A 27-year-old right-hand-dominant female presented to the emergency department due to severe pain in the right third finger with associated swelling, that had developed five days previously. She denied any history of trauma, fever, systemic complaints or arthralgias at other joints. On examination, she showed redness, swelling, local heat and tenderness of the radial side of the proximal interphalangeal (PIP) joint of the right third finger. She had limited passive and active mobilization of the finger because of pain. No other abnormalities were noted.
The initial radiographs showed a well-circumscribed ovoid calcification adjacent to the radial and volar aspects of the PIP joint of the right third finger (Fig. 1). Laboratory investigation revealed normal leukocyte count, normal serum uric acid, calcium, phosphorus, alkaline phosphatase and parathyroid hormone levels, and a mildly elevated C-reactive protein at 10.3mg/L (normal <3.0mg/L). An ultrasound performed 3 day later demonstrated an ovoid heterogeneous calcific mass (Fig. 2).
The patient was managed conservatively with nonsteroidal anti-inflammatory drugs, ice compression and immobilization.
Three weeks later, the patient experienced complete resolution of swelling and pain and exhibited full range of motion. Follow-up radiographs after two months showed complete disappearance of the calcification (Fig. 3).
Discussion
Acute calcific periarthritis is a form of hydroxyapatite deposition disease and is a rare cause of acute, severe periarticular pain in the hand.1,2 It occurs most frequently in the shoulder and wrist and patients are most commonly women with an average age of 45 years old (range 30–60), otherwise healthy.3,4
The differential diagnosis is broad and includes infectious arthritis/tenosynovitis, gout, pseudogout, fracture and tumoral conditions.2,4 Calcific periarthritis should be considered when faced with an acute painful finger, especially in the presence of calcification on radiographs or ultrasound. This would avoid unnecessary treatments such as antibiotics and surgery.2,3,5
Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.
Confidentiality of dataThe authors declare that no patient data appear in this article.
Right to privacy and informed consentThe authors declare that no patient data appear in this article.
Conflict of interestThe authors declare that there are no conflicts of interest.
