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Sample records for tenosynovitis

  1. Stenosing tenosynovitis

    Science.gov (United States)

    Vuillemin, V.; Guerini, H.; Bard, H.; Morvan, G.

    2012-01-01

    Tenosynovitis refers to an inflammatory condition involving the synovial sheath of a tendon. Stenosing tenosynovitis is a peculiar entity caused by multiple factors, including local anatomy, mechanical factors, and hormonal factors. The main forms include de Quervain tendinopathy; trigger finger (stenosing tenosynovitis involving the flexor digitorum tendons); stenosing tenosynovitis of the extensor carpi ulnaris, extensor carpi radialis, or extensor comunis tendons; stenosing tenosynovitis of the flexor hallucis tendon; and stenosing tenosynovitis of the peroneal tendons. The cardinal finding on ultrasonography is the presence of a thickened retinaculum or pulley that constricts the osseofibrous tunnel through which the tendon runs. PMID:23396894

  2. De Quervain's Tenosynovitis

    Science.gov (United States)

    Diseases and Conditions De Quervain's tenosynovitis By Mayo Clinic Staff De Quervain's tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful ... side of your wrist. If you have de Quervain's tenosynovitis, it will probably hurt when you turn ...

  3. Tuberculous Peroneal Tenosynovitis

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    Yu Chung Wong

    2016-06-01

    Full Text Available Musculoskeletal tuberculosis accounts for 1–5% of all cases of tuberculosis. Tuberculous tenosynovitis is an uncommon form of musculoskeletal tuberculosis occurring primarily in the hands and wrists and is rarely reported in the tendons of the feet. A case of tuberculous peroneal tenosynovitis is reported. Although tuberculosis is an uncommon cause of tenosynovitis, particularly in the foot, it should be included in the differential diagnosis of patients suffering from persistent swelling and pain in the hind foot, especially in countries where tuberculosis is prevalent.

  4. Sonographic characterization of tenosynovitis

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    Seo, Gwy Suk; Lim, Hyo Keum; Lee, In Jae; Lee, Kil Woo; Bae, Sang Hoon; Lee, Kyung Hwan [College of Medicine, Hallym University, Seoul (Korea, Republic of)

    1992-03-15

    Tenosynovitis of the extremities is not uncommon but its diagnosis is not easy owing to its non-specific clinical manifestation. Thus it was beyond the field of imaging diagnosis so far. Recently the development of high resolution ultrasonogram has aided preoperative imaging diagnosis of tenosynovitis. The authors performed a retrospective reviewed of 27 patients who had ultrasonography due to tendon pathology(including 18 tenosynovitis) by observing sonographic findings and evaluation the diagnosis value of each finding. The overall diagnostic accuracy was 81.1% and common sonographic findings were focal swelling of the tendon, well-defined margin of the lesion, preserved fibrillar pattern, echo change of the lesion site and fluid collection. Above all, fluid collection. was the only statistically significant criterion for diagnosis of tenosynovitis(p<0.05). But its sensitivity was as low as 50%. In conclusion the ultrasonography is useful in diagnosis of tenosynovitis and fluid collection is of diagnostic value, but the differentiation between nodular tenosynovitis without fluid collection and other benign tumor is still beyond the scope of ultrasonographic diagnosis.

  5. 9 CFR 113.332 - Tenosynovitis Vaccine.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Tenosynovitis Vaccine. 113.332 Section... Virus Vaccines § 113.332 Tenosynovitis Vaccine. Tenosynovitis Vaccine shall be prepared from virus... pure, safe, and immunogenic shall be used for preparing seeds for vaccine production. All serials of...

  6. Tenosynovitis: An unusual presentation of leprosy

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    Sukriti Baveja

    2017-01-01

    Full Text Available Tenosynovitis is an uncommon presentation of Type 1 reaction in leprosy. Herein, we report a case of bilateral tenosynovitis of wrist joints who after being unsuccessfully treated by a rheumatologist for several months, was finally diagnosed as a case of Hansen's disease (borderline lepromatous with Type 1 reaction.

  7. De Quervain disease caused by abductor pollicis longus tenosynovitis: a report of three cases.

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    Maruyama, Masahiro; Takahara, Masatoshi; Kikuchi, Noriaki; Ito, Kazuo; Watanabe, Tadayoshi; Ogino, Toshihiko

    2009-01-01

    De Quervain disease is caused by a stenosing tenosynovitis in the first dorsal compartment, and the main aetiology is extensor pollicis brevis (EPB) tenosynovitis. We encountered three cases in which EPB tenosynovitis was absent and abductor pollicis longus (APL) tenosynovitis was confirmed during operation. In the treatment of de Quervain disease, APL tenosynovitis should be paid as much attention as EPB tenosynovitis.

  8. Tenosynovitis

    Science.gov (United States)

    ... cuts to the hand, wrist, ankle, and foot. Alternative Names Inflammation of the tendon sheath References Biundo JJ. Bursitis, tendinitis, and other periarticular disorders and sports medicine. In: Goldman L, Schafer AI, eds. Goldman- ...

  9. The scintigraphic appearance of de Quervain tenosynovitis.

    Science.gov (United States)

    Leslie, William D

    2006-10-01

    The purpose of this study is to describe the scintigraphic pattern of de Quervain tenosynovitis, a common inflammatory condition of the thumb tendon sheaths related to repetitive use. The author conducted a retrospective audit of consecutive cases with independent clinical validation of the final diagnosis. There were 7 cases of clinically confirmed de Quervain tenosynovitis. The typical scintigraphic finding was a focal area of superficial linear hyperemia and skeletal uptake along the radial aspect of the distal radius corresponding to the anatomic location of the abductor pollicis longus and extensor pollicis brevis. All cases showed an abnormality on at least one phase of the bone scan. Bone scanning appears to be of value in the differential diagnosis of dorsolateral wrist pain when clinical findings are nondiagnostic. The scintigraphic appearance of de Quervain tenosynovitis can help to confirm the diagnosis while excluding other causes of wrist pain. Determining the sensitivity and specificity of this pattern will require further research.

  10. "It's just de Quervain's tenosynovitis" : case report

    National Research Council Canada - National Science Library

    Douglas, Robert; Nguyen, Anthony; Saies, Andrew; Asopa, Vipin

    2014-01-01

    .... She neither drank nor smoked. An X-ray of the wrist was reported to be normal. A diagnosis of de Quervain's tenosynovitis was made and she was treated with anti-inflammatory drugs and physiotherapy, and received an injection of corticosteroid...

  11. Corticosteroid injection for de Quervain's tenosynovitis

    NARCIS (Netherlands)

    Peters-Veluthamaningal, Cyriac; van der Windt, Danielle A. W. M.; Winters, Jan C.; Jong, Betty Meyboom-de

    2009-01-01

    Back ground De Quervain's tenosynovitis is a disorder characterised by pain on the radial (thumb) side of the wrist and functional disability of the hand. It can be treated by corticosteroid injection, splinting and surgery. Objectives To summarise evidence on the efficacy and safety of

  12. De quervain tenosynovitis of the wrist.

    Science.gov (United States)

    Ilyas, Asif M; Ilyas, Asif; Ast, Michael; Schaffer, Alyssa A; Thoder, Joseph

    2007-12-01

    De quervain disease, or stenosing tenosynovitis of the first dorsal compartment of the wrist, is a common wrist pathology. Pain results from resisted gliding of the abductor pollicis longus and the extensor pollicis brevis tendons in the fibro-osseus canal. de Quervain tenosynovitis of the wrist is more common in women than men. Diagnosis may be made on physical examination. Radiographs are helpful in ruling out offending bony pathology. Nonsurgical management, consisting of corticosteroid injections and supportive thumb spica splinting, is usually successful. In resistant cases, surgical release of the first dorsal compartment is done, taking care to protect the radial sensory nerve and identify all accessory compartments. Repair of the extensor retinaculum by step-cut lengthening or other techniques is rarely required.

  13. Tubercular tenosynovitis of extensor tendons of foot--a rare ...

    African Journals Online (AJOL)

    Tuberculosis of soft tissues as a result of spread from adjacent bone or joint is a well recognized entity. However isolated tuberculous pyomyositis, bursitis and tenosynovitis are rare, constituting about 1% of skeletal tuberculosis. Tubercular tenosynovitis commonly involves tendon sheaths of wrist and hand. Cases of ...

  14. Ankle tenosynovitis in rheumatoid arthritis: clinical and ultrasonographic evaluation

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    Ana Luiza Naves Pereira

    2016-11-01

    Full Text Available Objective: To investigate ankle tenosynovitis in rheumatoid arthritis patients, regarding its presence, the kind of tendon involved and the concordance between clinical and ultrasound findings. Methods: Twenty patients with rheumatoid arthritis and pain or swollen ankle joint were evaluated. Tendon involvement was evaluated with ultrasound imaging. The Health Assessment Questionnaire (HAQ was performed for disability evaluation. Age, sex, disease duration, and vocational activity levels were also obtained. The statistical analysis included Fisher’s exact test. The significance level was 0.05. Results: Tenosynovitis was found in 13 of 20 (65.0% patients in 19 joints, in which 6 were bilaterally (46.1% and unilateral in 7 (53.8%. Tibialis posterior tenosynovitis was seen in nine (45.0% patients, Achilles tenosynovitis in seven (35.0%, tibialis anterior tenosynovitis in three (15.0%, and peroneal tenosynovitis in three (15.0% patients. We found concordance between symptomatic ankle and ultrasonographic findings in 92.3% of the patients with tenosynovitis. Association between severe HAQ with tendon involvement was not found (p>0.05. Disease duration was not associated with tenosynovitis. Patients were predominantly older, female, with mean age around 50.8 years. The long disease duration of patients presented a mean of 11.4 years and, most of them, with no vocational activity (65.0%. Conclusions: The results indicate that ankle tenosynovitis is very common in rheumatoid arthritis patients, both unilateral and bilateral. Tibialis posterior was the most common tendon involvement found. Finally, we found concordance between the clinical and ultrasound findings in almost all rheumatoid arthritis patients with ankle tenosynovitis.

  15. Corticosteroid injection for de Quervain's tenosynovitis.

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    Peters-Veluthamaningal, Cyriac; van der Windt, Daniëlle A W M; Winters, Jan C; Meyboom-de Jong, Betty

    2009-07-08

    De Quervain's tenosynovitis is a disorder characterised by pain on the radial (thumb) side of the wrist and functional disability of the hand. It can be treated by corticosteroid injection, splinting and surgery. To summarise evidence on the efficacy and safety of corticosteroid injections for de Quervain's tenosynovitis. We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 2), MEDLINE (1966 to April 2009), EMBASE (1956 to April 2009), CINAHL (1982 to April 2009), AMED (1985 to April 2009), DARE, Dissertation Abstracts and PEDro (physiotherapy evidence database). Randomised and controlled clinical trials evaluating the efficacy and safety of corticosteroid injections for de Quervain's tenosynovitis. After screening abstracts of studies identified by the search we obtained full text articles of studies which fulfilled the selection criteria. We extracted data using a predefined electronic form. We assessed the methodological quality of included trials by using the checklist developed by Jadad and the Delphi list. We extracted data on the primary outcome measures: treatment success; severity of pain or tenderness at the radial styloid; functional impairment of the wrist or hand; and outcome of Finkelstein's test, and the secondary outcome measures: proportion of patients with side effects; type of side effects and patient satisfaction with injection treatment. We found one controlled clinical trial of 18 participants (all pregnant or lactating women) that compared one steroid injection with methylprednisolone and bupivacaine to splinting with a thumb spica. All patients in the steroid injection group (9/9) achieved complete relief of pain whereas none of the patients in the thumb spica group (0/9) had complete relief of pain, one to six days after intervention (number needed to treat to benefit (NNTB) = 1, 95% confidence interval (CI) 0.8 to 1.2). No side effects or local complications of

  16. Forgotten but Not Gone! Syphilis Induced Tenosynovitis

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    Felicia Ratnaraj

    2016-01-01

    Full Text Available Objective. Tenosynovitis, inflammation of a tendon and its synovial sheath, is a rare manifestation of secondary syphilis and if diagnosed early is reversible. Background. A 52-year-old male with past medical history of untreated syphilis presented with gradual onset of swelling and pain of the right fourth metacarpophalangeal joint (MCP. He reported a history of painless penile lesions after having sexual intercourse with a new partner approximately five months ago which was treated with sulfamethoxazole/trimethoprim. An RPR done at that time came back positive with a high titer; however, patient was lost to follow-up. On examination, patient had an edematous, nonerythematous right fourth proximal interphalangeal (PIP joint. Urgent irrigation, debridement, and exploration of the right hand into the tendon sheath were performed. With his history of syphillis, an RPR was done, which was reactive with a titer of 1 : 64. A confirmatory FTA-ABS test was completed, rendering a positive result. Based on his history of untreated syphilis, dormancy followed by clinical scenario of swelling of the right fourth finger, and a high RPR titer, he was diagnosed with secondary syphilis manifesting as tenosynovitis.

  17. Intravitreal injections inducing de quervain tenosynovitis: injector's wrist.

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    Belliveau, Michel J; Leung, Christina; Abouammoh, Marwan A

    2015-01-01

    To describe a case of de Quervain tenosynovitis triggered by the repetitive performance of intravitreal injections. Case report of a 32-year-old ophthalmologist. The ophthalmologist experienced de Quervain tenosynovitis while performing 425 intravitreal injections a month. These were predominantly performed in condensed sessions (injection clinics). Symptoms resolved with nonsurgical management. The repetitive performance of intravitreal injections may be an unrecognized occupational hazard for ophthalmologists.

  18. The prevalence of tenosynovitis of the interosseous tendons of the hand in patients with rheumatoid arthritis

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    Rowbotham, Emma L. [Leeds Teaching Hospitals NHS Trust, Musculoskeletal Radiology Department, Leeds (United Kingdom); Freeston, Jane E. [Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom); Emery, Paul [University of Leeds, Arthritis Research UK, Leeds Musculoskeletal Biomedical Research Unit, LTHT Leeds Institute of Rheumatic Musculoskeletal Medicine, Leeds (United Kingdom); Grainger, Andrew J. [Leeds Teaching Hospitals NHS Trust, Musculoskeletal Radiology Department, Leeds (United Kingdom); Chapel Allerton Hospital, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds (United Kingdom)

    2016-02-15

    The aim of this study was to establish the prevalence of tenosynovitis affecting the interosseous tendons of the hand in a rheumatoid arthritis (RA) population and to assess for association with metacarpophalangeal (MCP) joint synovitis, flexor tendon tenosynovitis or ulnar drift. Forty-four patients with RA underwent hand MRI along with 20 normal controls. Coronal 3D T1 VIBE sequences pre- and post-contrast were performed and reconstructed. The presence of interosseous tendon tenosynovitis was recorded alongside MCP joint synovitis, flexor tendon tenosynovitis and ulnar drift. Twenty-one (47.7 %) patients with RA showed interosseous tendon tenosynovitis. Fifty-two (14.8 %) interosseous tendons showed tenosynovitis amongst the RA patients. Interosseous tendon tenosynovitis was more commonly seen in association with adjacent MCP joint synovitis (p < 0.001), but nine MCP joints (5.1 %) showed adjacent interosseous tenosynovitis in the absence of joint synovitis. Interosseous tendon tenosynovitis was more frequently seen in fingers which also showed flexor tendon tenosynovitis (p < 0.001) and in patients with ulnar drift of the fingers (p = 0.01). Tenosynovitis of the hand interosseous tendons was found in 47.7 % of patients with RA. In the majority of cases this was adjacent to MCP joint synovitis; however, interosseous tendon tenosynovitis was also seen in isolation. (orig.)

  19. Tuberculous Tenosynovitis Presenting as Ganglion of Wrist

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    Shahaji Chavan

    2012-01-01

    Full Text Available Tuberculosis (TB is still endemic in many developed countries. Involvement of the hand and wrist at presentation is extremely rare, and the diagnosis is often missed. A 57 years old male presented with swelling over the left wrist since 3 years Three swellings over dorsal aspect of the left wrist Soft in consistency Non tender Non compressible Mobile at right angles to the plane of the wrist joint. ESR: 45 mm in 1 hr and rest blood investigations were normal. Ultrsonography showed giant cell tumor of Extensor Digitorum sheath. X-ray: soft tissue swelling and MRI was suggestive of extensor tendon sheath extraskeletal synovial Koch’s, or giant cell tumor of tendon sheath. Excision of swelling was planned and intraoperatively, rice bodies were seen inside it. Histopathological examination showed caseous necrosis with granuloma formation. Patient was put on DOT1 therapy. Tuberculous tenosynovitis was first described by Acrel in 1777. Rice bodies occurring in joints affected by tuberculosis were first described in 1895 by Reise. Rice bodies will be diagnosed on plain radiographs when mineralization occurs. More than 50% of cases recur within 1 year of treatment. The currently recommended 6-month course is often adequate with extensive curettage lavage and synovectomy should be performed. Surgery is essential, but the extent of surgical debridement is still debatable. The surgeon has to be aware of the significance of loose bodies when performing routine excision of innocuous looking wrist ganglia.

  20. Intraneural ganglion in superficial radial nerve mimics de quervain tenosynovitis.

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    Haller, Justin M; Potter, Michael Q; Sinclair, Micah; Hutchinson, Douglas T

    2014-11-01

    Background Intraneural ganglions in peripheral nerves of the upper extremity are extremely rare and poorly understood. Case Description We report a patient with symptoms consistent with de Quervain tenosynovitis who was found to have an intraneural ganglion in the superficial radial nerve. The ganglion did not communicate with the wrist joint. We removed the intraneural ganglion, and the patient's symptoms resolved. At her 6-month postoperative follow-up, she remained asymptomatic.  There is only one case report of intraneural ganglion in the superficial radial nerve. In that case, the patient had symptoms consistent with nerve irritation, including radiating pain and paresthesias. In contrast to that previous report, the patient in the current case had only localized pain, no paresthesias, and a physical exam consistent with de Quervain tenosynovitis. Clinical Relevance This case demonstrates that an intraneural ganglion cyst can mimic the symptoms of de Quervain tenosynovitis without the more usual presentation of painful paresthesias.

  1. Incidence of de Quervain's tenosynovitis in a young, active population.

    Science.gov (United States)

    Wolf, Jennifer Moriatis; Sturdivant, Rodney X; Owens, Brett D

    2009-01-01

    De Quervain's tenosynovitis is thought to occur most frequently in women, with presentation of pain and swelling in the first dorsal extensor sheath. The epidemiology of this extensor tendinitis is not well described. We evaluated the incidence and demographic risk factors for de Quervain's tenosynovitis using a large database of military personnel. The Defense Medical Epidemiology Database (DMED) collects International Classification of Diseases, 9th Revision, and Clinical Modification (ICD-9-CM) coding information for every patient encounter occurring for United States military personnel. We queried the DMED system by race, gender, military service, rank, and age for the years 1998-2006 using the ICD-9 code 727.04, limiting data to first presentations. Multivariate Poisson regression was used to estimate the rate of de Quervain's tenosynovitis per 1000 person-years, as well as incidence rate ratios and 95% confidence intervals. There were 11,332 cases of de Quervain's tenosynovitis in the population at risk of 12,117,749 person-years. Women had a significantly higher rate of de Quervain's tenosynovitis at 2.8 cases per 1000 person-years, compared to men at 0.6 per 1000 person-years. Age greater than 40 was also a significant risk factor, with this age category showing a rate of 2.0 per 1000 person-years compared to 0.6 per 1000 in personnel under 20 years. There was also a racial difference, with blacks affected at 1.3 per 1000 person-years compared to whites at 0.8. In analysis of a large population, we have described the epidemiology of stenosing tenosynovitis of the first extensor compartment. Risk factors for de Quervain's in our population include female gender, age greater than 40, and black race. Prognostic II.

  2. Osteoid osteoma of the radial styloid mimicking de quervain tenosynovitis.

    Science.gov (United States)

    Chloros, George D; Themistocleous, George S; Papagelopoulos, Panayiotis J; Khaldi, Lubna; Efstathopoulos, Dimitrios G; Soucacos, Panayotis N

    2007-10-01

    A very unusual location of osteoid osteoma arising in the radial styloid is presented, which strongly mimicked de Quervain tenosynovitis, thereby resulting in the patient undergoing an additional unnecessary operation and a substantial delay of more than 2 years in diagnosis.

  3. Shear wave elastography findings of de Quervain tenosynovitis.

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    Turkay, Rustu; Inci, Ercan; Aydeniz, Banu; Vural, Meltem

    2017-10-01

    Our aim was to evaluate the feasibility of using shear wave elastography (SWE) to assess first extensor compartment tendons rigidity and its alterations with tenosynovitis. We performed B-mode ultrasound and SWE to total number of 80 participants. All participants were evaluated clinically to call the diagnosis of de Quervain tenosynovitis or to rule out the diagnosis. We composed 2 groups. Group 1 included 40 healthy volunteers (33 females and 7 male participants with ages ranging from 24 to 60 years, median age was 37.5 years) and group 2 had 40 de Quervain patients (32 females and 8 male patients with ages ranging from 25 to 51 years, median age was 34 years). SWE measurements were repeated 3 times and arithmetic average was used for the final SWE value. The median SWE value of healthy group (group 1) was 72kPa and the de Quervain patient group (group 2) was 29kPa. Two groups demonstrated statistically significant difference (p<0.001). The ROC curve analysis was performed and the SWE value of 40.5kPA was calculated as a cut-off value for the diagnosis of de Quervain tenosynovitis with 95% specificity and 85% sensitivity. SWE modality can provide useful data regarding de Quervain tenosynovitis. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Hyperparathyroidism-related extensor tenosynovitis at the wrist: a general review of the literature.

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    Ichihara, Satoshi; Hidalgo-Diaz, Juan Jose; Prunières, Guillaume; Facca, Sybille; Bodin, Frédéric; Boucher, Stéphanie; Liverneaux, Philippe

    2015-07-01

    Extensor tenosynovitis often occurs accompanying with rheumatoid arthritis, gout, trauma, mycobacterium and dialysis-related amyloidosis. However, there is no recognition of extensor tenosynovitis accompanying with hyperparathyroidism. The purpose of this general review was to describe the clinical condition and to report the results of surgical intervention in the extensor tenosynovitis at the wrist related to hyperparathyroidism. Hyperparathyroidism is thought to be a rare disease in adult. Although renal symptoms are the commonest symptom, musculoskeletal complaints also occur in hyperparathyroidism. From our general review, hyperparathyroidism deserves consideration in the differential diagnosis of extensor tenosynovitis at the wrist.

  5. Mycoplasma Corogypsi–Associated Polyarthritis and Tenosynovitis in Black Vultures (Coragyps atratus)

    National Research Council Canada - National Science Library

    Wettere, A. J. Van; Ley, D. H; Scott, D. E; Buckanoff, H. D; Degernes, L. A

    2013-01-01

    .... Prolonged antibiotic therapy administered in 2 birds did not improve the clinical signs. Necropsy and histological examination demonstrated a chronic lymphoplasmacytic arthritis involving multiple joints and gastrocnemius tenosynovitis...

  6. Synovitis and tenosynovitis in Brazil: analysis of sickness benefit claims.

    Science.gov (United States)

    Andrade, Dilma Maria de; Barbosa-Branco, Anadergh

    2015-01-01

    To analyse the personal and occupational factors associated with the prevalence and duration of sickness benefit claims due to synovitis and tenosynovitis (CID10 M65). Cross-sectional study regarding sickness benefit claims due to synovitis and tenosynovitis granted to employees by National Institute of Social Security in Brazil in 2008. Data on economic activity (Economic Activities National Classification - CNAE division, class), sex, age, type and duration of benefits were collected from the Unified Benefit System. The study's population consists of the average monthly employment contracts declared to the National Register of Social Information. In 2008, 35,601 employees were granted sickness benefits due to synovitis and tenosynovitis, with a prevalence of 10.9/10,000 employments. Sickness benefits showed higher prevalence rates (PR) for work-related claims (PR 1,2), mostly made by females (PR 3.3) and by workers older than 39 years (PR 1,4). The CNAE 37-Sewage (55.4) and 60-Broadcasting Activity (47.1) had the highest overall prevalence. However, the 64-Financial service activities, except insurance and pension funding and 6422-Multiple banks with commercial service had the highest rates of work-related claims (RP 3.2 and 3.8, respectively), and the longer duration (70 and 73 days, respectively). Workers older than 39 years had the highest durations of work disability claims. Both the CNAE-division 60-Broadcasting Activity, and the CNAE-class 6010-Radio showed a high activity ratio of females (PR 8.1 and 10.8, respectively). The work disability due to synovitis and tenosynovitis presents prevalence and duration associated with economic activity, sex, age and kind of benefit (non work-related and work-related claims).

  7. Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice

    NARCIS (Netherlands)

    Peters-Veluthamaningal, Cyriac; Winters, Jan C.; Groenier, Klaas H.; Meyboom-deJong, Betty

    2009-01-01

    Background: De Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist and leads to wrist pain and to impaired function of the wrist and hand. It can be treated by splinting, local corticosteroid injection and operation. In this study effectiveness of local

  8. Aseptic tenosynovitis of the digital flexor tendon sheath, fetlock and pastern annular ligament constriction.

    Science.gov (United States)

    Dik, K J; Dyson, S J; Vail, T B

    1995-08-01

    The anatomy of the digital flexor tendon sheath and related tendons and ligaments is described. Diagnosis and management of acute tenosynovitis and long-term tenosynovitis and associated tendon injuries are discussed, as well as the syndrome of stenosis of the fetlock canal (or fetlock annular ligament constriction) and palmar annular ligament constriction. Desmitis of the palmar annular ligament is also described.

  9. Focal radial styloid abnormality as a manifestation of de Quervain tenosynovitis.

    Science.gov (United States)

    Chien, A J; Jacobson, J A; Martel, W; Kabeto, M U; Marcantonio, D R

    2001-12-01

    de Quervain disease is a stenosing tenosynovitis of the first dorsal wrist compartment. The purpose of this study was to determine whether focal radial styloid abnormality (cortical erosion, sclerosis, or periosteal bone apposition) as shown by radiography can be an indicator of de Quervain tenosynovitis. A retrospective review of 49 radiographs from 45 patients in whom the clinical diagnosis of de Quervain tenosynovitis was confirmed (positive findings on Finkelstein's test) and 64 radiographs from 62 asymptomatic patients was carried out independently by two musculoskeletal radiologists in a blinded fashion. Findings on radiographs were assessed for focal radial styloid abnormality and assigned a diagnostic grade (1, definitely normal; 2, probably normal; 3, equivocal; 4, probably abnormal; 5, definitely abnormal). Receiver operating characteristic curves were constructed and compared. Kappa statistics for interobserver and intraobserver variability were calculated. The presence of focal radial styloid abnormality correlated significantly with the presence of de Quervain tenosynovitis (p Quervain stenosing tenosynovitis of the wrist.

  10. [Closed irrigation system for pyogenic flexor tenosynovitis of the hand].

    Science.gov (United States)

    Pillukat, T; Schädel-Höpfner, M; Prommersberger, K-J; van Schoonhoven, J

    2011-07-01

    Treatment of pyogenic flexor tenosynovitis within the osteofibrous channel of the thumb and finger by insertion of a closed irrigation system. Pyogenic tenosynovitis of the flexor tendons of the hand. Necrosis of the flexor tendons or flexor tendon sheath, gangrene of the finger, extensive loss of soft tissue. Insertion of a flexible irrigation catheter via a guide wire into the flexor tendon sheath and a vacuum suction drain into the finger or the palm of the hand. Extensive exploration of the flexor tendon sheath is not mandatory. On days 0-3 continuous irrigation, on day 4 change of the irrigation catheter to suction, on day 5 removal of the irrigation catheter, on day 6 removal of the suction drain, on day 7 start of exercise. Irrigation volume: about 500-1500 ml/24 h isotonic solution. Of 35 patients treated for flexor tenosynovitis by closed irrigation, 33 were reviewed. There were 19 male patients and 14 female patients. The average age at the time of surgery was 51 (8-85) years. Hospital stay was 8.9 (3-26) days on average. At the time of follow-up, the average grip strength was 84% (23-163%) of the unaffected side. Pain at rest was 0.2 (0-4), pain during exercise 1.2 (0-8) on the analogue scale, the DASH score was 16.8 (0-58) points. According to the rating system for flexor tendon function, there were one poor, one fair, five good, and 26 excellent results.

  11. MRI assessment of tenosynovitis in children with juvenile idiopathic arthritis: inter- and intra-observer variability

    Energy Technology Data Exchange (ETDEWEB)

    Lambot, Karen; Brunelle, Francis [Hopital Necker-Enfants Malades, Department of Paediatric Radiology, Paris (France); Boavida, Peter [Great Ormond Street Hospital, Department of Radiology, London (United Kingdom); Damasio, Maria Beatrice [Ospedale Pediatrico Gaslini, Department of Radiology, Genoa (Italy); Tanturri de Horatio, Laura; Barbuti, Domenico [Ospedale Pediatrico Bambino Gesu, Department of Radiology, Rome (Italy); Desgranges, Marie; Bader-Meunier, Brigitte; Quartier, Pierre [Hopital Necker-Enfants Malades, Department of Paediatric Immunology, Hematology and Rheumatology, APHP French Reference Center ' ' Arthrites juveniles' ' , Paris (France); Malattia, Clara [University of Genoa, Department of Paediatrics, Genoa (Italy); Bracaglia, Claudia [Ospedale Pediatrico Bambino Gesu, Department of Paediatrics, Rome (Italy); Ording Mueller, Lil-Sofie [Great Ormond Street Hospital, Department of Radiology, London (United Kingdom); University Hospital of North Norway, Department of Radiology, Tromsoe (Norway); Elie, Caroline [Paris Descartes University, Department of Biostatistics, Hopital Necker-Enfants Malades, Paris (France); Rosendahl, Karen [Great Ormond Street Hospital, Department of Radiology, London (United Kingdom); Haukeland University Hospital, Department of Radiology, Bergen (Norway)

    2013-07-15

    There is sparse knowledge about grading tenosynovitis using MRI. The purpose of this study was to assess the reliability of a tenosynovitis MRI scoring system in juvenile idiopathic arthritis. Children with juvenile idiopathic arthritis and wrist involvement were enrolled in two paediatric centres, from October 2006 to January 2010. The extensor (compartments II, IV and VI) and flexor tendons were assessed for the presence of tenosynovitis on T1-weighted postcontrast fat-saturated MR images and were scored from 0 (normal) to 2 (moderate to severe) by two observers independently. Intra- and interobserver agreement was assessed. Ninety children (age range: 5-18.5 years) were included, of whom 34 had tenosynovitis involving extensors and 28 had tenosynovitis involving flexors. A total of 360 tendon areas were analysed, of which 114 had tenosynovitis (86/270 extensors and 28/90 flexors). Intra-reader 1 agreement was excellent for the extensors (k = 0.82-0.91) and for the flexors (k = 0.85); intra-reader 2 agreement was moderate to good for the extensors (k = 0.51-0.72) and good for the flexors (k = 0.64). Inter-reader agreement was good for the extensors (k = 0.69-0.73) and moderate for the flexors (k = 0.49). The proposed MRI scoring system for the assessment of wrist tenosynovitis in juvenile idiopathic arthritis appears feasible with an observer agreement sufficient for clinical use. (orig.)

