Differential Diagnosis
- Acute calcific periarthritis
- Wrist sprain
- Scapholunate dissociation
- Wrist osteoarthritis
Diagnosis
The correct diagnosis in this case is acute calcific periarthritis as the x-ray shows a linear calcification alongside the distal ulna. It is a painful monoarticular condition identified with juxta-articular deposition of calcium hydroxyapatite crystals and local inflammation. It is a clinical subset of hydroxyapatite deposition disease and occurs when crystals are acutely deposited in the periarticular capsular structures: tendons (calcific tendonitis), bursa (calcific bursitis), or shoulder joint (Milwaukee shoulder). Acute calcific periarthritis occurs more frequently in females than males, most often at middle age. There are a few rare genetic risk factors but no proven acquired risk factors.
What to Look For
- Patient will have severe pain of a single joint with focal tenderness, which may not correlate with the typical location of a joint line
- Erythema, warmth, and swelling may or may not be present
- Imaging will show well circumscribed ovoid or curvilinear calcification adjacent to a joint (usually on one side)
Pearls for Urgent Care Management
- Attacks are self-limited, usually lasting a few weeks to a few months
- First line conservative management with non-steroidal anti-inflammatory drugs usually achieves acute symptom improvement within 48-72 hours
- Intralesional corticosteroid injection may be administered
- Typically, calcification decreases in 3-4 weeks with about 6-8 weeks to clear completely
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