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

Differential Diagnosis

• Acute calcific periarthritis
• Gout
• Infectious arthritis
• Scaphoid fracture

Diagnosis

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 (www.experity.com/teleradiology).

Read More

• A 41-Year-Old With Dorsal Wrist Pain After A Slip-And-Fall
• A 47-Year-Old Male With Chronic Wrist Pain And No Recent Trauma