1124 - Regaining Functional Upper Extremity Range of Motion in Pediatric Patient with Juvenile Dermatomyositis-Related Calcinosis Universalis: A Case Report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

SW

Sean Weber, DO

Resident Physician
Shirley Ryan AbilityLab
Chicago, Illinois, United States
MM

Madeline Miller, MD

Resident Physician
Shirley Ryan AbilityLab, McGaw Medical Center
Chicago, Illinois, United States

Co-Author(s)

NH

Nova Hou, MD, MPH

Pediatric Rehabilitation Fellow
Northwestern University/Shirley Ryan Ability Lab
Chicago, Illinois, United States

Corresponding Author(s)

EC

Elizabeth Chan, MD

Pediatric Rehabilitation Attending Physician
Shirley Ryan Abilitylab
Chicago, Illinois, United States

Case Diagnosis: A 17-year-old male with juvenile dermatomyositis (JDM) was admitted to an inpatient rehabilitation facility (IRF) due to calcinosis universalis which significantly decreased range of motion (ROM) in bilateral upper extremities and impaired ability to perform activities of daily living (ADL’s).

Case Description:
After missing several weeks of immunosuppressant and anti-inflammatory medications, the patient was hospitalized with weakness, pain, and rapid functional decline. Most notably, he was unable to complete dressing or toileting due to severely impaired bilateral upper extremity ROM. On examination, impressive nodular calcium deposits were visualized and palpated throughout both arms, particularly at elbows and axillae where several open wounds were also present. Plain films demonstrated significant burden of subcutaneous calcinosis, but without intraarticular deposits.

Discussions:
Calcinosis is a known complication of JDM, yet there is little documented about management of severe cases. Prior to any manual manipulation, baseline imaging was obtained, and bone health was also discussed with his long-time rheumatologist. We then applied moist heat and gentle ROM to bilateral shoulders and elbows. Serial casting was contraindicated due to significant wounds on bilateral elbows, so soft, malleable splints were used nightly to maintain range. At discharge, our patient was able to perform self-care and toileting tasks independently. Over a four-week IRF stay, active ROM of bilateral upper extremities improved as represented by degrees of motion below.

Left shoulder:

Flexion: 50  75°

Abduction: 70  79°

External Rotation: 20  53°

Right shoulder:

Flexion 50  84°

Abduction: 55  79°

External Rotation: 20  55°

Left elbow range: 69-120  49-120°

Right elbow range: 67-116  45-116°

Conclusions:
To our knowledge, there are no other cases describing therapeutic modalities and medical interventions used to improve upper extremity ROM in patients with JDM-related calcinosis. Our case demonstrates that an IRF stay can help achieve functional ROM and improve independence.