Elsevier

Clinical Imaging

Volume 38, Issue 4, July–August 2014, Pages 380-383
Clinical Imaging

Review Article
Prevalence of sternoclavicular joint calcium pyrophosphate dihydrate crystal deposition on computed tomography,☆☆

https://doi.org/10.1016/j.clinimag.2014.02.016Get rights and content

Abstract

We sought to determine the prevalence of sternoclavicular (SC) joint calcium pyrophosphate dihydrate (CPPD) crystal deposition and its association with age, osteoarthritis, and atlantoaxial CPPD crystal deposition. In 209 consecutive patients, computed tomographic examinations of the cervical spine were retrospectively reviewed. Overall prevalence of CPPD crystal deposition in the SC joint was 17.2% (36/209), which increased with age (P<.0001). There was also a significant association between SC CPPD and osteoarthritis (P=.024) as well as atlantoaxial joint CPPD crystal deposition (P=.006).

Introduction

Calcium pyrophosphate dihydrate (CPPD) crystal deposition can occur in the following three forms: hereditary, sporadic, or associated with other disorders such as metabolic and degenerative joint diseases [1], [2]. CPPD crystals are usually observed bilaterally and symmetrically and are polyarticular in distribution [3], [4]. Crystals may be apparent in cartilage (i.e., chondrocalcinosis), capsule, tendons, synovium, ligaments, bursae, and soft tissues [2]. Intraarticular chondrocalcinosis can be detected in both hyaline cartilage and fibrocartilage [1], [2], [5], [6]. Calcification within fibrocartilage tends to appear thick and shaggy with irregular radiodense areas, particularly within the central aspect of the joint cavity. Calcification within hyaline cartilage has a thin linear appearance, paralleling the subjacent subchondral bone [2], [6].

Previous studies have indicated that the prevalence of CPPD crystal deposition increases with age [5]. Although CPPD crystal deposition generally is clinically asymptomatic, symptoms such as acute or chronic arthritis, pain, stiffness, swelling, and decreased range of motion have been observed [6], [7], [8]. In the sternoclavicular (SC) joint, joint space narrowing and bone sclerosis in cases of CPPD crystal deposition resemble osteoarthritis [9]. Additionally, however, calcification in hyaline cartilage or fibrocartilage, or both, may be evident, and perforation of the intraarticular disk is reported [10].

There are extensive studies about CPPD crystal deposition that have emphasized the importance of monitoring this condition [2], [5], [7], [10], [11], [12], [13], [14]. Furthermore, a recent study has confirmed an increased prevalence of CPPD crystal deposition in the atlantoaxial joint when compared with reported data and has found a positive correlation with age and retroodontoid soft tissue thickness [1].

To our knowledge, this is the first study in which the prevalence of CPPD crystal deposition in the SC joint is examined. To date, only a few case reports on this subject have been reported, which have focused on associated symptoms such as tenderness and swelling of the SC joint due to compression from the calcified mass [3], [14].

The purpose of this study was to (a) determine the prevalence of SC joint CPPD crystal deposition in a population of patients undergoing computed tomographic (CT) scanning for assessment of acute trauma and (b) to determine the association of SC joint CPPD crystal deposition with age, osteoarthritis, and atlantoaxial CPPD crystal deposition.

Section snippets

Material and methods

Our institutional review board approved this retrospective, HIPAA-compliant study with an exemption of informed consent. We used our picture archive and communication system (PACS) to search the medical records of all patients who were admitted to our Level I trauma center (both trauma triage and emergency room cases) between January 1, 2010, and March 31, 2010. Trauma patients underwent CT scanning of both the head and the cervical spine as part of our routine trauma protocol. As part of our

Population characteristics

The 209 patients included in the present study consisted of 129 males (median age, 49years; range, 19–98) and 80 females (median age, 65 years; range, 18–98). In our samples, the number of men outnumbered the number of women, and the women were significantly older than the men. Age and sex distributions are shown in Fig. 3 and Table 1.

SC CPPD crystal deposition

Thirty-six (22 woman and 14 men) of the 209 patients had calcification in either one or both SC joints. Of these 36, 27 demonstrated bilateral involvement, while

Discussion

In this study, we demonstrated that the prevalence of calcium CPPD crystal deposition in the SC joint is significant in the study population. We also have shown that, with advancing age, the prevalence of osteoarthritis and CPPD crystal deposition in the SC joint increases. Furthermore, there is an increase in the prevalence of CPPD crystal deposition after the age of 60years. A prior study on this same population was performed in 2013 [1] and demonstrated a high frequency of CPPD crystal

References (20)

  • CS Resnik et al.

    Crystal deposition disease

    Semin Arthritis Rheum

    (1983)
  • CS Resnik et al.

    Hand and wrist involvement in calcium pyrophosphate dihydrate crystal deposition disease

    J Hand Surg Am

    (1983)
  • EY Chang et al.

    Frequency of atlantoaxial calcium pyrophosphate dihydrate deposition at CT

    Radiology

    (2013)
  • D Resnick

    Diagnosis of bone and joint disorders

    (2002)
  • G De Marco et al.

    A rare case of chondrocalcinosis in the left sterno-clavicular joint

    Rheumatology (Oxford)

    (2011)
  • E Pascual

    The diagnosis of gout and CPPD crystal arthropathy

    Br J Rheumatol

    (1996)
  • M Abreu et al.

    Calcification in calcium pyrophosphate dihydrate (CPPD) crystalline deposits in the knee: anatomic, radiographic, MR imaging, and histologic study in cadavers

    Skeletal Radiol

    (2004)
  • LS Steinbach et al.

    Calcium pyrophosphate dihydrate crystal deposition disease revisited

    Radiology

    (1996)
  • T Thongngarm et al.

    Osteoarthritis of the sternoclavicular joint

    J Clin Rheumatol

    (2000)
  • CS Restrepo et al.

    Imaging appearances of the sternum and sternoclavicular joints

    Radiographics

    (2009)
There are more references available in the full text version of this article.

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Work performed at University of California, San Diego Medical Center.

☆☆

Eric Y. Chang, M.D., graciously acknowledges salary support from a VA CSR&D Career Development Award (5IK2CX000749).

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