Calcific Periarthritis: More Than a Shoulder Problem

Abstract

Of twelve histologically verified cases of calcific periarthritis adjacent to joints other than the shoulder, in only one patient (toe) was the preoperative clinical diagnosis accurate, which signals the need for greater awareness of this entity as a differential diagnostic option.

Acute calcific periarthritis—a commonly misdiagnosed pathology

“…Clinically, patients present with pain, localised swelling, erythema, tenderness and restricted range of motion [10,15,16]. Even without treatment, the majority of patients report a reduction in symptoms within 4-7 days after the acute onset of pain and resolution in 3-4 weeks [4,17].…”

“…Pathological examination demonstrates deposition of calcific material into psammoma-like bodies, which is surrounded by extensive inflammatory cells, in particular, neutrophils [25,26]. The composition of the calcific deposits on electron microscopy is controversial [15]. Previously, studies have reported the deposits to consist of calcium hydroxyapatite; hence, the term hydroxyapatite deposition disease has been used to describe the underlying disease process of calcific periarthritis and calcific tendonitis [13,[27][28][29][30].…”

“…In the fourth phase (intraosseous loculation), deposits may erode into the adjacent bone at the insertion of the involved tendon or joint capsule, due to osteoclastic activity, which is postulated to be secondary to a combination of mechanical pressure and local active hyperemia [31]. Bone erosions commonly contain histiocytic infiltrate [15]. In a study by the Armed Forces Institute of Pathology, cortical erosion and extension into the intramedullary bone were demonstrated in 78% and 36% of patients respectively [32].…”

Calcium Apatite Deposition Disease: Diagnosis and Treatment

“…The most commonly described area of involvement is the great toe, either presenting medial to the first metatarsophalangeal joint or at the flexor hallucis brevis tendon just proximal to the hallucal sesamoids (Figure 16) [4, 90]. When CADD involves the flexor hallucis brevis, it typically presents with focal tenderness along the plantar forefoot near the first metatarsal head and can be mistaken for hallucal sesamoiditis [4].…”

“…CADD of the first metatarsophalangeal joint can mimic gout arthropathy. However, slightly younger age distribution, female gender predilection, and normal serum urate levels can help distinguish calcium deposits of CADD from gouty tophus [90]. Less common sites of involvement described include the peroneus longus at the peroneal groove, navicular insertion of the tibialis posterior, and second through fifth metatarsophalangeal joints [90–92].…”