HSS Ultrasound of the Month Case 128

Clinical History 53-year-old male with medial elbow pain.

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Diagnosis: Calcific Tendinitis of the Flexor Tendon Origin.

Calcific tendinitis is a source of pain due to deposition of calcium hydroxyapatite crystals in the substance of a tendon.

Calcific tendinitis most commonly occurs in the shoulder (rotator cuff tendons), with the hip being the second most common site, but it can occur anywhere, including the elbow.

Calcific tendinitis can be diagnosed on xray, MRI, or ultrasound; ultrasound has the advantage of allowing for correlation of the calcific deposit with the patient’s site of symptomatology and allowing for guided therapeutic intervention at the same time.

In ultrasound-guided barbotage, a needle is safely placed into the calcific deposit and a lavage and aspiration are repeatedly performed to break up the calcium and remove some of the calcium.

Cortisone is usually injected at the end of the procedure for therapeutic purposes.

Although this procedure has been most commonly described in the shoulder, it can be performed anywhere in the body, provided that it can be accessed using ultrasound guidance.

If ultrasound-guided barbotage fails to provide pain relief, surgical debridement and repair of the affected tendon may be indicated.

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