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Athanaselis ED, Mylonas T, Mylonas T, Saridis A, Ioannou M, Malizos KN, Karachalios T, Varitimidis S. Solitary Radio-Opaque Lesion of Wrist (Tumoral Calcinosis) Disappears Spontaneously After Causing Acute Carpal Tunnel Syndrome: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00038. [PMID: 36795865 DOI: 10.2106/jbjs.cc.22.00638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
CASE We describe the case of a 53-year-old male patient with a history of acute carpal tunnel syndrome (CTS) provoked by a radio-opaque mass on the palmar side of the wrist. Although the mass disappeared in new radiographs 6 weeks later without any intervention apart from the carpal tunnel release, excisional biopsy was conducted on the residue, revealing tumoral calcinosis. CONCLUSION Both acute CTS and spontaneous resolution are clinical manifestations of this rare condition on suspicion of which biopsy can be avoided by following a "wait and see" strategy.
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Affiliation(s)
- Efstratios D Athanaselis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Theodoros Mylonas
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Theodoros Mylonas
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Alkis Saridis
- Department of Orthopaedic, General Hospital of Drama, Drama, Greece
| | - Maria Ioannou
- Department of Pathology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Theofilos Karachalios
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Sokratis Varitimidis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
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Krolikowski M, Vargas CR, Chepla KJ, DiLorenzo D. Mass-like calcific peri-arthritis in the wrist: a rare case presenting as acute carpal tunnel syndrome and requiring surgical intervention. Skeletal Radiol 2022; 51:1883-1888. [PMID: 35149897 DOI: 10.1007/s00256-022-04003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 02/02/2023]
Abstract
Hydroxyapatite deposition disease (HADD) is a common localized disorder characterized by deposition of hydroxyapatite in soft tissues. These hydroxyapatite deposits can be found in the periarticular soft tissues such as bursae, joint capsules, tendon sheaths, and ligaments as well as within the tendons themselves, and intra-articular involvement has also been described [1,2]. We present a case of a 50-year-old female with acute symptoms of carpal tunnel syndrome secondary to partially liquified, mass-like, inflammatory calcific peri-arthritis. The case is supplemented with the use of multimodality imaging, a surgical perspective, and histopathologic correlation.
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Affiliation(s)
- Michal Krolikowski
- Department of Radiology, Department of Pathology, Department of Surgery, Division of Plastic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Christina R Vargas
- Department of Surgery, Division of Plastic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kyle J Chepla
- Department of Radiology, Department of Pathology, Department of Surgery, Division of Plastic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David DiLorenzo
- Department of Radiology, Department of Pathology, Department of Surgery, Division of Plastic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Bernier D, Marteau E, Roulet S, Antar H, Triki A, Laulan J, Bacle G. Hydroxyapatite deposits of the hand and wrist: a diagnosis not to be ignored. Pan Afr Med J 2021; 38:408. [PMID: 34381552 PMCID: PMC8325461 DOI: 10.11604/pamj.2021.38.408.29253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 12/02/2022] Open
Abstract
Hydroxyapatite crystal deposition disease (HADD) of the hand and wrist is rare but can cause acute inflammatory syndromes that mimic infectious arthritis. These symptoms, which rapidly resolve with systemic anti-inflammatory drugs, are a source of diagnostic errors and inappropriate treatment. It is of crucial importance to make the diagnosis in order to avoid iatrogenic surgical management. The aim of this study was to determine the clinical and radiographic signs and the key features on which diagnosis depends. Treatment effectiveness and the course of the disease were also examined. Between 1992 and 2008, 12 patients consulted for an isolated acute local inflammatory syndrome of the hand or wrist, which was accompanied by a unique radiographic picture of calcific density. All patients were reassessed clinically and radiographically with a minimum follow-up of 2 years. All patients had presented with acute local inflammatory syndromes. Nine patients had edema and 8 had swelling and erythema. No patient had fever. The course was favorable in 11 patients and one patient required surgery. No patient had a recurrence at the mean final follow-up of 90 ± 64 months. The symptoms associated with hydroxyapatite crystal deposits suggest septic arthritis with acute joint inflammation. The radiological appearance is characteristic and corrects the diagnosis. Oral anti-inflammatory treatment gives more rapid spontaneous improvement, with complete and long-lasting resolution.