  12. Persistent de Quervain tenosynovitis induced by somatotropin treatment.

    Science.gov (United States)

    Yurdakul, Ozan Volkan; Aytüre, Lütfiye; Yalçinkaya, Ebru Yilmaz

    2017-10-09

    Growth hormone deficiency is a well-known clinical entity that is usually treated with somatotropin (growth hormone). Growth hormone has some frequent side effects such as intracranial hypertension, lymphedema and diabetes mellitus. We report the case of a 14-year-old girl with a history of wrist pain and clumsiness. Magnetic resonance imaging revealed de Quervain tenosynovitis. The patient had a history of using growth hormones for 12 months. We conservatively managed the patient with corticosteroid injections and oral nonsteroidal anti-inflammatory drugs and followed the course. However, the conservative treatment methods failed, and we recommended surgery, which was rejected. She was given nonsteroidal anti-inflammatory drugs and was followed up for 2 years, at the end of which her visual analog scale had decreased from 80 to 50. To the best of our knowledge this is the first case of de Quervain tenosynovitis related to somatotropin treatment. Physicians should consider the possibility of musculoskeletal side effects after somatotropin treatment.

  13. Os trigonum syndrome with flexor hallucis longus tenosynovitis in a professional football referee.

    Science.gov (United States)

    Cooper, M E; Wolin, P M

    1999-07-01

    The presentation of posterior ankle pain in any patient poses a diagnostic dilemma. The os trigonum syndrome and flexor hallucis longus stenosing tenosynovitis have been reported to occur in professional and amateur ballet dancers. It is important to consider these diagnoses in a patient who is not a dancer, as is shown in the case presented here. The patient in this case is a professional referee who injured his ankle while working on artificial turf. The treatment for os trigonum syndrome and flexor hallucis longus tenosynovitis is initially conservative, but in refractory cases, surgical removal of the os and release of the flexor hallucis longus tendon can be successfully performed. This is the first reported case of os trigonum syndrome and flexor hallucis longus tenosynovitis presenting simultaneously in a patient who is not a dancer.

  14. Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Tehranzadeh, J.; Ashilyan, O.; Anavim, A.; Tramma, S. [Univ. of California, Orange (United States). Dept. of Radiological Sciences

    2006-11-15

    The purpose of this study is to describe the appearance of tenosynovitis in various tendon groups in the wrist and hand and to compare MR enhanced and non-enhanced imaging evaluation of tenosynovitis of hand and wrist in inflammatory arthritis. We reviewed 72 MRI studies of hands and wrists, including coronal, axial and sagittal images in 30 consecutive patients with inflammatory arthritis and tenosynovitis. We compared the degree of synovitis on T2-weighted vs contrast-enhanced T1-weighted images, using a predetermined scale. We also measured the extent of tenosynovitis in three dimensions. The tendons were assigned to volar, dorsal, ulnar and radial groups in the wrist and to extensor, flexor and thumb groups in the hand. Degree of tenosynovitis (graded 0-3), cross-sectional area and volume of the inflamed synovium in various tendon groups were then compared by statistical analysis. Review of the medical records revealed the following diagnoses in our patient population: rheumatoid arthritis (n=16), unspecified inflammatory polyarthritis (n=9), psoriatic arthritis (n=2), CREST syndrome (n=1), systemic lupus erythematosus (n=1), paraneoplastic syndrome with arthritis (n=1). The average T2 brightness scores and post-gadolinium enhancement scores were 1.0 and 1.7 respectively (P<0.001) in the wrist studies. The average T2 brightness scores and post-gadolinium enhancement scores were 0.7 and 1.4, respectively (P<0.001) in the hand studies. The average sensitivity of T2-weighted imaging for detection of tenosynovitis was 40% in the hand and 67% in the wrist tendons, when contrast-enhanced images were used as a reference. Carpal tunnel flexor tendons were the most frequently affected tendons of the wrist. The most frequently affected tendons of the hand were second and third flexor tendons. The hand flexors demonstrated higher degrees of enhancement and larger volumes of the inflamed tenosynovium than did the hand extensors and tendons of the thumb.

  15. Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature

    OpenAIRE

    Tolis, K.; Spyridonos, S.; S. Tsiplakou; Fandridis, E.

    2015-01-01

    Erysipelothrix rhusiopathiae is a Gram-positive bacterium that in humans causes skin infections, such as erysipeloid, as a result of direct contact with contaminated animals or their waste or products. We present the first reported case of tenosynovitis of a finger in a 30-year-old woman.

  16. Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature.

    Science.gov (United States)

    Tolis, K; Spyridonos, S; Tsiplakou, S; Fandridis, E

    2015-11-01

    Erysipelothrix rhusiopathiae is a Gram-positive bacterium that in humans causes skin infections, such as erysipeloid, as a result of direct contact with contaminated animals or their waste or products. We present the first reported case of tenosynovitis of a finger in a 30-year-old woman.

  17. Tenosynovitis of a digit due to Erysipelothrix rhusiopathiae: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    K. Tolis

    2015-11-01

    Full Text Available Erysipelothrix rhusiopathiae is a Gram-positive bacterium that in humans causes skin infections, such as erysipeloid, as a result of direct contact with contaminated animals or their waste or products. We present the first reported case of tenosynovitis of a finger in a 30-year-old woman.

  18. First reported case of peroneal tenosynovitis caused by Coccidioides immitis successfully treated with fluconazole.

    Science.gov (United States)

    Majeed, Aneela; Ullah, Waqas; Hamadani, Auon Abbas; Georgescu, Anca

    2016-11-30

    Coccidioidomycosis is an insidious infection caused by Coccidioides spp (C. immitis and C. posadasii). Disseminated disease occasionally involves tendon sheaths and synovium of the joints leading to tenosynovitis. Here, we describe the case of a 72-year-old woman from southern Arizona, who presented with right ankle pain, redness and swelling for 2 months. Her serum IgG was positive for C. immitis on complement fixation, and her MRI of the right ankle joint showed extensive tenosynovitis of the right peroneal tendons, and subtalar joint effusions with associated synovitis. The purpose of this case is to report an extremely rare manifestation of disseminated C. immitis, that is, peroneal tenosynovitis and challenges involved with diagnosis and treatment. We also document that azole therapy is an effective treatment option for peroneal tenosynovitis caused by C. immitis, and we had to double the dose for slow symptom resolution with 4-week trial with usual 400 mg oral dose of fluconazole. 2016 BMJ Publishing Group Ltd.

  19. Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Naredo, Esperanza; D'Agostino, Maria Antonietta; Wakefield, Richard J

    2013-01-01

    recruited. Ten rheumatologists expert in MSUS blindly, independently and consecutively scored for tenosynovitis in B-mode and PD mode three wrist extensor compartments, two finger flexor tendons and two ankle tendons of each patient in two rounds in a blinded fashion. Intraobserver reliability was assessed...

  20. Abuse of growth hormone increases the risk of persistent de Quervain tenosynovitis.

    Science.gov (United States)

    Pagonis, Thomas; Ditsios, Konstantinos; Givissis, Panagiotis; Pagonis, Athanasios; Christodoulou, Anastasios

    2009-11-01

    de Quervain tenosynovitis usually responds well to nonsurgical treatment. Growth hormone abuse is associated with increased de Quervain tenosynovitis incidence in weight-training persons. Cohort study; Level of evidence, 3. We treated 19 weight-training male patients with de Quervain tenosynovitis. Nine were abusing growth hormone (group A), and 10 were not (group B). Four group A patients elected to cease growth hormone abuse. Treatment was stratified into 3 grades: (1) splinting and nonsteroidal anti-inflammatory drugs, (2) same as first grade but with the addition of cortisone injections, and (3) surgical decompression (after failure of treatment of first and second grades). Follow-up was at 3, 9, and 24 months. First follow-up: Only 33.3% of those using growth hormone in group A responded to splinting and nonsteroidal anti-inflammatory drugs, compared with 90% in group B. Six patients (66.6%) in group A experienced persistent symptoms and received second-grade treatment, compared with 1 patient in group B (10%). Second follow-up: Four patients (44.4%) in group A moved from second- to third-grade treatment, 1 symptom-free patient (11.1%) relapsed and received second-grade treatment while 2 (22.2%) requested conservative treatment, declining surgery. Group B patients were 100% symptom-free. Final follow-up: Six patients (66.6%) in group A were operated on and 1 (11.1%) suffered from persistent de Quervain tenosynovitis, declining surgery. In group B, 1 patient relapsed and was started on second-grade treatment. No patients in group B had surgery. Our results suggest that growth hormone abuse is associated with a more recalcitrant form of de Quervain tenosynovitis that does not respond well to nonsurgical treatment, thus leading to increased likelihood of surgical decompression.

  1. MRI features in de Quervain`s tenosynovitis of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Glajchen, N. [Mount Sinai Hospital, New York, NY (United States). Dept. of Radiology; Schweitzer, M. [Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology

    1996-01-01

    De Quervain`s stenosing tenosynovitis of the first dorsal extensor component is traditionally diagnosed clinically but may be encountered when performing MRI of the wrist. A retrospective review of wrist MR images was performed in cases where the diagnosis of de Quervain`s synovitis was suggested (n=5). Imaging findings were correlated with clinical findings in four cases and with wrist arthroscopy in one case. Increased thickness of the extensor pollicus brevis and abductor pollicis longus tendons was the most reliable finding on MRI, being present in all cases. Peritendinous edema was also a reliable finding. Surrounding subcutaneous edema and increased intratendinous signal were less reliable findings in confirmed cases of de Quervain`s disease. De Quervain`s tenosynovitis may be encountered when performing MRI of the wrist. Increased tendon thickness and peritendinous edema are the most reliable imaging findings. (orig.)

  2. Isolated Tenosynovitis as a Sole Manifestation: The Great Mimicker Still Continues to Surprise Us

    Science.gov (United States)

    De, Abhishek; Surana, Trupti V; Biswas, Saugato; Reja, Abu Hena Hasanoor; Chatterjee, Gobinda

    2015-01-01

    A middle aged male presented with non-tender cystic swelling over left distal forearm since 1 year. No other cutaneous abnormality could be found except mild paresthesia of the overlying skin and equivocal thickening of the ipsilateral ulnar nerve. Routine investigation was within normal limits. Detailed workup of the patient including MRI of the lesion suggested the diagnosis as tenosynovitis with a soft tissue mass. Fine needle aspiration cytology from the cyst showed foamy macrophages and acid fast bacilli; while PCR of the aspirate confirmed the etiological agent as M. leprae. We, thus, report a unique case of isolated tenosynovitis as a sole manifestation of pure neural leprosy which is extremely rare in world literature. PMID:25814736

  3. Frequency of De Quervain’s tenosynovitis and its association with SMS texting

    Science.gov (United States)

    Ali, Maryam; Asim, Muhammad; Danish, Syed Hasan; Ahmad, Farah; Iqbal, Afsheen; Hasan, Syed Danish

    2014-01-01

    Summary Objective: to assess the frequency of De Quervain’s tenosynovitis and its association with SMS texting. Method: a cross-sectional survey was conducted among undergraduate students studying in different physical therapy schools of Karachi belonging to both public and private sectors. Sample size was 300 students which were selected through convenience sampling. Data was collected through self-administered questionnaire and severity of the pain was assessed through Universal Pain Assessment Tool and De Quervain’s tenosynovitis was diagnosed through Finkelstein test. Data entry and analysis were done using computer software SPSS version 20. Frequency and percentages were taken for categorical variable. Chi-square was applied to determine association between different variables and Finkelstein test. P value Quervain’s positive in that students and there is a positive association between the thumb pain and frequent text messaging. PMID:24932451

  4. De Quervain's Tenosynovitis and Phonophoresis: A Randomised Controlled Trial in Pregnant Females

    OpenAIRE

    Hasan, Tabinda; Fauzi, Mahmood

    2015-01-01

    Background: De Quervain's tenosynovitis is a common cause of wrist pain in pregnant and postpartum females. This study provides objective evidence regarding the therapeutic efficacy of phonophoresis in treating de Quervain's disease during pregnancy. Methods: In a single blind, randomised, controlled trial (n = 50), ketoprofen phonophoresis was given to the intervention group and conventional ultrasound (US) was given to controls, coupled with thumb splint immobilisation, and supervised st...

  5. Effects of metabolic syndrome on the functional outcomes of corticosteroid injection for De Quervain tenosynovitis.

    Science.gov (United States)

    Roh, Y H; Noh, J H; Gong, H S; Baek, G H

    2017-06-01

    Metabolic syndrome is a constellation of medical conditions that arise from insulin resistance and abnormal adipose deposition and function. In patients with metabolic syndrome and De Quervain tenosynovitis this might affect the outcome of treatment by local corticosteroid injection. A total of 64 consecutive patients with De Quervain tenosynovitis and metabolic syndrome treated with corticosteroid injection were age- and sex-matched with 64 control patients without metabolic syndrome. The response to treatment, including visual analogue scale score for pain, objective findings consistent with De Quervain tenosynovitis (tenderness at first dorsal compartment, Finkelstein test result), and Disability of the Arm, Shoulder, and Hand score were assessed at 6, 12, and 24 weeks follow-up. Treatment failure was defined as persistence of symptoms or surgical intervention. Prior to treatment, patients with metabolic syndrome had mean initial pain visual analogue scale and Disability of the Arm, Shoulder, and Hand scores similar to those in the control group. The proportion of treatment failure in the metabolic syndrome group (43%) was significantly higher than that in the control group (20%) at 6 months follow-up. The pain visual analogue scale scores in the metabolic syndrome group were higher than the scores in the control group at the 12- and 24-week follow-ups. The Disability of the Arm, Shoulder, and Hand scores of the metabolic syndrome group were higher (more severe symptoms) than those of the control group at the 12- and 24-week follow-ups. Although considerable improvements in symptom severity and hand function will likely occur in patients with metabolic syndrome, corticosteroid injection for De Quervain tenosynovitis is not as effective in these patients compared with age- and sex-matched controls in terms of functional outcomes and treatment failure. III.

  6. Mycoplasma corogypsi-associated polyarthritis and tenosynovitis in black vultures (Coragyps atratus).

    Science.gov (United States)

    Van Wettere, A J; Ley, D H; Scott, D E; Buckanoff, H D; Degernes, L A

    2013-03-01

    Three wild American black vultures (Coragyps atratus) were presented to rehabilitation centers with swelling of multiple joints, including elbows, stifles, hocks, and carpal joints, and of the gastrocnemius tendons. Cytological examination of the joint fluid exudate indicated heterophilic arthritis. Radiographic examination in 2 vultures demonstrated periarticular soft tissue swelling in both birds and irregular articular surfaces with subchondral bone erosion in both elbows in 1 bird. Prolonged antibiotic therapy administered in 2 birds did not improve the clinical signs. Necropsy and histological examination demonstrated a chronic lymphoplasmacytic arthritis involving multiple joints and gastrocnemius tenosynovitis. Articular lesions varied in severity and ranged from moderate synovitis and cartilage erosion and fibrillation to severe synovitis, diffuse cartilage ulceration, subchondral bone loss and/or sclerosis, pannus, synovial cysts, and epiphyseal osteomyelitis. No walled bacteria were observed or isolated from the joints. However, mycoplasmas polymerase chain reactions were positive in at least 1 affected joint from each bird. Mycoplasmas were isolated from joints of 1 vulture that did not receive antibiotic therapy. Sequencing of 16S rRNA gene amplicons from joint samples and the mycoplasma isolate identified Mycoplasma corogypsi in 2 vultures and was suggestive in the third vulture. Mycoplasma corogypsi identification was confirmed by sequencing the 16S-23S intergenic spacer region of mycoplasma isolates. This report provides further evidence that M. corogypsi is a likely cause of arthritis and tenosynovitis in American black vultures. Cases of arthritis and tenosynovitis in New World vultures should be investigated for presence of Mycoplasma spp, especially M. corogypsi.

  7. Effectiveness of 1% diclofenac gel in the treatment of wrist extensor tenosynovitis in long distance kayakers.

    Science.gov (United States)

    May, Judith J; Lovell, Greg; Hopkins, Will G

    2007-02-01

    Anecdotally many athletes use non-steroidal anti-inflammatory gels during competition to allow continued participation. To determine if this clinical practice is useful a randomised placebo-controlled study was conducted at the 5-day 2004 Red Cross Murray River Marathon. Forty-two kayakers presented with wrist extensor tenosynovitis while competing in the single and double kayak events. All subjects received standard treatment of ice, stretches and massage for wrist tenosynovitis before being randomised into a placebo or 1% diclofenac gel group. Evaluation was done by using a visual analogue scale (0-10) for pain and by clinical grading (0-3). The main outcome measurements were reduction in pain and clinical grading, the requirement for a rescue medication (paracetamol or diclofenac tablets) and effect on performance times. Both groups had similar pain scores and clinical grading on the first and fifth days of pain. On the second to fourth days of pain there was clearly no benefit and possibly a detrimental effect on pain with diclofenac gel relative to placebo. However, diclofenac tablets were possibly beneficial for pain relative to paracetamol tablets. The effects of pain and the various treatments on performance time were either trivial (<0.5%) or small, but none was particularly clear. We conclude that standard treatment appears to be sufficient for the management of wrist extensor tenosynovitis during competition.

  8. Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy with characteristic MR imaging features

    Energy Technology Data Exchange (ETDEWEB)

    Parellada, Antoni J. [DII - Diagnostic Imaging, Inc., Philadelphia, PA (United States); Frankford Hospitals - Torresdale Campus, Department of Radiology, Philadelphia, PA (United States); Gopez, Angela G.; Morrison, William B. [Thomas Jefferson University, Department of Radiology, Philadelphia, PA (United States); Sweet, Stephanie [Thomas Jefferson University, Philadelphia Hand Center, Philadelphia, PA (United States); Leinberry, Charles F. [Thomas Jefferson University, Department of Orthopedic Surgery - Hand Surgery, Philadelphia, PA (United States); Reiter, Sean B.; Kohn, Mark [DII - Diagnostic Imaging, Inc., Philadelphia, PA (United States)

    2007-03-15

    To present the MRI imaging findings of extensor tenosynovitis at the distal intersection or crossover between the second (extensor carpi radialis longus (ECRL) and brevis (ECRB)) and third (extensor pollicis longus (EPL)) extensor compartment tendons, and the anatomical details that may play a role in the pathogenesis of this condition. The imaging studies and clinical records of five patients (three females and two males, with ages ranging between 22 and 78 years; mean age, 49 years) presenting with pain on the dorsal and radial aspect of the wrist were reviewed by two musculoskeletal radiologists in consensus. Three cases were identified serendipitously during routine clinical reading sessions; a follow-up computerized database search for additional cases reported in the prior two years yielded two additional cases. The overall number of cases screened was 1,031. The diagnosis of tendinopathy affecting the second and third compartment extensor tendons was made on the basis of MRI findings and clinical follow-up, or synovectomy. All patients showed signs of tenosynovitis: in four patients both the tendons of the second and third extensor compartments were affected; the fifth patient showed signs of tenosynovitis of the EPL tendon, and tendinosis of the extensor carpi radialis tendons. Three patients showed tenosynovitis proximal and distal to the point of intersection; and in two of them, a discrete point of constriction was appreciated at the crossover site in relation to the extensor retinaculum. Two patients showed tenosynovitis limited to the segment distal to the point of decussation. Tendinosis tended to follow the presence of tenosynovitis. In one of the patients, subtendinous reactive marrow edema in Lister's tubercle was noted. Distal intersection tenosynovitis may be related to the biomechanical pulley effect exerted by Lister's tubercle on the EPL tendon as it leaves the third compartment and crosses over the extensor carpi radialis tendons

  9. Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice

    Directory of Open Access Journals (Sweden)

    Groenier Klaas H

    2009-10-01

    Full Text Available Abstract Background De Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist and leads to wrist pain and to impaired function of the wrist and hand. It can be treated by splinting, local corticosteroid injection and operation. In this study effectiveness of local corticosteroid injections for de Quervain's tenosynovitis provided by general practitioners was assessed. Methods Participants with de Quervain's tenosynovitis were recruited by general practitioners. Short-term outcomes (one week after injections were assessed in a randomised, placebo-controlled trial. Long-term effectiveness was evaluated in an open prospective cohort-study of steroid responders during a follow-up period of 12 months. Participants were randomised to one or two local injections of 1 ml of triamcinolonacetonide (TCA or 1 ml of NaCl 0.9% (placebo. Non-responders to NaCl were treated with additional TCA injections. Main outcomes were immediate treatment response, severity of pain, improvement as perceived by participant and functional disability using sub items hand and finger function of the Dutch Arthritis Impact Measurement Scale (Dutch AIMS-2-HFF. Results 11 general practitioners included 21 wrists in 21 patients. The TCA-group had better results for short-term outcomes treatment response (78% vs. 25%; p = 0.015, perceived improvement (78% vs. 33%; p = 0.047 and severity of pain (4.27 vs. 1.33; p = 0.031 but not for the Dutch-AIMS-HFF (2.71 vs. 1.92; p = 0.112. Absolute risk reduction for the main outcome short-term treatment response was 0.55 (95% CI: 0.34, 0.76 with a number needed to treat of 2 (95% CI: 1, 3. In the cohort of steroid responders (n = 12 the beneficial effects of steroid injections were sustained during the follow-up of 12 months regarding severity of pain (p = 0.67 and scores of Dutch AIMS-2-HFF (p = 0.36, but not for patient perceived improvement (p = 0.02. No adverse events were observed during the 12

  10. Polymyalgia rheumatica is associated with extensor tendon tenosynovitis but not with synovitis of the hands: a magnetic resonance imaging study.

    Science.gov (United States)

    Cimmino, Marco A; Parodi, Massimiliano; Zampogna, Giuseppe; Barbieri, Francesca; Garlaschi, Giacomo

    2011-03-01

    To study with MRI the hands of consecutive PMR patients, who were not selected on the basis of peripheral arthritis, with a correlation to clinical and laboratory findings. Twenty-six hands of 15 PMR patients and 26 hands of 13 healthy controls were studied by extremity-dedicated MRI for the presence of synovitis, tenosynovitis, soft-tissue oedema, bone marrow oedema and erosions. Sixteen (61.6%) of the 26 PMR hands and 4 (15.4%) of the 26 control hands showed tenosynovitis (P = 0.001). Extensor tendon tenosynovitis was seen in 9 (34.6%) of the 26 PMR hands, but in only 1 (3.8%) control hand (P = 0.002) and flexor tenosynovitis was seen in 12 (46.1%) of the 26 PMR hands and in 4 (15.4%) of the 26 control hands (P = 0.03). All other features were similar in the two groups. Our data support the view that tenosynovitis, especially of the extensor tendons, is a frequent event in PMR, unrelated to clinical involvement of the hand. This finding is in agreement with the concept of PMR as a disease of extra-articular structures.

  11. Mycoplasma corogypsi associated polyarthritis and tenosynovitis in black vultures (Coragyps atratus)

    Science.gov (United States)

    Van Wettere, A. J.; Ley, D. H.; Scott, D. E.; Buckanoff, H. D.; Degernes, L. A.

    2013-01-01

    Three wild American black vultures (Coragyps atratus) were presented to rehabilitation centers with swelling of multiple joints, including elbows, stifles, hocks, and carpal joints, and of the gastrocnemius tendons. Cytological examination of the joint fluid exudate indicated heterophilic arthritis. Radiographic examination in 2 vultures demonstrated periarticular soft tissue swelling in both birds and irregular articular surfaces with subchondral bone erosion in both elbows in 1 bird. Prolonged antibiotic therapy administered in 2 birds did not improve the clinical signs. Necropsy and histological examination demonstrated a chronic lymphoplasmacytic arthritis involving multiple joints and gastrocnemius tenosynovitis. Articular lesions varied in severity and ranged from moderate synovitis and cartilage erosion and fibrillation to severe synovitis, diffuse cartilage ulceration, subchondral bone loss and/or sclerosis, pannus, synovial cysts, and epiphyseal osteomyelitis. No walled bacteria were observed or isolated from the joints. However, mycoplasmas polymerase chain reactions were positive in at least 1 affected joint from each bird. Mycoplasmas were isolated from joints of 1 vulture that did not receive antibiotic therapy. Sequencing of 16S rRNA gene amplicons from joint samples and the mycoplasma isolate identified Mycoplasma corogypsi in 2 vultures and was suggestive in the third vulture. Mycoplasma corogypsi identification was confirmed by sequencing the 16S-23S intergenic spacer region of mycoplasma isolates. This report provides further evidence that M. corogypsi is a likely cause of arthritis and tenosynovitis in American black vultures. Cases of arthritis and tenosynovitis in New World vultures should be investigated for presence of Mycoplasma spp, especially M. corogypsi. PMID:22903399

  12. [Effects of vacuum sealing drainage technique in acute and chronic suppurative tenosynovitis of hand].

    Science.gov (United States)

    Wang, H; Xia, F; Xing, D M; Ren, D; Feng, W; Chen, Y; Xiao, Z H; Zhao, Z M

    2017-05-01

    Objective: To investigate the effects of vacuum sealing drainage technique in acute and chronic suppurative tenosynovitis of hand. Methods: A total of 9 cases acute and chronic suppurative tenosynovitis patients from January 2013 to April 2015 in Puai Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology were retrospectively reviewed. There were 6 males and 3 females, aging from 27 to 65 years, the average age was 55 years. There were 3 cases of index finger, 3 cases of middle finger, 2 cases of ring finger, 1 case include three fingers. The infection causes included stabbing with fishbone in 3 cases, stabbing with animal bone fragments in 3 cases, wound by sawdust in 3 cases, meat grinder injury in 1 case, multiple fingers crush injury postoperative infection of garbage truck in 1 case. Bacterial infection included 2 cases with Staphylococcus aureus, 2 cases with Staphylococcus epidermidis, 1 case with normal Escherichia coli, 1 case with mixed infection of Enterobacter aerogenes, Klebsiella oxytoca and Staphylococcus, 1 case with Bauman Acinetobacter bacillus, 1 case with Proteus mirabilis and 1 case of no growth of pathogenic bacteria culture. After thorough debridement, vacuum sealing drainage was used to observe the characteristics of irrigation fluid, the formation of cavity inflammation, the prognosis of infection and the recovery of finger function. Results: Seven patients with suppurative tenosynovitis were treated for 7 to 14 days, replaced the vacuum sealing drainage dressing once; 1 patient was an illustration of the finger tip defect flap infected patients after 21 days of treatment, replaced the vacuum sealing drainage dressing twice, 1 patient was an illustration of the central refers to trauma, postoperative infection patients 28 d, replaced three times in the VSD. The follow-up time was 3 to 12 months (mean 8.2 months), 7 patients without tendon necrosis, secondary suture with no infection, 2 cases of

  13. de Quervain’s tenosynovitis: a review of the rehabilitative options

    OpenAIRE

    Goel, Ritu; Abzug, Joshua M.

    2014-01-01

    de Quervain’s tenosynovitis is an overuse disease that involves a thickening of the extensor retinaculum, which covers the first dorsal compartment. A case study approach was utilized in this article to demonstrate many of the available medical and occupational therapy modalities to treat this condition. A 34-year-old right hand-dominant female who works in a daycare facility presents with radial side wrist pain during lifting activity for the past 4–6 weeks. The patient was diagnosed with de...

  14. Corticosteroid injection with or without thumb spica cast for de Quervain tenosynovitis.

    Science.gov (United States)

    Mardani-Kivi, Mohsen; Karimi Mobarakeh, Mahmoud; Bahrami, Farzaneh; Hashemi-Motlagh, Kevyan; Saheb-Ekhtiari, Khashayar; Akhoondzadeh, Niloofar

    2014-01-01

    To compare the corticosteroid injection (CSI) with or without thumb spica cast (TSC) for de Quervain tendinitis. In this prospective trial, 67 eligible patients with de Quervain tenosynovitis were randomly assigned into CSI + TSC (33 cases) and CSI (34 cases) groups. All patients received 40 mg of methylprednisolone acetate with 1 cc lidocaine 2% in the first dorsal compartment at the area of maximal point tenderness. The primary outcome was the treatment success rate, and the secondary outcome was the scale and quality of the treatment method using Quick Disabilities of Arm, Shoulder and Hand and visual analog scale scores. The groups had no differences in mean age, sex, and occupation. The visual analog scale and Quick Disabilities of the Arm, Shoulder and Hand scores were similar in both groups before the treatment. The treatment success rate was 93% in the CSI + TSC group and 69% in the CSI group. Although both methods improved the patients' conditions significantly in terms of relieving pain and functional ability, CSI + TSC had a significantly higher treatment success rate. The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes. Therapeutic II. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. Isolation of Nocardia mexicana from focal proliferative tenosynovitis and arthritis in a steer.

    Science.gov (United States)

    Owen, H; Buckle, K; Olm, J; Leitner, M; Pandey, S; Gaughan, J B; Sullivan, M L; Lees, A M; Gibson, J S

    2015-05-01

    An 18-month-old Charolais steer was presented with lameness and fluctuant swelling of the right stifle joint, which yielded neutrophils on fine-needle aspiration. A diagnosis of bacterial proliferative tenosynovitis and arthritis was made on postmortem and histological examination. Culture and 16S rRNA sequencing identified a Nocardia sp. with 99% homology with the corresponding DNA fragment of N. mexicana DSM 44952. Antimicrobial susceptibility testing revealed the isolate was susceptible to co-trimoxazole and third-generation cephalosporins. We report the first case, both in Australia and internationally, of proliferative tenosynovitis and arthritis caused by Nocardia spp. infection in a bovine and the first report of pathology attributed to N. mexicana in a veterinary patient. Given the limited susceptibility of the bacteria, the poor antimicrobial penetration that would be expected and the morphological changes that had taken place in the joint; the steer would have required protracted antimicrobial treatment in addition to invasive debridement of the lesion. This case emphasises the importance of routinely performing cytology and extended incubation of cultures in cases of arthritis in order to make ethical and economically viable treatment decisions. © 2015 Australian Veterinary Association.

