Korean J Pain.  2015 Jan;28(1):52-56. 10.3344/kjp.2015.28.1.52.

Successful Treatment of Rectus Femoris Calcification with Ultrasound-guided Injection: A Case Report

• Hong MJ
• Kim YD
• Park JK
• Kang TU

• KMID: 2278253
• DOI: http://doi.org/10.3344/kjp.2015.28.1.52

Abstract

Painful periarticular calcification most commonly occurs within the rotator cuff of the shoulder and rarely around the elbow, hip, foot, and neck. As acute inflammatory reaction develops, severe pain, exquisite tenderness, local swelling, and limitation of motion with pain occur. In case of calcific tendinitis of the shoulder, it can be easily diagnosed according to the symptoms and with x-ray. However, in lesions of the hip, as it is a rare location and usually involves pain in the posterolateral aspect of the thigh, which can simulate radicular pain from a lumbar intervertebral disc, it could be difficult to diagnose. Hence, physicians usually focus on lumbar lesions; therefore, misdiagnosis is common and leads to a delayed management. Here, we report the case of a 30-year-old female patient with calcific tendinitis of the rectus femoris that was successfully managed with ultrasound-guided steroid injection. This study offers knowledge about the rectus femoris calcification.

Keyword

Calcific tendinitis; Calcification; Hip joint; Injection; Rectus femoris; Ultrasound

MeSH Terms

Adult
Diagnostic Errors
Elbow
Female
Foot
Hip
Hip Joint
Humans
Intervertebral Disc
Neck
Quadriceps Muscle*
Rotator Cuff
Shoulder
Tendinopathy
Thigh
Ultrasonography

Figure

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  Fig. 1 Magnetic resonance imaging finding of the lumbar spine, sagittal plane.

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  Fig. 2 Plain hip AP showed a small amorphous calcification near the right anterior inferior iliac spine, which is the attachment site of the rectus tendon, suggesting calcific tendinitis of rectus femoris (A). The lesion was more clearly defined when the patient posed frog leg position (B).

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  Fig. 3 Ultrasound scanning over the hip area showing calcification around the rectus femoris with mild fluid collection. AIIS: anterior inferior iliac spine, Ca: calcification, Rf: rectus femoris.

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  Fig. 4 Magnetic resonance imaging finding of the hip, axial plane. Calcification was noted in the right rectus femoris tendon showed thickening with small amount of fluid collection at the intermuscular fat plane. White arrow indicates calcification. AIIS: Anterior inferior iliac spine, Rf: Rectus femoris muscle and tendon, S: Sartorius muscle, I: Iliopsoas muscle, T: Tensor fasciae latae muscle, GMx: Gluteus maximus, GMe: Gluteus medius, GMi: Gluteus minimus.

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  Fig. 5 Ultrasonography scanning over the hip area, after 6 weeks. Decreased echogenicity of surrounding fat with decreased amount of fluid collection and size was observed.

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