Ann Rehabil Med.  2016 Apr;40(2):368-372. 10.5535/arm.2016.40.2.368.

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

• Jo H
• Kim G
• Baek S
• Park HW

• KMID: 2309939
• DOI: http://doi.org/10.5535/arm.2016.40.2.368

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.

Keyword

Gluteus medius; Calcific tendinopathy; Barbotage

MeSH Terms

Female
Follow-Up Studies
Hip
Humans
Intervertebral Disc
Middle Aged
Pain Clinics
Radiography
Shock
Spinal Nerve Roots
Tendinopathy*
Tendons

Figure

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  Fig. 1 (A) Simple X-ray and bone scan finding of L5 compression fracture. (B) Sagittal and axial T2-weighted magnetic resonance images showing L5-S1 intervertebral disc herniation.

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  Fig. 2 (A) An anteroposterior radiograph of the right hip showing an amorphous calcification (white arrow) adjacent to the greater trochanter. (B) Ultrasonography of the right hip showing a solid calcific nodule (white arrow) at 2.0 cm×0.7 cm in size adjacent to the insertion site of the gluteus medius tendon (asterisk) between the greater trochanter (GT) and the iliotibial band (arrowheads).

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  Fig. 3 Aspirated calcium deposit in 15 mL syringe.

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  Fig. 4 (A) Ultrasonography of the same site immediately after ultrasonography-guided barbotage showing significant reduction in the size of the calcific deposit (white arrow). A fluid collection (asterisk) of saline remained after the procedure. (B) The size of the calcification was reduced significantly after barbotage (white arrow).

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  Fig. 5 Anteroposterior radiograph of the right hip at 6-month follow-up showing near complete resolution of the calcific deposit.

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