  16. Biomechanical effects of steroid injections used to treat pyogenic flexor tenosynovitis

    Directory of Open Access Journals (Sweden)

    Turvey Blake R

    2012-10-01

    Full Text Available Abstract Background A recent study from our laboratory has demonstrated improved range of motion in the toes of broiler chickens afflicted with pyogenic flexor tenosynovitis when treated with local antibiotic and corticosteroid injections, without surgical drainage. However, the use of corticosteroids as an adjunct treatment raised peer concern, as steroids are thought to have deleterious effects on tendon strength. The purpose of this study was to compare the tensile strength of the aforementioned steroid treated tendons, to a group of tendons administered with the current standard treatment: systemic antibiotics, surgical drainage and no corticosteroids. Methods Twenty-three tendons’ structural and material properties were investigated (fifteen receiving the standard treatment, eight receiving the steroid treatment. The measurements from each group were interpreted via Student’s unpaired t-test and a post-hoc power analysis. Results The steroid treated tendons did demonstrate a trend toward decreased mechanical properties when compared with the standard treatment group, but the results were not statistically significant. Conclusions Treatment of septic tenosynovitis with local corticosteroid and local antibiotic injections resulted in better digital motion, without a significant loss of tendon strength, over a twenty-eight day recovery period.

  17. Successful treatment of de Quervain tenosynovitis with ultrasound-guided percutaneous needle tenotomy and platelet-rich plasma injection: a case presentation.

    Science.gov (United States)

    Peck, Evan; Ely, Erin

    2013-05-01

    De Quervain tenosynovitis is a disorder of the tendons of the first dorsal compartment of the wrist that causes pain and functional disability, which may be refractory to conservative treatments. We present a case of ultrasound-guided percutaneous needle tenotomy and platelet-rich plasma injection for the successful treatment of de Quervain tenosynovitis. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  18. De Qeurvian Tenosynovitis: Clinical Outcomes of Surgical Treatment with Longitudinal and Transverse Incision

    Directory of Open Access Journals (Sweden)

    Arefah Dehghani Tafti

    2011-03-01

    Full Text Available AbstractObjectives: De Quervain disease is a mechanical tenosynovitis due to inadequacy volume between abductor pollicis longus, extensor pollicis brevis and their tunnel. Treatment methods include immobilization, steroid injections, and operation. For the first time Fritz De Quervain described surgical treatment of this disease. Since then, various ways of treatment have been reported. The purpose of this study is to compare the clinical outcomes of a longitudinal incision with a transverse incision in De Quervain disease.Methods: This was a randomized controlled clinical trial conducted in three hospitals in Iran, Yazd from March 2003 to September 2008. One hundred-twenty patients with De Quervain disease who did not respond to conservative treatment were operated with two different incisions. The patients were followed for three months to compare the surgical outcomes.Results: During a three month follow-up, a significant difference was shown between the two methods (p=0.03. Results of surgical treatment with longitudinal incision were excellent (only 5 hypertrophic scars, but there were 13 postoperative complaints with transverse incision.Conclusion: According to our findings, longitudinal incision in surgical treatment of De Quervain disease is better than transverse incision.

  19. Complex Regional Pain Syndrome-Type 1 Presenting as deQuervain's Stenosing Tenosynovitis.

    Science.gov (United States)

    Vas, Lakshmi; Pai, Renuka

    2016-01-01

    To report the presentation of complex regional pain syndrome-1 (CRPS-1) as deQuervain's stenosing tenosynovitis (DQST). A 24-year-old woman presented with 3-year history of clinical diagnostic criteria (CDC) of CRPS-1. Conservative and surgical treatment for this as DQST had failed to relieve her. We diagnosed the problem as CRPS-1with CDC as inflammatory manifestations of a mechanical tendinoses of all her 5 digital tendons caused by movement of the fingers and hand tethered by agonist (flexor)/ antagonist (extensor) muscles in co-contraction. Ultrasound guided dry needling (USGDN) relaxed the muscles, replacing the abnormal agonist/antagonist co-contraction with normal agonist/antagonist coordination. Resolution of tendinoses reversed the inflammation causing the CDC. Six months later she leads normal personal and professional life, with reduction of scores of painDetect (from 21 to 5), Patient Health Questionnaire (from 13 to 4), Disability of arm, shoulder and hand from 70.8 to 25 and reversal of muscle abnormality characteristic of CRPS-1 on Musculoskeletal Ultrasonography (MSKUSG). We believe the primary pathology of CRPS-1 to be co-contraction of agonist (flexor)/antagonist(extensor) muscles of digits resulting in tendinoses akin to DQST. CDC of CRPS are actually inflammatory manifestations of tendinoses amenable to reversal by USGDN which also addresses the disability, a hallmark of CRPS.

  20. Systematic review and meta-analysis on the work-related cause of de Quervain tenosynovitis: a critical appraisal of its recognition as an occupational disease.

    Science.gov (United States)

    Stahl, Stéphane; Vida, Daniel; Meisner, Christoph; Lotter, Oliver; Rothenberger, Jens; Schaller, Hans-Eberhard; Stahl, Adelana Santos

    2013-12-01

    The authors systematically reviewed all of the etiopathologic factors discussed in the literature to verify the classification of de Quervain tenosynovitis on the list of occupational diseases. The authors searched Ovid MEDLINE, EMBASE, and the Cochrane Library for articles discussing the cause of de Quervain tenosynovitis. The literature was classified by the level of evidence presented, the etiopathologic hypothesis discussed, the authors' conclusion about the role of the etiopathologic hypothesis, and the first author's professional background. The quality of reporting of the observational studies was evaluated by an extended Strengthening the Reporting of Observational Studies in Epidemiology statement checklist. A meta-analysis of all controlled cohort studies was performed. The Bradford Hill criteria were used to evaluate a causal relationship between de Quervain tenosynovitis and occupational risk factors. A total of 179 references were found, and 80 articles were included. On average, only 35 percent (median, 35 percent; range, 16 to 60 percent) of all items on the extended Strengthening the Reporting of Observational Studies in Epidemiology checklist were addressed per article. The meta-analysis to evaluate the strength of the association between de Quervain tenosynovitis and (1) repetitive, (2) forceful, or (3) ergonomically stressful manual work suggested an odds ratio of 2.89 (95 percent CI, 1.4 to 5.97; p = 0.004). No evidence was found to support the Bradford Hill criteria for a causal relationship between de Quervain tenosynovitis and occupational risk factors. No sufficient scientific evidence was provided to confirm a causal relationship between de Quervain tenosynovitis and occupational risk factors. Risk, III.

  1. Tibialis posterior tenosynovitis and associated pes plano valgus in rheumatoid arthritis: electromyography, multisegment foot kinematics, and ultrasound features.

    Science.gov (United States)

    Barn, Ruth; Turner, Deborah E; Rafferty, Daniel; Sturrock, Roger D; Woodburn, James

    2013-04-01

    To compare electromyographic (EMG), kinematic, kinetic, and ultrasound (US) features of pes plano valgus associated with US-confirmed tibialis posterior (TP) tenosynovitis in rheumatoid arthritis (RA) and healthy control subjects. In this cross-sectional study, patients with RA and US-confirmed tenosynovitis of TP underwent gait analysis, including 3-dimensional kinematics, kinetics, and intramuscular EMG of TP, and findings were compared with a group of healthy individuals. The RA group also underwent B mode and power Doppler US scanning of the TP tendon to assess and score levels of pathology. Ten patients with RA, median (range) disease duration of 3 years (1-18 years), and 5 control subjects were recruited. Compared to control subjects, the RA patients walked slower and presented with moderate levels of foot-related disability. The mean ± SD Disease Activity Score in 28 joints was 4.6 ± 1.6. Increased magnitude of TP activity was recorded in the RA group compared to controls in the contact period of stance (P = 0.007), in conjunction with reduced ankle joint power (P = 0.005), reduced navicular height in the medial arch (P = 0.023), and increased forefoot dorsiflexion (P = 0.027). TP tendon thickening, fluid, and power Doppler signal were observed in the majority of patients. This study has demonstrated, for the first time, increased TP EMG activity in the presence of US-confirmed TP tenosynovitis in RA. Altered muscle function occurred in conjunction with suboptimal mechanics, moderate levels of tendon pathology, and active disease. Targeted therapy may be warranted to reduce inflammation and mechanically off-load diseased tendon states. Copyright © 2013 by the American College of Rheumatology.

  2. Improved corticosteroid treatment of recalcitrant de Quervain tenosynovitis with a novel 4-point injection technique.

    Science.gov (United States)

    Pagonis, Thomas; Ditsios, Konstantinos; Toli, Paraskevi; Givissis, Panagiotis; Christodoulou, Anastasios

    2011-02-01

    Previously described corticosteroid injection techniques for de Quervain tenosynovitis (DQT) refer to either 1-point or 2-point injection techniques, showing superiority of the latter. The authors' novel 4-point injection technique (point 4 technique) yields more favorable results than do the older techniques. Randomized controlled trial; Level of evidence, 2. The authors treated 2 groups (A and B), each including 24 high-resistance training individuals (randomly allocated to each group) with persistent DQT. Group A received the point 4 technique, and group B, the 2-point injection technique. Follow-up was in 2, 4, 8, and 52 weeks after the first treatment. After 2 weeks of treatment, 7 group A patients were symptom-free, whereas the rest scored better than their group B counterparts on the DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure, of whom only 1 was symptom-free. Ten group A patients received repeated injections, in contrast to 19 from group B. Four weeks after the first treatment, 13 group A patients were symptom-free, in contrast to 4 from group B. In group A, 2 patients received repeated injections, in contrast to 20 in group B. Eight weeks after the first treatment, 1 group A patient received repeated injection. One group B patient relapsed, whereas 4 opted for surgical decompression and 16 received repeated injections. Fifty-two weeks after the first treatment, 21 patients in group A were symptom-free, 1 was operated on, and 2 relapsed; in group B, 12 were symptom-free, 9 were operated on, 3 relapsed, and 3 received repeated injections. In high-resistance training athletes, recalcitrant DQT responds more favorably to the novel point 4 technique than to the standard 2-point injection technique.

  3. Validity and sensitivity to change of the semi-quantitative OMERACT ultrasound scoring system for tenosynovitis in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Ammitzbøll-Danielsen, Mads; Østergaard, Mikkel; Naredo, Esperanza

    2016-01-01

    in a 6-month follow-up study. METHODS: US and clinical assessments of the tendon sheaths of the clinically most affected hand and foot were performed at baseline, 3 and 6 months in 51 patients with RA. Tenosynovitis was assessed using the semi-quantitative scoring system (0-3) proposed by the OMERACT US...

  4. Small longitudinal S incision and page turning style of annular ligament partial resection to treat stenosing tenosynovitis of thumb flexor tendon.

    Science.gov (United States)

    Liu, Yu-ping; Du, Yan-ying; Wang, Ming-ming; Li, Ming; Liu, Shi-you; Liu, Wei

    2014-04-24

    To present the treatment outcome for patients with stenosing tenosynovitis of thumb flexor tendon treated with a small S incision and page turning style of annular ligament partial resection. During a 2-year period between August 2011 and July 2013, 12 consecutive patients (mean age, 45.8 years) with stenosing tenosynovitis of the thumb flexor tendon were prospectively enrolled into this study. All 12 patients underwent longitudinal S skin incision to expose annular ligament and thumb flexor tendon, and with page turning style of annular ligament partial resection to finish the operation. The average range of motion of metacarpophalangeal thumb joint, Quick disability of arm, shoulder, and hand and Short Musculoskeletal Function Assessment Dysfunction score of arm and hand were primary outcome measures. There were 9 cases of stiff metacarpophalangeal joint of thumb and 3 cases of snapping thumb for stenosing tenosynovitis. At 1-year follow-up, all stenosing tenosynovitis had healed by an average of 4 weeks. The average range of motion of the metacarpophalangeal joint was 37.1° (range, 34-40°). No patients had recurrence, cicatricial contraction, or postoperative infection. The average disability of arm, shoulder, and hand was 0.3 out of 100 (range, 0-1.67), and average Short Musculoskeletal Functional Assessment Dysfunction score of arm and hand was 6.9 out of 40 (range, 0-15.6). All 12 patients stated that they were highly satisfied. Small S incision and page turning style of annular ligament partial resection for stenosing tenosynovitis of thumb flexor tendon is a safe, simple, and reliable alternative treatment with minimal soft-tissue irritation, good functional results and recovery can be expected.

  5. Poliartritis y tenosinovitis grave por Streptococcus agalactiae en un paciente con hipoesplenia funcional Severe polyarthritis and tenosynovitis caused by Streptococcus agalactiae in a patient with functional hyposplenia

    Directory of Open Access Journals (Sweden)

    Domingo C. Balderramo

    2002-08-01

    Full Text Available La artritis por Streptococcus agalactiae es infrecuente. No conocemos publicaciones de casos sobre la afección tendinosa por este microorganismo. Se presenta una mujer de 46 años que consultó por fiebre, poliartralgias, mialgias, diarrea y vómitos. Como antecedentes presentaba carcinoma papilar de tiroides e hipoesplenia funcional. Al examen se encontraba hemodinámicamente inestable, febril, con artritis de mano izquierda, muñecas, codos, hombro derecho y tobillo izquierdo. Presentaba tenosinovitis en ambos pies y en la mano izquierda. Los hemocultivos y el cultivo de la bursa olecraniana derecha fueron positivos para S. agalactiae. La ecografía mostró signos de tenosinovitis del tibial anterior izquierdo. Completó 20 días de tratamiento endovenoso con cefazolina y 12 días de cefuroxima oral. El cuadro articular revirtió completamente en 60 días. El Streptococcus agalactiae puede causar, en forma infrecuente, un síndrome de poliartritis, tenosinovitis y fiebre similar al producido por la infección gonocócica.Cases of arthritis caused by Streptococcus agalactiae are infrequent and in our knowledge there are no case reports of tenosynovitis caused by S. agalactiae. A 46-year-old woman presented with fever, polyarthralgia, myalgia, diarrhea and vomiting. She had a history of papillary thyroid carcinoma and functional hyposplenia. She was febrile, with arthritis in hands, wrists, elbows, right shoulder and left ankle joints, and presented tenosynovitis in both feet and left hand. Blood and right olecranon bursa sample cultures were positive for S. agalactiae. An ultrasound scan made at the musculus tibialis anterior of left foot revealed signs of tenosynovitis. She was treated with intravenous cefazolin for 20 days and oral cefuroxime for 12 days. The joint involvement completely subsided in 60 days. Streptococcus agalactiae can cause, infrequently, a polyarthritis and tenosynovitis syndrome similar to disseminated gonococcal

  6. Stenosing Tenosynovitis of the Flexor Hallucis Longus Tendon Associated with the Plantar Capsular Accessory Ossicle at the Interphalangeal Joint of the Great Toe

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    Song Ho Chang

    2017-01-01

    Full Text Available This report presents a case of stenosing tenosynovitis of the flexor hallucis longus tendon associated with the plantar capsular accessory ossicle at the interphalangeal joint of the great toe, which was confirmed by intraoperative observation and was successfully treated with surgical resection of the ossicle. As the plantar capsular accessory ossicle was not visible radiographically due to the lack of ossification, ultrasonography was helpful for diagnosing this disorder.

  7. Tuberculosis prophylaxis with levofloxacin in liver transplant patients is associated with a high incidence of tenosynovitis: safety analysis of a multicenter randomized trial.

    Science.gov (United States)

    Torre-Cisneros, Julian; San-Juan, Rafael; Rosso-Fernández, Clara M; Silva, J Tiago; Muñoz-Sanz, Agustin; Muñoz, Patricia; Miguez, Enrique; Martín-Dávila, Pilar; López-Ruz, Miguel Angel; Vidal, Elisa; Cordero, Elisa; Montejo, Miguel; Blanes, Marino; Fariñas, M Carmen; Herrero, Jose Ignacio; Rodrigo, Juan; Aguado, Jose Maria

    2015-06-01

    It is necessary to develop a safe alternative to isoniazid for tuberculosis prophylaxis in liver transplant recipients. This study was designed to investigate the efficacy and safety of levofloxacin. An open-label, prospective, multicenter, randomized study was conducted to compare the efficacy and safety of levofloxacin (500 mg q24h for 9 months) initiated in patients awaiting liver transplantation and isoniazid (300 mg q24h for 9 months) initiated post-transplant when liver function was stabilized. Efficacy was measured by tuberculosis incidence at 18 months after transplantation. All adverse events related to the medication were recorded. CONSORT guidelines were followed in order to present the results. The safety committee suspended the study through a safety analysis when 64 patients had been included (31 in the isoniazid arm and 33 in the levofloxacin arm). The reason for suspension was an unexpected incidence of severe tenosynovitis in the levofloxacin arm (18.2%). Although the clinical course was favorable in all cases, tenosynovitis persisted for 7 weeks in some patients. No patients treated with isoniazid, developed tenosynovitis. Only 32.2% of patients randomized to isoniazid (10/31) and 54.5% of patients randomized to levofloxacin (18/33, P = .094) completed prophylaxis. No patient developed tuberculosis during the study follow-up (median 270 days). Levofloxacin prophylaxis of tuberculosis in liver transplant candidates is associated with a high incidence of tenosynovitis that limits its potential utility. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  8. Mycobacterium arupense, Mycobacterium heraklionense, and a Newly Proposed Species, "Mycobacterium virginiense" sp. nov., but Not Mycobacterium nonchromogenicum, as Species of the Mycobacterium terrae Complex Causing Tenosynovitis and Osteomyelitis.

    Science.gov (United States)

    Vasireddy, Ravikiran; Vasireddy, Sruthi; Brown-Elliott, Barbara A; Wengenack, Nancy L; Eke, Uzoamaka A; Benwill, Jeana L; Turenne, Christine; Wallace, Richard J

    2016-05-01

    Mycobacterium terrae complex has been recognized as a cause of tenosynovitis, with M. terrae and Mycobacterium nonchromogenicum reported as the primary etiologic pathogens. The molecular taxonomy of the M. terrae complex causing tenosynovitis has not been established despite approximately 50 previously reported cases. We evaluated 26 isolates of the M. terrae complex associated with tenosynovitis or osteomyelitis recovered between 1984 and 2014 from 13 states, including 5 isolates reported in 1991 as M. nonchromogenicum by nonmolecular methods. The isolates belonged to three validated species, one new proposed species, and two novel related strains. The majority of isolates (20/26, or 77%) belonged to two recently described species: Mycobacterium arupense (10 isolates, or 38%) and Mycobacterium heraklionense (10 isolates, or 38%). Three isolates (12%) had 100% sequence identity to each other by 16S rRNA and 99.3 to 100% identity by rpoB gene region V sequencing and represent a previously undescribed species within the M. terrae complex. There were no isolates of M. terrae or M. nonchromogenicum, including among the five isolates reported in 1991. The 26 isolates were susceptible to clarithromycin (100%), rifabutin (100%), ethambutol (92%), and sulfamethoxazole or trimethoprim-sulfamethoxazole (70%). The current study suggests that M. arupense, M. heraklionense, and a newly proposed species ("M. virginiense" sp. nov.; proposed type strain MO-233 [DSM 100883, CIP 110918]) within the M. terrae complex are the major causes of tenosynovitis and osteomyelitis in the United States, with little change over 20 years. Species identification within this complex requires sequencing methods. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  9. Outpatient management of flexor tenosynovitis: use of On-Q system to deliver constant antibiotic irrigation and pain control improves rehabilitation.

    Science.gov (United States)

    Alizadeh, Kaveh; Danielpour, Payman J; Brewer, Bruce; Layke, John

    2013-02-01

    Flexor tenosynovitis accounts for nearly 10% of all hand infections and, if untreated, can have devastating consequences. Late presentation often requires operative intervention that requires open drainage and irrigation of the flexor tendon sheath with prolonged rehabilitation. We report the use of closed-catheter irrigation system with the On-Q delivery system that allows for simultaneous in situ antibiotic and pain control for outpatient treatment of flexor tenosynovitis. The On-Q delivery system was placed in 6 consecutive patients who met the criteria of all 4 Knavel signs. They all underwent open drainage and closed irrigation system with 0.25% bupivacaine and 250 mg cefazolin over a 1-week period. In all 6 patients, there was no use of narcotic analgesics or oral antibiotics upon discharge. Postoperative hand therapy and range of motion was initiated on postoperative day 1. There was satisfactory progression of range of motion and hand therapy. This initial clinical case series supports the use of the closed irrigation delivery system with in situ antibiotic and analgesic delivery for more rapid rehabilitation of patients with flexor tenosynovitis.

  10. Kinematic, kinetic and electromyographic response to customized foot orthoses in patients with tibialis posterior tenosynovitis, pes plano valgus and rheumatoid arthritis.

    Science.gov (United States)

    Barn, Ruth; Brandon, Mhairi; Rafferty, Daniel; Sturrock, Roger D; Steultjens, Martijn; Turner, Deborah E; Woodburn, James

    2014-01-01

    To describe the effect of customized foot orthoses (FOs) on the kinematic, kinetic and EMG features in patients with RA, tibialis posterior (TP) tenosynovitis and associated pes plano valgus. Patients with RA and US-confirmed tenosynovitis of TP underwent gait analysis, including three-dimensional (3D) kinematics, kinetics, intramuscular EMG of TP and surface EMG of tibialis anterior, peroneus longus, soleus and medial gastrocnemius. Findings were compared between barefoot and shod with customized FO conditions. Ten patients with RA with a median (range) disease duration of 3 (1-18) years were recruited. Moderate levels of foot pain and foot-related impairment and disability were present with moderately active disease states. Altered timing of the soleus (P = 0.05) and medial gastrocnemius (P = 0.02) and increased magnitude of tibialis anterior (P = 0.03) were noted when barefoot was compared with shod with FO. Trends were noted for reduced TP activity in the contact period (P = 0.09), but this did not achieve statistical significance. Differences in foot motion characteristics were recorded for peak rearfoot eversion (P = 0.01), peak rearfoot plantarflexion (P foot motion characteristics in patients with RA, pes plano valgus and US-confirmed TP tenosynovitis in response to customized FOs. Complex adaptations were evident in this cohort and further work is required to determine whether these functional alterations lead to improvements in patient symptoms.

  11. Nonseptic tenosynovitis of the digital flexor tendon sheath caused by longitudinal tears in the digital flexor tendons: a retrospective study of 135 tenoscopic procedures.

    Science.gov (United States)

    Arensburg, L; Wilderjans, H; Simon, O; Dewulf, J; Boussauw, B

    2011-11-01

    Longitudinal tears (LTs) of the digital flexor tendons are an important cause of chronic tenosynovitis of the digital flexor tendon sheath (DFTS). The origin of those marginal tears is not yet fully understood. The long-term outcome after medical and surgical treatment is guarded. To determine the prevalence of LTs of the digital flexor tendons in a large population of horses undergoing diagnostic tenoscopy of the DFTS and to assess the outcome of surgical treatment and the factors influencing the outcome. Medical records of 130 horses with chronic tenosynovitis of the DFTS that had tenoscopic surgery between 1999 and 2009 were evaluated. One hundred and thirty-five DFTSs were examined. LTs were diagnosed in 104 DFTSs in 101 horses and long-term follow-up was obtained. Seventy-eight percent of the horses with a nonseptic tenosynovitis of the DFTS had a LT. Preoperative ultrasonographic examination diagnosed tears in 76% of the cases. In showjumpers forelimbs were more frequently affected than hindlimbs (88 vs. 12%), with the right front having a higher incidence of injury than the left front (76 vs. 24%). Seventy-nine percent of the tears involved the deep digital flexor tendon (DDFT) and 87% were located on the lateral tendon border. Thirty-seven horses (38%) returned to an equal or higher level of work. The use of a radiofrequency probe (coblation) was associated with a lower level of performance and decreased the cosmetic end result. Persistence of marked post operative distension of the DFTS carried a poor prognosis for return to previous level of work. A guarded prognosis for future soundness should be given to horses presented for treatment of LTs of the digital flexor tendons. The use of coblation wands had a negative effect on the final outcome. © 2010 EVJ Ltd.

  12. Subclinical synovitis and tenosynovitis by ultrasonography (US) 7 score in patients with rheumatoid arthritis treated with synthetic drugs, in clinical remission by DAS28.

    Science.gov (United States)

    Ventura-Ríos, Lucio; Sánchez Bringas, Guadalupe; Hernández-Díaz, Cristina; Cruz-Arenas, Esteban; Burgos-Vargas, Rubén

    2017-11-29

    To identify synovitis and tenosynovitis active by using the Ultrasound 7 (US 7) scoring system in patients with rheumatoid arthritis (RA) in clinical remission induced by synthetic disease-modifying antirheumatic drugs (DMARDs). This is a multicentric, cross-sectional, observational study including 94 RA patients >18 years old who were in remission as defined by the 28-joints disease activity score (DAS28) <2.6 induced by synthetic DMARD during at least 6 months. Patients with a previous or current history of biologic DMARD treatment were not included in the study. Demographic and clinical data were collected by the local rheumatologist; the US evaluation was performed by a calibrated rheumatologist, who intended to detect grayscale synovitis and power Doppler (PD) using the 7-joint scale. Intra and inter-reader exercises of images between 2 ultrasonographers were realized. Patients' mean age was 49.1±13.7 years; 83% were women. The mean disease duration was 8±7 years and remission lasted for 27.5±31.8 months. The mean DAS28 score was 1.9±0.66. Grayscale synovitis was present in 94% of cases; it was mild in 87.5% and moderate in 12.5%. Only 12.8% of the patients had PD. The metatarsophalangeal, metacarpophalangeal, and carpal joints of the dominant hand were the joints more frequently affected by synovitis. Tenosynovitis by grayscale was observed in 9 patients (9.6%). The intra and inter-reading kappa value were 0.77, p<0.003 (CI 95%, 0.34-0.81) and 0.81, p<0.0001 (CI 95%, 0.27-0.83) respectively. Low percentage of synovitis and tenosynovitis active were founded according to PD US by 7 score in RA patients under synthetic DMARDs during long remission. This score has benefit because evaluate tenosynovitis, another element of subclinical disease activity. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  13. Variations of anatomy on MRI of the first extensor compartment of the wrist and association with DeQuervain tenosynovitis

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    Chang, Connie Y.; Kheterpal, Arvin B.; Terneria Vicentini, Joao Rafael; Huang, Ambrose J. [Massachusetts General Hospital, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States)

    2017-08-15

    To study anatomical variations on MRI of the first extensor compartment of the wrist in DeQuervain tenosynovitis (DQT). A retrospective search for DQT patients yielded 47 subjects (51 ± 15 years, 36 female, 11 male). The age-matched control group (normal first extensor compartment) was 49 ± 15 years (29 female, 18 male). Two independent readers reviewed: the number of abductor pollicis longus (APL) tendon slips, tendon sheath septations (compartmentalization), and APL and EPB cross-sectional area (CSA) at the radial styloid. A tendon slip was defined as a discrete structure for ≥5 contiguous slices with its own insertion. The distribution of APL tendon slips was different for the DQT and control groups (Reader 1/Reader 2: P = 0.0001 and 0.001). The most common arrangement for both groups was two APL tendon slips. One tendon slip was less common (P = 0.03 and 0.1) and compartmentalization was more common (P = 0.003; < 0.0001) for the DQT group than the control group. There was no difference in tendon slip insertions on one or multiple bones (P = 0.1; 0.7). APL and EPB compartment CSAs were also higher for the DQT group (combined first extensor compartment area: 21.3 ± 7.6 mm{sup 2}; 21.0 ± 7.1) than the control group (17.2 ± 3.8; 17.1 ± 3.9) (P = 0.002; 0.002). We found a statistically significantly increased proportion of supernumerary tendon slips and compartmentalization of the first extensor compartment in patients with DQT and greater CSA of the first extensor compartment at the radial styloid, consistent with previous anatomical, surgical, and ultrasound studies. (orig.)

  14. Tenosinovitis flexora piógena de la mano: hallazgos ecográficos Pyogenic flexor tenosynovitis of the hand: sonographic findings

    Directory of Open Access Journals (Sweden)

    A. Rodríguez

    2007-09-01

    Full Text Available Los autores describen los hallazgos ecográficos en tres pacientes con tenosinovitis flexora piógena (TFP de la mano. Los hallazgos patológicos encontrados en el Eco-Doppler Color fueron un halo hipoecogénico peritendinoso y una hipervascularización de la vaina sinovial. La Ecografía es un procedimiento no invasivo que permite diagnosticar de manera eficiente y precoz la TFP y permite además realizar un estadiaje preoperatorio siendo una guía útil para planificar la cirugía en función de la cantidad y localización de la colección purulenta y de la integridad tendinosa.The authours describe the sonographic findings in three cases of pyogenic flexor tenosynovitis of the hand. Hipoechogenic peritendinous area and hipervascularization of the synovial sheath revealed as the pathologic findings. In Color Doppler US Ultrasound is a non-invasive procedure that allows to make an accurate and early diagnosis of pyogenic flexor tenosynovitis, it is an useful guide for planning surgery taking account the amount and localization of the purulence and the integrity of the tendons.

  15. Trigger Finger (Stenosing Tenosynovitis)

    Science.gov (United States)

    ... the fingers glide easily with the help of pulleys. These pulleys hold the tendons close to the bone. This ... rod (Figure 1). Trigger finger occurs when the pulley becomes too thick, so the tendon cannot glide ...

  16. De Quervain's Tenosynovitis

    Science.gov (United States)

    ... dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on ... Discovery's Edge Magazine Search Publications Training Grant Positions Education Mayo Clinic College of Medicine and Science Mayo ...

  17. A treat-to-target strategy with methotrexate and intra-articular triamcinolone with or without adalimumab effectively reduces MRI synovitis, osteitis and tenosynovitis and halts structural damage progression in early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Axelsen, Mette Bjørndal; Eshed, Iris; Hørslev-Petersen, Kim

    2015-01-01

    effect. METHODS: In a double-blind, placebo-controlled trial, 85 disease-modifying antirheumatic drug-naïve patients with ERA were randomised to receive methotrexate, intra-articular glucocorticosteroid injections and placebo/adalimumab (43/42). Contrast-enhanced MRI of the right hand was performed...... with conventional MRI inflammatory parameters. Clinical measures decreased highly significantly during follow-up. CONCLUSIONS: A treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid in patients with ERA effectively decreased synovitis, osteitis and tenosynovitis and halted structural...

  18. Effect of a treat-to-target strategy based on methotrexate and intra-articular betamethasone with or without additional cyclosporin on MRI-assessed synovitis, osteitis, tenosynovitis, bone erosion, and joint space narrowing in early rheumatoid arthritis: results from a 2-year randomized double-blind placebo-controlled trial (CIMESTRA)

    DEFF Research Database (Denmark)

    Møller-Bisgaard, S.; Ejbjerg, B. J.; Eshed, I.

