INVITED COMMENTARY This is a most welcome paper highlighting an uncommon an advanced infective lesion, the absence of lymphaden- condition which is usually misdiagnosed as infection, opathy, and the presence of calcium deposits on X-ray leading to inappropriate treatment. The authors are to be at the site of redness, swelling and pain. It is interesting warmly congratulated not only on the thoroughness and that one patient in this series had lymphangitis; does this clarity of their clinical evaluation and documentation of mean that calcium or a derivative has been scavenged and this group of patients, but also on the fact that they got entered the lymphatic drainage system? It is also valuable the diagnosis right and treated them appropriately. to know that radionuclide bone scans were generally un- CHAD, or calcific tendonitis as it is more often re- helpful. ferred to, exemplifies the high level of diagnostic acumen The sequence that can lead to correct diagnosis of this demanded of the practising hand surgeon, and more par- condition, with the avoidance of unnecessary surgery, is ticularly of doctors in the front line in accident depart- referral of an apparently infected hand, recognition of ments. The condition can closely imitate infection, yet normal ESR and white count and lack of regional lym- the treatment could not be more different, being conserva- phadenopathy, and suspicion of calcific tendonitis leading tive except in the presence of nerve compression or an un- to X-ray with confirmation of the diagnosis. This paper resolving solid mass of calcium deposits. Although it was should make such appropriate action possible through avoided in this series, it has been well documented that awareness. inappropriate surgery can at best do not good and at worst do considerable harm. Although the infrequency of re- D.M. Evans ported cases in the hand has meant that there is little men- The Hand Clinic, tion of it in the hand literature. Oakley Green, The crucial diagnostic features are normal ESR and Windsor, white count in the presence of what would appear to be Berks. SL4 4LH, UK Ms. No.: 429 Author: Evans Ms.: 1 Pages: 1 Springer-Verlag, Heidelberg / H. Stürtz AG, Würzburg Provisorische Seitenzahlen / Provisional page numbers 1. Korr.: Date: P European Journal of Plastic Surgery Springer Journals


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Copyright © 1998 by Springer-Verlag Berlin Heidelberg
Medicine & Public Health; Plastic Surgery
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