The Journal of Rheumatology
Volume 42, no. 9
Wrist Involvement of Calcium Hydroxyapatite Deposition Disease THANU NADARAJAH RUBAN and LORI ALBERT J Rheumatol 2015;42;1724-1725 http://www.jrheum.org/content/42/9/1724 1. Sign up for our monthly e-table of contents http://www.jrheum.org/cgi/alerts/etoc 2. Information on Subscriptions http://jrheum.com/subscribe.html 3. Have us contact your library about access options [email protected] 4. Information on permissions/orders of reprints http://jrheum.com/reprints.html The Journal of Rheumatology is a monthly international serial edited by Earl D. Silverman featuring research articles on clinical subjects from scientists working in rheumatology and related fields.
Downloaded from www.jrheum.org on September 18, 2015 - Published by The Journal of Rheumatology
Images in Rheumatology
Wrist Involvement of Calcium Hydroxyapatite Deposition Disease
THANU NADARAJAH RUBAN, MD, FRCPC, Rheumatology; LORI ALBERT, MD, FRCPC, Rheumatology, University of Toronto, Toronto, Ontario, Canada. Address correspondence to Dr. T.N. Ruban, Rheumatology, University of Toronto, 2075 Bayview Ave., Suite M1-400, Toronto, Ontario M4N 3M5, Canada. E-mail: [email protected]. J Rheumatol 2015;42:1724–5; doi:10.3899/jrheum.150178
Acute calcium deposits cause significant pain and swelling of abrupt onset in an otherwise asymptomatic patient, usually in the shoulder joint. Diagnosis can be difficult; the condition is sometimes mistaken for infection, malignancy, or other crystal arthropathy. A 77-year-old, right hand-dominant woman presented with a 2-day history of acute right wrist pain and swelling. She was constitutionally well with no history of local trauma. She was unable to move her right wrist and had increased
pain with finger flexion. She had normal limits of white blood cell count, serum uric acid, calcium, inorganic phosphorus, and creatinine. Radiograph showed amorphous calcification (Figure 1). Ultrasound of right wrist revealed multiple confluent-appearing lobulated echogenic lesions throughout radiocarpal and midcarpal joints, most prominently over volar aspect with trace fluid within wrist joint. There was no evidence of tenosynovitis of the flexors or extensors. She was given a volar wrist splint. She was discharged home while
Figure 1. A. Radiograph of the right wrist at initial presentation revealed amorphous calcification volar to the wrist joint. B. Repeat radiographs of the patient’s hands 2 weeks later revealed near resolution of the calcification. 1724
Personal non-commercial use only. The Journal of Rheumatology Copyright © 2015. All rights reserved.
The Journal of Rheumatology 2015; 42:9; doi:10.3899/jrheum.150178
Downloaded from www.jrheum.org on September 18, 2015 - Published by The Journal of Rheumatology
receiving prednisone 25 mg, to be tapered by 5 mg every 3 days. She had slow improvement in her wrist pain and range of motion. Acute calcium deposits, consisting of calcium hydroxyapatite crystals within soft tissue, present with significant pain and swelling in an otherwise asymptomatic patient1,2,3,4,5. This can often be mistaken for acute bacterial infection, malignancy, or other crystal arthropathies (gout and pseudogout). The shoulder joint is the most commonly affected structure, followed by hip, knee, elbow, wrist, and hand2. Crystal deposition may occur within a joint as well as periarticular structures, including tendons and ligaments3. Affected patients are treated with splint immobilization, steroid injection, or antiinflammatories and rarely require
surgery1,3,5. Radiographic changes resolve over 2–3 weeks with resorption of deposition by macrophages over time4,5. REFERENCES
1. Kim JK, Park ES. Acute calcium deposits in the hand and wrist; comparison of acute calcium peritendinitis and acute calcium periarthritis. J Hand Surg Eur 2014:39;436-9. 2. Doumas C, Vazirani RM, Clifford PD, Owens P. Acute calcific periarthritis of the hand and wrist: a series and review of the literature. Emerg Radiol 2007;14:199-203. 3. Stahl S, Kaufman T, Schapira D. Calcium hydroxyapatite deposition disease in the hand and wrist: a report of six cases. Eur J Plast Surg 1998;21:366-9. 4. Dilley DF, Tonkin MA. Acute calcific tendinitis in the hand and wrist. J Hand Surg Br 1991;16:215-6. 5. Moyer RA, Bush DC, Harrington TM. Acute calcific tendinitis of the hand and wrist: a report of 12 cases and a review of the literature. J Rheumatol 1989;16:198-202.
Personal non-commercial use only. The Journal of Rheumatology Copyright © 2015. All rights reserved.