    2017-01-01

    in the MRI substudy, and had contrast-enhanced MR images of the non-dominant hand at months 0, 6, 12, and 24. MR images were evaluated for osteitis, synovitis, tenosynovitis, bone erosion, and joint space narrowing (JSN), using validated scoring methods.Results: Significant reductions were seen at 6months...

  19. De Quervain's Tenosynovitis: A Review of the Rehabilitative Options

    National Research Council Canada - National Science Library

    Goel, Ritu; Abzug, Joshua M

    2015-01-01

    .... Conservative care involved anti-inflammatory medication and corticosteroid injections as well as occupational therapy to include splinting, activity modification, modalities, manual treatment, and therapeutic exercise...

  20. Tenosynovitis in rheumatoid arthritis patients on biologic treatment

    DEFF Research Database (Denmark)

    Hammer, Hilde Berner; Kvien, Tore K; Terslev, Lene

    2017-01-01

    OBJECTIVES: Extensor carpi ulnaris (ECU) and tibialis posterior (TP) tendons are often involved in RA and the present aim was to examine by ultrasound (US) their frequency of inflammation and sensitivity to change in comparison to joint involvement as well as clinical examinations. METHODS: US, c...

  1. Retrospective patient-reported assessment of quality of life after surgical release for de Quervain tenosynovitis

    Directory of Open Access Journals (Sweden)

    Sorg, Heiko

    2015-03-01

    Full Text Available Background: Evaluation of the quality of life following surgical release of the first extensor compartment in adult patients with de Quervain disease. Patients and methods: This retrospective study included hospital chart review and patient-reported outcome assessment using the German version of the Disabilities of the Arm, Shoulder and Hand (DASH Outcome Measure and the validated German Michigan Hand Outcomes Questionnaire (MHQ. Results: A total of 46 patients underwent a surgical release of the first extensor compartment for de Quervain disease. Postoperative German MHQ was 78±4. Postoperative DASH score was 19±5. Satisfaction with surgery was rated positive in 85%, and 89% would undergo the procedure again. Patients with a transversal incision line had a DASH result of 11±6 and a German MHQ score of 83±7, patients with a longitudinal incision had a DASH score of 22±9 and a German MHQ score of 80±6. The patients pain level after transversal incision was markedly lower (resting pain=0.4±0.3; stress pain=1.0±0.6 than in patients operated with a longitudinal incision (resting pain=2.4±0.9; stress pain=3.1±1.1. Conclusion: The surgical approach for the treatment of de Quervain disease is associated with a high postoperative quality of life, a low postoperative morbidity and a low level of postoperative pain. A transversal incision is associated with better postoperative results than the longitudinal approach.

  2. Role of Guided Ultrasound in the Treatment of De Quervain Tenosynovitis by Local Steroid Infiltration.

    Science.gov (United States)

    Danda, Raja Shekar; Kamath, Jagannath; Jayasheelan, Nikil; Kumar, Prashanth

    2016-04-01

    Ultrasound guidance for steroid injection in de Quervain disease is useful in identifying the presence of subcompartments and effectively injecting the drug into tendon sheath. We prospectively studied 50 patients with features of de Quervain disease to determine the effectiveness of ultrasound in positioning of needle for steroid injection and effectiveness of single versus multiple injections in the presence of subcompartments. Scalp vein set was inserted into the tendon sheath under ultrasound guidance and sterile conditions. Mixture containing 1 mL of methylprednisolone 40 mg with 1 mL of 2% lignocaine was injected and the patient followed for 6 months. In patients having subcompartments, improvement was better when two separate injections into each subcompartment were given compared with single. Ultrasound guidance is helpful in identifying the existence of subcompartment and injecting the subcompartments separately. Scalp vein set may be very effective in ultrasound-guided injection. This is a level III study.

  3. De Quervain Tenosynovitis Following Trapeziometacarpal Ball-and-Socket Joint Replacement.

    Science.gov (United States)

    Goubau, Jean F; Goubau, Laurent; Goorens, Chul Ki; van Hoonacker, Petrus; Kerckhove, Diederick; Vanmierlo, Bert; Berghs, Bart

    2015-02-01

    Background One of the surgical treatment options for trapeziometacarpal (TMC) joint arthritis is a prosthetic ball-and-socket replacement. One of the complications in the postoperative setting is de Quervain tendinopathy. Purposes Although this complication has been reported following a resection athroplasty, we questioned whether lengthening of the thumb following the Ivory (Memometal, Stryker Corporate, Kalamazoo, MI, USA) ball-and-socket arthroplasty could be a causal factor. Methods In a prospective study regarding the overall outcome of the Ivory prosthesis, we analyzed 96 cases (83 patients; 69 female, 12 male, 8 bilateral) of primary implanted Ivory prosthesis and the incidence of de Quervain disease during the first year following surgery. We found a particularly high incidence (17%) of de Quervain tendinopathy the first year following this ball-and-socket arthroplasty. We measured the lengthening of the thumb radiographically in the group presenting de Quervain and the asymptomatic group and compared this measure between the two groups. Results We did not find any measurable or statistically significant difference between the groups regarding lengthening. Discussion These findings suggest that lengthening of the thumb following ball-and-socket arthroplasty is not a causal factor in the development of de Quervain tendinopathy within one year after surgery.

  4. Surgical and anatomical studies on De Quervain's tenosynovitis syndrome: Variations in the first extensor compartment

    Directory of Open Access Journals (Sweden)

    Paulo Randal Pires J and uacute;nior

    2016-08-01

    Clinical relevance: As septation of the first extensor compartment and multiple APL tendons appears to represent risk factors for the development of DQT, prior knowledge of the frequency of such anomalies may assist surgeons in pre-operative evaluation and perioperative procedures. [Hand Microsurg 2016; 5(2.000: 50-55

  5. Carpal Tunnel Syndrome with Wrist Trigger Caused by Hypertrophied Lumbrical Muscle and Tenosynovitis

    Directory of Open Access Journals (Sweden)

    Ayuko Shimizu

    2015-01-01

    Full Text Available We present a case of carpal tunnel syndrome involving wrist trigger caused by a hypertrophied lumbrical muscle with flexor synovitis. The case was a 40-year-old male heavy manual worker complaining of numbness and pain in the median nerve area. On active flexion of the fingers, snapping was observed at the carpal area, and forceful full grip was impossible. Tinel’s sign was positive and an electromyographic study revealed conduction disturbance of the median nerve at the carpal tunnel. Magnetic resonance imaging revealed edematous lumbrical muscle with synovial proliferation around the flexor tendons. Open carpal tunnel release was performed under local anesthesia. Synovial proliferation of the flexor tendons was found and when flexing the index and middle fingers, the lumbrical muscle was drawn into the carpal tunnel with a triggering phenomenon. After releasing the carpal tunnel, the triggering phenomenon and painful numbness improved.

  6. Surgical release of de Quervain's stenosing tenosynovitis postpartum: can it wait?

    National Research Council Canada - National Science Library

    Capasso, Giovanni; Testa, Vittorino; Maffulli, Nicola; Turco, Giovanni; Piluso, Gabriella

    2002-01-01

    ...) and 30 nonpregnant women (group 2). All patients underwent conservative management consisting of 2 weeks of splinting of the affected wrist, followed by physiotherapy and antiinflammatory drugs (NSAIDs...

  7. Tenosynovitis Evaluation Using Image Fusion and B-Flow - A Pilot Study on New Imaging Techniques in Rheumatoid Arthritis Patients

    DEFF Research Database (Denmark)

    Ammitzbøll-Danielsen, Mads; Glinatsi, Daniel; Torp-Pedersen, Søren

    2017-01-01

    tendon and tendon sheath, using two tendon measures on MRI, area 1 and area 2, excluding and including partial volume artifacts, respectively, 3. Assessment using the OMERACT semi-quantitative scoring systems for US and MRI. Furthermore, BFI was assessed as: 0: No flow, 1: Focal flow, 2: Multifocal flow...

  8. The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff's Test.

    Science.gov (United States)

    Goubau, J F; Goubau, L; Van Tongel, A; Van Hoonacker, P; Kerckhove, D; Berghs, B

    2014-03-01

    De Quervain's disease has different clinical features. Different tests have been described in the past, the most popular test being the Eichhoff's test, often wrongly named as the Finkelstein's test. Over the years, a misinterpretation has occurred between these two tests, the latter being confused with the first. To compare the Eichhoff's test with a new test, the wrist hyperflexion and abduction of the thumb test, we set up a prospective study over a period of three years for a cohort of 100 patients (88 women, 12 men) presenting spontaneous pain over the radial side of the styloid of the radius (de Quervain tendinopathy). The purpose of the study was to compare the accuracy of the Eichhoff's test and wrist hyperflexion and abduction of the thumb test to diagnose correctly de Quervain's disease by comparing clinical findings using those tests with the results on ultrasound. The wrist hyperflexion and abduction of the thumb test revealed greater sensitivity (0.99) and an improved specificity (0.29) together with a slightly better positive predictive value (0.95) and an improved negative predictive value (0.67). Moreover, the study showed us that the wrist hyperflexion and abduction of the thumb test is very valuable in diagnosing dynamic instability after successful decompression of the first extensor compartment. Our results support that the wrist hyperflexion and abduction of the thumb test is a more precise tool for the diagnosis of de Quervain's disease than the Eichhoff's test and thus could be adopted to guide clinical diagnosis in the early stages of de Quervain's tendinopathy.

  9. PET/CT imaging in polymyalgia rheumatica: praepubic 18F-FDG uptake correlates with pectineus and adductor longus muscles enthesitis and with tenosynovitis

    Directory of Open Access Journals (Sweden)

    Rehak Zdenek

    2017-01-01

    Full Text Available The role of 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT is increasing in the diagnosis of polymyalgia rheumatica (PMR, one of the most common inflammatory rheumatic diseases. In addition to other locations, increased 18F-FDG accumulation has been detected in the praepubic region in some patients. However, a deeper description and pathophysiological explanation of this increased praepubic accumulation has been lacking. The aim of the presented study is to confirm a decrease in praepubic 18F-FDG accumulation in response to therapy and to describe potential correlations to other 18F-FDG PET/CT scan characteristics during the course of disease. As a secondary objective, we describe the pathological aspects of the observed praepubic 18F-FDG uptake.

  10. Tenosynovitis of the carpal sheath of the digital flexor tendons associated with tears of the radial head of the deep digital flexor: observations in 11 horses.

    Science.gov (United States)

    Minshall, G J; Wright, I M

    2012-01-01

    Tears of the radial head of the deep digital flexor (DDF) have not previously been documented. To describe the presentation, clinical, ultrasonographic and tenoscopic features associated with tears of the radial head of the DDF and to report the results of treatment. Tears of the radial head of the DDF cause lameness and distension of the carpal sheath of the digital flexor tendons. Removal of disrupted tissue that is extruded into the sheath can result in clinical resolution and restoration of function. Case records and diagnostic images of horses in which tearing of the radial head of the DDF was diagnosed were reviewed retrospectively and follow-up information obtained. Eleven cases were identified. Clinical, ultrasonographic and tenoscopic commonality was recorded and treatment techniques were documented. All cases returned post operatively to pre-injury levels of work. Tearing of the radial head of the DDF is a clinical entity with consistent diagnostic features. Tenoscopic removal of the torn tissue is associated with a good outcome. Clinicians evaluating lame horses should include tearing of the radial head of the DDF as a differential diagnosis in animals with distended carpal sheaths. Tenoscopic surgery is a recommended treatment. © 2011 EVJ Ltd.

  11. Poliartritis y tenosinovitis grave por Streptococcus agalactiae en un paciente con hipoesplenia funcional Severe polyarthritis and tenosynovitis caused by Streptococcus agalactiae in a patient with functional hyposplenia

    OpenAIRE

    Domingo C. Balderramo; Ana M. Bertoli; Miguel A. PaganiniI; Abel Zárate; Zlocowski, Juan C.; Alejandro Alvarellos; Francisco Caeiro; Caeiro, Juan P.

    2002-01-01

    La artritis por Streptococcus agalactiae es infrecuente. No conocemos publicaciones de casos sobre la afección tendinosa por este microorganismo. Se presenta una mujer de 46 años que consultó por fiebre, poliartralgias, mialgias, diarrea y vómitos. Como antecedentes presentaba carcinoma papilar de tiroides e hipoesplenia funcional. Al examen se encontraba hemodinámicamente inestable, febril, con artritis de mano izquierda, muñecas, codos, hombro derecho y tobillo izquierdo. Presentaba tenosin...

  12. Tenosinovitis flexora piógena de la mano: hallazgos ecográficos Pyogenic flexor tenosynovitis of the hand: sonographic findings

    OpenAIRE

    Rodríguez, A; F. J. Pérez-Fontán; Fernández, P.; Álvarez, A.; Midón, J.; Martelo, F.

    2007-01-01

    Los autores describen los hallazgos ecográficos en tres pacientes con tenosinovitis flexora piógena (TFP) de la mano. Los hallazgos patológicos encontrados en el Eco-Doppler Color fueron un halo hipoecogénico peritendinoso y una hipervascularización de la vaina sinovial. La Ecografía es un procedimiento no invasivo que permite diagnosticar de manera eficiente y precoz la TFP y permite además realizar un estadiaje preoperatorio siendo una guía útil para planificar la cirugía en función de la c...

  13. Repetitive Motion Disorders

    Science.gov (United States)

    ... or daily activities. RMDs include carpal tunnel syndrome, bursitis, tendonitis, epicondylitis, ganglion cyst, tenosynovitis, and trigger finger. ... or daily activities. RMDs include carpal tunnel syndrome, bursitis, tendonitis, epicondylitis, ganglion cyst, tenosynovitis, and trigger finger. ...

  14. De Quervain tendinitis

    Science.gov (United States)

    Tendinopathy - De Quervain tendinitis; de Quervain tenosynovitis ... De Quervain tendinitis can be caused by playing sports such as tennis, golf, or rowing. Constantly lifting children can also strain ...

  15. Hazards of steroid injection: Suppurative extensor tendon rupture

    Directory of Open Access Journals (Sweden)

    Woon Colin

    2010-01-01

    Full Text Available Local steroid injections are often administered in the office setting for treatment of trigger finger, carpal tunnel syndrome, de Quervain′s tenosynovitis, and basal joint arthritis. If attention is paid to sterile technique, infectious complications are rare. We present a case of suppurative extensor tenosynovitis arising after local steroid injection for vague symptoms of dorsal hand and wrist pain. The progression of signs and symptoms following injection suggests a natural history involving bacterial superinfection leading to tendon rupture. We discuss the pitfalls of local steroid injection and the appropriate management of infectious extensor tenosynovitis arising in such situations.

  16. Pain: Hope through Research

    Science.gov (United States)

    ... tendonitis or tenosynovitis , affecting one or more tendons. Sciatica is a generic term representing pain in the ... down into the thighs, legs, ankles, and feet . Sciatica can be caused by a number of factors ...

  17. Cervical Spondylotic Myelopathy (CSM)

    Science.gov (United States)

    ... June 2017September 2000Sex and Sexualityfamilydoctor.org editorial staffde Quervain’s TenosynovitisOctober 2017November 2009Sex and Sexualityfamilydoctor.org editorial staffShinglesSeptember ...

  18. Colds and the Flu: Respiratory Infections during Pregnancy

    Science.gov (United States)

    ... staffAnemiaMay 2017January 1996Infants and Toddlersfamilydoctor.org editorial staffde Quervain’s TenosynovitisOctober 2017November 2009Infants and Toddlersfamilydoctor.org editorial staffRecovering ...

  19. Ending a Pregnancy

    Science.gov (United States)

    ... staffAnemiaMay 2017January 1996Infants and Toddlersfamilydoctor.org editorial staffde Quervain’s TenosynovitisOctober 2017November 2009Infants and Toddlersfamilydoctor.org editorial staffRecovering ...

  20. Diclofenac Patch for Treatment of Mild to Moderate Tendonitis or Bursitis

    Science.gov (United States)

    2008-08-05

    Rotator Cuff Tendonitis; Bicipital Tendonitis; Subdeltoid Bursitis of the Shoulder; Subacromial Bursitis of the Shoulder; Medial Epicondylitis of the Elbow; Lateral Epicondylitis of the Elbow; DeQuervain's Tenosynovitis of the Wrist

  1. Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy:

    DEFF Research Database (Denmark)

    Bakkegaard, Mads; Johannsen, Finn E; Højgaard, Betina

    2015-01-01

    eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow...

  2. Musculoskeletal infections: ultrasound appearances

    Energy Technology Data Exchange (ETDEWEB)

    Chau, C.L.F. [Department of Radiology, North District Hospital, NTEC, Fanling, NT, Hong Kong (China)]. E-mail: c8681@yahoo.com; Griffith, J.F. [Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, NTEC, Shatin, NT, Hong Kong (China)

    2005-02-01

    Musculoskeletal infections are commonly encountered in clinical practice. This review will discuss the ultrasound appearances of a variety of musculoskeletal infections such as cellulitis, infective tenosynovitis, pyomyositis, soft-tissue abscesses, septic arthritis, acute and chronic osteomyelitis, and post-operative infection. The peculiar sonographic features of less common musculoskeletal infections, such as necrotizing fasciitis, and rice body formation in atypical mycobacterial tenosynovitis, and bursitis will also be presented.

  3. Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated?

    Energy Technology Data Exchange (ETDEWEB)

    Stomp, Wouter; Bloem, Johan L.; Reijnierse, Monique [Leiden University Medical Center, Department of Radiology, P.O. Box 9600, Leiden (Netherlands); Krabben, Annemarie; Heijde, Desiree van der; Huizinga, Tom W.J.; Helm-van Mil, Annette H.M. van der [Leiden University Medical Center, Department of Rheumatology, P.O. Box 9600, Leiden (Netherlands); Oestergaard, Mikkel [University of Copenhagen, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spinal Diseases, Glostrup Hospital, Glostrup (Denmark)

    2015-05-01

    To evaluate whether intravenous gadolinium (Gd) contrast administration can be eliminated when evaluating synovitis and tenosynovitis in early arthritis patients, thereby decreasing imaging time, cost, and invasiveness. Wrist MRIs of 93 early arthritis patients were evaluated by two readers for synovitis of the radioulnar, radiocarpal, and intercarpal joints, according to the Rheumatoid Arthritis MRI Scoring method (RAMRIS), and for tenosynovitis in ten compartments. Scores of MRI images without Gd contrast enhancement were compared to scores obtained when evaluating all, including contrast-enhanced, MRI images as reference. Subsequently, a literature review and pooled analysis of data from the present and two previous studies were performed. At the individual joint/tendon level, sensitivity to detect synovitis without Gd contrast was 91 % and 72 % for the two readers, respectively, with a specificity of 51 % and 81 %. For tenosynovitis, the sensitivity was 67 % and 54 %, respectively, with a specificity of 87 % and 91 %. Pooled data analysis revealed an overall sensitivity of 81 % and specificity of 50 % for evaluation of synovitis. Variations in tenosynovitis scoring systems hindered pooled analyses. Eliminating Gd contrast administration resulted in low specificity for synovitis and low sensitivity for tenosynovitis, indicating that Gd contrast administration remains essential for an optimal assessment. (orig.)

  4. Ultrasonographic abnormalities and inter-reader reliability in Danish patients with systemic lupus erythematosus - a comparison with clinical examination of wrist and metacarpophalangeal joints

    DEFF Research Database (Denmark)

    Dreyer, L; Jacobsen, Søren; Juul, L

    2015-01-01

    . METHODS: Thirty-three female SLE patients were twice examined with US by three trained examiners. Using B-mode and Doppler US, unilateral wrist and metacarpophalangeal (MCP) joints were examined for synovitis and erosions as well as signs of hand tenosynovitis using a GE Logiq 9 US machine with Doppler......%) and 0 (p = 0.06). In SLE patients, 18% had hand tenosynovitis and 6% bone erosions. Wrist synovitis was detected by US in 16 SLE patients (81%) with arthralgia compared with 17 patients without (18%) (p = 0.0005). Any US abnormalities were observed in 44% of 25 wrists without tenderness at clinical...... of synovitis, erosions and tenosynovitis indicating subclinical disease. Even SLE patients without clinical signs of joint inflammation demonstrated US abnormalities. Good to excellent inter-observer reliability was found in US evaluation of hands in patients with SLE....

  5. Ultrasound-Guided Interventional Procedures of the Wrist and Hand: Anatomy, Indications, and Techniques.

    Science.gov (United States)

    Colio, Sean W; Smith, Jay; Pourcho, Adam M

    2016-08-01

    Acute and chronic wrist and hand conditions are commonly seen by neuromuscular and musculoskeletal specialists. High-frequency diagnostic ultrasonography (US) has facilitated advances in the diagnosis and interventional management of wrist and hand disorders. US provides excellent soft tissue resolution, accessibility, portability, lack of ionizing radiation, and the ability to dynamically assess disorders and precisely guide interventional procedures. This article review the relevant anatomy, indications, and interventional techniques for common disorders of the wrist and hand, including radiocarpal joint arthritis, scaphotrapeziotrapezoidal joint arthritis, trapeziometacarpal joint arthritis, phalangeal joint arthritis, first dorsal compartment tenosynovitis, ganglion cysts, and stenosing tenosynovitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Karpaltunnelsyndrom. En arbejdsbetinget lidelse?

    DEFF Research Database (Denmark)

    Madsen, F H; Jensen, O C

    1991-01-01

    Attention is drawn to early and correct diagnosis of the carpal tunnel syndrome (CTS). Our case history describes how a 44 year old man contracted bilateral CTS by forceful repetitive bending of plastic frames with both hands. The syndrome is most often referred to as a result of a tenosynovitis ...

  7. A systematic literature review of US definitions, scoring systems and validity according to the OMERACT filter for tendon lesion in RA and other inflammatory joint diseases.

    Science.gov (United States)

    Alcalde, María; D'Agostino, Maria Antonietta; Bruyn, George A W; Möller, Ingrid; Iagnocco, Annamaria; Wakefield, Richard J; Naredo, Esperanza

    2012-07-01

    To present the published data concerning the US assessment of tendon lesions as well as the US metric properties investigated in inflammatory arthritis. A systematic literature search of PubMed, Embase and the Cochrane Library was performed. Selection criteria were original articles in the English language reporting US, Doppler, tenosynovitis and other tendon lesions in patients with RA and other inflammatory arthritis. Data extraction focused on the definition and quantification of US-detected tenosynovitis and other tendon abnormalities and the metric properties of US according to the OMERACT filter for evaluating the above tendon lesions. Thirty-three of 192 identified articles were included in the review. Most articles were case series (42%) or case-control (33%) studies describing hand and/or foot tenosynovitis in RA patients. The majority of older articles used only B-mode, whereas the most recent studies have incorporated Doppler mode. Definition of tenosynovitis or other tendon lesion was provided in 70% of the evaluated studies. Most of the studies (61%) used a binary score for evaluating tendon abnormalities. Concerning the OMERACT filter, 24 (73%) articles dealt with construct validity. The comparator most commonly used was clinical assessment and MRI. There were few studies assessing criterion validity. Some studies evaluated reliability (36%), responsiveness (21%) and feasibility (12%). US seems a promising tool for evaluating inflammatory tendon lesions. However, further validation is necessary for implementation in clinical practice and trials.

  8. A posterior tibial tendon skipping rope

    NARCIS (Netherlands)

    van Sterkenburg, M. N.; Haverkamp, D.; van Dijk, C. N.; Kerkhoffs, G. M. M. J.

    2010-01-01

    This report presents an athletic patient with swelling and progressive pain on the posteromedial side of his right ankle on weight bearing. MRI demonstrated tenosynovitis and suspicion of a length rupture. On posterior tibial tendoscopy, there was no rupture, but medial from the tendon a tissue cord

  9. Magnetic resonance imaging, radiography, and scintigraphy of the finger joints

    DEFF Research Database (Denmark)

    Klarlund, M; Ostergaard, M; Jensen, K E

    2000-01-01

    To evaluate synovial membrane hypertrophy, tenosynovitis, and erosion development of the 2nd to 5th metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints by magnetic resonance imaging in a group of patients with rheumatoid arthritis (RA) or suspected RA followed up for one year...

  10. Achilles Pain.

    Science.gov (United States)

    Connors, G. Patrick

    Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon…

  11. Cervical Spondylitis and Epidural Abscess Caused by Brucellosis: a Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Reşorlu Hatice

    2016-12-01

    Full Text Available Brucellosis is a zoonotic disease widely seen in endemic regions and that can lead to systemic involvement. The musculoskeletal system is frequently affected, and the disease can exhibit clinical involvements such as arthritis, spondylitis, spondylodiscitis, osteomyelitis, tenosynovitis and bursitis. Spondylitis and spondylodiscitis, common complications of brucellosis, predominantly affect the lumbar and thoracic vertebrae.

  12. Antimicrobial resistant coagulase positive Staphylococcus aureus ...

    African Journals Online (AJOL)

    Staphylococcus aureus is an Important agent of food poisoning. In many countries, it is the main bacterial organism responsible for diseases caused by exotoxin production and direct invasion with systemic dissemination. In poultry, S. aureus is associated with many clinical syndromes including tenosynovitis, omphalitis, ...

  13. Achilles tendon: US diagnosis of pathologic conditions. Work in progress

    Energy Technology Data Exchange (ETDEWEB)

    Blei, C.L.; Nirschl, R.P.; Grant, E.G.

    1986-06-01

    Twenty-three patients were prospectively examined with ultra-sound (US) for acute or recurrent Achilles tendon symptoms. Three types of pathologic conditions of the Achilles tendon were found: tendinitis/tenosynovitis, acute tendon trauma, and postoperative changes. US appears to enable differentiation of these conditions and to contribute to the diagnosis of a broad range of Achilles tendon disorders.

  14. Internet Journal of Medical Update

    African Journals Online (AJOL)

    Arun Agnihotri

    but that of foot tendons is even rarer4. This article presents a rare case of tubercular tenosynovitis of extensor tendons of foot in a one year child. CASE DETAILS. A one year old boy from Jaunpur, Uttar Pradesh presented to our OPD with history of trauma followed by pain and swelling on the left ankle and foot, which was ...

  15. Rotator Cuff Injuries.

    Science.gov (United States)

    Connors, G. Patrick

    Many baseball players suffer from shoulder injuries related to the rotator cuff muscles. These injuries may be classified as muscular strain, tendonitis or tenosynovitis, and impingement syndrome. Treatment varies from simple rest to surgery, so it is important to be seen by a physician as soon as possible. In order to prevent these injuries, the…

  16. Tenosinovitis por Mycobacterium chelonae: a propósito de un caso

    OpenAIRE

    Alfredo Berrocal Kasay; Juan Echevarria Zarate; Erick Ramirez Aranda; Elsa Castro Leon; Dina Gonzales Bendezu

    2004-01-01

    We report a patient with a diagnosis of synovial tenosynovitis who developed septic tenosinovitis with cold abscess on right hand, after a local punction. Mycobacterium chelonae a fast-growing mycobacteria, was isolated. We discuss aspects related to differential diagnosis, epidemiology, risk factors. diagnostic procedures and issues related to treatment of this nosocomial infection. (Rev Med Hered 2004;15:229-231).

  17. Magnetic resonance imaging in the assessment of synovial inflammation of the hindfoot in patients with rheumatoid arthritis and other polyarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Maillefert, Jean Francis E-mail: jean-francis.maillefert@chu-dijon.fr; Dardel, Pascal; Cherasse, Anne; Mistrih, Rami; Krause, Denis; Tavernier, Christian

    2003-07-01

    Objectives: To describe the localisation of synovitis and tenosynovitis of the hindfoot observed on magnetic resonance imaging (MRI) in patients with chronic polyarthritis, and to correlate the findings of physical examination and MRI. Methods: Patients with chronic polyarthritis, and one or two painful hindfoot were included. On physical examination and on MRI, the tibio-talar, talo-calcaneal, and talo-navicular and calcaneo-cuboidal joints were adjudged to have or not synovitis, and the tibialis anterior and posterior, the peroneus longus and brevis, the flector digitorum and hallucis longus tendons to have or not tenosynovitis. Criteria for synovitis and tenosynovitis were a high signal intensity on T2-weighted images, a low signal intensity on T1-weighted images, and enhancement after Gd-DTPA injection, in the joint area, and around the tendon, respectively. The correlation between the findings of physical examination and those of MRI were evaluated using the Kappa statistics. Results: 12 patients (three men, nine women, mean age of 55.5 years{+-}11.4 S.D.) with chronic polyarthritis (rheumatoid arthritis (RA): nine, ankylosing spondylitis: one; psoriatic arthritis: one, unclassified: one) were included. All presented with one (7 patients) or two (5 patients) painful hindfeet (and swelling for 16 out of 17 hindfeet). On physical examination, 25 joints and eight tendons were adjudged to have synovitis and tenosynovitis. MRI showed synovitis in 12 out of 25 of these joints (48%), and tenosynovotis in three out of eight of these tendons (37.5%). Moreover, MRI showed ten and seven clinically unsuspected synovitis and tenosynovitis, respectively. The proportion of agreements between physical examination and MRI were 54.9% (kappa=0.1) and 88.2% (kappa=0.27) for synovitis and tenosynovitis, respectively. Conclusion: A weak correlation was observed between the findings of physical examination and MRI in patients with chronic polyarthritis and a painful hindfoot. MRI

  18. MR imaging findings of trigger thumb

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Eric Y.; Chen, Karen C.; Chung, Christine B. [VA San Diego Healthcare System, Radiology Service, San Diego, CA (United States); University of California, San Diego Medical Center, Department of Radiology, San Diego, CA (United States)

    2015-08-15

    Trigger finger (or trigger thumb), also known as sclerosing tenosynovitis, is a common clinical diagnosis that rarely presents for imaging. Because of this selection bias, many radiologists may not be familiar with the process. Furthermore, patients who do present for imaging frequently have misleading examination indications. To our knowledge, magnetic resonance (MR) imaging findings of trigger thumb have not been previously reported in the literature. In this article, we review the entity of trigger thumb, the anatomy involved, and associated imaging findings, which include flexor pollicis longus tendinosis with a distinct nodule, A1 pulley thickening, and tenosynovitis. In addition, in some cases, an abnormal Av pulley is apparent. In the rare cases of trigger finger that present for MR imaging, accurate diagnosis by the radiologist can allow initiation of treatment and avoid further unnecessary workup. (orig.)

