Carpal tunnel syndrome due to hydroxyapatite crystal deposition disease

Mass-like calcific peri-arthritis in the wrist: a rare case presenting as acute carpal tunnel syndrome and requiring surgical intervention

Hydroxyapatite deposition disease (HADD) is a common localized disorder characterized by deposition of hydroxyapatite in soft tissues. These hydroxyapatite deposits can be found in the periarticular soft tissues such as bursae, joint capsules, tendon sheaths, and ligaments as well as within the tendons themselves, and intra-articular involvement has also been described [1,2]. We present a case of a 50-year-old female with acute symptoms of carpal tunnel syndrome secondary to partially liquified, mass-like, inflammatory calcific peri-arthritis. The case is supplemented with the use of multimodality imaging, a surgical perspective, and histopathologic correlation.

Pseudogout: A Rare Cause of Acute Carpal Tunnel Syndrome and Acute Guyon Canal Syndrome

Pseudogout is an acute inflammatory arthropathy that often presents as a hot, swollen, painful joint. Rarely, the inflammatory response caused by pseudogout has led to acute neuropathic symptoms of the hand. We present a case of pseudogout causing acute neuropathic symptoms in the median and ulnar nerves, ultimately necessitating urgent surgical decompression. The patient’s symptoms were alleviated after surgical decompression. Pseudogout should be considered a rare cause of acute neuropathic compression of the hand. Its management may require surgical intervention and should involve postoperative follow-up with a rheumatologist.

Osteogenic ability using porous hydroxyapatite scaffold-based delivery of human placenta-derived mesenchymal stem cells

Previous preliminary studies have suggested that hydroxyapatite with a grooved structure (HAG) scaffold has good osteogenic potential. This type of scaffold may aid osteogenesis during the repair of large maxillofacial bony defects. The ectopic osteogenic effect and underlying mechanism were further studied using porous HAG scaffold-based delivery of human placenta-derived mesenchymal stem cells (hPMSCs). A total of 18 dogs were randomly allocated into a HAG scaffold group and a HAG scaffold-based hPMSC (HAG/hPMSC) group, and three scaffolds were implanted into the dorsal muscle of each dog. Samples were taken for subsequent analysis and tested 4, 8 and 12 weeks following heterotopic implantation. H&E staining was used to study the osteogenic effect in dog dorsal muscles, and RNA sequencing (RNA-seq) was used for exploring the underlying osteogenic mechanism. The osteogenic ability and effector of the HAG/hPMSC group were significantly greater than those of the HAG scaffold group at 4 weeks after implantation. After 12 weeks, a mature bone plate structure was seen in the HAG/hPMSC group. RNA-seq demonstrated that various osteogenesis-related pathways participated at different stages of metabolism, and that the expression of collagen-1 and runt-related transcription factor 2 increased with implantation time. The present study preliminarily focused on the ectopic osteogenic effect of the porous HAG scaffold-based delivery of hPMSCs in vivo, which may be helpful for the improved application of HAG scaffolds in the future.

Hydroxyapatite deposition disease of the wrist with intraosseous migration to the lunate bone

Hydroxyapatite deposition disease (HADD) is a mostly uniarticular, self-limiting condition caused by deposition of hydroxyapatite (HA) crystals in tendons or in the peritendinous soft tissues. Commonly, the glenohumeral joint is affected. More rarely, the HA depot can be cause of a carpal tunnel syndrome due to an acute inflammatory reaction and space-occupying soft tissue oedema. We report a case of acute HA depot located at the volar site of the right wrist with affection of the deep flexor tendons and intraosseous migration into the lunate bone in a 50-year-old female. There are two main goals of this case report: First, to remind the diagnosis of HADD as a cause of wrist pain and also of carpal tunnel syndrome, as this entity being often misdiagnosed clinically, and second, to report a rare case of intraosseous migration of HA crystals into the lunate bone.