Combined Use of Ultrasound-Guided Fenestration, Hydrodissection, and Prolotherapy in Treating Medial Elbow Pain from Common Flexor Calcific Tendinopathy

Case Diagnosis: Successful resolution of chronic medial elbow pain due to calcific tendinitis using repetitive needle fenestration and hydrodissection with glucose solution.

Case Description or Program Description: A 65-year-old patient presented to our physical medicine and rehabilitation (PM&R) clinic with persistent medial elbow pain lasting over six months. Despite multiple prior treatments including steroid injections, platelet-rich plasma (PRP) therapy, shockwave therapy, and physical therapy, the patient reported no significant pain relief. Musculoskeletal ultrasound evaluation revealed multiple calcific deposits at the common flexor tendon near its insertion on the medial epicondyle with significant hyperemia, leading to a diagnosis of calcific tendinitis. The patient underwent four sessions of fine needle fenestration of the calcification areas, followed by hydrodissection with 15% glucose water. The treatments were spaced three weeks apart.

Setting: Outpatient PM&R clinic.

Assessment/Results: Following four treatment sessions, the patient reported significant pain relief, and was able to resume playing golf without discomfort. Follow-up musculoskeletal ultrasound demonstrated a marked reduction in calcifications and resolution of hyperemia, confirming treatment effectiveness.

Discussion (relevance): Medial elbow pain is a common condition which is often attributed to medial epicondylitis. Alternative diagnoses such as calcific tendinitis should be considered when standard treatments fail. Musculoskeletal ultrasound is a valuable diagnostic tool in differentiating between these conditions and also guiding targeted interventions. This case highlights the effectiveness of repetitive needle fenestration combined with hydrodissection as a minimally invasive, ultrasound-guided treatment for calcific tendinitis.

Conclusions: Musculoskeletal ultrasound plays a critical role in accurately diagnosing medial elbow pain and guiding effective interventions. Ultrasound-guided needle fenestration combined with hydrodissection provides a promising, minimally invasive treatment option for calcific tendinitis, offering significant pain relief and improved function for patients.