Images in Clinical Medicine
Acute Calcific Tendinitis
N Engl J Med 2008; 359:2477December 4, 2008
- Article
A 56-year-old woman presented to the emergency department with a 3-day history of severe pain in and loss of movement of her right index finger. She reported that for the previous 2 months, she had noted a small, tender lump, with no progression in size, near the finger joint. Marked palmar erythema and a tender, firm swelling overlying the index metacarpophalangeal joint were noted (Panel A). Initially, a flexor-sheath infection was suspected, and antibiotics were administered. However, radiography showed a calcified mass within the flexor digitorum tendon (Panel B, arrow), and calcific tendinitis was diagnosed. Calcific tendinitis may be an acute, intensely painful synovitis of the flexor sheath. It is common in the rotator cuff of the shoulder but rare in the hand. The diagnosis is often overlooked, and differentiation from septic tenosynovitis can be made on the basis of an absence of systemic findings. Initial treatment, which is targeted to alleviate symptoms, consists of elevation of the affected site (e.g., the hand) and the use of antiinflammatory agents. Repeated radiography at 2 to 4 weeks usually shows resolution. Surgery is rarely indicated. At a follow-up visit 6 weeks after the initial presentation, the lump was barely palpable, and the patient had no pain and a normal range of movement.
Jonathan D. Wiper, M.B., Ch.B.
Anselmo Garrido, M.D.
St. James University Hospital, Leeds LS9 7TF, United Kingdom
jaywiper@doctors.org. uk
