Disclosures: Daniel C. Oh, MD: No financial relationships or conflicts of interest
Case Description: The right iliac crest calcinosis was approximately 6.5cm x 13.7cm, confirmed by radiograph. Patient denied pain at rest, but reported 5/10 pain with donning/doffing pants and with hip flexion. Orthopedics recommended surgery, but required stopping all immunosuppressants. Notably, she received extracorporeal shockwave therapy (ESWT) to calcinosis in her feet with improvement of size and pain. Given previous successes and no alternative conservative measures, patient underwent five sessions of ESWT with intensity, frequency, number of pulses, and type of ESWT titrated to patient’s intra-procedural comfort. She started with 3000 pulses of focused ESWT (F-ESWT) at 3 Hz and 0.25-0.55 mJ/mm2. At week 1, she received 3000 pulses of F-ESWT at 3 Hz and 0.55 mJ/mm2, followed by 2000 pulses of radial ESWT (R-ESWT) at 12 Hz and 3.5 bar. At week 2, she received 3000 pulses of F-ESWT at 3 Hz and 0.55 mJ/mm2, followed by 500 pulses of R-ESWT at 12Hz and 4 bar. At week 10, she received 3000 pulses of F-ESWT at 3 Hz and 0.55 mJ/mm2. At week 11, she received 3000 pulses of F-ESWT at 3 Hz and 0.40 mJ/mm2. The patient noted significant improvement in calcinosis size.
Setting: Outpatient.
Patient: A 44-year-old woman with diffuse cutaneous systemic sclerosis, on mycophenolic acid, presented with severe calcinosis in her bilateral feet, elbows, lumbar spine, and anterior iliac crests, larger on the right. Assessment/
Results: This patient had multiple sites of calcinosis, worst in the right anterior iliac crest. Surgery required ceasing immunosuppressants, important for managing her other scleroderma-associated symptoms. As such, she opted for conservative management with ESWT, which resulted in subjective and objective improvement of pain, calcinosis size, and ease of lower-body dressing.
Discussion: There are minimal reports of ESWT to treat scleroderma-related calcinosis and none of successful treatment of large calcinosis.
Conclusion: ESWT may be a viable alternative for even large calcinoses.
Level of Evidence: Level V
To cite this abstract in AMA style:
Oh DC, Patel AA, Quirolgico K. Extracorporeal Shockwave Therapy for Large Calcinosis from Systemic Scleroderma: A Case Report [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/extracorporeal-shockwave-therapy-for-large-calcinosis-from-systemic-scleroderma-a-case-report/. Accessed November 21, 2024.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/extracorporeal-shockwave-therapy-for-large-calcinosis-from-systemic-scleroderma-a-case-report/