Calcification about the wrist associated with acute pain (periarthritis calcarea); a clinical and roentgenological study.

Abstract

Calcium deposits about joints with associated acute pain are generally considered to be a clinical and pathological entity (4, 5, 6, 10, 11). The disease is apparently a self-limited one, and the symptoms generally subside within two weeks. If an operation is performed, a substance of varying consistency, containing calcium salts, will be found. The shoulder is the most commonly involved area and reported clinical and pathological observations chiefly concern this localization. There is, however, an increasing number of recent publications dealing with calcification about other joints, associated with an acute (or subacute) painful condition. These publications indicate an involvement of almost all the joints of the extremities. Observations at the Army Dispensary, in the Pentagon (Washington, D. C), have revealed that calcification about joints other than the shoulder, while not common, is far from being a rarity. A review of the two-year period July 1, 1949, to June 30, 1951, showed 84 cases involving the shoulder, 9 the hip, 9 the elbow, 7 the wrist, 6 the knee, and 2 a finger. With greater attention to this possibility in acute painful conditions of the joints, and the taking of different oblique films of the affected area for the discovery of calcification, more cases of this sort are being found, and it is our impression that the occurrence is more frequent than is indicated by the above figures. In this paper we are concerned primarily with calcium deposits about the wrist. This anatomical area occupies fourth place in point of incidence in our series. It is felt, however, that incidence alone is not an adequate expression of clinical significance, which is better emphasized by the particular differential diagnostic difficulties encountered in this area. Our report is based on 8 cases, 5 of which will be presented in detail. (Case IV was first observed prior to the two-year period represented by the figures given above and is not included in them.) Case Reports Calcium Deposit in the Area of the Flexor Carpi Ulnar is Tendon: Case I: A 52-year-old white male gave a four-day history of gradually developing pain over the radial aspect of the left wrist, followed two days later by similar pain on the ulnar side, over the pisiform bone. The latter area was slightly swollen at the time of observation. Tenderness could be elicited by local pressure in both regions. There was no increased heat or redness. The patient is a golf player, but did not recall any recent injury. Several years earlier he had suffered a superficial laceration on the volar aspect of the left wrist, and on examination a scar was visible on the ulnar side, just over the pisiform bone. A tentative diagnosis of “arthritis” was made.