Atypical Calcium Hydroxyapatite Deposition Peri-articular To The Proximal Tibio-fibular Joint, Treated With Sonographically-guided Percutaneous Lavage: A Case Report - Page #4

Working Diagnosis:
Atypical Calcium hydroxyapatite deposition
Common peroneal nerve palsy

Relative rest of two weeks
Sonographically guided percutaneous lavage and corticosteroid injection of calcific deposit was performed.

After two weeks of rest, paresthesias in peroneal n. distribution resolved. She continued to have pain with sitting & prolonged standing
Pain improved (0/10 VAS) 2 weeks post percutaneous lavage, with resolution of calcific density at tibio-fibular joint at one month
Aspirate was negative for urate or pyrophosphate crystals and positive for calcium hydroxyapatite

Author's Comments:
Calcium hydroxyapatite deposition is often a self-limiting condition typically seen in tendons
Evidence shows sonographically guided calcific lavage combined with steroid injection, can provide significant relief.
Our patient presented with an atypical deposition proximal and posterior to the biceps femoris tendon insertion on the proximal fibula.
Our patient had significant improvement following sonographically guided lavage and steroid injection.
Sonographically guided lavage for atypical calcium deposits may be effective in regaining function and improving pain.

Editor's Comments:
Great case with not only a nice differential and a rare etiology/entity, but also a novel treatment with use of US and corticosteroid injection and lavage.

Gatt DL and Charalambous CP. J Arth Rel Surg 2014, 30; 9:1166-1172
Davidson J and Jayaraman S. Clin Rad 2011, 66:140-152
Jacobson J. Fundamentals of Musculoskeletal Ultrasound. Philadelphia, PA: Saunders; 2007

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