  19. Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. The TIRA Group

    DEFF Research Database (Denmark)

    Klarlund, Mette; Østergaard, Mikkel; Jensen, K E

    2000-01-01

    year. Additionally, to compare the results with radiography, bone scintigraphy, and clinical findings. PATIENTS AND METHODS: Fifty five patients were examined at baseline, of whom 34 were followed up for one year. Twenty one patients already fulfilled the American College of Rheumatology (ACR) criteria......, and tenosynovitis score. RESULTS: MRI detected progression of erosions earlier and more often than did radiography of the same joints; at baseline the MRI to radiography ratio was 28:4. Erosions were exclusively found in patients with RA at baseline or fulfilling the ACR criteria at one year. At one year follow up......, scores of MR synovial membrane hypertrophy, tenosynovitis, and scintigraphic tracer accumulation had not changed significantly from baseline; in contrast, swollen and tender joint counts had declined significantly (pradiography. MR synovial membrane...

  20. Minor rheumatology: Nonsystemic rheumatic disease of juxta-articular soft tissues of the upper extremity. Part 1

    Directory of Open Access Journals (Sweden)

    A. E. Karateev

    2015-01-01

    Full Text Available Rheumatic diseases of juxta-articular soft tissues (RDJAST (tendinitis, tenosynovitis, bursitis, etc. are one of the most common causes of disability and one the most common reasons for seeking medical advice. To manage patients with RDJAST is an important part of practising rheumatologists’ work. But unfortunately, the issues of diagnosis and therapy of this pathology have been relatively rarely discussed on the pages of Russian medical journals and at the scientific congresses and conferences of rheumatologists in recent years. This review is to refresh physicians’interest in this problem. Part 1 of this review briefly considers the general issues relating to the epidemiology, pathogenesis, and diagnosis of RDJAST of the upper extremity, such as rotator cuff tendinitis, lateral and medial epicondylitis, stenosing flexor tenosynovitis, de Quervain’s syndrome, and carpal tunnel syndrome.

  1. A Seropositive Nodular Rheumatoid Polyarthritis without Arthritis: Does It Exist?

    Directory of Open Access Journals (Sweden)

    Fatma Ben Fredj Ismail

    2012-01-01

    Full Text Available The rheumatoid polyarthritis is the most frequent chronic polyarthritis. It affects essentially the woman between 40 and 60 years. Rheumatic subcutaneous nodules and tenosynovitis are usually associated with seropositive symptomatic rheumatoid polyarthritis. It is, however, rare that they constitute the essential clinical expression of the disease. In this case, it makes dispute another exceptional form of rheumatoid arthritis such as rheumatoid nodulosis. A 60-year-old woman was hospitalized for tumefaction of the dorsal face of the right hand evolving two months before. The clinical examination found subcutaneous nodules from which the exploration ended in rheumatoid nodules with tenosynovitis. The evolution after four years was favourable under corticosteroid therapy, methotrexate, and colchicine.

  2. Disseminated gonococcal infection presenting as vasculitis: a case report.

    Science.gov (United States)

    Jain, Sangita; Win, Htet Nwe; Chalam, Venkat; Yee, Lian

    2007-01-01

    A 50-year-old man with alcoholic liver disease presented with fever, tenosynovitis, polyarthritis and a vasculitic rash on the hands and feet for 4 days. He had neutrophilia and raised inflammatory markers. He had no history of sore throat, urethral discharge or travel abroad. His initial blood cultures were negative, and he was treated for vasculitis with steroids. The rash and arthritis seemed to improve initially, but he had another episode of fever. Repeat blood cultures grew Neisseria gonorrhoeae,and he received intravenous ceftriaxone followed by oral ciprofloxacin. He had marked improvement in rash, tenosynovitis and arthritis, and the fever dropped. He also had chlamydial urethritis and received azithromycin. The presentation of disseminated gonococcal infection after a presumptive episode of asymptomatic urethral gonorrhoea is highlighted.

  3. Physical Performance Characteristics of Military Aircraft Maintenance Personnel Resistant to Work-Related Musculoskeletal Disorders of the Hand and Wrist

    Science.gov (United States)

    2006-01-01

    tendonitis, carpal tunnel syndrome , and arthritis are included in the category of WMSDs. Risk factors such as repetition, vibration, awkward positions...work. For example, WMSDs such as carpal tunnel syndrome , wrist injuries and repetitive motion injuries resulted in 32, 17, and 22 days absence from work...inflammatory disorders include tendonitis, trigger finger, and tenosynovitis. Nerve compression conditions include carpal tunnel syndrome and ulnar

  4. Inter & intra-observer reliability of grading ultrasound videoclips with hand pathology in rheumatoid arthritis by using non- sophisticated internet tools (LUMINA study).

    Science.gov (United States)

    Vlad, Violeta; Berghea, Florin; Iagnocco, Annamaria; Micu, Mihaela; Damjanov, Nemanja; Skakic, Vlado; Prodanovic, Slavica; Radunovic, Goran; Szkudlarek, Marcin; Nestorova, Rodina; Petranova, Tzvetanka; Kakavouli, Jasna; Porta, Francesco; Perricone, Carlo; Ciechomska, Anna; Moller, Ingrid; Varzaru, Luminita; Peric, Porin; Dejaco, Christian; Bojinca, Mihai; Fodor, Daniela; Milicescu, Mihaela; Naredo, Esperanza

    2014-03-01

    To evaluate the inter- and intraobserver agreement of a group of European rheumatologist ultrasonographers in grading musculoskeletal ultrasound videoclips posted on the Internet by using a non-sophisticated electronic environment. Forty short movie clips (less than 30 secs) were made available over the Internet to all participants. Normal and pathological RA hand joints and tendons were included in the movie clips. In the first phase 30 investigators from European countries were invited to evaluate the clips and to interpret/grade them. No instruction session was held prior to the initiation of the study. For synovitis the requested scoring system included 0 to3 grades and for tenosynovitis a binary variable 0/1; separate evaluations were performed for gray scale (GS) and Power Doppler (PD) examinations. In the second phase the responders were asked to grade the same clips in a different order without having access to their first grading scale. Light's k and Cohen's k were used to analyse inter- and intraobserver reliability. Twenty two European rheumatologists agreed to finalise both study phases. Mean Cohen's κ for intraobserver reliability was 0.614/0.689 for tenosynovitis GS/PD and 0.523/0.621 for synovitis GS/PD. Light's k for interobserver reliability was 0.503 for tenosynovitis evaluation and 0.455 for global (synovitis and tenosynovitis) evaluation. Mean global overall agreement was 84.95% (90.2% for global synovitis). An over-the-net US evaluation and grading has shown moderate to good reliability. The results could be improved if a training session is added at the beginning of the study.

  5. Peroneal tendon disorders

    OpenAIRE

    Davda, Kinner; Malhotra, Karan; O'Donnell, Paul; Singh, Dishan; Cullen, Nicholas

    2017-01-01

    Pathological abnormality of the peroneal tendons is an under-appreciated source of lateral hindfoot pain and dysfunction that can be difficult to distinguish from lateral ankle ligament injuries. Enclosed within the lateral compartment of the leg, the peroneal tendons are the primary evertors of the foot and function as lateral ankle stabilisers. Pathology of the tendons falls into three broad categories: tendinitis and tenosynovitis, tendon subluxation and dislocation, and tendon splits and ...

  6. Surgical anatomy of the first extensor compartment: A systematic review and comparison of normal cadavers vs. De Quervain syndrome patients.

    Science.gov (United States)

    Lee, Z-Hye; Stranix, J T; Anzai, Lavinia; Sharma, Sheel

    2017-01-01

    De Quervain syndrome or tenosynovitis is a common wrist pathology caused by stenosing tenosynovitis of the first dorsal compartment. Multiple studies have demonstrated significant anatomic variation within the first extensor compartment. The terms "De Quervain's tenosynovitis" and "first extensor compartment anatomy" were comprehensively searched using the PubMed, MEDLINE, and Cochrane database. The presence of a septum within the first dorsal compartment, the number of APL (abductor pollicis longus), and EPB (extensor pollicis brevis) tendon slips were identified. A total of 574 articles were identified on initial search, of which 21 met inclusion criteria. There were 1901 normal cadaver specimens and 470 surgically treated De Quervain disease patients, whose data were available. A septum was present in 43.7% of normal cadavers versus 62.2% De Quervain patients with 58.5% (327 of 559) of the septi characterized as incomplete. There was a difference in the number of APL tendons with a single APL tendon slip noted in 18.3% of normal cadavers (200/1096) versus 27.2% of De Quervain patients (87/230). There was a difference in the number of EPB tendons between the normal cadavers and De Quervain's wrists with 2 or more EPB tendinous slips observed in 5.9% of normal cadavers compared with 2.9% of De Quervain patients. Significant anatomic variability exists within the first extensor compartment. Patients with De Quervain disease were more likely to have a septum dividing the compartment and a single slip of APL. These variations are clinically relevant in the pathophysiology and treatment of De Quervain's tenosynovitis. Prognostic studies. Level III. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Minor rheumatology: Nonsystemic rheumatic disease of juxta-articular soft tissues of the upper extremity. Part 1

    OpenAIRE

    A. E. Karateev; D. E. Karateev; E. S. Orlova; Yu. A. Ermakova

    2015-01-01

    Rheumatic diseases of juxta-articular soft tissues (RDJAST) (tendinitis, tenosynovitis, bursitis, etc.) are one of the most common causes of disability and one the most common reasons for seeking medical advice. To manage patients with RDJAST is an important part of practising rheumatologists’ work. But unfortunately, the issues of diagnosis and therapy of this pathology have been relatively rarely discussed on the pages of Russian medical journals and at the scientific congresses and confere...

  8. Compartment syndrome can also be seen in the forearm

    DEFF Research Database (Denmark)

    Asmar, Ali; Broholm, Rikke; Bülow, Jens

    2014-01-01

    Chronic compartment syndrome is a challenge for the clinician and symptomatic similar to neuropathies, tenosynovitis, stress fractures and referred pain from lumbar cervicalis. Thus, chronic compartment syndrome of the upper extremities is probably an underdiagnosed condition. In patients...... with stress-induced pain in the upper limbs, chronic compartment syndrome should be considered - particularly in young patients with high physical activity. Despite limited literature, the effect of surgical treatment is promising....

  9. Kompartmentsyndrom kan også ses i underarmen

    DEFF Research Database (Denmark)

    Asmar, Ali; Broholm, Rikke; Bülow, Jens

    2014-01-01

    Compartment syndrome can also be seen in the forearm Chronic compartment syndrome is a challenge for the clinician and symptomatic similar to neuropathies, tenosynovitis, stress fractures and referred pain from lumbar cervicalis. Thus, chronic compartment syndrome of the upper extremities...... is probably an underdiagnosed condition. In patients with stress-induced pain in the upper limbs, chronic compartment syndrome should be considered – particularly in young patients with high physical activity. Despite limited literature, the effect of surgical treatment is promising....

  10. OSTEOID OSTEOMA IN SCAPHOID: CASE REPORT.

    Science.gov (United States)

    Severo, Antônio Lourenço; de Araújo Filho, Raimundo; Puentes, Rulby; Lemos, Marcelo Barreto; Piluski, Paulo Faiad; Lech, Osvandré

    2012-01-01

    Osteoid osteoma is a benign osteoblastic tumor that is unusual in the hand. A location in the carpal bones is infrequent, which leads to errors in diagnosing it because of polymorphism of the clinical symptoms. Reviewing the literature shows that nine cases of osteoid osteoma in the scaphoid have been reported. Here, one case of osteoid osteoma in the scaphoid that was initially treated as De Quervain's stenosing tenosynovitis is reported, with a definitive diagnosis that was delayed for five years.

  11. Subdeltoid Bursa Tuberculosis with Rice Body Formation–A Case Report

    Directory of Open Access Journals (Sweden)

    Santosh L. Munde

    2015-01-01

    Full Text Available Tuberculous tenosynovitis and bursitis account for approximately 1%. A 56 years old female presented with swelling in left shoulder, gradually increasing in size with slight restriction in movement since last three months. X-ray revealed no abnormality of humerus head. Histopathological examination showed granulomatous tissue with multiple rice bodies. A positive culture of mycobacterium tuberculosis confirmed the diagnosis of tuberculosis. We here report a case of subdeltoid bursitis with rice body formation and without active bone and joint tuberculosis.

  12. Intrasynovial lipoma causing trigger wrist and carpal tunnel syndrome.

    Science.gov (United States)

    Imai, Shinji; Kodama, Narihito; Matsusue, Yoshitaka

    2008-01-01

    Triggering of the flexor tendon at the wrist is rare. We report a case of intrasynovial lipoma that caused a trigger wrist. As far as we know it is unique in that the intrasynovial lipoma simultaneously caused carpal tunnel syndrome. The massive tenosynovitis and adhesion of flexors tendons after the locking of the intrasynovial lipoma may have resulted from inflammation caused by attrition within the carpal tunnel.

  13. Digital flexion contracture and severe carpal tunnel syndrome due to tophaceus infiltration of wrist flexor tendon: first manifestation of gout.

    Science.gov (United States)

    Hernández-Cortés, P; Caba, M; Gómez-Sánchez, R; Gómez-Morales, M

    2011-11-09

    The authors report an unusual case of flexor tenosynovitis, severe carpal tunnel syndrome, and triggering at the carpal tunnel as the first manifestation of gout. A 69-year-old man presented with digital flexion contracture and severe carpal tunnel syndrome of his right hand and was treated surgically. A flexor tenosynovectomy and a median nerve neurolysis were performed through an extended carpal tunnel approach. The sublimis and the profundus tendons were involved. Partial ruptures and multiple whitish lesions suggestive of tophacceous infiltration of the flexor tendons were seen. Macroscopically, the removed synovial tissue was involved by multiple whitish nodules that were milimetric in size and was suggestive of monosodium urate crystals deposits. By light microscopy examination, numerous nonnecrotizing granulomas of different sizes were observed that were compounded by large aggregations of acellular nonpolarized material, surrounded by epithelioid histiocytes, mononuclear cells, and foreign body multinucleated giant cells. Postoperatively, the patient recovered with resolution of the median nerve symptoms and a near-to-full range of motion of the affected digits.To the authors' knowledge, this patient is the first case report with flexor tendons tophacceous infiltration as the first clinical sign of gout. Gouty flexor tenosynovitis can occur in the absence of a long history of gout. A high index of suspicion is paramount to the initiation of proper management. Operative treatment of gouty flexor tenosynovitis is mandatory to debulk tophaceous deposits, improve tendon gliding, and decompress nerves. Routine uric acid determination could be helpful in the preoperative evaluation of patients with flexor tenosynovitis. Copyright 2011, SLACK Incorporated.

  14. Dynamic contrast-enhanced magnetic resonance imaging of articular and extraarticular synovial structures of the hands in patients with psoriatic arthritis

    DEFF Research Database (Denmark)

    Cimmino, Marco Amedeo; Barbieri, Francesca; Boesen, Mikael

    2012-01-01

    Dynamic, contrast-enhanced magnetic resonance imaging (DCE-MRI), the quantification of enhancement within the synovial membrane and bone by extracting curves using fast T1-weighted sequences during intravenous administration of contrast agent, evaluates synovitis and bone marrow edema in psoriati...... arthritis (PsA). In this pilot study, we looked at possible differences between joint synovitis and tenosynovitis in PsA as compared with rheumatoid arthritis (RA)....

  15. Type 1 (reversal) lepra reaction in borderline leprosy with unusual clinical presentation--a case report.

    Science.gov (United States)

    Kar, H K; Saxena, A K; Jain, R K; Sharma, A K

    1987-01-01

    A male 26 years old patient with BB type of leprosy was encountered with a typical clinical presentations of up-grading (reversal) Type 1 Lepra Reaction. These included sudden appearance of tender, erythematous nodular eruptions mimicking ENL, severe constitutional symptoms like high grade fever, malaise, vomiting, epistaxis, joint pain and tenosynovitis simulating Type 2 Lepra Reaction. To the best of our knowledge, this may be the first such case in our hand.

  16. Tenosinovitis por Mycobacterium chelonae: a propósito de un caso

    Directory of Open Access Journals (Sweden)

    Alfredo Berrocal Kasay

    2004-10-01

    Full Text Available We report a patient with a diagnosis of synovial tenosynovitis who developed septic tenosinovitis with cold abscess on right hand, after a local punction. Mycobacterium chelonae a fast-growing mycobacteria, was isolated. We discuss aspects related to differential diagnosis, epidemiology, risk factors. diagnostic procedures and issues related to treatment of this nosocomial infection. (Rev Med Hered 2004;15:229-231.

  17. Tarsal tunnel disease and talocalcaneal coalition: MRI features

    Energy Technology Data Exchange (ETDEWEB)

    FitzGerald Alaia, Erin; Rosenberg, Zehava Sadka; Bencardino, Jenny T.; Ciavarra, Gina A.; Petchprapa, Catherine N. [New York University Langone Medical Center, New York, NY (United States); Rossi, Ignacio [New York University Langone Medical Center, New York, NY (United States); Centro de Diagnostico Dr. Enrique Rossi, Buenos Aires (Argentina)

    2016-11-15

    To assess, utilizing MRI, tarsal tunnel disease in patients with talocalcaneal coalitions. To the best of our knowledge, this has only anecdotally been described before. Sixty-seven ankle MRIs with talocalcaneal coalition were retrospectively reviewed for disease of tendons and nerves of the tarsal tunnel. Interobserver variability in diagnosing tendon disease was performed in 30 of the 67 cases. Tarsal tunnel nerves were also evaluated in a control group of 20 consecutive ankle MRIs. Entrapment of the flexor hallucis longus tendon (FHL) by osseous excrescences was seen in 14 of 67 cases (21 %). Attenuation, split tearing, tenosynovitis, or tendinosis of the FHL was present in 26 cases (39 %). Attenuation or tenosynovitis was seen in the flexor digitorum longus tendon (FDL) in 18 cases (27 %). Tenosynovitis or split tearing of the posterior tibial tendon (PT) was present in nine cases (13 %). Interobserver variability ranged from 100 % to slight depending on the tendon and type of disease. Intense increased signal and caliber of the medial plantar nerve (MPN), indicative of neuritis, was seen in 6 of the 67 cases (9 %). Mildly increased T2 signal of the MPN was seen in 15 (22 %) and in 14 (70 %) of the control group. Talocalcaneal coalitions may be associated with tarsal tunnel soft tissue abnormalities affecting, in decreasing order, the FHL, FDL, and PT tendons, as well as the MPN. This information should be provided to the referring physician in order to guide treatment and improve post-surgical outcome. (orig.)

  18. Arthroscopic Release of Flexor Hallucis Longus Tendon Sheath in Female Ballet Dancers: Dynamic Pathology, Surgical Technique, and Return to Dancing Performance.

    Science.gov (United States)

    Funasaki, Hiroki; Hayashi, Hiroteru; Sakamoto, Kanako; Tsuruga, Rei; Marumo, Keishi

    2015-12-01

    Stenosing tenosynovitis of the flexor hallucis longus (FHL) tendon is known as a major overuse lesion in female dancers. We describe arthroscopic surgical techniques in relation to the dynamic pathology of the disease. Crepitus and pain on moving the great toe with the ankle in plantar flexion on preoperative examination confirm the diagnosis of FHL stenosing tenosynovitis even if the os trigonum is not evident. The ankle is approached through standard posterolateral and posteromedial portals. A 4.0-mm-diameter 30° arthroscope is used. Soft tissues around the talus are cleared with a motorized shaver and a radiofrequency device. The posterior aspects of the talus, os trigonum, and FHL tendon surrounded by the tendon sheath are visualized. The dynamic pathology of the FHL tendon is well observed on passive motion of the great toe. The prominent bone fragment of the talus is removed and the tendon sheath is cut with a retrograde knife and a motorized shaver from the superior border down to the entrance of the fibro-osseous tunnel. Arthroscopic release of the FHL tendon sheath is a useful and easy method to directly approach the dynamic pathology of FHL tenosynovitis in female ballet dancers.

  19. Atypical extraspinal musculoskeletal tuberculosis in immunocompetent patients: Part II, tuberculous myositis, tuberculous bursitis, and tuberculous tenosynovites

    Energy Technology Data Exchange (ETDEWEB)

    Abdelwahab, I.F. [Coney Island Hospital, Brooklyn, New York (United States); Bianchi, S. [Clinique et Fondation des Grangettes, Geneva (Switzerland)]. E-mail: stefanobianchi@bluewin.ch; Martinoli, C. [Universita di Genova, Cattedra di Radiologia, DICMI, Genoa (Italy); Klein, M. [Univ. of Alabama School of Medicine, Dept. of Pathology, Birmingham, Alabama (United States); Hermann, G. [Mount Sinai Medical Center, Dept. of Radiology, New York, New York (United States)

    2006-12-15

    Tuberculosis involving the soft tissue from adjacent bone or joint is well recognized. However, primary tuberculous pyomyositis, tuberculous bursitis, and tuberculous tenosynovitis are rare entities constituting 1% of skeletal tuberculosis. Tuberculosis tenosynovitis involves most commonly the tendon sheaths of the hand and wrist, and tuberculous bursitis occurs most commonly around the hip. The greater trochanteric bursa and the greater trochanter are the most frequent sites of tuberculous bursitis. Cases of primary tuberculous pyomyositis and tenosynovitis of the tendons of the ankle and foot are seldom reported in the radiology literature. All imaging modalities - plain radiography, bone scan, computed tomography, and magnetic resonance imaging (MRI) - provide information that is helpful in determining therapy. MRI in particular, with its multiplanar capabilities and superb contrast of soft tissue, can demonstrate the extent of the soft tissue mass and access the adjacent bones and joints. However, MRI has no diagnostic specificity in regard to tuberculosis, and in nonendemic areas, biopsy is strongly recommended. All patients in this review were permanent residents of North America or Western Europe and were immunocompetent. Examples of atypical presentations of the above entities are demonstrated. (author)

  20. [Peroneal tendoscopy: our experience].

    Science.gov (United States)

    Bravo-Giménez, B; García-Lamas, L; Jiménez-Díaz, V; Llanos-Alcázar, L F; Vilá-Rico, J

    2013-01-01

    The peroneal tendon pathology is a common cause of posterolateral ankle pain. Recently, the incidence and awareness of this disease and its treatment are booming thanks to the development of tendoscopic procedures. To describe and assess the current role and indications of tendoscopy for peroneal tendon pathology. From June 2010 to July 2011, twenty three patients with retrofibular pain were treated with peroneal tendoscopy. We founded twelve peroneal brevis tendon tears, six peroneal longus tendon tears, three cases of tenosynovitis and two cases of luxation, one patient with an intrasheath subluxation and another one of extrasheath. Of the 23 patients, 12 had another injury associated: 4 talar osteochondral lesions, 3 instabilities and 7 cases of soft tissue impingement. The three main indications include tendon tears, tenosynovitis and subluxation or luxation. It is a technically demanding procedure that requires extensive experience in arthroscopic management of small joints and can be particularly complex in cases of wide tenosynovitis, broad tendon tears or anatomical defects but very useful for the evaluation of the lesions and for the treatment of peroneal tendon disorders. Tendoscopy is a useful procedure with low morbidity and excellent functional results to treat the pathology of the peroneal tendons. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  1. Tendo-ligamentous pathologies of the wrist joint: Can ultrasonography replace magnetic resonance imaging?

    Directory of Open Access Journals (Sweden)

    Kunwarpal Singh

    2017-09-01

    Full Text Available Background: Characterization of tendo-ligamentous pathologies of wrist remains problematic, despite advances in imaging. By using clinical history and imaging appearance, one can determine the diagnosis. USG is used as first imaging modality whereas MRI aids in making a specific diagnosis of few of the lesions. Aims: To investigate the etiological spectrum of tendo-ligamentous pathologies of wrist on USG & MRI with statistical correlation. Patients and methods: 80 patients (male/female = 46/34 with complaint of swelling or pain in wrist were included and underwent USG and MRI of both the wrists. Results: The spectrum included ganglion cysts, vascular malformations, tenosynovitis, tendinopathy, ligament tears and fibrosis. The analysis was done using kappa coefficient and spearman's rho correlation coefficient. The strength of agreement between USG and MRI for the diagnosis of ganglion cysts, vascular malformations, tenosynovitis and tendinopathy was found to be very good. Conclusion: USG provides detailed depiction of superficial structures, is less expensive, and allows dynamic examinations of the wrist. It should be the first choice of investigation for majority of the cystic, tendinous, vascular, and fibrotic pathologies of the wrist. However, less promising results were observed for ligamentous pathologies on USG in our study. Keywords: Tendo-ligamentous pathologies, Ganglion cyst, Tenosynovitis, Ultrasonography, MRI

  2. [Imaging study of ankle injury in professional soccer player of males].

    Science.gov (United States)

    Li, Shaolin; Zhao, Wenji; Hao, Shuai; Hu, Shaoyong; Zhang, Rui; Zhang, Xintao

    2015-05-05

    51.0%), 25 ankles were calcanofibular ligaments injury (incidence was 49.0%), 29 ankles was the synovitis and local effusion at posterior ankle (incidence was 56.9%), the partial ligaments injured of deltoid ligaments were usually found and entirely torn were very rare (only three ankles). The former groups and shallow ligaments of deltoid ligaments were prone to injury. The common tendon disease of injury was tenosynovitis, 18 flexor hallucis longus tenosynovitis, 13 posterior tibialis tenosynovitis,7 flexor digitorium tenosynovitis, 5 peroneus longus tenosynovitis, 2 peroneus brevis tenosynovitis and 6 Achilles tendinopathy. Tendinosis and tendon degeneration was relatively rare. The professional soccer players have been easily lead to the anatomic abnormal and pathological changes in the bones, ligaments and tendons due to long-term training and competition. The majority changes were chronic injury. Imaging examination can be found the abnormal changes of ankle and could help athletes, coachs, doctors to understand and assess the ankle structure and functional status.

  3. Experimentally induced lameness in turkeys inoculated with a newly emergent turkey reovirus.

    Science.gov (United States)

    Sharafeldin, Tamer A; Mor, Sunil K; Bekele, Aschalew Z; Verma, Harsha; Noll, Sally L; Goyal, Sagar M; Porter, Robert E

    2015-02-24

    Newly emergent turkey arthritis reoviruses (TARVs) have been isolated from cases of lameness in male turkeys over 10 weeks of age. In a previous study, experimental inoculation of TARV in one-week-old turkey poults produced lymphocytic tenosynovitis at four weeks post inoculation but without causing clinical lameness. This study was undertaken to determine if TARV infection at an early age can lead to clinical lameness in birds as they age. One-week-old male turkeys were inoculated orally with a TARV (strain TARV-O'Neil) and monitored for the development of gait defects until 16 weeks of age. At 4, 8, 12 and 16 weeks of age, a subset of birds was euthanized followed by the collection of gastrocnemius tendon, digital flexor tendon, and intestines for virus detection by rRT-PCR and for histologic inflammation scoring. Clinical lameness was first displayed in TARV-infected turkeys at 8 weeks of age and ruptured gastrocnemius tendons with progressive lameness were also seen at 12-16 weeks of age. The virus was detected in gastrocnemius tendon of 4- 8- and 12-week-old turkeys but not in 16-week-old turkeys. Histologic inflammation scores of tendons at each of the four time points were significantly higher in the virus-inoculated group than in the control group (p < 0.01). Lesions began as lymphocytic tenosynovitis with mild synoviocyte hyperplasia at four weeks of age and progressed to fibrosis as the birds aged. These results demonstrate the potential of TARV to infect young turkeys and to produce subclinical tenosynovitis that becomes clinically demonstrable as the turkeys age.

  4. Ultrasound assessment of new onset bilateral painful shoulder in patients with polymyalgia rheumatica and rheumatoid arthritis.

    Science.gov (United States)

    Ruta, Santiago; Rosa, Javier; Navarta, David A; Saucedo, Carla; Catoggio, Luis J; Monaco, Ricardo García; Soriano, Enrique R

    2012-09-01

    The aim of our study was to investigate by ultrasound (US) the anatomical structures affected during a new episode of bilateral painful shoulder in patients with polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA) and to compare the findings between these two conditions. PMR and RA patients complaining of new onset bilateral painful shoulder were included. Subjects without any known rheumatic condition with a new onset unilateral painful shoulder were assessed as a control group. US evaluation includes the depiction subacromial-subdeltoid (SAD) bursitis, long head biceps (LHB) tenosynovitis and/or gleno-humeral (GH) synovitis. Thirty patients with PMR, 30 with RA, and 60 controls were included for a total of 60 shoulders per group. Unilateral SAD bursitis and LHB tenosynovitis were significantly more frequent in patients with PMR when compared to those with RA (p < 0.0001 and p < 0.01, respectively) and controls (p < 0.001 and p < 0.01, respectively). Unilateral GH synovitis was more common in RA than in PMR and controls (p < 0.05 and p < 0.01, respectively). Bilateral SAD bursitis was significantly more frequent in patients with PMR than in those with RA (p < 0.01) as was bilateral LHB tenosynovitis (p < 0.01). No significant differences were found in bilateral GH synovitis. US-detected periarticular inflammatory involvement more frequently in PMR both unilaterally and bilaterally and intra-articular inflammatory involvement was commonly in RA but only unilaterally.

  5. Industrial medicine and acute musculoskeletal rehabilitation. 6. Upper- and lower-limb injections for acute musculoskeletal injuries and injured workers.

    Science.gov (United States)

    Foye, Patrick M; Sullivan, William J; Panagos, Andre; Zuhosky, Joseph P; Sable, Aaron W; Irwin, Robert W

    2007-03-01

    This self-directed study module focuses on the use of corticosteroids and other injections in the treatment of lateral epicondylitis, de Quervain's tenosynovitis, carpal tunnel syndrome, Achilles' tendinitis, and plantar fasciitis. It is part of the study guide on industrial rehabilitation medicine and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. To review the medical literature to help clinicians make treatment decisions regarding corticosteroid and other injections in the upper and lower limbs in injured workers.

  6. Carpal tunnel syndrome caused by a giant cell tumour of the flexor tendon sheath.

    Science.gov (United States)

    Meek, Marcel F; Sheikh, Zahid A; Quinton, David N

    2014-02-01

    A 76-year-old woman developed right carpal tunnel syndrome after being conservatively treated for tenosynovitis of the flexor tendons with associated mild carpal tunnel syndrome. A magnetic resonance imaging scan showed a tumour in the carpal tunnel. Re-exploration showed that the median nerve was being compressed by a giant cell tumour of the flexor tendon sheaths. Appropriate imaging is advised in patients with additional findings (such as swelling) or in patients with secondary carpal tunnel syndrome and incomplete response to conservative treatment, to exclude a space-occupying lesion.

