Arthroscopic Treatment of Calcific Tendinitis of Gemellus Superior and Gemellus Inferior: A Case Report and Literature Review

Abstract

Background: Tendon calcification is a common disease, and it could happen in the tendons of the shoulder, wrist, etc. However, tendon calcification in the superior and inferior gemellus is rare, and in this region is likely to be misdiagnosed.Case Presentation: Here, our case report first reported a 53-year-old female patient with an unusual case of calcific tendinitis of the gemellus superior and gemellus inferior muscles. The patient presented with severe pain in the right hip and lower extremities, not relieved using nonsteroidal anti-inflammatory drugs (NSAIDs). The preoperative physical examination indicated an abnormality in the hip joint. Preoperative imaging confirmed the results of the physical examination and showed a right hip lesion. We did not make a definite diagnosis preoperatively but considered that the patient might have an osteochondroma. However, surgical findings indicated that the lesion was not in the hip capsule on subsequent arthroscopic surgery, which suggested that the preoperative diagnosis might be wrong. We opened the posterior capsule and found a "toothpaste-like" lesion in the superior and inferior gemellus muscles' tendon. We thought this might be the calcified tendon. Then the arthroscopic surgery was finished to remove the lesion, and the removed tissue was sent to the pathology department for pathological examination. The pathological report confirmed the diagnosis of the calcified tendon. Postoperative follow-up was conducted. The effect of the operation was noticeable. Postoperative symptoms were relieved.Conclusions: Calcification of the tendons of the superior and inferior gemellus muscles can be easily misdiagnosed, and the disease can be treated minimally with arthroscopy.

Endoscopic treatment for calcific tendinitis of the gluteus medius: A case report and review

“…Surgical treatment can be adopted in patients with failed conservative treatments or severe symptoms. However, the use of endoscopy to treat the disease is not widespread, as tendon calcification of the hip joint is rare and sporadic, and endoscopic treatment has been reported only in a few cases (2,6,(9)(10)(11). Comba et al (10).…”

“…The most common site of calcific tendinitis is the shoulder, occurring in approximately 3% of adults ( 1 ); other sites include the joint tendons such as wrists ( 14 ) or knees ( 15 – 17 ). In addition, calcific tendinitis has been reported in tendons near the hip joint, such as the gluteus minimus ( 6 ), gluteus medius ( 18 ), gluteus maximus ( 12 , 19 ), gemellus superior, gemellus inferior ( 2 ), and rectus femoris ( 9 ).…”

“…Several tendons can become calcified, including those in the shoulder rotator cuffs, near the hip joints, and in hands and wrists (1,2). However, calcific tendinitis of the gluteus medius, first described by Goldenberg and Leventhal in 1936 (3), is relatively uncommon and sporadically reported (4)(5)(6)(7)(8).…”

“…Hip endoscopy is minimally invasive and entirely extra-articular, which can help avoid incising the hip capsule fibers, which causes hip joint instability. However, this procedure has been reported only in a few calcific tendinitis cases (2,6,(9)(10)(11). Herein, we report the case of a patient with rare calcific tendinitis of the gluteus medius.…”

“…Calcific tendinitis is the deposition of calcium hydroxyapatite crystals in periarticular muscular attachments ( 1 ). The etiology of calcific tendinitis is unclear, and the suggested causes include hereditary, metabolic, post-traumatic, and postoperative conditions ( 2 ).…”