Calcium pyrophosphate deposition disease (CPPD) of the elbow and wrist
Presentation
Blunt trauma, the patient fell and injured her forearm and wrist. Incidental findings on imaging.
Patient Data
No acute/chronic or occult fractures, dislocations or subluxations of the right elbow, forearm, wrist and hand. There is juxta-articular osteopenia rather than diffuse osteoporosis in view of the patient's advanced age.
Although the lateral view of the elbow is not true lateral, the anterior fat pad is displaced suggesting an effusion or hemarthrosis in view of blunt trauma. There are medial and lateral including proximal radio-ulna calcifications suggestive of chondrocalcinosis.
There are extensive right wrist dorsal and volar calcifications involving the radiocarpal, triscaphe, DRUJ, TFCC, and intercarpal joint spaces consistent with chondrocalcinosis.
There are additional calcifications involving the first carpometacarpal joint, and the second to fifth metacarpophalangeal joints.
There is minimal PIP and DIP osteoarthritis. There is osteoarthritis of the third metacarpophalangeal joint. There is mild osteoarthritis of the first carpometacarpal joint. There is incidental negative ulna variance with mildly dense lunate however no overt evidence to suggest avascular necrosis (Kienbock's disease).
Case Discussion
Features consistent with chondrocalcinosis of the right elbow, wrist and hand in this elderly patient.
In view of the fall and blunt trauma, no acute post-traumatic bony abnormalities were amazingly present. She also did not really have severe osteoarthritis either secondary to CPPD or due to her age (90 years).
Although no typical hook osteophytes were present the calcifications as identified are strongly suggestive of CPPD.
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