  7. A long-term follow-up of Japanese mother and her daughter with Blau syndrome: Effective treatment of anti-TNF inhibitors and useful diagnostic tool of joint ultrasound examination.

    Science.gov (United States)

    Otsubo, Yoshikazu; Okafuji, Ikuo; Shimizu, Toshimasa; Nonaka, Fumiaki; Ikeda, Kei; Eguchi, Katsumi

    2017-01-01

    Blau syndrome (BS) is an autosomal dominant autoinflammatory disease associated with NOD2 gene mutations. It is characterized by arthritis, skin rash, and uveitis. Here, we report contrasting outcomes of a daughter and her mother with BS. Their long-term follow-up revealed the efficacy of anti-tumor necrosis factor inhibitor (TNF) with respect to BS. Joint findings of BS feature tenosynovitis over articular synovitis on ultrasonography. BS might be one of the differential diagnoses of juvenile idiopathic arthritis and rheumatoid arthritis.

  8. Destructive arthritis in a patient with chikungunya virus infection with persistent specific IgM antibodies

    Directory of Open Access Journals (Sweden)

    Receveur Marie-Catherine

    2009-12-01

    Full Text Available Abstract Background Chikungunya fever is an emerging arboviral disease characterized by an algo-eruptive syndrome, inflammatory polyarthralgias, or tenosynovitis that can last for months to years. Up to now, the pathophysiology of the chronic stage is poorly understood. Case presentation We report the first case of CHIKV infection with chronic associated rheumatism in a patient who developed progressive erosive arthritis with expression of inflammatory mediators and persistence of specific IgM antibodies over 24 months following infection. Conclusions Understanding the specific features of chikungunya virus as well as how the virus interacts with its host are essential for the prevention, treatment or cure of chikungunya disease.

  9. Diseases of the tendons and tendon sheaths.

    Science.gov (United States)

    Steiner, Adrian; Anderson, David E; Desrochers, André

    2014-03-01

    Contracted flexor tendon leading to flexural deformity is a common congenital defect in cattle. Arthrogryposis is a congenital syndrome of persistent joint contracture that occurs frequently in Europe as a consequence of Schmallenberg virus infection of the dam. Spastic paresis has a hereditary component, and affected cattle should not be used for breeding purposes. The most common tendon avulsion involves the deep digital flexor tendon. Tendon disruptions may be successfully managed by tenorrhaphy and external coaptation or by external coaptation alone. Medical management alone is unlikely to be effective for purulent tenosynovitis. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Painful Os Peroneum Syndrome: Underdiagnosed Condition in the Lateral Midfoot Pain

    Science.gov (United States)

    de Souza, Barbara Nogueira Caracas

    2016-01-01

    Os peroneum is an accessory ossicle located within the peroneus longus tendon. The painful os peroneum syndrome (POPS) results from a wide spectrum of conditions, including fractures, diastases, and other causes. POPS can result in tenosynovitis or discontinuity of the peroneus longus tendon with a clinical presentation of pain in the lateral aspect of the midfoot. Authors report a typical case of POPS, illustrating this entity through different imaging methods (radiographs, ultrasound, and magnetic resonance imaging). We emphasize the prevalence of this ossicle and discuss painful complications. PMID:27478674

  11. Disseminated gonococcal infection presenting as vasculitis: a case report

    OpenAIRE

    Jain, Sangita; Win, Htet Nwe; Chalam, Venkat; Yee, Lian

    2007-01-01

    A 50‐year‐old man with alcoholic liver disease presented with fever, tenosynovitis, polyarthritis and a vasculitic rash on the hands and feet for 4 days. He had neutrophilia and raised inflammatory markers. He had no history of sore throat, urethral discharge or travel abroad. His initial blood cultures were negative, and he was treated for vasculitis with steroids. The rash and arthritis seemed to improve initially, but he had another episode of fever. Repeat blood cultures grew Neisseria go...

  12. Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever.

    Science.gov (United States)

    Mogami, Roberto; Pereira Vaz, João Luiz; de Fátima Barcelos Chagas, Yêdda; de Abreu, Mirhelen Mendes; Torezani, Rodrigo Sperling; de Almeida Vieira, André; Junqueira Filho, Eduardo Alvarenga; Barbosa, Yasmin Baptista; Carvalho, Antonio Carlos Pires; Lopes, Agnaldo José

    2018-02-01

    The purpose of this series was to describe the ultrasonographic and radiographic manifestations of changes to the hands and wrists in 50 patients with chronic musculoskeletal symptoms secondary to Chikungunya fever during the 2016 outbreak that occurred in Rio de Janeiro, Brazil. Most of the plain radiographs were normal (62%). The most common ultrasonographic findings were small joint synovitis (84%), wrist synovitis (74%), finger tenosynovitis (70%), and cellulitis (50%). In most cases, power Doppler did not show an increase in synovial vascular flow. The plain radiographs showed no specific findings, whereas the ultrasound images revealed synovial compromise and neural thickening. © 2017 by the American Institute of Ultrasound in Medicine.

  13. Presentaciones poco comunes y peligros de la sífilis secundaria: periosteitis, tenosinovitis y anomalías hepáticas.

    Science.gov (United States)

    Rosa-Gonçalves, Diana; Bernardes, Miguel; Costa, Lúcia

    2017-06-02

    We herein describe two cases of secondary syphilis in patients with human immunodeficiency virus (HIV) infection with an unusual presentation, a diffuse polyostotic periosteitis. Patients referred mainly intense bone pain. Other relevant aspects of the clinical pictures were flexor tenosynovitis and hepatic abnormalities. Given the persistence of symptoms, the treatment duration performed was different from most described in literature. However, although more slowly than expected, both obtained a favorable clinical response after treatment with benzathine penicillin G. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  14. Musculoskeletal ultrasound: an alternative imaging modality for sports-related injuries.

    Science.gov (United States)

    Torriani, Martin; Kattapuram, Susan V

    2003-02-01

    Advanced technology and increasing clinical experience have established sonography as a reliable imaging modality for sports-related injuries. Tears of muscles and tendons, tendinosis, and tenosynovitis are promptly diagnosed using ultrasound. Dynamic assessment of joints can be performed, allowing diagnoses of conditions that may remain undetected when evaluated with conventional magnetic resonance imaging. Sonography provides expeditious image guidance for procedures such as drainage of fluid collections and cysts. This article reviews the applications of sonography to sports-related injuries in which its diagnostic performance may be comparable to magnetic resonance imaging.

  15. OSTEOID OSTEOMA OF THE HAMATE AS A CAUSE OF COMPRESSION NEUROPATHY OF THE ULNAR NERVE IN GUYON CANAL (CASE REPORT

    Directory of Open Access Journals (Sweden)

    O. M. Semenkin

    2017-01-01

    Full Text Available Osteoid  osteoma of the wrist bones is rare and its diagnostics is complicated. A clinical case of the surgical treatment of the patient with osteoid osteoma is presented. The clinical manifestations included  pain, extensors  tenosynovitis and neuropathy of the ulnar nerve in guyon’s canal. The diagnosis was confirmed by computer tomography, ultrasonography and electromyography. Partial resection of the hamate including pathology area, and mobilization of the ulnar nerve in the wrist enabled authors  to obtain a good functional outcome.

  16. Clinical and sonographic evaluation of subpectoral biceps tenodesis with a dual suture anchor technique demonstrates improved outcomes and a low failure rate at a minimum 2-year follow-up.

    Science.gov (United States)

    Jacxsens, Matthijs; Granger, Erin K; Tashjian, Robert Z

    2018-01-01

    The purpose of this study was to evaluate the clinical outcomes and integrity of an open subpectoral biceps tenodesis using a dual suture anchor construct. Patients with at least 2 years of follow-up were retrospectively evaluated for simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES) score, and visual analog scales (VAS) for pain, function and satisfaction. A physical exam assessed shoulder range of motion and elbow strength. Ultrasonography visualized construct integrity. Of 43 eligible patients, 36 completed questionnaire evaluation and 22 completed an additional physical examination. Indications included superior labral anterior-posterior (SLAP) lesions (4), partial thickness tears (6), instability (6), and tenosynovitis of the biceps tendon (20). Eighteen patients (50%) had an associated rotator cuff tear. Patient-reported outcomes improved pre- vs postoperatively: ASES score (45.4 vs 78.6, P suture anchor technique is a treatment option for SLAP lesions, partial thickness tears, subluxation, and tenosynovitis of the long head of the biceps with high rates of postoperative patient satisfaction, a low failure rate, and improved outcome scores. The presence of a concomitant rotator cuff tear did not influence clinical outcomes.

  17. A Case Report of Herpetic Whitlow with Positive Kanavel’s Cardinal Signs: A Diagnostic and Treatment Difficulty

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    Milos Brkljac

    2014-01-01

    Full Text Available Herpetic whitlow is an acute viral infection of the hand caused by either herpes simplex virus (HSV 1 or 2. Its characteristic findings are significant pain and erythema with overlying nonpurulent vesicles. The differential diagnosis includes flexor tenosynovitis. We present a case of recurrent infection of the middle finger in an immunocompetent 19-year-old girl. Multiple painful pustules with tracking cellulitis were partially treated by oral antibiotics. A recurrence with positive Kanavel’s signs suggested flexor tenosynovitis at seven months. Her symptoms improved transiently following emergent surgical open flexor sheath exploration and washout however, she required two further washouts; at eleven and thirteen months to improve symptoms. Viral cultures were obtained from the third washout as HSV infection was disclosed from further history taking. These were positive for HSV2. Treatment with acyclovir at thirteen months after presentation led to a complete resolution of her symptoms with no further recurrences to date. This rare case highlights the similarity in presentation between flexor sheath infection and herpetic whitlow which can lead to diagnostic confusion and mismanagement. We emphasise the importance of careful past medical history taking as well as considering herpetic whitlow as a differential diagnosis despite the presence of strongly positive Kanavel’s signs.

  18. On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds. 1895.

    Science.gov (United States)

    de Quervain, F

    1997-09-01

    This paper represents the first English translation of the original article "On A Form Of Chronic Tendovaginitis" by Fritz de Quervain, published in 1895. This classic paper describes the natural history, symptomatology, pathology, and etiology of stenosing tenovaginitis of the first dorsal compartment (de Quervain's tenosynovitis). Dr. de Quervain also discusses the differential diagnosis for this disorder, his approach to management of the problem, and the results of surgical treatment in this series of collected patients. The paper concludes with a brief discussion of trigger digits. In addition to providing a classic description of the disease, the paper makes the following points that should prove of particular interest to the orthopedic surgeon. First, the term "de Quervain's tenosynovitis" is a misnomer. In fact, Dr. de Quervain credits Dr. Kocher with the first description of the disease and its first surgical treatment. Second, treating orthopedists have much to learn from this eloquent description of a common problem, particularly because the management of this disease has changed little since de Quervain's paper was first published.

  19. De Quervain disease in volleyball players.

    Science.gov (United States)

    Rossi, Costantino; Cellocco, Paolo; Margaritondo, Enrico; Bizzarri, Francesco; Costanzo, Giuseppe

    2005-03-01

    Chronic inflammatory tendon diseases in athletes are frequent, and they often result from modifications in normal kinematics of a tendon associated with a patient's anatomical determinants. De Quervain stenosing tenosynovitis is an inflammatory disease of tendons of the first dorsal compartment of the wrist. There is no literature about this disease concerning professional volleyball players. Limited, multiple trauma on the dorsal radial portion of the wrist, associated with long training times, can be involved in the pathogenetic process of de Quervain disease in professional volleyball players. Case series; Level of evidence, 4. The authors studied 45 consecutively enrolled volleyball players (27 professional, 18 nonprofessional) satisfying clinical criteria for the diagnosis of de Quervain stenosing tenosynovitis. All patients were evaluated by questionnaire and physical examination. They were divided into group A (mild) and group B (severe) based on the severity of the symptoms and physical findings; they were followed for a mean of 37 months. Total training quantity (mean weekly training time multiplied by mean sports activity duration) in group A was 74, whereas it was 155 in group B (P Quervain disease.

  20. Sonography of Non-neoplastic Disorders of the Hand and Wrist Tendons.

    Science.gov (United States)

    Gitto, Salvatore; Draghi, Anna Guja; Draghi, Ferdinando

    2017-07-14

    Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis. © 2017 by the American Institute of Ultrasound in Medicine.

  1. Are rheumatoid arthritis patients discernible from other early arthritis patients using 1.5T extremity magnetic resonance imaging? a large cross-sectional study.

    Science.gov (United States)

    Stomp, Wouter; Krabben, Annemarie; van der Heijde, Désirée; Huizinga, Tom W J; Bloem, Johan L; van der Helm-van Mil, Annette H M; Reijnierse, Monique

    2014-08-01

    Magnetic resonance imaging (MRI) is increasingly used in rheumatoid arthritis (RA) research. A European League Against Rheumatism (EULAR) task force recently suggested that MRI can improve the certainty of RA diagnosis. Because this recommendation may reflect a tendency to use MRI in daily practice, thorough studies on the value of MRI are required. Thus far no large studies have evaluated the accuracy of MRI to differentiate early RA from other patients with early arthritis. We performed a large cross-sectional study to determine whether patients who are clinically classified with RA differ in MRI features compared to patients with other diagnoses. In our study, 179 patients presenting with early arthritis (median symptom duration 15.4 weeks) underwent 1.5T extremity MRI of unilateral wrist, metacarpophalangeal, and metatarsophalangeal joints according to our arthritis protocol, the foot without contrast. Images were scored according to OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) by 2 independent readers. Tenosynovitis was also assessed. The main outcome was fulfilling the 1987 American College of Rheumatology (ACR) criteria for RA. Test characteristics and areas under the receiver-operator-characteristic curves (AUC) were evaluated. In subanalyses, the 2010 ACR/EULAR criteria were used as outcome, and analyses were stratified for anticitrullinated protein antibodies (ACPA). The ACR 1987 criteria were fulfilled in 43 patients (24.0%). Patients with RA had higher scores for synovitis, tenosynovitis, and bone marrow edema (BME) than patients without RA (p arthritis patients.

  2. Genomic characterization of a broiler reovirus field strain detected in Pennsylvania.

    Science.gov (United States)

    Tang, Yi; Lu, Huaguang

    2015-04-01

    Avian reovirus (ARV) infections have been increasingly diagnosed in Pennsylvania (PA) from 2011 to the present time. A field ARV strain (Reo/PA/Broiler/05682/12) isolated from sick broilers suffered from severe arthritis/tenosynovitis of a PA broiler flock was conducted full genome sequence studies using RT-PCR and RACE techniques. The complete genome of the PA broiler ARV field strain was 23,494bp in length with an approximately 50% G+C content and 10 dsRNA segments encoding 12 viral proteins. The 10 genomic segments were ranged from 1192bp (S4) to 3958bp (L1) in length, which were almost identical to those of published reference strains. The amino acid (aa) alignments of the putative proteins encoded by the ORF in each segment revealed a high similarity to the counterpart proteins encoded by other avian orthoreoviruses in the Orthoreovirus genus, particularly with the reference strain AVS-B (89.4-98.9%). The phylogenetic analysis of the nucleotide sequences of all 10 genome segments of the PA broiler ARV revealed that a moderate to significant nucleotide sequence divergence from sequences of cognate genome segments of reference ARV S1133 and 138 strains. These genomic data demonstrate that this PA broiler ARV field strain is a unique tenosynovitis ARV and is different from the traditional ARV vaccine strains. Published by Elsevier B.V.

  3. A new musculoskeletal ultrasound scoring system (US10) of the hands and wrist joints for evaluation of early rheumatoid arthritis patients.

    Science.gov (United States)

    Luz, Karine R; Pinheiro, Marcelo M; Petterle, Giovanna S; Dos Santos, Marla F; Fernandes, Artur R C; Natour, Jamil; Furtado, Rita N V

    2016-07-08

    To propose a novel ultrasound scoring system for hand and wrist joints (US10) for evaluation of patients with early rheumatoid arthritis (RA) and to correlate the US10 with clinical, laboratory and functional variables. Forty-eight early RA patients underwent clinical and laboratory evaluations as well as blinded ultrasound (US) examinations at baseline, three, six and 12 months. The proposed US10 system involved the assessment of the wrist, second and third metacarpophalangeal and proximal interphalangeal joints. The score consisted of inflammation parameters (synovial proliferation [SP], power Doppler [PD] and tenosynovitis [TN]) and joint damage parameters (bone erosion [BE] and cartilage damage [CD]). SP, PD, BE and CD were scored qualitatively (0-1) and semi-quantitatively (grades 0-3). Tenosynovitis was scored as presence/absence. The evaluation also involved the 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and C-reactive protein level (CRP). Mean duration of symptoms was 7.58±3.59 months. Significant correlations (psystem proved to be a useful tool for monitoring inflammation and joint damage in early RA patients, demonstrating significant correlations with longitudinal changes in disease activity and functional status. Copyright © 2016. Published by Elsevier Editora Ltda.

  4. Altered Biomechanical Properties of Gastrocnemius Tendons of Turkeys Infected with Turkey Arthritis Reovirus

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    Tamer A. Sharafeldin

    2016-01-01

    Full Text Available Turkey arthritis reovirus (TARV causes lameness and tenosynovitis in commercial turkeys and is often associated with gastrocnemius tendon rupture by the marketing age. This study was undertaken to characterize the biomechanical properties of tendons from reovirus-infected turkeys. One-week-old turkey poults were orally inoculated with O’Neil strain of TARV and observed for up to 16 weeks of age. Lameness was first observed at 8 weeks of age, which continued at 12 and 16 weeks. At 4, 8, 12, and 16 weeks of age, samples were collected from legs. Left intertarsal joint with adjacent gastrocnemius tendon was collected and processed for histological examination. The right gastrocnemius tendon’s tensile strength and elasticity modulus were analyzed by stressing each tendon to the point of rupture. At 16 weeks of age, gastrocnemius tendons of TARV-infected turkeys showed significantly reduced (P<0.05 tensile strength and modulus of elasticity as compared to those of noninfected control turkeys. Gastrocnemius tendons revealed lymphocytic tendinitis/tenosynovitis beginning at 4 weeks of age, continuing through 8 and 12 weeks, and progressing to fibrosis from 12 to 16 weeks of age. We propose that tendon fibrosis is one of the key features contributing to reduction in tensile strength and elasticity of gastrocnemius tendons in TARV-infected turkeys.

  5. Ultrasound Findings of the Painful Ankle and Foot

    Directory of Open Access Journals (Sweden)

    Suheil Artul

    2014-01-01

    Full Text Available Objectives: To document the prevalence and spectrum of musculoskeletal ultrasound (MSKUS findings at different parts of the foot. Materials and Methods: All MSKUS studies conducted on the foot during a 2-year period (2012-2013 at the Department of Radiology were reviewed. Demographic parameters including age, gender, and MSKUS findings were documented. Results: Three hundred and sixty-four studies had been conducted in the 2-year period. Ninety-three MSKUS evaluations were done for the ankle, 30 studies for the heel, and 241 for the rest of the foot. The most common MSKUS finding at the ankle was tenosynovitis, mostly in female patients; at the heel it was Achilles tendonitis, also mostly in female patients; and for the rest of the foot it was fluid collection and presence of foreign body, mainly in male patients. The number of different MSKUS abnormalities that were reported was 9 at the ankle, 9 at the heel, and 21 on the rest of the foot. Conclusions: MSKUS has the potential for revealing a huge spectrum of abnormalities. The most common finding was collection/hematoma and foreign bodies at the foot, tenosynovitis at the ankle, and Achilles tendinitis at the heel.

  6. Intersection Syndrome: The Subtle Squeak of an Overused Wrist.

    Science.gov (United States)

    Skinner, Thomas M

    2017-01-01

    Patient histories that include wrist pain can be pivotal in the distinction between intersection syndrome (IS) and the more common de Quervain's tenosynovitis (DQT). Presented here is a 26-year-old pregnant woman with a history of rowing who developed left radial/dorsal wrist pain and a rubbing/squeaking sensation. Nine months of conservative DQT therapy and a landmark-guided corticosteroid injection failed to relieve her symptoms. An in-clinic ultrasound showed tenosynovitis at the intersection of the first and second compartments, confirming a diagnosis of IS. She found immediate relief with ultrasound-guided saline hydrodissection, the injection of saline into the intercompartmental space to reduce adhesions. Both DQT and IS are overuse injuries caused by repetitive wrist extension, as occurs in rowing, and either condition can worsen after pregnancy. Distinguishing the subtleties between DQT and IS can be challenging. Close attention to the patient's description of the pain can guide treatment, potentially expediting recovery. In addition, saline hydrodissection can be both a diagnostic tool and a potentially therapeutic alternative to steroid injections for such tendinopathies. © Copyright 2017 by the American Board of Family Medicine.

  7. High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis.

    Science.gov (United States)

    Tan, Ai Lyn; Fukuba, Eiji; Halliday, Nicola Ann; Tanner, Steven F; Emery, Paul; McGonagle, Dennis

    2015-01-01

    Dactylitis is a hallmark of psoriatic arthritis (PsA) where flexor tenosynovitis is common. This study explored the microanatomical basis of dactylitis using high-resolution MRI (hrMRI) to visualise the small entheses around the digits. Twelve patients with psoriatic dactylitis (4 fingers, 8 toes), and 10 healthy volunteers (6 fingers, 4 toes) had hrMRI of the digits using a 'microscopy' coil and contrast enhancement. All structures were evaluated including the tendons and ligaments, related enthesis organs, pulleys, volar/plantar plates and tendon sheaths. In dactylitis, collateral ligament enthesitis was seen in nine digits (75%), extensor tendon enthesitis in six digits (50%), functional enthesitis (5 digits, 42%), abnormal enhancement at the volar plates (2/5 joints, 40%) and the plantar plate (1/5 joints, 20%). Nine cases (75%) demonstrated flexor tenosynovitis, with flexor tendon pulley/flexor sheath microenthesopathy observed in 50% of all cases. Less abnormalities which were milder was observed in the normal controls, none of whom had any signal changes in the tendon pulleys or fibrous sheaths. This study provides proof of concept for a link between dactylitis and 'digital polyenthesitis' including disease of the miniature enthesis pulleys of the flexor tendons, further affirming the concept of enthesitis in PsA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Minimally invasive repair of a calcaneus fracture in a Standardbred foal.

    Science.gov (United States)

    Bonilla, Alvaro G; Smith, Katie J

    2012-11-01

    A 4-month-old Standardbred colt was examined because of a fractured right calcaneus of 8 days' duration with increased distraction of the fracture fragment evident on sequential radiographs. The foal was severely lame with diffuse periarticular tarsal swelling. Radiographically, a complete, displaced long oblique fracture of the right calcaneal body was evident. Because the fracture gap was increasing with time and lameness remained severe, despite medical management, surgical repair was recommended. The foal was anesthetized, and minimally invasive fracture reduction and internal fixation were achieved by use of two 4.5-mm cortical screws placed in lag fashion via stab incisions over the lateral aspect of the calcaneus. External coaptation with a Robert-Jones bandage only was used after surgery. The foal recovered well and the fracture healed appropriately, but at 8 weeks following surgery, tenosynovitis of the tarsal sheath had developed. This was attributed to the tip of the distal screw encroaching on the sheath. The screw was removed under anesthesia and the tarsal sheath drained. The tenosynovitis resolved with rest and bandaging. Fourteen months after surgery, the colt was free of lameness. Findings suggested that a minimally invasive internal fixation technique for treatment of a calcaneus fracture in horses may be successful and may be associated with decreased morbidity, compared with the use of open reduction and plate fixation.

  9. Inter- and intra-observer agreement of high-resolution ultrasonography and power Doppler in assessment of joint inflammation and bone erosions in patients with rheumatoid arthritis.

    Science.gov (United States)

    Chávez-López, Mario Alfredo; Hernández-Díaz, Cristina; Moya, Carlos; Pineda, Carlos; Ventura-Ríos, Lucio; Möller, Ingrid; Naredo, Esperanza; Espinosa, Rolando; Peña, Angélica; Rosas-Cabral, Alejandro; Filippucci, Emilio

    2013-01-01

    To assess the inter- and intra-observer reproducibility of musculoskeletal ultrasonography among rheumatologist in detecting inflammatory and morphostructural changes in small joints of the hands in patients with rheumatoid arthritis (RA). Five members of the "Escuela de Ecografía del Colegio Mexicano de Reumatología" tested their inter- and intra-observer reliabilities in the assessment of basic sonographic findings of joint inflammation and bone erosion. Their results were compared to those obtained by a group of international experts from European League Against Rheumatism. A clinical rheumatologist evaluated eight RA patients. Five Siemens Acuson Antares ultrasound machines (7-13 MHz linear probes) were used. The OMERACT preliminary definitions of joint effusion, synovial hypertrophy, bone erosions and tenosynovitis were adopted. Inter-observer and intra-observer agreement was calculated by overall agreement and kappa statistics. Mean kappa value for joint effusion was good, 0.654 (85%); synovial hypertrophy, 0.550 (77.2%); power Doppler signal, 0.550 (82.5%); bone erosions, 0.549 (81%); and tenosynovitis, 0.500 (91.5%). Mean and overall intra-observer agreement for semiquantitative score was good for joint effusion, 0.630 (77.2%) and bone erosions, 0.605 (56.25%); and moderate to synovial hypertrophy, 0.476 (65%) and power Doppler signal, 0.471 (80%). Mean kappa value for joint effusion was 0.381 (95%), synovial hypertrophy, 0.447 (72%); power Doppler signal, 0.496 (81%); bone erosions, 0.294 (81%); and tenosynovitis, 0.030 (66%). Mean and overall inter-observer agreement for semiquantitative score was poor for joint effusion, 0.325 (57%) and bone erosions, 0.360 (43%); and moderate to synovial hypertrophy, 0.431 (55%) and power Doppler signal, 0.496 (81%). Intra-observer variability reached the highest levels of agreement. Factors related to the experience of the rheumatologist, the time spent in each examination and knowledge of the software ultrasound

  10. Ultrasonographic evaluation of canine supraspinatus calcifying tendinosis.

    Science.gov (United States)

    Mistieri, Maria Ligia A; Wigger, Antje; Canola, Julio C; Filho, João G P; Kramer, Martin

    2012-01-01

    Supraspinatus calcifying tendinosis is an uncommon finding in dogs. Although its radiographic appearance has been described previously, radiographs alone do not provide detailed information about the tendon parenchyma. Tendon ultrasonography has been widely applied for the diagnosis of human tendinosis, but it remains underused in dogs. This article reviews the ultrasonographic technique and variable appearance of canine supraspinatus calcifying tendinosis observed in 33 tendons. The ultrasonographic findings are described. The most common ultrasonographic finding was a hyperechoic area accompanied by distal acoustic shadowing. No relationship with bicipital tenosynovitis was found. A color Doppler examination was possible in only five of the tendons, revealing no blood flow in those tendons. There was evidence that the presence of a hypoechoic area surrounding the calcification was related to clinical signs of pain, suggesting an active inflammatory process. Ultrasonography was an excellent technique to evaluate lesions of the supraspinatus tendon and it revealed details not apparent on radiographs.

  11. The effect of the Futuro wrist brace in pain conditions of the wrist.

    Science.gov (United States)

    Biddulph, S L

    1981-09-05

    In a study to assess the effects of the Futuro wrist brace (Adcock-Ingram) in 22 patients with osteoarthritis, rheumatoid arthritis, tenosynovitis and gout of the wrist, grip and pinch dynamometers were used to measure improvement in function. The study confirmed the efficacy of the wrist brace by demonstrating an average of 23.7% improvement in grip strength over the 10-day study, as well as a significant average improvement in pinch strength of 14.8% (P less than 0.05). In the subgroup of 8 rheumatoid arthritis patients a significant average increase in grip strength of 48.9% (P less than 0.025) was obtained. Both day and night pain was reduced and there was improvement in patients' ability to carry out their daily activities. The brace was found to be comfortable and easy to use.

  12. Injectable Corticosteroids: Take Precautions and Use Caution.

    Science.gov (United States)

    Freire, Véronique; Bureau, Nathalie J

    2016-11-01

    Corticosteroids are routinely injected into soft tissues, tendon sheaths, bursae, and joints. These anti-inflammatory agents have different potency and solubility, and solubility is inversely correlated with the duration of action. Corticosteroids carry a low risk of complications but commonly cause systemic and local adverse effects. The use of intra-articular corticosteroid injections in the treatment of inflammatory arthritis and osteoarthritis is well established. Evidence also supports the use of injectable corticosteroids in the treatment of inflammatory tenosynovitis and bursitis associated with rheumatic diseases, trigger finger and de Quervain disease, and carpal tunnel syndrome. The role of corticosteroid injections in the management of rotator cuff disease remains unclear. Strong scientific evidence indicates that corticosteroid injections for lateral epicondylosis worsen the long-term outcomes of patients. This review article discusses the considerations related to the use of corticosteroid injections in the management of nonspinal musculoskeletal conditions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  13. BORDERLINE INDUSTRIAL INJURIES

    Science.gov (United States)

    Barritt, J. L.

    1958-01-01

    Sometimes in cases of injury in which a claim for compensation is made on the basis that the injury is attributable to the claimant's work, the etiology is not clear cut. Such injuries tend to merge with and to overlap non-industrial ailments. This presentation deals with some of the more troublesome conditions of this order—among them chondromalacia of the patella, causalgia, Sudek's atrophy, shoulder-hand syndrome, whiplash injury, tenosynovitis, epicondylitis, acoustic trauma and acute coronary occlusion. Often in these conditions, it is almost impossible to determine accurately how much or how little of the associated disability is attributable to industrial cause. In most of them, however, early diagnosis and sympathetic management of injury when it does occur, are of great help in determining compensability and in returning the employe to suitable work. PMID:13608299

  14. De quervain disease: Ibri technique to avoid superficial radial nerve injury.

    Science.gov (United States)

    Suresh, Saraswathivilasam S; Zaki, Hosam

    2009-06-01

    Tenosynovitis of the first dorsal compartment of the wrist, commonly known as de Quervain disease, is most of the time amenable to conservative treatment in form of splinting and injection of steroids into the compartment. Resistant cases need surgical release of the compartment but with high incidence of incomplete release owing to tendon anomalies and damage to the superficial branch of the radial nerve (SBRN). Many techniques evolved for a period of years, techniques using longitudinal, transverse, and oblique incisions, but damage to SBRN still remains unsolved. The authors describe a technique they have been using since 2004 and, so far, operated on 17 wrists without a single incidence of damage to the SBRN.

