An active 47yo male with no history of trauma presented with acute onset anteromedial thigh pain, pain on weight bearing and limited ROM.
The patient was scanned supine and a large hip joint effusion was noted. The clinical presentation along with the hip joint effusion pointed to a crystal deposition disease. The patient was rolled onto his side and the lateral and posterior joint were assessed. A 27x20mm deposit of acute soft appearing calcification was noted at the posterior joint capsule/labrum.
Hydroxyapatite crystal deposition disease (HCDD) is frequently seen within the rotator cuff tendons of the shoulder during the presentation of classic calcific tendonitis. Just as in the shoulder tendons, this can be mildly symptomatic but it is felt acute rupture of the calcium deposit into the intra-articular joint space or bursa can lead to an acute, severe inflammatory event.
For treatment a 22-gauge needle was advanced into the calcium which was infiltrated with local anaesthetic and calcium crystals aspirated. This was followed by further 2 cc of Celestone Chronodose both in the calcium and around it. A further 1 cc of Celestone Chronodose and 2 cc of local anaesthetic was injected into the anterior hip joint. Significant improvement of symptoms immediately resulted post injection.
Scanning from lateral to posterior hip joint demonstates capsular thickening and calcific deposit within joint labrum.
Large anterior hip joint effusion noted.
Focus of calcification noted at posterior joint line.