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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. [ABSTRACT FROM AUTHOR]

Background: The management of frozen shoulder (FS) differs depending on experience level and variation between scientific guidelines and actual practice. Purpose: To determine the current trends and practices in the management of FS among shoulder specialists and compare them with senior shoulder specialists. Study Design: Consensus statement. Methods: A team of 15 senior shoulder specialists (faculty group) prepared a questionnaire comprising 26 questions regarding the definition, terminology, clinical signs, investigations, management, and prognosis of FS. The questionnaire was mailed to all the registered shoulder specialists of Shoulder and Elbow Society, India (SESI) (specialist group; n = 230), as well as to the faculty group (n = 15). The responses of the 2 groups were compared, and levels of consensus were determined: strong (>75%), broad (60%-74.9%), inconclusive (40%-59.9%), or disagreement (<40%). Result: Overall, 142 of the 230 participants in the specialist group and all 15 participants in the faculty group responded to the survey. Both groups strongly agreed that plain radiographs are required to rule out a secondary cause of FS, routine magnetic resonance imaging is not indicated to confirm FS, nonsteroidal anti-inflammatory drugs should be administered at bedtime, steroid injection (triamcinolone or methylprednisolone) is the next best option if analgesics fail to provide pain relief, passive physical therapy should be avoided in the freezing phase, <10% of patients would require any surgical intervention, and patients with diabetes and thyroid dysfunction tend to fare poorly. There was broad agreement that routine thyroid dysfunction screening is unnecessary for women, a single 40-mg steroid injection via intra-articular route is preferred, and arthroscopic capsular release (ACR) results in a better outcome than manipulation under anesthesia (MUA). Agreement was inconclusive regarding the use of combined random blood sugar (RBS) and glycosylated hemoglobin versus lone RBS to screen for diabetes in patients with FS, preference of ACR versus MUA to treat resistant FS, and the timing of surgical intervention. There was disagreement over the most appropriate term for FS, the preferred physical therapy modality for pain relief, the most important movement restriction for early diagnosis of FS, and complications seen after MUA. Conclusion: This survey summarized the trend in prevalent practices regarding FS among the shoulder specialists and senior shoulder surgeons of SESI. [ABSTRACT FROM AUTHOR]