  15. Magnetic resonance imaging assessed inflammation in the wrist is associated with patient-reported physical impairment, global assessment of disease activity and pain in early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Glinatsi, Daniel; Baker, Joshua F; Hetland, Merete L

    2017-01-01

    metacarpophalangeal joints in the analyses did not strengthen the associations between MRI pathology and PRO s. Conclusions MRI-assessed inflammation, but not damage, in early RA wrists is associated with patientreported physical impairment, global assessment of disease activity and pain and influences the physical......Objectives T o examine whether MRI assessed inflammation and damage in the wrist of patients with early rheumatoid arthritis (RA) are associated with patient-reported outcomes (PRO s). Methods Wrist and hand MRIs of 210 patients with early RA from two investigator-initiated, randomised controlled...... studies (CIMESTR A/OP ERA) were assessed according to the Outcome Measures in Rheumatology RA MRI score (RAMRIS) for synovitis, tenosynovitis, osteitis, bone erosions and joint space narrowing (JSN) at baseline, 1 and 5 years follow-up. These features, and changes therein, were assessed for associations...

  16. Hand infections: anatomy, types and spread of infection, imaging findings, and treatment options.

    Science.gov (United States)

    Patel, Dakshesh B; Emmanuel, Neelmini B; Stevanovic, Milan V; Matcuk, George R; Gottsegen, Christopher J; Forrester, Deborah M; White, Eric A

    2014-01-01

    Infections of the hand are common, particularly in immunocompromised patients, and can lead to significant morbidity, including amputation, if not treated properly. Hand infection can spread far and wide from the original site of inoculation through interconnections between the synovium-lined and nonsynovial potential spaces. Because surgery is the mainstay of treatment, knowledge of the pertinent anatomy is imperative for accurately describing the presence, location, and extent of infection. The authors review the pertinent anatomy of the spaces of the hand and describe different types of infection-including cellulitis, necrotizing fasciitis, paronychia, felon, pyogenic flexor tenosynovitis, deep space infections, septic arthritis, and osteomyelitis-and common causative organisms of these infections. They also describe various modes of spread; the common radiologic appearances of hand infections, with emphasis on findings at magnetic resonance imaging and ultrasonography; and the role of radiology in the management of these infections, along with a brief overview of treatment options. ©RSNA, 2014.

  17. The OMERACT rheumatoid arthritis magnetic resonance imaging (MRI) scoring system

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Peterfy, Charles G.; Bird, Paul

    2017-01-01

    Objective: The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Magnetic Resonance Imaging (MRI) scoring system (RAMRIS), evaluating bone erosion, bone marrow edema/osteitis, and synovitis, was introduced in 2002, and is now the standard method of objectively quantifying...... Group, which used these data to provide updated considerations on image acquisition, RAMRIS definitions, and scoring systems for the original and new RA pathologies. Further, a research agenda was outlined. Results: Since 2002, longitudinal studies and clinical trials have documented RAMRIS variables...... with conventional radiography. Technical improvements, including higher field strengths and improved pulse sequences, allow higher image resolution and contrast-to-noise ratio. These have facilitated development and validation of scoring methods of new pathologies: joint space narrowing and tenosynovitis...

  18. Novel transdermal photodynamic therapy using ATX-S10.Na(II) induces apoptosis of synovial fibroblasts and ameliorates collagen antibody-induced arthritis in mice.

    Science.gov (United States)

    Miyazawa, S; Nishida, K; Komiyama, T; Nakae, Y; Takeda, K; Yorimitsu, M; Kitamura, A; Kunisada, T; Ohtsuka, A; Inoue, H

    2006-06-01

    We aimed to test the effect of transdermal photodynamic therapy (PDT) on synovial proliferation in vitro and in vivo, using a novel photosensitizer, ATX-S10.Na(II). Synovial fibroblasts were obtained from patients with RA (RASF). Cell viability with or without PDT was determined by MTT assay. Cell morphology was examined by light and transmission electron microscopy. DNA fragmentation was labeled by TUNEL stain. Collagen antibody-induced arthritis (CAIA) was induced in DBA/1 mice, and the effects of transdermal PDT were evaluated by clinical and histological examination. PDT showed drug concentration-dependent and laser dose-dependent cytotoxicity on RASF. TUNEL stain and TEM study revealed the induction of apoptotic cell death of RASF. Transdermal PDT significantly reduced clinical arthritis and synovial inflammation in this model of arthritis. These results suggest that transdermal PDT using ATX-S10.Na(II) might be a novel less invasive treatment strategy for small joint arthritis and tenosynovitis.

  19. The diabetic hand

    Directory of Open Access Journals (Sweden)

    C. Circhetta

    2011-09-01

    Full Text Available Diabetes mellitus is a chronic metabolic condition characterized by persistent hyperglycaemia with resultant morbidity and mortality related to its microvascular and macrovascular complications. In addition diabetes is also associated with several musculoskeletal disorders of the hand, that can be debilitating. There is increased incidence of these abnormalities in patients with type 1 and type 2 diabetes compared with the general population, related to disease duration but not to the age or sex. Typical diabetes associated hand condition include the palmar flexor tenosynovitis, Dupuytren’s contracture, syndrome of limited joint mobility, carpal tunnel syndrome, Charcot arthropathy and reflex sympathetic dystrophy. Maintaining good glycaemic control by exercise, diet and drugs improves or prevents the development of these hand rheumatic condition. In this brief report we review the rational therapeutic approach to these disorders.

  20. Synovitis with pitting edema as the presenting manifestation of systemic lupus erythematosus.

    Science.gov (United States)

    Hegazi, M O; Saleh, F; Al Rashidi, A; Yaktien, M M

    2014-09-01

    Rheumatologists are increasingly aware of the entity synovitis with pitting edema. The remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome has been reported with an array of conditions that include polymyalgia rheumatica, rheumatoid arthritis, Sjögren's syndrome and psoriatic arthropathy. Synovitis with pitting edema is now being increasingly recognized with systemic lupus erythematosus (SLE). We report a patient who presented with edema of hands and feet and was diagnosed eventually with definite SLE. With magnetic resonance imaging, joint effusions and tenosynovitis were confirmed to be associated with the otherwise-unexplained extremity edema. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. Cellulitis and Bacteremia Caused by Bergeyella zoohelcum

    Directory of Open Access Journals (Sweden)

    Wei-Ru Lin

    2007-01-01

    Full Text Available Bergeyella zoohelcum is a rod-shaped, aerobic, Gram-negative, non-motile and non-saccharolytic bacterium. It is frequently isolated from the upper respiratory tract of dogs, cats and other mammals. Clinically, B. zoohelcum has been known to cause cellulitis, leg abscess, tenosynovitis, septicemia, pneumonia and meningitis, and is associated with animal bites. In addition, food-borne transmission was considered in a recent case report. We report a 73-year-old man with liver cirrhosis who had no history of dog bite but had dog exposure, who developed cellulitis of the left lower leg and B. zoohelcum was isolated from blood culture. This patient, without evidence of polymicrobial infection, was treated with cefazolin and gentamicin with a good outcome. B. zoohelcum is a zoonotic pathogen that may cause bacteremia in patients with underlying disease such as liver cirrhosis; it can be treated with a beta-lactam or quinolone.

  2. Imaging of musculoskeletal soft tissue infections

    Energy Technology Data Exchange (ETDEWEB)

    Turecki, Marcin B.; Taljanovic, Mihra S.; Holden, Dean A.; Hunter, Tim B.; Rogers, Lee F. [University of Arizona HSC, Department of Radiology, Tucson, AZ (United States); Stubbs, Alana Y. [Southern Arizona VA Health Care System, Department of Radiology, Tucson, AZ (United States); Graham, Anna R. [University of Arizona HSC, Department of Pathology, Tucson, AZ (United States)

    2010-10-15

    Prompt and appropriate imaging work-up of the various musculoskeletal soft tissue infections aids early diagnosis and treatment and decreases the risk of complications resulting from misdiagnosis or delayed diagnosis. The signs and symptoms of musculoskeletal soft tissue infections can be nonspecific, making it clinically difficult to distinguish between disease processes and the extent of disease. Magnetic resonance imaging (MRI) is the imaging modality of choice in the evaluation of soft tissue infections. Computed tomography (CT), ultrasound, radiography and nuclear medicine studies are considered ancillary. This manuscript illustrates representative images of superficial and deep soft tissue infections such as infectious cellulitis, superficial and deep fasciitis, including the necrotizing fasciitis, pyomyositis/soft tissue abscess, septic bursitis and tenosynovitis on different imaging modalities, with emphasis on MRI. Typical histopathologic findings of soft tissue infections are also presented. The imaging approach described in the manuscript is based on relevant literature and authors' personal experience and everyday practice. (orig.)

  3. Imaging of musculoskeletal tuberculosis; Imagerie de la tuberculose osteo-articulaire

    Energy Technology Data Exchange (ETDEWEB)

    Boussel, L.; Marchand, B.; Blineau, N.; Picaud, G.; Emn, M.; Coulon, A.; Pagnon, P.; Rode, A.; Pin-Leveugle, J.; Berthezene, Y.; Pariset, C.; Boibieux, A. [Hopital de la Croix-Rousse, 69 - Lyon (France); Hermier, M. [Hopital de la Croix-Rousse, Serv. de Neuroradiologie, 69 - Lyon (France)

    2002-09-01

    Purpose and methods. To perform an illustrated and educational review of musculoskeletal tuberculosis. Results. As the incidence of musculoskeletal tuberculosis still increases, a review appears justified. The following four main presentations are detailed and illustrated, by emphasizing the value of both CT and MR imaging: a) spine tuberculosis ({approx} 50 %/) commonly involves two adjacent vertebral bodies with usual large paravertebral abscesses. The following lesions are highly suggestive of tuberculosis: solitary vertebral involvement, solitary epidural abscess with or without erosive spondylitis; b) osteo-arthritis: peripherally located erosions at synovial insertions with gradual narrowing of the joint space are highly suggestive; c) osteomyelitis: unusual, may involve any bones; d) tenosynovitis and bursitis. Conclusion. Imaging studies are essential for diagnosis and to assess the extent of musculo-skeletal tuberculosis. (author)

  4. Osteomyelitis Infection of Mycobacterium marinum: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Hao H. Nguyen

    2015-01-01

    Full Text Available Mycobacterium marinum (M. marinum is a ubiquitous waterborne organism that grows optimally at temperatures around 30°C. It is a nontuberculous Mycobacterium found in nonchlorinated water with worldwide prevalence. It is the most common atypical Mycobacterium that causes opportunistic infection in humans. M. marinum can cause superficial infections and localized invasive infections in humans, with the hands being the sites most frequently affected. It can cause skin lesions, which are either single, papulonodular lesions, confined to an extremity, or may resemble cutaneous sporotrichosis. This infection can also cause deeper infections including tenosynovitis, bursitis, arthritis, and osteomyelitis. Disseminated infections and visceral involvements have been reported in immunocompromised patients. We here report a case of severe deep soft tissue infection with necrotizing fasciitis and osteomyelitis of the left upper extremity (LUE caused by M. marinum in an immunocompromised patient.

  5. MR imaging assessment of clinical problems in rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Narvaez, Jose A.; Roca, Yolanda; Aguilera, Carlos [Department of CT and MR Imaging, Hospital Duran i Reynals, Universitaria de Bellvitge, Barcelona (Spain); Narvaez, Javier [Department of Medicine, Delfos Medical Center, Barcelona (Spain)

    2002-07-01

    Although MR imaging has been increasingly recognized as a useful tool in the diagnosis of early rheumatoid arthritis (RA) and in the assessment of disease activity, these applications have not yet been usually included in the routine management of this condition. Our goal is to review the current role of MRI in the everyday clinical management of patients with RA. The usefulness of MRI in the evaluation of articular and para-articular changes in specific locations, mainly the craniocervical region and the temporomandibular joint, are reviewed. Clinical problems derived from local extra-articular involvement, such as tenosynovitis, ''rice-bodies'' bursitis, and Baker's cyst rupture, are also described. Finally, we also review the value of MRI in evaluation of some complications of RA such as tendinous rupture, osteonecrosis, stress fracture, and septic arthritis/osteomyelitis. (orig.)

  6. The Effect of Postoperative Rehabilitation for Hand Infection

    Directory of Open Access Journals (Sweden)

    Takako Nagai

    2017-12-01

    Full Text Available When initial treatment and rehabilitation are inappropriate, it may leave severe dysfunction in hand infection. We experienced rehabilitation with postoperative hand based splint therapy and obtained good results. Case 1: A 59-yearold male stuck chopsticks in the right-hand metacarpus, the middle of the left volar hand was painful. The postoperative rehabilitation conducted blocking exercise and adductor stretching. There are not the pain and excursion restrictions. Case 2: A 64-year old male was operated for purulent flexor tendon tenosynovitis. The postoperative rehabilitation was done in the same method and there are not the pain and excursion as Case 1. Enforcement of careful exercise therapy depending on an episode of care is important.

  7. Ultrasound-guided procedures around the wrist and hand: How to do

    Energy Technology Data Exchange (ETDEWEB)

    Orlandi, Davide; Corazza, Angelo [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Silvestri, Enzo [Diagnostica per Immagini, Ospedale Evangelico Internazionale, Corso Solferino 29A, 16100 Genova (Italy); Serafini, Giovanni [Dipartimento di Diagnostica per Immagini, Ospedale Santa Corona, Via XXV Aprile 38, 17037 Pietra Ligure, Savona (Italy); Savarino, Edoardo Vincenzo [Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Via Giustiniani, Padova (Italy); Garlaschi, Giacomo [Dipartimento di Scienze per la Salute, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Mauri, Giovanni [Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milano (Italy); Cimmino, Marco Amedeo [Dipartimento di Medicina Interna, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Sconfienza, Luca Maria, E-mail: io@lucasconfienza.it [Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milano (Italy); Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Piazza Malan 2, San Donato Milanese, Milano (Italy)

    2014-07-15

    Ultrasound has emerged as a low-cost, radiation-free and effective imaging technique to detect joint abnormalities and to guide percutaneous procedures. Being superficial, wrist and hand tendons and joints represent a good target to perform such procedures using ultrasound guidance. This kind of approach allows for a clear and real-time visualization of the needles during their whole path. In this setting, the knowledge of technical aspects and tips is essential to act in the most accurate way on target tissues that can be as small as a few millimetres. The aim of this review is to summarize the local treatments of inflammatory and degenerative disease described in literature (such as treatment of De Quervain's tenosynovitis, trigger finger, trapezio-metacarpal joint osteoarthritis, etc.), emphasizing precautions and tricks based on day-by-day experience that may help to improve the outcome of percutaneous ultrasound-guided procedures around the wrist and hand.

  8. Pseudotumoral form of soft-tissue tuberculosis of the wrist.

    Science.gov (United States)

    Sbai, Mohamed Ali; Benzarti, Sofien; Msek, Hichem; Boussen, Monia; Khorbi, Adel

    2016-03-01

    Tuberculosis is a major public health problem in developing countries. Hand and wrist is a rare localization for extra-pulmonary tuberculosis, a pseudotumoral form of soft tissue tuberculosis of the wrist is exceptional. We report the case of a 45-year-old male presenting with a painful swelling of the dorsal aspect of the right wrist evolving for six months. Clinical study was evoking a ganglion cyst of the wrist. Intraoperatively a pseudotumoral mass with rice bodies was found, suggesting tuberculous tenosynovitis. The histopathological study revealed caseating giant cell granulomas with epithelioid cells. Cultures on Löwenstein-Jensen medium detected Mycobacterium tuberculosis. Synovectomy with removal of all the rice bodies followed by anti-tuberculous chemotherapy provided uneventful recovery. Copyright © 2015 Asian African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

  9. Hypothenar hammer syndrome: case report and literature review Síndrome do martelo hipotenar: relato de caso e revisão da literatura

    Directory of Open Access Journals (Sweden)

    Márcia Maria Muniz de Queiroz

    2013-01-01

    Full Text Available Case report of a 69 year-old patient, with history of repetitive trauma events in the wrist, clinically simulating tenosynovitis, being held with Doppler Ultrasound and Magnetic Nuclear Resonance, which showed ulnar artery thrombosis. The accurate diagnosis of the hammer hypothenar disease through those tests enable an early intervention, improving the prognosis of patients affected by this rare disease.Paciente de 69 anos, com história de traumas repetitivos no punho, simulando clinicamente tenossinovite, sendo feitas ultrassonografia com doppler e ressonância nuclear magnética, que evidenciaram trombose da artéria ulnar. O diagnóstico preciso da doença do martelo hipotenar por meio desses exames possibilita uma intervenção precoce e melhora o prognóstico dos pacientes acometidos por essa rara afecção.

  10. Optimal use of MRI in clinical trials, clinical care and clinical registries of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Møller-Bisgaard, Signe

    2014-01-01

    the benefits of including MRI in treat-to-target strategies. The benefits of incorporating MRI into clinical registries are not yet known, but may include improved knowledge about the real-life advantages of MRI, as well as opportunities to develop better clinical and laboratory composite measures to monitor......Magnetic resonance imaging (MRI) clearly is more sensitive than clinical examination and conventional radiography (x-ray) for detection of inflammation (synovitis, bone marrow oedema (osteitis) and tenosynovitis) and damage (bone erosion and cartilage loss/joint space narrowing) in patients...... with rheumatoid arthritis (RA). The question is when and how MRI should be used. The present article reviews our knowledge about, and provides suggestions for, the use of MRI in clinical trials, clinical care and clinical registries. In clinical trials, the OMERACT RA MRI scoring system (RAMRIS) is a thoroughly...

  11. Complete genome sequence of Tsukamurella paurometabola type strain (no. 33T)

    Energy Technology Data Exchange (ETDEWEB)

    Munk, Christine [U.S. Department of Energy, Joint Genome Institute; Lapidus, Alla L. [U.S. Department of Energy, Joint Genome Institute; Lucas, Susan [U.S. Department of Energy, Joint Genome Institute; Nolan, Matt [U.S. Department of Energy, Joint Genome Institute; Tice, Hope [U.S. Department of Energy, Joint Genome Institute; Cheng, Jan-Fang [U.S. Department of Energy, Joint Genome Institute; Glavina Del Rio, Tijana [U.S. Department of Energy, Joint Genome Institute; Goodwin, Lynne A. [Los Alamos National Laboratory (LANL); Pitluck, Sam [U.S. Department of Energy, Joint Genome Institute; Liolios, Konstantinos [U.S. Department of Energy, Joint Genome Institute; Huntemann, Marcel [U.S. Department of Energy, Joint Genome Institute; Ivanova, N [U.S. Department of Energy, Joint Genome Institute; Mavromatis, K [U.S. Department of Energy, Joint Genome Institute; Mikhailova, Natalia [U.S. Department of Energy, Joint Genome Institute; Pati, Amrita [U.S. Department of Energy, Joint Genome Institute; Chen, Amy [U.S. Department of Energy, Joint Genome Institute; Palaniappan, Krishna [U.S. Department of Energy, Joint Genome Institute; Tapia, Roxanne [Los Alamos National Laboratory (LANL); Han, Cliff [Los Alamos National Laboratory (LANL); Land, Miriam L [ORNL; Hauser, Loren John [ORNL; Chang, Yun-Juan [ORNL; Jeffries, Cynthia [Oak Ridge National Laboratory (ORNL); Brettin, Thomas S [ORNL; Yasawong, Montri [HZI - Helmholtz Centre for Infection Research, Braunschweig, Germany; Brambilla, Evelyne-Marie [DSMZ - German Collection of Microorganisms and Cell Cultures GmbH, Braunschweig, Germany; Rohde, Manfred [HZI - Helmholtz Centre for Infection Research, Braunschweig, Germany; Sikorski, Johannes [DSMZ - German Collection of Microorganisms and Cell Cultures GmbH, Braunschweig, Germany; Goker, Markus [DSMZ - German Collection of Microorganisms and Cell Cultures GmbH, Braunschweig, Germany; Woyke, Tanja [U.S. Department of Energy, Joint Genome Institute; Bristow, James [U.S. Department of Energy, Joint Genome Institute; Eisen, Jonathan [U.S. Department of Energy, Joint Genome Institute; Markowitz, Victor [U.S. Department of Energy, Joint Genome Institute; Hugenholtz, Philip [U.S. Department of Energy, Joint Genome Institute; Kyrpides, Nikos C [U.S. Department of Energy, Joint Genome Institute; Klenk, Hans-Peter [DSMZ - German Collection of Microorganisms and Cell Cultures GmbH, Braunschweig, Germany

    2011-01-01

    Tsukamurella paurometabola corrig. (Steinhaus 1941) Collins et al. 1988 is the type species of the genus Tsukamurella, which is the type genus to the family Tsukamurellaceae. The spe- cies is not only of interest because of its isolated phylogenetic location, but also because it is a human opportunistic pathogen with some strains of the species reported to cause lung in- fection, lethal meningitis, and necrotizing tenosynovitis. This is the first completed genome sequence of a member of the genus Tsukamurella and the first genome sequence of a member of the family Tsukamurellaceae. The 4,479,724 bp long genome contains a 99,806 bp long plasmid and a total of 4,335 protein-coding and 56 RNA genes, and is a part of the Ge- nomic Encyclopedia of Bacteria and Archaea project.

  12. The OMERACT ultrasound task force--status and perspectives.

    LENUS (Irish Health Repository)

    Naredo, Esperanza

    2011-09-01

    This article reports the most recent work of the Outcome Measures in Rheumatology (OMERACT) Ultrasound Task Force, and highlights the future research priorities discussed at the OMERACT 10 meeting. Results of the following studies were presented: (1) intra- and interobserver reliability of ultrasound detecting and scoring synovitis in different joints of patients with rheumatoid arthritis (RA); (2) systematic review of previous ultrasound scoring systems of synovitis in RA; (3) enthesitis systematic review and Delphi definition exercise in spondyloarthritis enthesitis; (4) enthesitis intra- and interobserver reliability exercise; and (5) Delphi definition exercise in hand osteoarthritis, and reliability exercises. Study conclusions were discussed, and a future research agenda was approved, notably further validation of an OMERACT ultrasound global synovitis score (GLOSS) in RA, emphasizing the importance of testing feasibility, predictive value, and added value over standard clinical variables. Future research areas will include validating scoring systems for enthesitis and osteoarthritis, and testing the metric qualities of ultrasound for evaluating tenosynovitis and structural damage in RA.

  13. Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis

    DEFF Research Database (Denmark)

    Wiell, Charlotte; Szkudlarek, Marcin; Hasselquist, Maria

    2007-01-01

    (x-ray), and clinical findings. Fifteen patients with PsA, 5 with rheumatoid arthritis (RA), and 5 healthy control persons were examined by means of US, contrast-enhanced MRI, x-ray, and clinical assessment. Each joint of the 2nd-5th finger (metacarpophalangeal joints, proximal interphalangeal [PIP...... tendons of the fingers were assessed for the presence of insertional changes and tenosynovitis. One hand was assessed by means of MRI for the aforementioned changes. X-rays of both hands and feet were assessed for bone erosions and proliferations. US was repeated in 8 persons by another ultrasonographer....... US and MRI were more sensitive to inflammatory and destructive changes than x-ray and clinical examination, and US showed a good interobserver agreement for bone changes (median 96% absolute agreement) and lower interobserver agreement for inflammatory changes (median 92% absolute agreement). A high...

  14. [Standardisation of the MRI and US images evaluation in the diagnostics of rheumatoid arthritis within the wrist and metacarpophalangeal joints].

    Science.gov (United States)

    Kapuścińska, Katarzyna; Urbanik, Andrzej; Wojciechowski, Wadim; Podsiadło, Lilianna; Grochowska, Anna; Nardzewska-Szczepanik, Monika

    2010-01-01

    In Rheumatoid arthritis (RA) it is very important to recognize pathologic condition and to start proper treatment as early as possible to lessen its consequences. Currently, magnetic resonance imaging and ultrasonography are the best imaging modalities because they depict early stages of this disease and allows to control response to treatment. MRI depicts also bone oedema, which is a strong predictor of further progression. The process of standardization is needed in assessing both MR and US pictures. Standardization allows to compared both examinations of the same patient in different time and examinations of different patients. An aim of this article is to present: MR protocols of hand and wrist MR examinations for rheumatologic demand and standards of results, according to worldwide OMERAC RAMRIS 2002 and supplemented by tenosynovitis system; proposals for US examination of hands in rheumatoid patients.

  15. 3D splint prototype system for applications in muscular rehab by transcutaneous electrical nerve stimulation (TENS)

    Science.gov (United States)

    Saldaña-Martínez, M. I.; Guzmán-González, J. V.; Barajas-González, O. G.; Guzman-Ramos, V.; García-Garza, A. K.; González-García, R. B.; García-Ramírez, M. A.

    2017-03-01

    It is quite common that patients with ligamentous ruptures, tendonitis, tenosynovitis or sprains are foreseen the use of ad hoc splints for a swift recovery. In this paper, we propose a rehabilitation split that is focused on upper-limb injuries. By considering that upper-limb patient shows a set of different characteristics, our proposal personalizes and prints the splint custom made though a digital model that is generated by a 3D commercial scanner. To fabricate the 3D scanned model the Stereolithography material (SLA) is considered due to the properties that this material offers. In order to complement the recovery process, an electronic system is implemented within the splint design. This system generates a set of pulses for a fix period of time that focuses mainly on a certain group of muscles to allow a fast recovery process known as Transcutaneous Electrical Nerve Stimulation Principle (TENS).

  16. Prevalence and Role of a Low-Lying Peroneus Brevis Muscle Belly in Patients With Peroneal Tendon Pathologic Features: A Potential Source of Tendon Subluxation.

    Science.gov (United States)

    Mirmiran, Roya; Squire, Chad; Wassell, Daniel

    2015-01-01

    A peroneus brevis low-lying muscle belly (LLMB) is a rare anomaly. A few published studies have supported the presence of this anomaly as an etiology for a peroneal tendon tear. However, the association between a peroneus brevis LLMB and tendon subluxation has not been well explored. In the present retrospective study, the magnetic resonance imaging (MRI) and intraoperative findings of 50 consecutive patients undergoing primary peroneal tendon surgery during a 5-year period were assessed. The sensitivity and specificity of MRI compared with the intraoperative findings for identifying peroneal tendon disease were investigated. The presence of associated peroneal tendon pathologic features in patients with and without a peroneus brevis LLMB was also compared. The sensitivity of MRI was high for identifying peroneal tenosynovitis (81.58%) and tear (85.71%). Although the sensitivity of MRI for detecting a peroneus brevis LLMB (3.23%) and tendon subluxation (10.00%) was low, MRI had high specificity at 94.74% and 100%, respectively. Intraoperatively, a peroneus brevis LLMB was seen in 62.00% of the patients with chronic lateral ankle pain and was associated with 64.52% of the patients with tenosynovitis, 29.03% of those with tendon subluxation, and 80.65% of those with a peroneus brevis tendon tear. Although the presence of a peroneus brevis LLMB did not show any statistically significant association with peroneus brevis tendon subluxation, of the 10 patients with intraoperatively observed tendon subluxation, 9 had a concomitant peroneus brevis LLMB. More studies with larger patient populations are needed to better investigate the role of a peroneus brevis LLMB as a mass-occupying lesion resulting in peroneal tendon subluxation. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Evaluation of the diagnostic accuracy of hand and foot MRI for early Rheumatoid Arthritis.

    Science.gov (United States)

    Nieuwenhuis, Wouter P; van Steenbergen, Hanna W; Mangnus, Lukas; Newsum, Elize C; Bloem, Johan L; Huizinga, Tom W J; le Cessie, Saskia; Reijnierse, Monique; van der Helm-van Mil, Annette H M

    2017-08-01

    To assess the diagnostic value of MRI for early RA. In some RA patients, a classifiable diagnosis cannot be made at first presentation; these patients present with unclassified arthritis (UA). The use of MRI for early diagnosis of RA is recommended, yet the evidence for its reliability is limited. MRI of hand and foot was performed in 589 early arthritis patients included in the Leiden Early Arthritis Clinic (229 presented with RA, 159 with other arthritides and 201 with UA). Symptom-free controls provided a reference for defining an abnormal MRI. In preliminary investigations, MRI of patients who presented with RA was compared with MRI of symptom-free controls and of patients with other arthritides. Thereafter, the value of MRI in early RA diagnosis was determined in UA patients using the 1-year follow-up on fulfilling the 1987 RA criteria and start of disease-modifying drugs as outcomes. Preliminary investigations were promising. Of the UA patients, 14% developed RA and 37% started disease-modifying treatment. MRI-detected tenosynovitis was associated with RA development independent of other types of MRI-detected inflammation [odds ratio (OR) = 7.5, 95% CI: 2.4, 23] and also independent of age and other inflammatory measures (swollen joints, CRP) (OR = 4.2, 95% CI: 1.4, 12.9). Within UA patients, the negative predictive value of abnormal tenosynovitis was 95% (95% CI: 89%, 98%) and the positive predictive value 25% (95% CI: 17%, 35%). The performance was best in the subgroup of UA patients presenting with oligoarthritis (18% developed RA): the positive predictive value was 36% (95% CI: 23%, 52%), the negative predictive value was 98% (95% CI: 88%, 100%), the sensitivity was 93% (95% CI: 70%, 99%) and the specificity was 63% (95% CI: 51%, 74%). MRI contributes to the identification of UA patients who will develop RA, mostly in UA patients presenting with oligoarthritis.

  18. Asymptomatic Versus Symptomatic Ankle Joints in Rheumatoid Arthritis: A High-Resolution B-Mode and Power Doppler Ultrasound Study.

    Science.gov (United States)

    Alsuwaidi, Mohammed; Ehrenstein, Boris; Fleck, Martin; Hartung, Wolfgang

    2016-06-01

    Ankle joints are frequently neglected in activity scoring systems, including the Disease Activity Score in 28 joints (DAS28). Only a few studies have assessed pathologies detected by ultrasonography of the ankles in symptomatic rheumatoid arthritis (RA) patients. We evaluated ankle joints in RA patients regardless of symptomatology, using musculoskeletal ultrasound (MSUS) as well as power Doppler ultrasound (PDUS). A total of 160 ankle joints of 80 RA patients were examined using MSUS and PDUS, according to the European League Against Rheumatism MSUS guidelines. Additionally, the talonavicular joints (TNJs) and the medial and the lateral tendon compartments were examined. The visual analog scale (VAS) score was recorded for each patient. A total of 80 RA patients with a median age of 60 years and disease duration of 5 years were enrolled in our study. The median DAS28 score was 5. A total of 97 ankles were painful (VAS 1-10), whereas 63 ankles were asymptomatic (VAS 0). Overall, the predominant pathology was arthritis of the tibiotalar joint (TTJ) and/or TNJ in 124 ankles (77%), followed by tenosynovitis of the medial compartment tendons in 44 ankles (28%). Arthritis of the TTJ was present in 59% and synovitis of the TNJ in 35% of the symptomatic ankles. In asymptomatic ankles, TTJ synovitis was detected in 35%, whereas TNJ arthritis was observed in 18%. PDUS activity was higher in the subgroup of symptomatic ankles. The most frequent pathologies detected by MSUS were arthritis of the TTJ and TNJ, followed by tenosynovitis of the medial compartment tendons. Pathologic findings were more frequent in symptomatic but also common in asymptomatic patients, whereas PDUS activity was generally low and mainly observed in symptomatic patients. © 2016, American College of Rheumatology.

