<< Back to the abstract archive
Mass-like Hydroxyapatite Deposition Disease Presenting as Acute Carpal Tunnel Syndrome
Christina R Vargas, MD
Michal Krolikowski, MD
David DiLorenzo, MD
Kyle J Chepla, MD
University Hospitals Cleveland Medical Center
2021-01-30
Presenter: Christina Vargas, MD
Affidavit:
100% of this project represents the original work of the submitting resident, Christina Vargas.
Director Name: Edward Davidson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Purpose: To describe an unusual presentation of acute median neuropathy which may have had significant negative functional complication if not recognized promptly and appropriately managed with surgical decompression.
Methods: The case of a 50-year-old female who presented to the emergency department with symptoms of acute, atraumatic unilateral carpal tunnel syndrome is highlighted. Initial exam was notable for positive provocative testing at the wrist; she was provided with a splint and anti-inflammatory medication and referred for follow up. Upon evaluation in hand clinic, the patient had severe discomfort unrelieved by splinting and medication. Pain with passive digital extension and median paresthesias were noted with soft compartments and mild edema in the palm and radial digits. ESR and CRP were elevated without leukocytosis. Radiographs demonstrated a large calcified mass along the volar wrist; CT highlighted the large ossification extending proximally from the capitate and volar intercarpal ligaments. MRI showed numerous foci of calcium hydroxyapatite along the deep flexor tendon compartment with marked edema and prominent mass effect, thenar denervation in a median distribution, and tenosynovitis.
Results: Multimodal imaging and clinical findings led to surgical decompression and debridement of the inflammatory mass and median neurolysis with subsequent improvement in symptoms. The patient's presentation was ultimately confirmed to be secondary to hydroxyapatite deposition disease on surgical pathology evaluation.
Conclusions: Acute carpal tunnel syndrome is a rare and potentially significant manifestation of hydroxyapatite deposition disease. Knowledge of this etiology is important in prompt recognition and surgical treatment in order to avoid permanent neurologic insult.
