KYLE FRANCIS CULLIN, DO
Research Assistant
NYU Langone
MOUNT SINAI, New York, United States
Lawrence G. Chang, DO
Attending, Physiatry, Sports Medicine
NYU Langone
New York, New York, United States
43-year-old male with noncontributory past medical history presents with 1 year of intermittent left lateral hip pain that is interfering with sleep and causing patient to limp and have difficulty ambulating. Pain is graded as 6/10 pain and is a 10/10 at worst. Real time X-ray and ultrasound revealed gluteal calcific tendonitis, with multiple calcifications measuring 21.4 x 4.8 mm, 25.6 x 8.7 mm, and 10.9 x 6.8 mm prior to first barbotage. Patient elected to undergo ultrasound guided barbotage of calcifications due to incomplete relief with conservative management. Patient reported marked improvement in pain and function after two barbotage treatments.
Barbotage technique was elected due to the one-year history of pain resistant to prior conservative management. Barbotage of calcifications has been demonstrated to be more effective than corticosteroid injection alone for the treatment of rotator cuff tendinitis as documented in de Witte et al. Additionally, barbotage was established to be superior to extracorporeal shock wave therapy (ESWT) for the treatment of rotator cuff calcific tendinitis in Louwerens et al. Similarly, in Jo et al, physical modalities and ESWT failed to properly address the pain from gluteal calcific tendinopathy, which was finally controlled through ultrasound guided barbotage. We achieved similar efficacy as noted by reduction in calcium deposit sizes, and improvement to what was formerly treatment resistant calcific tendonitis. It is for these reasons that barbotage was considered as a useful means to treat calcific tendonitis, and this treatment modality can be applied to non-rotator cuff calcific tendinopathy.
In cases of gluteal calcific tendinopathy, ultrasound guided barbotage may be a viable treatment modality. This is beyond its standard application for rotator cuff calcific tendinitis, highlighting the promising clinical outcomes that this new utilization of a common procedure can offer.
