Woman with Acute Finger Pain and Swelling.

A 42-year-old woman presented to our emergency department with a 2-day history of acute pain and swelling of her right fourth distal phalanx. She denied history of trauma, injury or fever. Physical examination revealed erythematous and swelling at the volar side of right fourth distal phalanx (Figure 1). There was limited range of motion due to the pain and tenderness. The laboratory tests revealed a white blood cell count of 5.53 × 109/L and C-reactive protein level of 0.13 mg/dL. The patient underwent radiography and sonography of the hand (Figures 2 and 3).Figure 2Sonography of right fourth distal phalanx showed a 0.6-cm well-defined calcification (asterisk) adjacent to diffusely thickened flexor digitorum profundus (arrows) with synovial thickening (arrowheads) and mild effusion (left panel). Doppler scan showed increased vascularity around the swollen tendon sheath indicating inflammation with hyperemia change (right panel).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Lateral view of radiograph confirmed the calcification on the volar side of right fourth distal interphalangeal joint (arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Acute calcific peritendinitis. The sonography focusing on the right fourth distal phalanx showed a 0.6-cm well-defined calcification adjacent to diffusely thickened flexor digitorum profundus with mild effusion and hyperemia (Figure 2). Radiograph confirmed the calcification on the volar side of right fourth distal interphalangeal joint (Figure 3). Our patient responded to oral nonsteroidal anti-inflammatory medication. Acute calcific peritendinitis is characterized by deposition of calcium hydroxyapatite resulting in acute soft tissue inflammation. It often involves rotator cuff tendons and is rarely seen around the hand and wrist.1Whittaker J.P. Kelly C.P. Gregson P.A. Acute flexor calcific peritendinitis of the wrist after trauma.Injury. 2003; 34: 533-534Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar It is more common in women aged between 30 and 60 years and usually manifests as sudden swelling and restricted motion due to pain.2Moradi A. Kachooei A.R. Mudgal C.S. Acute calcium deposits in the hand and wrist.J Hand Surg Am. 2014; 39 (quiz 1858): 1854-1857Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar It is a benign, self-limiting disease and patients mostly respond to conservative treatment within 4 to 7 days and complete clinical resolution within 4 weeks.3Doumas C. Vazirani R.M. Clifford P.D. Owens P. Acute calcific periarthritis of the hand and wrist: a series and review of the literature.Emerg Radiol. 2007; 14: 199-203Crossref PubMed Scopus (57) Google Scholar It is often misdiagnosed as another disease such as gout, pseudogout, infectious tenosynovitis, septic arthritis, or avulsion fracture. Diagnosis of acute calcific peritendinitis is straightforward with typical clinical manifestation and characteristic imaging. Awareness of this disease is important to avoid unnecessary invasive surgical treatment.