CASE 993 Published on 18.04.2001

Calcific Periarthritis of the Finger

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

DR Jeffrey, CJ Wakeley

Patient

48 years, female

Clinical History
A 48 year old female with pain and swelling of the right index finger PIPJ
Imaging Findings
A 48 year old female presented with a two week history of pain and swelling of the right index finger proximal interphalangeal joint (PIPJ). A conventional radiograph of the finger demonstrates an area of amorphous calcification adjacent to the ulnar side of the index finger PIPJ with overlying soft tissue swelling. There is some irregularity of the adjacent cortex of the proximal and middle phalanges (Fig1). A repeat radiograph seven months later demonstrates complete resolution of the calcific deposit. Well defined periarticular erosions with sclerotic margins are seen at the site of the previous cortical irregularity (Fig2).
Discussion
Calcific periarthritis refers to recurrent painful periarticular deposits of calcium in tendons and soft tissues. The deposits are usually monoarticular and the commonest site involved is the shoulder. The hand is less commonly involved, but within the hand, the metacarpophalangeal joints are the commonest sites. The disease may be associated with acute painful episodes or chronic low grade pain and tenderness, but many patients are asymptomatic and the deposits are detected incidentally when radiographed for another reason. The deposits consist of calcium hydroxyapatite crystals. The cause of the crystal deposition is not known but it may be simply secondary to trauma. Radiologically the deposits often appear initially cloud-like, becoming denser and more clearly defined with time. The adjacent bones are usually normal, although contour irregularities, cystic lesions and reactive sclerosis may occasionally occur[1]. The deposits may remain static, enlarge, or reduce in size over time. The diagnosis is important as the symptoms are often misdiagnosed as septic arthritis or gout and inappropriately treated leading to a delay in recovery. The correct treatment consists of immobilisation plus nonsteroidal anti-inflammatory agents. Local steroid injections do not confer any additional benefit. The majority of cases demonstrate resolution of the calcium deposits within a few weeks on follow up radiographs if appropriately treated[2].Several authors have described cases of calcific periarthritis associated with cortical erosions[3, 4]. However, these were all associated with large tendons of the glutei or pectoralis muscles. We have been unable to find any previous descriptions of calcific periarthritis associated with cortical erosions in the digits. Uhthoff and Sarkar[5] describe three distinct stages of calcific periarthritis: precalcific, calcific and postcalcific. The postcalcific stage occurs after the calcific deposit has been phagocytosed and there are said to be no radiographic findings at this stage. This does not concur with our findings in which the cortical erosions persisted after resolution of the calcific deposit. We therefore suggest that calcific periarthritis should be included in the differential diagnosis of periarticular bone erosions.
Differential Diagnosis List
Calcific Periarthritis of the Finger
Final Diagnosis
Calcific Periarthritis of the Finger
Case information
URL: https://www.eurorad.org/case/993
DOI: 10.1594/EURORAD/CASE.993
ISSN: 1563-4086