gms | German Medical Science

Objectives/Interrogation: Acute calcific periarthritis is a subset of acute calcium deposition disease which is characterised by the presence of calcium hydroxyapatite crystals in the periarticular soft tissues. It is frequently seen around shoulder joint and greater trochanter of the hip. Hand and wrist are rarely affected.

Case Report: A 47-year-old right-handed lady presented with a 4-day history of worsening pain and swelling of her left ring finger metacarpophalangeal joint (MCPJ). She has no past medical history and reported no history of hand trauma. On examination, swelling and tenderness over A1 pulley were noticed with limited range of movement due to pain. There was no evidence flexor sheath infection. WCC, CRP and serum urate were all normal.

X-rays were requested and showed amorphous calcifications in relation to the left fourth MCPJ in keeping with acute calcific periarthritis. Symptoms settled after four days of resting splint, hand elevation and non-steroidal anti-inflammatory medications. Resolution of calcification was seen on follow-up x-rays eight weeks after onset of symptoms.

Results and Conclusions: Acute calcific periarthritis is idiopathic self-limited monoarticular periarticular inflammation which is characterised by sudden onset of pain and swelling. These painful periarticular calcifications were described by Painter CF in 1907. In 1938 Standstrom reported that of 329 cases with acute calcium deposits, only eight (2.4%) involved the hand and wrist.

Due to it is low incidence in the hand as well as its clinical resemblance of other acute presentations, many cases were reported to be misdiagnosed and, unnecessarily, treated aggressively with antibiotics and surgical intervention. Hand surgeons should be aware of this pathology and associated radiological signs in order to avoid unnecessary intervention.