Long segment hamstrings calcific tendinopathy: A masters athlete and response to extracorporeal shockwave therapy – Case Report

Abstract

Introduction: Calcific tendinopathy most commonly affects the rotator cuff and typically presents as small, focal deposits. Involvement of the hamstring tendons is rare, and long-segment intratendinous calcifications have not been well described to our knowledge. Case Presentation: We report the case of a 47-year-old male Masters athlete who presented with posterior thigh pain following a fall during a sprinting activity. Imaging revealed an unusually extensive 9.66 cm linear calcification within the proximal semimembranosus tendon. Initial conservative management (such as rest and icing) failed to provide symptomatic relief. The patient subsequently underwent a course of focused extracorporeal shockwave therapy (ESWT). Pain scores decreased from a visual analogue scale (VAS) of 3 to 1 at one month, with corresponding improvements in functional outcomes (LEFS, EQ-5D-5L, and Roles and Maudsley score). At six months, the patient achieved complete symptom resolution (VAS 0) and returned to full competitive activity. Discussion: This case represents a rare presentation of long-segment semimembranosus calcific tendinopathy with a morphology distinct from the focal deposits typically described in the literature. The favourable clinical response to ESWT suggests that treatment principles established for rotator cuff calcific tendinopathy may be applicable to atypical anatomical locations. It also expands the spectrum of imaging appearances and clinical presentations of calcific tendinopathy affecting the hamstring tendons. Conclusion: Long-segment calcific tendinopathy of the semimembranosus tendon is an uncommon entity that should be considered in patients with persistent posterior thigh pain. Focused ESWT may provide an effective non-operative treatment option, resulting in significant symptom improvement and successful return to sport.