559 - Platelet Rich Plasma Injection Therapy for a 63-Year-Old Veteran with Calcific Triceps Tendonitis: A Case Report

Case Diagnosis: Calcific tendonitis of distal triceps status post ultrasound-guided platelet rich plasma injection

Case Description: A 63-year-old male presented for evaluation of left elbow pain for past year after left triceps tendon repair surgery. He described a chronic, sharp 6/10 pain with point of maximal tenderness located 2-3 cm proximal to the olecranon. Prior imaging consisted mainly of MRI showing a chronic appearing irregular thickening of the distal triceps tendon with chronic bony spurring in the olecranon process at its insertion. Point of care ultrasound image during encounter showed a hyperechoic, curved area of calcification around the myotendinous junction, correlated to the patient’s point of maximal tenderness. Image-confirmed calcific triceps tendonitis was treated using 3cc of leukocyte rich platelet rich plasma product, which was introduced with ultrasound guidance to the area surrounding the calcification.

One year after injection, patient reports 100% pain relief that began within 2 weeks of injection. Ultrasound imaging indicates calcification slightly decreased in size, but is currently asymptomatic.

Discussions: Calcific tendonitis is a condition that frequently affects the shoulder and has an incidence of 2-4% in the population, but its occurence in the elbow joint is quite rare and review of literature indicates it is the joint least commonly affected by calcification. Similarly, there are numerous cases indicating platelet rich plasma being effective for reducing pain in patients with calcific tendonitis, but these cases are largely localized to shoulder pathology. Therefore, given the sparse literature regarding calcific tendonitis of the distal triceps tendon, this case provides unique insight into the efficacy of platelet rich plasma for treating this distinct form of refractory elbow pain.

Conclusions: Patients with calcific tendonitis of the distal triceps may experience symptomatic improvement and increased function in daily life from leukocyte-rich platelet rich plasma injection, warranting further investigation into this ultrasound guided intervention in this specific pathology.