Calcific Patellar Tendinopathy. A Case Report Integrating Diagnostic Ultrasound Throughout a Multi-Modal Treatment Approach.

BACKGROUND

Calcific tendinopathy can be difficult to diagnose and manage from a traditional, non-invasive physical therapy perspective. However, there is preliminary evidence supporting the use of diagnostic ultrasound and dry needling interventions to evaluate and treat the pain and disability associated with this chronic condition. The purpose of this case report was to describe the integration of diagnostic ultrasound in the successful evaluation and multi-modal treatment of a patient with calcific patellar tendinopathy.

CASE PRESENTATION: A 46-year-old active female with a six-week history of anterior knee pain, presented to the physical therapy clinic for a direct-access evaluation. The history and physical examination were consistent with the diagnosis of patellar tendinopathy. Diagnostic ultrasound confirmed the presence of patellar tendinopathy with multiple calcifications at the inferior pole of the patella. Treatment progression included spinal/extremity manipulation, ultrasound guided needle fenestration, electrical dry needling, and exercise. Outcomes included the numeric pain rating scale (NPRS), lower extremity functional scale (LEFS), Global Rating of Change (GROC), strength, and assessment of tissue healing with diagnostic ultrasound.

OUTCOMES: The patient was treated for 18 visits over 24 weeks. The multi-modal intervention resulted in clinically meaningful reductions in the NPRS and LEFS, with optimal recovery to strength training. Reductions in calcific foci and tendon tissue healing was also confirmed with diagnostic ultrasound. Outcomes were tracked at 3, 6, 9, and 11-months.