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Affiliation(s)
- Daniel Bernier
- Department of Orthopedic Surgery, Hand Surgery Unit, Trousseau University Hospital, Medical University François Rabelais of Tours, Tours, France
| | - Emilie Marteau
- Department of Orthopedic Surgery, Hand Surgery Unit, Trousseau University Hospital, Medical University François Rabelais of Tours, Tours, France
| | - Steven Roulet
- Department of Orthopedic Surgery, Hand Surgery Unit, Trousseau University Hospital, Medical University François Rabelais of Tours, Tours, France
| | - Hèdi Antar
- Department of Orthopedic Trauma and Burns Center Ben Arous, Tunis, Tunisia
| | - Ameur Triki
- Mohamed Kassab Institute of Orthopedics, La Manouba, Tunis, Tunisia
| | - Jacky Laulan
- Department of Orthopedic Surgery, Hand Surgery Unit, Trousseau University Hospital, Medical University François Rabelais of Tours, Tours, France
| | - Guillaume Bacle
- Department of Orthopedic Surgery, Hand Surgery Unit, Trousseau University Hospital, Medical University François Rabelais of Tours, Tours, France.,Unité Mixte de Recherche, Institut National de la Santé et de la Recherche Médicale (INSERM), iBrain, Medical University François Rabelais of Tours, Tours, France
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Goller SS, Hesse N, Dürr HR, Ricke J, Schmitt R. Hydroxyapatite deposition disease of the wrist with intraosseous migration to the lunate bone. Skeletal Radiol 2021; 50:1909-1913. [PMID: 33712879 PMCID: PMC8277614 DOI: 10.1007/s00256-021-03758-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/07/2021] [Accepted: 03/07/2021] [Indexed: 02/02/2023]
Abstract
Hydroxyapatite deposition disease (HADD) is a mostly uniarticular, self-limiting condition caused by deposition of hydroxyapatite (HA) crystals in tendons or in the peritendinous soft tissues. Commonly, the glenohumeral joint is affected. More rarely, the HA depot can be cause of a carpal tunnel syndrome due to an acute inflammatory reaction and space-occupying soft tissue oedema. We report a case of acute HA depot located at the volar site of the right wrist with affection of the deep flexor tendons and intraosseous migration into the lunate bone in a 50-year-old female. There are two main goals of this case report: First, to remind the diagnosis of HADD as a cause of wrist pain and also of carpal tunnel syndrome, as this entity being often misdiagnosed clinically, and second, to report a rare case of intraosseous migration of HA crystals into the lunate bone.
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Affiliation(s)
- Sophia S Goller
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Hans Roland Dürr
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Campus Grosshadern, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Rainer Schmitt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Pai V, Pai V, Muir R. Periarticular calcification causing acute carpal tunnel syndrome: a case report. J Orthop Surg (Hong Kong) 2009; 17:234-7. [PMID: 19721161 DOI: 10.1177/230949900901700225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a case of acute carpal tunnel syndrome caused by periarticular calcification (hydroxyapatite deposition disease) around the wrist joint in a 64-year-old woman. She had acute severe pain, exacerbated by wrist movements and extension of the fingers. Her full blood count, urea, electrolytes, uric acid, calcium, phosphate, alkaline phosphatase, and thyroid function levels were all within normal ranges, and her serum was negative for rheumatoid factor. Computed tomography revealed lobulated calcification close to the volar capsule. She underwent an emergency surgical decompression of the carpal tunnel under general anaesthesia within 3 hours of presentation. The flexor tendon sheaths were excised, and 'toothpaste-like' chalky material (hydroxyapatite crystals) in the capsule was removed. The pain was relieved dramatically and her median nerve function recovered. She was symptom-free at the one-year follow-up.
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Affiliation(s)
- V Pai
- Gisborne Hospital, New Zealand.
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