Role of Radiographs and Ultrasound in Diagnosing Calcific Tendinitis and Periarthritis in the Wrist and Hand with Ultrasound-Guided Barbotage as Management Tool

A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders

Introduction

Non-traumatic wrist disorders (NTWD) are commonly encountered yet sparse resources exist to aid management. This study aimed to produce a literature map regarding diagnosis, management, pathways of care and outcome measures for NTWDs in the United Kingdom.

Methods

An interdisciplinary team of clinicians and academic researchers used Joanna Briggs Institute guidelines and the PRISMA ScR checklist in this scoping review. A mixed stakeholder group of patients and healthcare professionals identified 16 questions of importance to which the literature was mapped. An a-priori search strategy of both published and non-published material from five electronic databases and grey literature resources identified records. Two reviewers independently screened records for inclusion using explicit eligibility criteria with oversight from a third. Data extraction through narrative synthesis, charting and summary was performed independently by two reviewers.

Results

Of 185 studies meeting eligibility criteria, diagnoses of wrist pain, De Quervain's syndrome and ulna-sided pain were encountered most frequently, with uncontrolled non-randomised trial or cohort study being the most frequently used methodology. Diagnostic methods used included subjective questioning, self-reported pain, palpation and special tests. Best practice guidelines were found from three sources for two NTWD conditions. Seventeen types of conservative management, and 20 different patient-reported outcome measures were suggested for NTWD.

Conclusion

Substantial gaps in evidence exist in all parts of the patient journey for NTWD when mapped against an analytic framework (AF). Opportunities exist for future rigorous primary studies to address these gaps and the preliminary concerns about the quality of the literature regarding NTWD.

Calcific tendinopathy of the pronator quadratus muscle: A rare site and cause of ulnar sided wrist pain

Ulnar -sided wrist pain is a common complaint and can present a diagnostic challenge for a musculoskeletal clinician. Calcific tendinopathy is a well-recognised disorder related to the deposition of calcium hydroxyapatite crystals within tendons. Classically, tendons around the shoulder and the hip joints are the most commonly affected sites. We report a rare site of calcific tendinopathy of the Pronator Quadratus muscle presenting with ulnar-sided wrist pain in a 36-year-old male posing a diagnostic dilemma. This case-report highlights the importance of a thorough clinical evaluation and crucial role of cross-sectional imaging in reaching a diagnosis of calcific tendinopathy of the Pronator Quadratus muscle as unusual cause of ulnar-sided wrist pain. This is the first reported case of calcific tendinopathy in pronator quadratus in the literature we could review.

Calcified Tendinitis of the Flexor Carpi Ulnaris Tendon: A Case Report

Introduction

Calcification in the tendon (Calcific Tendinitis) occurs commonly in the shoulder, but this condition can happen in other tendon sites. Calcific tendinitis of the hand and wrist occurs rarely, which causes unfamiliarity toward the disease. With the symptoms mimicking other causes, misdiagnosis often happens. This can cause ineffective and over treatment.

Case Report

A 51-year-old man presented with a 2-week-pain on his right wrist with localized erythema and tenderness on physical examination. Imaging with ultrasound and X-ray shows calcification on the flexor carpi ulnaris tendon. Patient was treated with splinting for 2 weeks and NSAID for pain management and was free of pain afterwards.

Conclusion

Calcific tendinitis mimics the symptoms of various causes. The ability to differentiate this entity to other differential diagnosis leads to an effective and precise treatment.