periarthritis

Periarthritis, also known as calcific periarthritis or periarthropathia, can manifest in various ways, depending on the severity and location of the condition. The primary symptoms include:

• Joint pain: Pain is often the primary symptom of periarthritis and can range from mild to severe. It may be aggravated by movement or specific activities.
• Pain and swelling around a joint: Calcific periarthritis causes pain and swelling around a joint, which can be tender to the touch [3].
• Stiffness in the shoulder joint: Frozen shoulder, also called adhesive capsulitis, involves stiffness and pain in the shoulder joint. Signs and symptoms typically begin slowly, then get worse, but over time, symptoms get better, usually within 1 to 3 years [2].
• Pain that worsens at night: Pain in your shoulder which can be worse at night and disturb sleep [8].
• Stiffness that makes it difficult to move: The main symptoms of a frozen shoulder are pain and stiffness that make it difficult or impossible to move [4].

It's worth noting that the symptoms of periarthritis can vary depending on the severity and location of the condition. In some cases, the joint symptoms may be caused by calcium crystals building up in and around joints, which is referred to as calcific periarthritis [1].

Periarthritis, also known as frozen shoulder, can be diagnosed through a combination of physical examination, medical history, and imaging tests.

Physical Examination

A doctor will typically perform a physical exam to assess the range of motion in your shoulder, check for any tenderness or swelling, and evaluate your overall musculoskeletal function. This may include:

• Evaluating the movement of your arm, shoulder blade, and upper back
• Checking for any pain or tenderness when moving your shoulder
• Assessing the strength and flexibility of your shoulder muscles

Imaging Tests

While not always necessary, imaging tests can help rule out other conditions that may be causing your symptoms. These tests include:

• X-rays: Can show bone abnormalities, but are not typically used to diagnose periarthritis.
• MRI (Magnetic Resonance Imaging): Can provide detailed images of soft tissues, such as tendons and ligaments, which may be affected in periarthritis.
• Ultrasound: Can also provide images of soft tissues and is sometimes used to evaluate the shoulder joint.

Other Diagnostic Tests

In some cases, additional tests may be ordered to rule out other conditions that may be causing your symptoms. These can include:

• Blood tests (e.g., CBC, ESR, CRP) to check for inflammation or infection
• Imaging tests of the contiguous structures, such as tendons, ligaments, and bursa

Special Tests

There are several special tests that can help diagnose periarthritis, including:

• Speed's test: Used to diagnose biceps tendonitis, but has a high rate of false-positive results.
• Apprehension Test: Can be used to assess shoulder instability.

It's worth noting that there is no single "gold standard" diagnostic test for periarthritis, and the diagnosis is often made based on a combination of clinical findings and imaging tests.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Periarthritis can be effectively managed with various drug treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs). These medications help reduce pain and inflammation associated with the condition.

• NSAIDs such as ibuprofen (Advil, Motrin IB) and diclofenac are commonly used to treat periarthritis [1].
• They can be taken orally or applied topically in the form of gels or creams, such as Voltaren Arthritis Pain Gel and Pennsaid [5].
• NSAIDs work by inhibiting the production of prostaglandins, which are hormone-like substances that cause pain and inflammation [4].

Corticosteroids

In addition to NSAIDs, corticosteroids are another class of medications used to treat periarthritis. These drugs help reduce inflammation and swelling in the affected joint.

• Corticosteroid injections can be administered directly into the affected joint to provide relief from pain and inflammation [11].
• Oral corticosteroids may also be prescribed to manage symptoms of periarthritis [8].

Other Medications

Other medications, such as colchicine and novocaine blockades, may also be used in the treatment of periarthritis. However, their use is typically reserved for more severe cases or when other treatments have failed.

• Colchicine can help reduce inflammation and pain associated with periarthritis [14].
• Novocaine blockades involve injecting a local anesthetic into the affected joint to numb the area and provide relief from pain [15].

References

[1] JP Famaey, "Ibuprofen and diclofenac in the treatment of patients with periarthritis," 1984.

[4] "Nonsteroidal anti-inflammatory drugs (NSAIDs)," [5]

[8] V Pandey, "Corticosteroid: Apart from NSAIDs, steroids are the second most commonly used drugs in the treatment of the frozen shoulder," 2021.

[11] "Pharmacological treatment includes the use of analgesic or non-steroidal anti-inflammatory drugs, oral or intra-articular use of corticosteroids, and sodium hyaluronate injections."

[14] "Acute calcific periarthritis can be managed with a variety of nonsteroidal antiinflammatory drugs (NSAIDs) and colchicine."

[15] "Methods of immobilization, drug therapy (NSAIDs, corticosteroids), novocaine blockades, physiotherapy, massage, gymnastics are used in the treatment of shoulder-grabbing periarthritis."

Periarthritis, also known as calcific periarthritis, is a condition that requires accurate differential diagnosis to rule out other conditions with similar symptoms.

Common Differential Diagnoses

• Infectious Arthritis: This condition can be ruled out by the absence of soft tissue calcification in acute septic arthritis [8].
• Tendon-related HADD (Heterotopic Ossification): This condition should also be differentiated using physical examination and imaging findings [9].
• Gout: While gout typically has a higher frequency of joint involvement, it can sometimes mimic periarthritis in its presentation [12].
• CPPD (Calcium Pyrophosphate Deposition Disease): This condition is another differential diagnosis that should be considered based on clinical and radiographic findings [8].

Other Benign Calcifying or Ossifying Lesions

• Gout: Typically has a higher frequency of joint involvement, but can sometimes mimic periarthritis in its presentation [12].
• Pseudogout: A condition characterized by the deposition of calcium pyrophosphate dihydrate crystals in the joints.
• Tumoral Calcinosis: A rare condition that involves the deposition of calcium salts in soft tissues.
• Flexor Tenosynovitis: An inflammatory condition affecting the tendons and synovial sheaths.

Key Points to Consider

• Periarthritis is often misdiagnosed, particularly when it presents as a symptom of other conditions [10].
• Radiographs can be used to distinguish between periarthritis and acute pyogenic infection based on the absence of calcification in the latter [11].
• A high index of suspicion is necessary to diagnose periarthritis accurately, especially in cases where it may mimic other pathology.

References:

[4] Context 10 [6] Context 12 [8] Context 8 [9] Context 9 [10] Context 10 [11] Context 11 [12] Context 12