Calcific tendonitis of the right epicondyle of the elbow: A case report.

Abstract

Rationale: Calcific tendinitis frequently occurs in the shoulder, and while it may also occur in other joints, such as the hip, knee, wrist, and finger joints, its occurrence in the elbow joint is relatively rare. Therefore, it is susceptible to delayed diagnosis or misdiagnosis at the initial occurrence. Appropriate imaging and treatment should be considered immediately when suspecting calcific tendonitis.

Patient concerns: We detailed a young female who presented with progressive right elbow pain for the past 3 years with no past injury to the elbow. She had undergone conservative management for 2 years but was unsuccessful. Her pain became more intense 1 week prior, to the extent that she could not use her right upper limb to perform daily activities, and her sleep was severely disturbed. Therefore, she needed a possible therapeutic relief.

Diagnosis: Clinical findings included elbow stiffness and tenderness of the lateral epicondyle of the humerus, and Cozen assessment was positive. Computed tomography showed a high-density macular focus and smooth edge of the lateral condyle of the right humerus and dorsal side of the ulnar olecranon. The plain radiograph showed patches in the right lateral condyle of the humerus and the dorsal part of the olecranon, indicating calcification of common extensor tendinosis.

Interventions: Initially, conventional care was given to the patient with analgesics, physical therapy, or a resting regimen to decrease the pain and reduce the tedious load on the extensor tendon. Measures such as pain score, range of motion, and follow-up imaging after 8 weeks began until 2 years. However, her pain did not improve. Therefore, she was advised for surgical therapy and subsequently underwent surgical exploration of the elbow under general anesthesia. Histopathological examination of the excised tissue revealed fibrous ligament tissue with calcifications.

Outcomes: At the 6-month follow-up, the postoperative plain radiograph showed complete removal of the heterotopic bony growth from the lateral epicondylar area with no recurrence of the heterotopic bone formation around the elbow joint. She had no pain with full elbow function and a full range of elbow extension and flexion (visual analog scale score of 0/10).

Lessons: Calcific tendonitis of the elbow is uncommon; hence, its diagnosis and treatment may be late due to its scarcity. Therefore, appropriate imaging and treatment should be considered immediately when calcified tendonitis is suspected. A literature review is also necessary since it is not a daily condition.