Upper limb pyrophosphate tenosynovitis outside the carpal tunnel

Article Abstract:

The deposition of calcium pyrophosphate dihydrate (CPPD) crystals in the joint results in chondrocalcinosis, a gout-like condition characterized by long-term recurrent inflammation of the joint. Three cases are described in which CPPD crystals were deposited in the tendons outside the carpal tunnel, a canal-like structure in the wrist through which tendons and the median nerve pass. The crystals were identified by X-ray and microscopic methods. All three patients with CPPD crystal deposits had hand tenosynovitis, or the inflammation of the tendon sheath. One patient had CPPD crystals in the neighboring synovium (membrane lining the joint) in addition to chondrocalcinosis in the knee and wrist joints. These cases show that CPPD crystal deposits in the hand at sites other than the joint can cause tenosynovitis without any evidence of chondrocalcinosis in the joints. CPPD crystal deposition can also cause the carpal tunnel syndrome, which is characterized by soreness, tenderness, and weakness of the muscles of the thumb. Examination of the synovial or joint fluid may be a more simple and sensitive method for detecting crystal deposition than biopsy or tissue sampling of the synovial membrane lining the joint. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Inflammation, Carpal tunnel syndrome, Tendons

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Evidence for a causal relationship between the structure, size, and load of calcium pyrophosphate dihydrate crystals, and attacks of pseudogout

Article Abstract:

There may be an association between the size and nature of the calcium crystals deposited in synovial fluid of pseudogout patients during an episode of inflammation. Pseudogout is an inflammatory joint disease characterized by calcium salt deposits in the affected joint fluid. Researchers analyzed and compared the crystals found in the knee joint fluid of 9 patients with pseudogout during and following an inflammatory episode. There were significantly more calcium salt deposits present in the joint fluid samples taken during an inflammatory episode as compared to the samples taken following the episode. The ratio of larger, symmetrical calcium crystals (monoclinic) to smaller, asymmetrical calcium crystals (triclinic) was higher during an inflammatory episode. This evidence suggests that the monoclinic calcium crystals play a role in the inflammation process.

Physiological aspects, Calcification

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Chronic flexor tenosynovitis: missed diagnosis for a decade

Article Abstract:

Retention of a foreign body may be mistaken for tenosynovitis. Tenosynovitis is a chronically inflamed tendon. A woman reported a 10-year history of pain and stiffness of her index finger. At age ten, she fell on a sea urchin. Antibiotics relieved the resultant pain and swelling. Eight months later she re-experienced swelling, pain, and stiffness, which was diagnosed as tenosynovitis. The current recommendation was surgery, which revealed a tiny spine fragment surrounded by chronically inflamed tissues in the tendon sheath. Removal of the fragment was curative. Thorns may also cause this kind of problem.

Case studies, Joints, Injuries, Joints (Anatomy), Diagnostic errors, Wounds and injuries

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