Case 52 - Calcific tendinitis of the hip

Summary

Imaging description

Calcific tendinitis (also known as hydroxyapatite deposition disease) is best recognized on radiographic images. It appears as an area of amorphous calcification in the gluteal tendons near the greater trochanter, the iliopsoas tendon near the lesser trochanter, or the gluteus maximus tendon near the gluteal tuberosity of the femur (Figure 52.1). On MRI, the surrounding soft tissues will be edematous as evidenced by hyperintense signal on T2-weighted or STIR sequences.

Importance

Calcific tendinitis about the shoulder is well described and documented in the literature. Therefore, it is a well-known clinical entity. It is important to remember that calcific tendinitis is not confined to the shoulder but can occur within tendons at many different locations throughout the body. The hip is one of the more common locations for calcific tendinitis. When evaluating radiographic studies that include images of the hip, it is important to exclude amorphous calcifications near tendinous insertions as calcific tendinitis is a source of hip pain that can be readily treated with injection and aspiration.

Typical clinical scenario

A 44-year-old female presents with a 24-hour history of severe, debilitating left hip pain. The pain is non-radiating and is exacerbated significantly by any motion of the hip. There is significant pain with palpation over the greater trochanter. A radiograph demonstrated amorphous calcifications within the gluteus medius tendon near the greater trochanter. The calcification was aspirated under fluoroscopic guidance and then a corticosteroid/local anesthetic injection was performed. The patient exhibited immediate decrease in pain after the procedure.

Teaching point

As in the shoulder, amorphous calcifications about the hip at tendinous insertion sites are a sign of calcific tendinitis. This can be treated with imaging-guided aspiration and injection.