Ultrasonography-Guided Common Musculoskeletal Interventions from Head to Toe: Procedural Tips for General Radiologists

Painful Os Peroneum Syndrome Secondary to Hydroxyapatite Deposition Disease

Painful os peroneum syndrome (POPS) is one of the uncommon causes of lateral foot pain in orthopaedic practice. POPS encompasses a spectrum of pathologies such as an acute or a chronic fracture, peroneus longus tenosynovitis, and attrition or partial rupture of the peroneus longus tendon. Herein, we reported the first case of POPS secondary to hydroxyapatite deposition disease in a 32-year-old female patient. The clinical presentation, the role of radiological interventions, particularly ultrasound-guided barbotage in its diagnosis and effective management, is highlighted.

An Unusual Case of Calcific Periarthritis Causing Carpal Tunnel Syndrome and Its Management with Ultrasound-Guided Barbotage

Hydroxyapatite crystal deposition disease (HADD) is a common disorder resulting from the deposition of calcium hydroxyapatite crystals in various soft tissues, typically in periarticular distribution, including tendons, tendon sheaths, joint capsules, ligaments, bursae, periarticular soft tissues, and occasionally within the joints. The more commonly known subtypes of HADD are calcific tendinopathy and calcific periarthritis. Carpal tunnel syndrome (CTS) can be rarely caused by calcific deposits within the carpal tunnel in the setting of HADD-related calcific periarthritis. Imaging, particularly ultrasound and radiographs, is crucial in distinguishing this entity from the conventional form of CTS that tends to be idiopathic. We describe a rare presentation of CTS secondary to calcific periarthritis in a 45-year-old patient, with imaging demonstrating mass-like calcification within the carpal tunnel, with typical features of those seen with HADD. The patient was treated with ultrasound-guided barbotage, with significant clinical improvement. The case highlights a lesser-known cause of CTS as well as a presentation of HADD, and the role of ultrasound-guided barbotage, a minimally invasive procedure, as a viable first-line management option as an alternative to surgery.