Not Every Hot, Tender, Inflamed Joint is Infected (or Gout)!

Abstract

Calcific tendinitis is a rare condition that classically involves the rotator cuff. Only isolated case reports exist of the disease affecting other anatomical locations. Our case is noteworthy because it describes calcific tendinitis in an uncommon location; the flexor pollicis longus of the thumb. Calcific tendinitis has a prevalence of 3-10% in the general population, and is most commonly seen among women in their 4th to 6th decade of life. Calcific tendinitis is best diagnosed by imaging where plain radiography and ultrasound are both helpful for detecting calcifications. Blood tests are generally not used for making the diagnosis. However, elevated white blood cells and inflammatory markers (e.g. sedimentation rate and C-reactive protein) may be seen in the acute phase of calcific tendinitis, but are usually normal. Although the exact pathophysiology of calcific tendinitis is unknown. Calcific tendinitis condition is often self-limited and interventions (i.e. anti-inflammatory medications, analgesics, glucocorticoid injections, physical therapy) are used with a “try it and see” mindset. Other treatment options (extracorporeal shock wave therapy, therapeutic ultrasound, iontophoresis, platelet rich plasma) have been tried. Acute calcific tendinitis should be on the differential diagnosis for acute musculoskeletal pain—even pain that is not at the rotator cuff. This case demonstrates that pain that is associated with a tender, inflamed joint can be more than either infection or gout. It is important to recognize calcific tendinitis as a potential diagnosis, as this could prevent unnecessary interventions and therapy such as intravenous antibiotics.