Periarticular calcification causing acute carpal tunnel syndrome: a case report

Area of Science:

• Orthopedics
• Rheumatology
• Neurology

Background:

• Carpal tunnel syndrome (CTS) is common, often idiopathic or associated with systemic conditions.
• Periarticular calcification, specifically hydroxyapatite deposition disease (HADD), is a less common cause of acute CTS.
• Prompt diagnosis and intervention are crucial for favorable outcomes in acute CTS.

Observation:

• A 64-year-old woman presented with acute, severe wrist pain and median nerve dysfunction.
• Physical examination revealed symptoms exacerbated by wrist movement and finger extension.
• Laboratory tests were unremarkable, ruling out common inflammatory and metabolic causes.

Findings:

• Computed tomography identified lobulated calcification near the wrist's volar capsule.
• Surgical exploration revealed 'toothpaste-like' chalky material consistent with hydroxyapatite crystals.
• Emergency carpal tunnel decompression and removal of calcific deposits were performed.

Implications:

• This case highlights HADD as a treatable cause of acute carpal tunnel syndrome.
• Early surgical decompression can lead to rapid pain relief and functional recovery.
• Periarticular calcification should be considered in the differential diagnosis of acute CTS, even with normal systemic labs.