Disclosures: Benjamin A. Klyachman, DO: No financial relationships or conflicts of interest

Case Diagnosis: Calcific Tendonitis of the Flexor Carpi Ulnaris

Case Description: A 53-year-old male presented to the outpatient clinic with complaints of acute right sided medial-volar wrist pain, swelling, and erythema that he first recognized after driving a long distance. He also reported a rollerblading accident one week prior. At that time of the accident, he sustained a concussion, but was wearing wrist guards and recalled no injury to his hands/wrists. He denied other injury to the wrist or similar traumatic episodes in the past. On examination, he had moderate erythema, effusion, and tenderness across the volar wrist, pisiform, and distal ulna. There was pain at end flexion and extension.

Setting: Academic HospitalAssessment/

Results: Diagnostic ultrasound revealed sub-centimeter calcifications along the volar aspect of the pisiform at the insertion of the flexor carpi ulnaris tendon with associated hyperemia, consistent with calcific tendonitis.

Discussion: Calcific tendonitis is a basic-calcium-phosphate-associated MSK syndrome which presents more commonly around large joints such as the shoulder (eg. supraspinatus). The etiology is poorly understood, but theorized that mineral formation occurs at sites of local tissue damage, injury, and inflammation. Local stress necrosis or hypoxia due to mechanical or vascular changes may be implicated. This leads to transformation of the tendinous fibrocartilage and production of calcifications through chondrocyte activity. Conventional management involves three main goals: eliminating pain, reducing inflammation, and dissolving calcific deposits. NSAID therapy alone or with bracing and injection of intralesional glucocorticoids can be used. There is no clear diagnostic approach, but this report demonstrates that diagnostic ultrasound is useful in distinguishing it from other differentials.

Conclusion: Due to its rare occurrence and overlap of clinical symptoms with other entities, calcific tendonitis of the hand is frequently misdiagnosed as acute infection, fracture, tenosynovitis, or crystalline arthropathy. Understanding the clinical manifestations and use of diagnostic ultrasound can save patients from misdiagnosis and unnecessary treatments/procedures.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unusual-presentation-of-calcific-tendonitis-a-case-report/