Open Excision and Neurolysis for Calcific Tendinitis of the Proximal Hamstring With Sciatic-Distribution Neuropathic Symptoms: A Case Report

Calcific tendinitis is the most common form of hydroxyapatite deposition disease and classically involves the rotator cuff, while involvement of the proximal hamstring origin is rare.We describe a 62-year-old White female with a body mass index of 19 kg/m 2 who presented with a four-year history of left posterior hip pain and paresthesias in the distribution of the sciatic nerve that persisted despite physical therapy, nonsteroidal anti-inflammatory drugs, and muscle relaxants.Radiographs and magnetic resonance imaging demonstrated an approximately 2 cm calcific deposit at the conjoint hamstring origin adjacent to the sciatic nerve, with perineural edema but without displacement or deformation of the nerve.She underwent open excision of the deposit with neurolysis of the sciatic and posterior femoral cutaneous nerves, including release of overlying fibrous tissue and of fibrous bands constricting the posterior femoral cutaneous nerve.Histopathology showed calcification within fibroconnective tissue without atypia, and cultures showed no growth.At eight months, her sciatic-distribution paresthesias had improved, and she had full strength on provocative hamstring testing, although she reported persistent subjective weakness and a discrete area of decreased sensation adjacent to the incision.Calcific tendinitis of the proximal hamstring should be considered in patients with posterior hip pain and sciatic-distribution neuropathic symptoms, and surgical excision with neurolysis may be considered when conservative treatment fails.