Technical Innovation Case Report: Ultrasound-Guided Prolotherapy Injection for Insertional Achilles Calcific Tendinosis
Table 1
Ultrasound-guided prolotherapy injection of insertional Achilles calcific tendinosis in the primary care setting.
Indications
Painful calcific tendinosis unresponsive to conservative therapy
Ultrasound-guided technique
A linear or small footprint high frequency (7–12 MHz) ultrasound probe is used to visualize any calcified area or enthesopathy and target the area just inferiorly for injection
Positioning
Patient is placed in prone position with a towel or pillow under the distal tibia while the foot hangs freely
Needle approach
In plane or out plane of plane approach with a 25-gauge 1.5 inch standard needle
Important anatomy
Achilles tendon, calcaneus, enthesophyte, and Plantaris tendon
Potential complications
Significant complications have not been reported. Possible complications that are typical of similar injections are pain, bleeding, infection, and local irritation
