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Differential Diagnosis

  • Acute calcific periarthritis
  • Gout
  • Infectious arthritis
  • Scaphoid fracture
55-year-old female with sudden on-set wrist pain xr2


The x-ray shows linear calcification alongside the distal ulna. This patient was diagnosed with acute calcific periarthritis, an acutely painful monoarticular condition where there is juxta-articular deposition of calcium hydroxyapatite crystals and local inflammation.

Learnings/What to Look for

  • Acute calcific periarthritis occurs more frequently in females than males, between 40 and 70 years of age
  • This condition is a clinical subset of hydroxyapatite deposition disease and occurs when crystals are acutely deposited in the periarticular capsular structures:
    • Deposits in tendons result in calcific tendonitis
    • Deposits in bursa result in calcific bursitis
    • Deposits in the shoulder joint result in Milwaukee shoulder
  • Well-circumscribed ovoid or curvilinear calcification may be observed adjacent to a joint (usually on one side)

Pearls for Urgent Care Management

  • Acute calcific periarthritis is managed conservatively with NSAIDs but may require corticosteroid injection
  • Acute symptom resolution may be achieved within a week
  • Calcification significantly decreases in 3-4 weeks, and clears completely in 6-8 weeks

Acknowledgement: Image and case presented by Experity Teleradiology (

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A 55-Year-Old Female with Sudden-Onset Wrist Pain