tendinitis of the common extensor tendon which was successfully treated with US-guided barbotage combined with ESWT. US-guided barbotage combined with ESWT may be a good non-surgical therapeutic option for management of chronic refractory calcific tendinitis of the common extensor tendon.
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Fig. 1. (A) T2 MRI showed calcification under common extensor tendon (arrows). The tendon showed high signal intensity (arrowheads). (B) US demonstrated hyperechoic calcification. CET, common extensor tendon; LE, lateral epicondyle; RH, radial head.
Fig. 2. Baseline numeric pain score was 7. Pain score gradually started to decrease after US-guided barbotage combined with ESWT and continued to decrease up to zero at 12 month follow-up. ESWT, extracorporeal shock-wave therapy; US, ultrasonography.
Fig. 3. Radiography of elbow demonstrated large curvilinear calcification lateral to epicondyle (A) 2 years before and (B) just before barbotage and ESWT. (C) 2-month and (D) 8-month follow-up. (E) Calcification nearly disappeared at 12-month follow-up.
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