Chondrocalcinosis Workup

  • Author: Neil J Barkin, MD, FAAOS; Chief Editor: Harris Gellman, MD   more...
 
Updated: Feb 7, 2012
 

Laboratory Studies

  • Because of the occasional association with the metabolic conditions listed above (ie, hyperparathyroidism, hemochromatosis, hemosiderosis, hypomagnesemia, hypophosphatemia), perform hematologic tests to exclude hyperparathyroidism (elevated serum calcium, decreased serum phosphate, elevated parathyroid hormone or parathormone, elevated alkaline phosphatase), hypomagnesemia, and hemochromatosis (increased serum ferritin).
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Imaging Studies

  • Plain x-ray films are most valuable diagnostically.
  • The presence of chondrocalcinosis (streaking of the soft tissues with calcium) is pathognomonic.
  • Attempts to identify calcium pyrophosphate using MRI have produced variable results; therefore, this technique is not yet suitable for routine screening.
  • A 3-dimensional saturated fat gradient echo technique appears to be more sensitive than plain x-ray films for identifying the presence of crystals in articular cartilage, yet it has not yet been proven to reveal meniscal involvement.
  • High-frequency ultrasonography provides a highly sensitive method to detect the presence of crystals in the synovial fluid and those deposited within soft tissue.[20, 21, 22]
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Diagnostic Procedures

  • Crystals are identified in synovial fluid analysis. Arthrocentesis yields calcium pyrophosphate crystals with their own distinct profile. These demonstrate weak positive birefringence on polarized light microscopy and are rhomboid in shape. The fluid itself most often demonstrates an elevated WBC count, which is indicative of inflammation (2,000-50,000 cells/µL). A WBC count exceeding 50,000 cells/µL suggests a septic joint; obtain cultures and perform a Gram stain.
  • The Diff-Quik staining method may be used with synovial fluid smears to produce specimens that can be examined for crystal detection and identification. This method may be valuable for delayed analysis situations, because it allows for cytologic examination and crystal identification for up to 2 years.[23]
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Histologic Findings

Soft tissues demonstrate the presence of crystal deposition with adjacent chondroid metaplasia. Synovial hyperplasia with inflammatory changes often is visualized and may be mild to moderate, consisting of mononuclear cells. In tophaceous pseudogout, giant cells often are visualized.

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Contributor Information and Disclosures
Author

Neil J Barkin, MD, FAAOS  Consulting Surgeon, Capitol Orthopaedics & Rehabilitation, LLC

Neil J Barkin, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Anne Tesar, PA-C  Physician Assistant, Capitol Orthopaedics and Rehabilitation, LLC

Anne Tesar, PA-C is a member of the following medical societies: American Academy of Physician Assistants

Disclosure: Nothing to disclose.

Specialty Editor Board

Jegan Krishnan, MBBS, FRACS, PhD  Professor, Chair, Department of Orthopedic Surgery, Flinders University of South Australia; Senior Clinical Director of Orthopedic Surgery, Repatriation General Hospital; Private Practice, Orthopaedics SA, Flinders Private Hospital

Jegan Krishnan, MBBS, FRACS, PhD, is a member of the following medical societies: Australian Medical Association, Australian Orthopaedic Association, and Royal Australasian College of Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Paul E Di Cesare, MD, FACS  Professor, Department of Orthopedic Sugery, University of California, Davis, School of Medicine

Paul E Di Cesare, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and Sigma Xi

Disclosure: Stryker Consulting fee Consulting; Smith & Nephew Consulting fee Consulting

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

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Left images depict femoral and tibial surfaces. Right images depict anterior cruciate ligament.
Upper left image depicts anterior horn medial meniscus. Lower left image depicts undersurface of meniscus. Upper right image depicts medial femoral condyle. Lower right image depicts synovium.
 
 
 
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