Abstract
We report an unusual case of a 65-year-old lady with CREST syndrome with multiple upper and lower limb calcinosis, who presented with severe shoulder pain and stiffness, with widespread intra- and extra-articular calcinosis, which was refractory to conservative measures. We were able to identify the main cause of her symptoms through serial diagnostic injections as calcific biceps tendinosis. We will discuss her assessment and surgical management and the pathophysiology and various treatment modalities for managing the soft tissue calcinosis in rheumatological diseases.
Highlights
CREST syndrome is a limited form of scleroderma, characterised by calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia
We discuss a patient who presented with debilitating shoulder pain and stiffness for many years, who was successfully treated with surgery
Winterbauer noted esophageal dysmotility in 4 of the 8 patients in his series, he did not include this feature in his original description of CRST syndrome
Summary
CREST syndrome is a limited form of scleroderma, characterised by calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia. The calcinosis is a difficult entity to treat, given the paucity of effective treatment options in the literature. It is clinically often difficult to determine whether the calcinosis, irrespective of its manifestation intra- or extra-articularly, is the source for the patient’s symptoms. The presentation varies from soft tissue swelling with associated pressure symptoms (e.g., with shoe wear), spontaneous discharge and infection, tendon infiltration with associated tendinopathy, or spontaneous tendon rupture or joint related pain. Clinical assessment and decision making can be challenging. We discuss a patient who presented with debilitating shoulder pain and stiffness for many years, who was successfully treated with surgery
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