Role of Radiographs and Ultrasound in Diagnosing Calcific Tendinitis and Periarthritis in the Wrist and Hand with Ultrasound-Guided Barbotage as Management Tool

Abstract

Aim To demonstrate the role of radiographs and ultrasound (USG) in the diagnosis of calcific tendinitis and periarthritis in the wrist and hand and the efficacy of USG-guided barbotage for its management. Materials and Methods A retrospective chart review was performed in six patients who presented with acute-onset pain in the wrist and hand varying from 3 days to 2 weeks. Four patients had tenderness over pisiform and two patients had pain along the lateral aspect of the wrist and thumb. Radiographs and USG revealed calcific focus corresponding to the site of pain. USG-guided calcific barbotage and injection was performed for the same and pain relief was assessed immediately and through telephonic follow-up at 6 months using subjective satisfaction score. Data were analyzed using Microsoft Excel 2013. Results Four patients with tenderness over pisiform had flexor carpi ulnaris calcific tendinitis and two patients with pain along the lateral aspect of the wrist and thumb had first metacarpophalangeal calcific periarthritis and abductor pollicis brevis calcific tendinitis on radiographs as well as USG. In post-USG-guided calcific barbotage and injection, all patients had significant immediate and 6 months delayed relief in symptoms with excellent satisfaction scores. Conclusion Acute calcific tendinitis/periarthritis is a benign and self-limiting inflammatory condition. Radiographs are extremely helpful in identifying calcific focus. Ultrasonography in experienced hands is the best modality to identify, confirm the symptomatic calcific focus, and perform USG-guided intervention. USG-guided calcific barbotage is the simplest, quickest, and effective way to treat this condition and avoid compromised functional capacity.

Calcific tendinopathy of the pronator quadratus muscle: A rare site and cause of ulnar sided wrist pain

“…Cross-sectional imaging plays a crucial role in the diagnosis of wrist conditions and allow targeted management of the wrist pain. 20,21 CT can help better delineate calcification in comparison to radiographs and focused high-resolution sequences can be undertaken to reduce radiation. US imaging provides a noninvasive modality for assessing wrist conditions avoiding radiation.…”

Calcified Tendinitis of the Flexor Carpi Ulnaris Tendon: A Case Report

“…It also helps in giving information on the nature of the calcification, whether it’s hard or soft. Doppler utility can also determine whether the calcification is in the acute or chronic phase [ 14 ]. With dynamic ultrasonography available in our outpatient clinic, we found calcification on the FCU tendon before confirming with X-ray.…”

“…Injection using local anesthetics, with or without corticosteroid has shown to be effective, with the complete resolution within 6 days [ 5 ]. A series done by Ahuja et al, has shown that ultrasound guided barbotage, has been shown to be effective with immediate improvement of symptoms [ 14 ]. Splinting has also shown to be effective as it shortens the span of pain to 12 days, and it is what was done to our patient and has shown good result [ 15 ].…”

Acute calcific tendinitis of the FCR tendon in a 24-year-old male: A case report

“…Although the condition tends to resolve on its own without treatment, administration of prednisone and a steroid injection in combination with splinting has been shown to decrease the duration and severity of symptoms [10] . Use of ultrasound during said injection may aid in locating the deposit [11] . It is of utmost importance to carry out a thorough physical examination, laboratory work-up, and diagnostic imaging to ensure that the correct diagnosis is made, given the rarity of this condition developing in the wrist in current literature.…”