Ruban and Albert: Calcium hydroxyapatite deposition in wrist
Downloaded from www.jrheum.org on September 18, 2015 - Published by The Journal of Rheumatology
1725
Volume 42, no. 9
Wrist Involvement of Calcium Hydroxyapatite Deposition Disease THANU NADARAJAH RUBAN and LORI ALBERT J Rheumatol 2015;42;1724-1725 http://www.jrheum.org/content/42/9/1724 1. Sign up for our monthly e-table of contents http://www.jrheum.org/cgi/alerts/etoc 2. Information on Subscriptions http://jrheum.com/subscribe.html 3. Have us contact your library about access options [email protected] 4. Information on permissions/orders of reprints http://jrheum.com/reprints.html The Journal of Rheumatology is a monthly international serial edited by Earl D. Silverman featuring research articles on clinical subjects from scientists working in rheumatology and related fields.
Downloaded from www.jrheum.org on September 18, 2015 - Published by The Journal of Rheumatology
Images in Rheumatology
Wrist Involvement of Calcium Hydroxyapatite Deposition Disease
THANU NADARAJAH RUBAN, MD, FRCPC, Rheumatology; LORI ALBERT, MD, FRCPC, Rheumatology, University of Toronto, Toronto, Ontario, Canada. Address correspondence to Dr. T.N. Ruban, Rheumatology, University of Toronto, 2075 Bayview Ave., Suite M1-400, Toronto, Ontario M4N 3M5, Canada. E-mail: [email protected]. J Rheumatol 2015;42:1724–5; doi:10.3899/jrheum.150178
Acute calcium deposits cause significant pain and swelling of abrupt onset in an otherwise asymptomatic patient, usually in the shoulder joint. Diagnosis can be difficult; the condition is sometimes mistaken for infection, malignancy, or other crystal arthropathy. A 77-year-old, right hand-dominant woman presented with a 2-day history of acute right wrist pain and swelling. She was constitutionally well with no history of local trauma. She was unable to move her right wrist and had increased
pain with finger flexion. She had normal limits of white blood cell count, serum uric acid, calcium, inorganic phosphorus, and creatinine. Radiograph showed amorphous calcification (Figure 1). Ultrasound of right wrist revealed multiple confluent-appearing lobulated echogenic lesions throughout radiocarpal and midcarpal joints, most prominently over volar aspect with trace fluid within wrist joint. There was no evidence of tenosynovitis of the flexors or extensors. She was given a volar wrist splint. She was discharged home while
Figure 1. A. Radiograph of the right wrist at initial presentation revealed amorphous calcification volar to the wrist joint. B. Repeat radiographs of the patient’s hands 2 weeks later revealed near resolution of the calcification. 1724
Personal non-commercial use only. The Journal of Rheumatology Copyright © 2015. All rights reserved.
The Journal of Rheumatology 2015; 42:9; doi:10.3899/jrheum.150178
Downloaded from www.jrheum.org on September 18, 2015 - Published by The Journal of Rheumatology
receiving prednisone 25 mg, to be tapered by 5 mg every 3 days. She had slow improvement in her wrist pain and range of motion. Acute calcium deposits, consisting of calcium hydroxyapatite crystals within soft tissue, present with significant pain and swelling in an otherwise asymptomatic patient1,2,3,4,5. This can often be mistaken for acute bacterial infection, malignancy, or other crystal arthropathies (gout and pseudogout). The shoulder joint is the most commonly affected structure, followed by hip, knee, elbow, wrist, and hand2. Crystal deposition may occur within a joint as well as periarticular structures, including tendons and ligaments3. Affected patients are treated with splint immobilization, steroid injection, or antiinflammatories and rarely require
surgery1,3,5. Radiographic changes resolve over 2–3 weeks with resorption of deposition by macrophages over time4,5. REFERENCES
1. Kim JK, Park ES. Acute calcium deposits in the hand and wrist; comparison of acute calcium peritendinitis and acute calcium periarthritis. J Hand Surg Eur 2014:39;436-9. 2. Doumas C, Vazirani RM, Clifford PD, Owens P. Acute calcific periarthritis of the hand and wrist: a series and review of the literature. Emerg Radiol 2007;14:199-203. 3. Stahl S, Kaufman T, Schapira D. Calcium hydroxyapatite deposition disease in the hand and wrist: a report of six cases. Eur J Plast Surg 1998;21:366-9. 4. Dilley DF, Tonkin MA. Acute calcific tendinitis in the hand and wrist. J Hand Surg Br 1991;16:215-6. 5. Moyer RA, Bush DC, Harrington TM. Acute calcific tendinitis of the hand and wrist: a report of 12 cases and a review of the literature. J Rheumatol 1989;16:198-202.
Personal non-commercial use only. The Journal of Rheumatology Copyright © 2015. All rights reserved.
Ruban and Albert: Calcium hydroxyapatite deposition in wrist
Downloaded from www.jrheum.org on September 18, 2015 - Published by The Journal of Rheumatology
1725
