Presentation
Swelling and pain at the dorsum of the left hand between the 3rd and 4th metacarpophalangeal joints.
Patient Data
Findings:
large periarticular low-intensity structure (approx. 12 x 6 x 3 mm) ulnar and dorsal at the level of the 3rd MCP joint below the extensor hood and ulnar sagittal band in the region of the ulnar proper collateral ligament with a distance of approximately 4 mm to the D3 extensor tendon
associated inflammatory changes in the joint capsule
osseous involvement of the dorsoulnar aspect to the 3rd metacarpal head with mild bone marrow edema
intact extensor tendon
Impression:
Calcific deposit and associated inflammatory changes of the dorsoulnar aspect of the 3rd metacarpophalangeal joint.
Exam courtesy: Ines Lischka (radiographer)
Calcific deposit in the soft tissues ulnar and dorsal to the head of the third metacarpal bone.
About 1.5 years earlier the patient came to our institution for evaluation of shoulder pain and complained of a painfully decreased range of motion in the right shoulder.
Findings:
calcific deposit just above the greater tuberosity on the bursal side of the supraspinatus tendon
inflammatory changes of the subacromial-subdeltoid bursa
a linear high signal between the superior glenoid rim and the superior labrum
Impression
Calcific deposit within the bursal aspect of the footprint of the rotator cuff specifically the supraspinatus tendon insertion with associated subacromial-subdeltoid bursitis.
The linear high signal between the superior glenoid rim and superior labrum on this non-athrographic MRI is probably consistent with a superior sublabral sulcus.
Exam courtesy: Stefanie Otto (radiographer)
Calcific deposit above the greater tuberosity in the region of the supraspinatus tendon.
Case Discussion
A case of hydroxyapatite deposition disease (HADD) with calcium deposition and associated inflammatory changes of the 3rd metacarpophalangeal joint capsule and intraosseous extension into the dorsoulnar aspect of the third metacarpal head.
The patient had an episode of calcific tendinitis of the rotator cuff about 1.5 years earlier with the shoulder being the most frequently involved joint in the disease 1 and giving an important clue to the diagnosis.
Other locations that can be affected by hydroxyapatite deposition disease include the hip, elbow, knee, ankle and foot and the longus colli muscle.
Treatment is usually conservative with nonsteroidal anti-inflammatory drugs (NSAIDs) being considered the treatment of choice. The more recalcitrant disease can be treated with corticosteroid injections image-guided barbotage and aspiration or surgical removal.
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