Today’s Interesting Case: Hydroxyapatite Deposition Disease

Radsource radiologists are constantly communicating and sharing knowledge with each other. In our new blog series, Today’s Interesting Case, our team will post notable cases and images for discussion from time to time. 

Diffuse flexor tenosynovitis
A STIR axial image reveals a low signal intensity focus within the dorsal aspect of the carpal tunnel. Diffuse flexor tenosynovitis is present.

 

Today’s case is from a 58 year old female with wrist numbness and tingling. The findings are compatible with hydroxyapatite deposition disease, with associated mass effect and inflammation causing carpal tunnel syndrome.

While carpal tunnel syndrome is common, it is rare that the condition is caused by HADD. In addition, the wrist is an unusual location for this entity.

 

Adjacent flexor tendons
A T1-weighted coronal image confirms the low signal intensity abnormality splaying the adjacent flexor tendons.

As stated by Dr. Stephen Quinn in the March 2009 web clinic on hydroxyapatite deposition disease, the most common sites of HADD are in the shoulder, the hip and the elbow. “HADD can involve the tendons and ligaments of the wrist and hand. The wrist is more commonly affected than the hand.1 The pisiform insertion site of the flexor carpi ulnaris tendon is reportedly the most common site of involvement in the wrist.

“HADD is a common disorder hallmarked by peri-articular deposition of calcium hydroxyapatite (CHA) crystals and an accompanying inflammatory process. Although any joint can be involved, the shoulder is the most commonly affected site.

Densely calcified lesion
A lateral radiograph reveals that the lesion is densely calcified.

 

 

‘With MR imaging, CHA deposits present as small, oval foci of decreased signal intensity. In the acute symptomatic phase of HADD, called acute calcific periarthritis, soft tissue and osseous edema can be present and needs to be distinguished from infection, tumor and trauma,” said Quinn.

 

 

 

References

1 Moyer RA, Bush DC, Harrington TM. Acute calcific tendinitis of the hand and wrist: a report of 12 cases and a review of the literature. J Rheumatol 1989; 16:198-202.

2 Gandee RW, Harrison RB, Dee PM. Peritendinitis calcarea of flexor carpi ulnaris. AJR Am J Roentgenol 1979; 133:1139-1141.