  19. Concordance between inflammation at physical examination and on MRI in patients with early arthritis.

    Science.gov (United States)

    Krabben, A; Stomp, W; Huizinga, T W J; van der Heijde, D; Bloem, J L; Reijnierse, M; van der Helm-van Mil, A H M

    2015-03-01

    MRI is increasingly used to measure inflammation in rheumatoid arthritis (RA) research, but the correlation to clinical assessment is unexplored. This study determined the association and concordance between inflammation of small joints measured with MRI and physical examination. 179 patients with early arthritis underwent a 68 tender joint count and 66 swollen joint count and 1.5T MRI of MCP (2-5), wrist and MTP (1-5) joints at the most painful side. Two readers scored synovitis and bone marrow oedema (BME) according to the OMERACT RA MRI scoring method and assessed tenosynovitis. The MRI data were first analysed continuously and then dichotomised to analyse the concordance with inflammation at joint examination. 1790 joints of 179 patients were studied. Synovitis and tenosynovitis on MRI were independently associated with clinical swelling, in contrast to BME. In 86% of the swollen MCP joints and in 92% of the swollen wrist joints any inflammation on MRI was present. In 27% of the non-swollen MCP joints and in 66% of the non-swollen wrist joints any MRI inflammation was present. Vice versa, of all MCP, wrist and MTP joints with inflammation on MRI 64%, 61% and 77%, respectively, were not swollen. BME, also in case of severe lesions, occurred frequently in clinically non-swollen joints. Similar results were observed for joint tenderness. Inflammation on MRI is not only present in clinically swollen but also in non-swollen joints. In particular BME occurred in clinically non-inflamed joints. The relevance of subclinical inflammation for the disease course is a subject for further studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Factors associated with regional rheumatic pain disorders in a population of Puerto Ricans with diabetes mellitus

    Science.gov (United States)

    Font, Yvonne M.; Castro-Santana, Lesliane E.; Nieves-Plaza, Mariely; Maldonado, Mirna; Mayor, Ángel M.

    2015-01-01

    The aim of the study was to determine the prevalence and factors associated with bursitis/tendonitis disorders in Puerto Ricans with diabetes mellitus (DM). A cross-sectional study was performed in 202 adult Puerto Ricans (100 DM patients and 102 non-diabetic subjects). For each participant, a complete medical history and a musculoskeletal exam were systematically performed. Socio-demographic parameters, health-related behaviors, comorbidities, and pharmacotherapy were determined for all subjects. For DM patients, disease duration, glycemic control, and DM long-term complications were also examined. Multivariate logistic regression analyses were used to determine the factors associated with bursitis/tendonitis disorders. The mean (SD) age for DM patients and non-diabetic controls were 53.3 (12.9) and 50.0 (13.1) years; 64.0 and 64.7 % of DM patients and controls were females, respectively. Overall, the prevalence of bursitis/tendonitis was higher in DM patients than among non-diabetics (59.0 % vs. 29.4 %, pbursitis/tendonitis as compared to non-diabetics. Specifically, DM patients had a higher frequency of flexor tenosynovitis, De Quervain’s tenosynovitis, lateral epicondylitis, medial epicondylitis, trochanteric bursitis, and anserine bursitis than non-diabetic subjects (pbursitis/tendonitis were more likely to be female [OR (95 % CI) 4.55 (1.42, 14.55)] and have peripheral vascular disease [OR (95 % CI) 8.48 (1.71, 41.93)]. In conclusion, bursitis/tendonitis disorders were common in this population of Hispanics with DM. Among DM patients, bursitis/tendonitis disorders were more frequent in women and those with long-term complications such as peripheral vascular disease. PMID:24522480

  1. Epidemiology of rheumatic diseases in Iran from analysis of four COPCORD studies.

    Science.gov (United States)

    Davatchi, Fereydoun; Sandoughi, Mahnaz; Moghimi, Nasrin; Jamshidi, Ahmad-Reza; Tehrani Banihashemi, Arash; Zakeri, Zahra; Sadeghi Abdollahi, Bahar

    2016-11-01

    To calculate the epidemiology of Rheumatic Diseases in Iran. The data of Tehran, Zahedan, Sanandaj (urban) and Tuyserkan (rural) stage Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) studies were gathered. The data were adjusted to the population number of the studied areas to represent Iran. The population of Iran is 75 149 669 (71.5% urban areas, males 50.4%) and of the mentioned area were respectively 10 000 000, 580 071, 311 444 and 109 262. The interviewed subjects were 10 291, 1565, 2100 and 5830. Male/female ratio was 0.9/1, 0.8/1, 08/1 and 0.8/1. Musculoskeletal complaints during the past 7 days (people aged ≥ 15 years) were detected in 44.7% of subjects. They were: shoulder 15.6%, wrist 10.4%, hands and fingers 10.2%, hip 8.3%, knee 27.4%, ankle 12.3%, toes 6.2%, cervical spine 14.2% and dorsolumbar spine 23.7%. Osteoarthritis (OA) was detected in 16.9%: knee 15.5%, hands 2.9% and hip 0.32%. Low back pain was found in 15.7%, sciatica in 0.94%, and soft tissue rheumatism in 4.6% (shoulder tenosynovitis 2.5%, frozen shoulder 0.56%, tennis elbow 1.2%, golf elbow 0.48%, de Quervain tenosynovitis 0.24%, trigger finger 0.2%, carpal tunnel syndrome 1.3%). Rheumatoid arthritis was detected in 0.37%, seronegative spondyloarthropathy in 0.24%, ankylosing spondylitis in 0.12%, systemic lupus erythematosus in 0.06%, Behcet's disease in 0.08%, fibromyalgia in 0.79% and gout in 0.13%. Compared to other COPCORD reports (17 countries), Iran gets the following rank: musculoskeletal complaints second, low back pain fourth, osteoarthritis second, knee osteoarthritis third, soft tissue rheumatism sixth, rheumatoid arthritis tenth, seronegative spondyloarthropathies fifth, gout eleventh and fibromyalgia fifth. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  2. Body mass index and extent of MRI-detected inflammation: opposite effects in rheumatoid arthritis versus other arthritides and asymptomatic persons.

    Science.gov (United States)

    Mangnus, Lukas; Nieuwenhuis, Wouter P; van Steenbergen, Hanna W; Huizinga, Tom W J; Reijnierse, Monique; van der Helm-van Mil, Annette H M

    2016-10-22

    In the population a high body mass index (BMI) has been associated with slightly increased inflammatory markers. Within rheumatoid arthritis (RA), however, a high BMI has been associated with less radiographic progression; this phenomenon is unexplained. We hypothesized that the phenomenon is caused by an inverse relationship between BMI and inflammation in hand and foot joints with RA. To explore this hypothesis, local inflammation was measured using magnetic resonance imaging (MRI) in early arthritis patients presenting with RA or other arthritides and in asymptomatic volunteers. A total of 195 RA patients, 159 patients with other inflammatory arthritides included in the Leiden Early Arthritis Clinic, and 193 asymptomatic volunteers underwent a unilateral contrast-enhanced 1.5 T MRI scan of metacarpophalangeal, wrist, and metatarsophalangeal joints. Each MRI scan was scored by two readers on synovitis, bone marrow edema (BME), and tenosynovitis; the sum yielded the total MRI inflammation score. Linear regression on log-transformed MRI data was used. A higher BMI was associated with higher MRI inflammation scores in arthritides other than RA (β = 1.082, p < 0.001) and in asymptomatic volunteers (β = 1.029, p = 0.040), whereas it was associated with lower MRI inflammation scores in RA (β = 0.97, p = 0.005). Evaluating the different types of inflammation, a higher BMI was associated with higher synovitis, BME, and tenosynovitis scores in arthritides other than RA (respectively β = 1.084, p < 0.001, β = 1.021, p = 0.24, and β = 1.054, p = 0.003), but with lower synovitis and BME scores in RA (respectively β = 0.98, p = 0.047 and β = 0.95, p = 0.002). Increased BMI is correlated with less severe MRI-detected synovitis and BME in RA. This might explain the paradox in RA where obesity correlates with less severe radiographic progression.

  3. Survival of turkey arthritis reovirus in poultry litter and drinking water.

    Science.gov (United States)

    Mor, Sunil K; Verma, Harsha; Sharafeldin, Tamer A; Porter, Robert E; Ziegler, Andre F; Noll, Sally L; Goyal, Sagar M

    2015-04-01

    Turkey reoviruses (TRVs) can cause arthritis, tenosynovitis, and enteric diseases in turkeys, leading to huge economic losses. The TRVs are tentatively divided into turkey arthritis reoviruses (TARVs) and turkey enteric reoviruses (TERVs) depending on the type of disease they produce. This study was conducted to determine the survival of these viruses in autoclaved and nonautoclaved poultry litter and drinking water at room temperature (approx. 25°C). Three isolates of TARV (TARV-O'Neil, TARV-MN2, and TARV-MN4) and one each of TERV (TERV-MN1) and chicken arthritis reovirus (CARV) were used in this study. The viruses were propagated and titrated on QT-35 cells. In autoclaved dechlorinated tap water, all 5 viruses were able to survive for 9 to 13 wk. In nonautoclaved water, all 5 viruses survived for at least 2 wk. In autoclaved litter, the viruses survived for 6 to 8 wk, and in nonautoclaved litter, they survived for 6 to 8 d only. The implications of these results are discussed below. © 2015 Poultry Science Association Inc.

  4. Osteoma osteoide em escafoide: relato de caso Osteoid osteoma in scaphoid: case report

    Directory of Open Access Journals (Sweden)

    Antônio Lourenço Severo

    2012-10-01

    Full Text Available O osteoma osteoide é um tumor benigno osteoblástico, incomum na mão. A localização nos ossos do carpo é infrequente, a qual leva a erros no diagnóstico em decorrência do polimorfismo de sinais clínicos. Na revisão bibliográfica foram referidos nove casos de osteoma osteoide no escafoide. Relata-se um caso de osteoma osteoide no escafoide, tratado inicialmente como tenossinovite estenosante de De Quervain, tendo diagnóstico definitivo retardado por cinco anos.Osteoid osteoma is a benign osteoblastic tumor that is unusual in the hand. A location in the carpal bones is infrequent, which leads to errors in diagnosing it because of polymorphism of the clinical symptoms. Reviewing the literature shows that nine cases of osteoid osteoma in the scaphoid have been reported. Here, one case of osteoid osteoma in the scaphoid that was initially treated as De Quervain's stenosing tenosynovitis is reported, with a definitive diagnosis that was delayed for five years.

  5. Clinical Mimics: An Emergency Medicine-Focused Review of Cellulitis Mimics.

    Science.gov (United States)

    Blumberg, Garrett; Long, Brit; Koyfman, Alex

    2017-10-01

    Cellulitis is a common clinical condition with low rates of morbidity and mortality if treated appropriately. Mimics of cellulitis presenting with erythema, edema, warmth, and pain can be associated with grave morbidity and mortality if misdiagnosed. This review investigates the signs and symptoms of cellulitis, mimics of cellulitis, and an approach to the management of both cellulitis and its mimics. The current emergency medicine definition of cellulitis includes erythema, induration, warmth, and swelling. Given the common pathophysiologic pathways, cellulitis mimics often present in an analogous manner. These conditions include septic bursitis, septic joint, deep vein thrombosis, phlegmasia cerulea dolens, necrotizing fasciitis, flexor tenosynovitis, fight bite (closed fist injury), orbital cellulitis, toxic shock syndrome, erysipelas, abscess, felon, paronychia, and gouty arthritis. Many of these diseases have high morbidity and mortality if missed by the emergency physician. Differentiating these mimics from cellulitis can be difficult in the fast-paced emergency setting. A combination of history, physical examination, and focused diagnostic assessment may assist in correctly identifying the underlying etiology. For many of the high mortality cellulitis mimics, surgical intervention is necessary. Cellulitis and its mimics present similarly due to the same physiologic responses to skin and soft tissue infections. A combination of history, physical examination, and diagnostic assessment will help the emergency physician differentiate cellulitis from mimics. Surgical intervention is frequently needed for high morbidity and mortality mimics. Published by Elsevier Inc.

  6. MDCT of hand and wrist infections: emphasis on compartmental anatomy.

    Science.gov (United States)

    Ahlawat, S; Corl, F M; LaPorte, D M; Fishman, E K; Fayad, L M

    2017-04-01

    Hand and wrist infections can present with a spectrum of manifestations ranging from cellulitis to deep-space collections. The various infectious processes can be categorised as superficial or deep infections based on their respective locations relative to the tendons. Superficial hand infections are located superficial to the tendons and are comprised of cellulitis, lymphangitis, paronychia, pulp-space infections, herpetic whitlow, and include volar as well as dorsal subcutaneous abscesses. Deep hand infections are located deep to the tendon sheaths and include synovial space infections, such as infectious tenosynovitis, deep fascial space infections, septic arthritis, necrotising fasciitis, and osteomyelitis. Knowledge of hand and wrist compartmental anatomy is essential for the accurate diagnosis and management of hand infections. Although early and superficial infections of the hand may respond to non-surgical management, most hand infections are surgical emergencies. Multidetector computed tomography (MDCT), with its muliplanar reformation (MPR) and three-dimensional (3D) capabilities, is a powerful tool in the emergency setting for the evaluation of acute hand and wrist pathology. The clinical and imaging features of hand and wrist infections as evident on MDCT will be reviewed with emphasis on contiguous and closed synovial and deep fascial spaces. Knowledge of hand compartmental anatomy enables accurate characterisation of the infectious process and localise the extent of disease in the acute setting. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  7. Peroneal tendon disorders.

    Science.gov (United States)

    Davda, Kinner; Malhotra, Karan; O'Donnell, Paul; Singh, Dishan; Cullen, Nicholas

    2017-06-01

    Pathological abnormality of the peroneal tendons is an under-appreciated source of lateral hindfoot pain and dysfunction that can be difficult to distinguish from lateral ankle ligament injuries.Enclosed within the lateral compartment of the leg, the peroneal tendons are the primary evertors of the foot and function as lateral ankle stabilisers.Pathology of the tendons falls into three broad categories: tendinitis and tenosynovitis, tendon subluxation and dislocation, and tendon splits and tears. These can be associated with ankle instability, hindfoot deformity and anomalous anatomy such as a low lying peroneus brevis or peroneus quartus.A thorough clinical examination should include an assessment of foot type (cavus or planovalgus), palpation of the peronei in the retromalleolar groove on resisted ankle dorsiflexion and eversion as well as testing of lateral ankle ligaments.Imaging including radiographs, ultrasound and MRI will help determine the diagnosis. Treatment recommendations for these disorders are primarily based on case series and expert opinion.The aim of this review is to summarise the current understanding of the anatomy and diagnostic evaluation of the peroneal tendons, and to present both conservative and operative management options of peroneal tendon lesions. Cite this article: EFORT Open Rev 2017;2:281-292. DOI: 10.1302/2058-5241.2.160047.

  8. MR imaging features of foot involvement in patients with psoriasis

    Energy Technology Data Exchange (ETDEWEB)

    Erdem, C. Zuhal [Department of Radiology, Zonguldak Karaelmas University, School of Medicine, Zonguldak (Turkey)], E-mail: sunarerdem@yahoo.com; Tekin, Nilgun Solak [Department of Dermatology, Zonguldak Karaelmas University, School of Medicine, Zonguldak (Turkey); Sarikaya, Selda [Department of Physical Therapy and Rehabilitation, Zonguldak Karaelmas University, School of Medicine, Zonguldak (Turkey); Erdem, L. Oktay; Gulec, Sezen [Department of Radiology, Zonguldak Karaelmas University, School of Medicine, Zonguldak (Turkey)

    2008-09-15

    Objective: To determine alterations of the soft tissues, tendons, cartilage, joint spaces, and bones of the foot using magnetic resonance (MR) imaging in patients with psoriasis. Materials and methods: Clinical and MR examination of the foot was performed in 26 consecutive patients (52 ft) with psoriasis. As a control group, 10 healthy volunteers (20 ft) were also studied. Joint effusion/synovitis, retrocalcaneal bursitis, retroachilles bursitis, Achilles tendonitis, soft-tissue edema, para-articular enthesophytes, bone marrow edema, sinus tarsi syndrome, enthesopathy at the Achilles attachment and at the plantar fascia attachment, plantar fasciitis, tenosynovitis, subchondral cysts, and bone erosions, joint space narrowing, subchondral signal changes, osteolysis, luxation, and sub-luxation were examined. Results: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in none of the patients while frequency of involvement was 92% (24/26) by MR imaging. The most common MR imaging findings were Achilles tendonitis (acute and peritendinitis) (57%), retrocalcaneal bursitis (50%), joint effusion/synovitis (46%), soft-tissue edema (46%), and para-articular enthesophytes (38%). The most commonly involved anatomical region was the hindfoot (73%). Conclusion: Our data showed that the incidence of foot involvement was very high in asymptomatic patients with psoriasis on MR imaging. Further MR studies are needed to confirm these data. We conclude that MR imaging may be of importance especially in early diagnosis and treatment of inflammatory changes in the foot.

  9. Shock-absorbing insoles reduce the incidence of lower limb overuse injuries sustained during Royal Marine training.

    Science.gov (United States)

    House, Carol; Reece, Allyson; Roiz de Sa, Dan

    2013-06-01

    This study was undertaken to determine whether the incidence of lower limb overuse injuries (LLOIs) sustained during Royal Marine training could be reduced by issuing the recruits with shock-absorbing insoles (SAIs) to wear in their military boots. This was a retrospective longitudinal trial conducted in two phases. Injury data from 1,416 recruits issued with standard Saran insoles and 1,338 recruits issued with SAI were compared. The recruits in the two groups were of similar height, body mass, and aerobic fitness and followed the same training course. The incidence of LLOI sustained by the recruits was lower (p tibial periostitis, tenosynovitis of foot, achilles tendonopathy, other tendonopathy and anterior knee pain were lower (p Tibial stress fracture incidence was lower (p < 0.05) in the SAI Group but metatarsal and femoral stress fracture incidences were the same for the two insole groups. Thus, issuing SAIs to military recruits undertaking a sustained, arduous physical training program with a high incidence of LLOI would provide a beneficial reduction in the incidence of LLOI. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

  10. Ultrasonographic assessment of the equine palmar tendons.

    Science.gov (United States)

    Padaliya, N R; Ranpariya, J J; Kumar, Dharmendra; Javia, C B; Barvalia, D R

    2015-02-01

    The present study was conducted to evaluate the equine palmar tendon by ultrasonography (USG) in standing the position. USG of palmar tendons was performed in 40 adult horses using linear transducer having frequency of 10-18 MHz (e-soate, My Lab FIVE) and L52 linear array transducer (Titan, SonoSite) with frequencies ranging from 8 to 10 MHz. Palmar tendon was divided into 7 levels from distal to accessory carpal bone up to ergot in transverse scanning and 3 levels in longitudinal scanning. The USG evaluation was very useful for diagnosis of affections of the conditions such as chronic bowed tendon, suspensory ligament desmitis, carpal sheath tenosynovitis and digital sheath effusions. The mean cross-sectional area (cm(2)) of affected tendons was significantly increased in affected than normal tendons. The echogenicity was also found reduced in affected tendons and ligaments along with disorganization of fiber alignment depending on the severity of lesion and injury. USG proved ideal diagnostic tool for diagnosis and post-treatment healing assessment of tendon injuries in horses.

  11. Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema?

    Energy Technology Data Exchange (ETDEWEB)

    Stomp, Wouter; Bloem, Johan L.; Reijnierse, Monique [Leiden University Medical Center, Department of Radiology, P.O. Box 9600, Leiden (Netherlands); Krabben, Annemarie; Heijde, Desiree van der; Huizinga, Tom W.J.; Helm-van Mil, Annette H.M. van der [Leiden University Medical Center, Department of Rheumatology, P.O. Box 9600, Leiden (Netherlands)

    2014-10-15

    To determine whether T1 post-gadolinium chelate images (T1Gd) can replace T2-weighted images (T2) for evaluating bone marrow oedema (BME), thereby allowing a shorter magnetic resonance imaging (MRI) protocol in rheumatoid arthritis (RA). In 179 early arthritis patients and 43 advanced RA patients, wrist and metacarpophalangeal joints were examined on a 1.5-T extremity MRI system with a standard protocol (coronal T1, T2 fat-saturated and coronal and axial T1 fat-saturated after Gd). BME was scored according to OMERACT RAMRIS by two observers with and without T2 images available. Agreement was assessed using intraclass correlation coefficients (ICCs) for semi-quantitative scores and test characteristics with T2 images as reference. Agreement between scores based on T2 and T1Gd images was excellent ICC (0.80-0.99). At bone level, sensitivity and specificity of BME on T1Gd compared to T2 were high for both patient groups and both readers (all ≥80 %). T1Gd and T2 images are equally suitable for evaluating BME. Because contrast is usually administered to assess (teno)synovitis, a short MRI protocol of T1 and T1Gd is sufficient in RA. (orig.)

  12. New surgical approach to the plantar fetlock joint through the digital flexor tendon sheath wall and suspensory ligament apparatus in cases of concurrent septic synovitis in two cattle.

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    Kofler, J; Martinek, B

    2005-05-01

    A new surgical approach to the infected fetlock joint is described in two cattle suffering from septic tenosynovitis of the lateral digital flexor tendon sheaths of the right lateral hind-digits with concurrent septic serofibrinous arthritis of the adjoining fetlock joints, caused by penetrating wounds. In both patients, the infected sheaths were opened and the superficial and deep digital flexor tendons were removed. Intraoperatively, a small entry through the fetlock joint capsule was detected, directly distal to the lateral proximal sesamoid bone. The tract was surgically enlarged and a second approach into the plantar fetlock joint pouch was created proximally by making a 3 cm long and 0.5 cm wide incision between the two lateral suspensory ligament branches. This allowed easy access to the plantar joint pouch, removal of fibrin clots and an effective joint lavage using 5L of sterile saline solution. The incisions of the fetlock joint capsules remained unsutured and were drained using soft polyurethane foam to preclude premature closure. The tendon sheath wounds remained unsutured. In both patients, the digital flexor tendon sheath and the fetlock joint were lavaged daily for the following three days. The infection was eliminated in both cattle and both fully recovered without residual lameness.

  13. Chronic arthritis in chikungunya virus infection.

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    Mateo, Lourdes; Roure, Silvia

    2017-07-24

    Chikungunya virus infection causes arthralgia and arthritis in the acute phase of the disease but, in more than half of the cases, musculoskeletal manifestations can be prolonged over time and, in some cases, become chronic. Although polyarthralgia is the most frequent chronic manifestation, forms with polyarthritis, tenosynovitis and enthesopathy are also common. To analyze the clinical characteristics of patients with persistent articular manifestations after infection with the Chikungunya virus. Report of 3 cases of chronic arthritis after infection with chikungunya virus diagnosed at outpatient care in a university hospital of Catalonia, all of them imported after exposure in areas of epidemic infection between 2013-2015. All three patients had inflammatory joint pain for more than one year after acute disease (3, 2 and 1 years, respectively). In all cases, it appeared as polyarthritis with involvement of small joints of hands and feet (pseudorheumatoid arthritis-like). Laboratory tests showed a slight elevation of acute phase reactants, and analyses for immune markers were negative. Two of the patients required treatment with glucocorticoids and hydroxychloroquine. The course led to slow clinical improvement, but only one of them came to be completely asymptomatic. In the differential diagnosis of chronic polyarthritis, Chikungunya virus disease should also be considered in areas in which it is not endemic. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  14. Kluyvera cryocrescens finger infection: case report and review of eighteen Kluyvera infections in human beings.

    Science.gov (United States)

    West, B C; Vijayan, H; Shekar, R

    1998-11-01

    We report a case of soft tissue infection with Kluyvera cryocrescens and a critical review of Kluyvera infections. A 31-year-old diabetic man used a new chemical for stripping the floor with his bare hands. Two days later he developed a blister on a finger which progressed to tenosynovitis in spite of intravenous nafcillin therapy. After 11 days culture and sensitivity results dictated treatment with intravenous ticarcillin/clavulanic acid. The wound was debrided twice, and later a skin flap was done. Wound cultures became sterile after 7 days of treatment with ticarcillin/clavulanic acid, and he recovered. This case represents the fourth clinical infection with K. cryocrescens and the eighteenth of Kluyvera to be reported. Four others were K. ascorbata, and the remaining ten Kluyvera infections in humans were not identified beyond genus. Our case and review of the 17 previous cases emphasize that while Kluyvera rarely cause disease, these opportunistic Gram-negative bacilli may be virulent in a variety of sites under as yet poorly defined host conditions. Sites of infection varied, but the brain and meninges were not among them. Two patients had diabetes mellitus, none had AIDS, and four died. Once shown clinically to be the cause of an infection, Kluyvera deserve aggressive treatment which acknowledges their ampicillin resistance.

  15. Tendinopathy of the long head of the biceps tendon: histopathologic analysis of the extra-articular biceps tendon and tenosynovium.

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    Streit, Jonathan J; Shishani, Yousef; Rodgers, Mark; Gobezie, Reuben

    2015-01-01

    Bicipital tendinitis is a common cause of anterior shoulder pain, but there is no evidence that acute inflammation of the extra-articular long head of the biceps (LHB) tendon is the root cause of this condition. We evaluated the histologic findings of the extra-articular portion of the LHB tendon and synovial sheath in order to compare those findings to known histologic changes seen in other tendinopathies. Twenty-six consecutive patients (mean age 45.4±13.7 years) underwent an open subpectoral biceps tenodesis for anterior shoulder pain localized to the bicipital groove. Excised tendons were sent for histologic analysis. Specimens were graded using a semiquantitative scoring system to evaluate tenocyte morphology, the presence of ground substance, collagen bundle characteristics, and vascular changes. Chronic inflammation was noted in only two of 26 specimens, and no specimen demonstrated acute inflammation. Tenocyte enlargement and proliferation, characterized by increased roundness and size of the cell and nucleus with proteoglycan matrix expansion and myxoid degenerative changes, was found in all 26 specimens. Abundant ground substance, collagen bundle changes, and increased vascularization were visualized in all samples. Anterior shoulder pain attributed to the biceps tendon does not appear to be due to an inflammatory process in most cases. The histologic findings of the extra-articular portion of the LHB tendon and synovial sheath are similar to the pathologic findings in de Quervain tenosynovitis at the wrist, and may be due to a chronic degenerative process similar to this and other tendinopathies of the body.

  16. Evaluation of a PCR multiplex for detection and differentiation of Mycoplasma synoviae, M. gallisepticum, and M. gallisepticum strain F-vaccine

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    Elena Mettifogo

    2015-01-01

    Full Text Available Mycoplasma gallisepticum (MG and Mycoplasma synoviae (MS are the mycoplasma infections of most concern for commercial poultry industry. MG infection is commonly designated as chronic respiratory disease (CRD of chickens and infections sinusitis of turkeys. MS causes sub clinical upper respiratory infection and tenosynovitis or bursitis in chickens and turkeys. The multiplex PCR was standardized to detect simultaneously the MS, MG field strains and MG F-vaccine strain specific. The generic PCR for detection of any species of Mollicutes Class was performed and compared to the multiplex PCR and to PCR using species-specific primers. A total of 129 avian tracheal swabs were collected from broiler-breeders, layer hens and broilers in seven different farms and were examined by multiplex PCR methods. The system (multiplex PCR demonstrated to be very rapid, sensitive, and specific. Therefore, the results showed a high prevalence of MS in the flocks examined (27.9%, and indicate that the MS is a recurrent pathogen in Brazilian commercial poultry flocks.

  17. Musculoskeletal disorders associated with HIV infection and AIDS. Part I: Infectious musculoskeletal conditions

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    Tehranzadeh, Jamshid [Department of Radiological Sciences, University of California, Irvine, Irvine, California (United States); Department of Radiological Sciences, Rt. 140, 101 The City Drive ZC 5005, CA 92868-3298, Orange (United States); Ter-Oganesyan, Ramon R. [College of Medicine, University of California, Irvine, Irvine, California (United States); Steinbach, Lynne S. [Department of Radiological Sciences, University of California, San Francisco, San Francisco, California (United States)

    2004-05-01

    The musculoskeletal system can be affected by a variety of abnormalities in association with human immunodeficiency virus (HIV) infection. Although not as common as complications involving other organ systems, such as the pulmonary and the central nervous systems, HIV-associated musculoskeletal disorders are sometimes the initial presentation of the viral illness. Knowledge of the existence and the characteristic appearance of the conditions affecting bone, joint, and muscle in HIV-infected patients is valuable to radiologists for diagnosis and to clinicians for detection and appropriate treatment. We reviewed recent literature to provide a comprehensive assessment of the HIV-associated musculoskeletal disorders, and present radiologic examples from our own collection. This article is divided into two parts. In the first part we review the infectious musculoskeletal disorders associated with HIV illness and AIDS, including cellulitis, abscesses, pyomyositis, septic bursitis, septic arthritis, osteomyelitis, and bacillary angiomatosis. We also present a comprehensive spectrum of mycobacterial infections, consisting of tuberculous spondylitis and spondylodiskitis, arthritis, osteomyelitis, and tenosynovitis, as well as infections caused by atypical mycobacteria. Part II of this review will concentrate on non-infectious musculoskeletal conditions, including rheumatic disorders and neoplasms. (orig.)

  18. Subclinical Partial Attritional Rupture of the Flexor Digitorum Profundus as an Etiology of Atraumatic Trigger Finger

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    D. Anthony Bastian

    2017-01-01

    Full Text Available Background. Trigger finger is a relatively common clinical entity. The etiology is most often attributable to stenosing tenosynovitis though traumatic cases have been described. When trigger finger is associated with an underlying flexor tendon rupture, previous cases have reported a clear association with overt laceration or previous trauma. Methods. We present the case of a 23-year-old male active duty military service member who presented with a characteristic history and clinical exam consistent with trigger finger. The symptomatic onset was gradual, with no history of inciting trauma. Results. Given symptomatic persistent triggering following failure of conservative management to include cortisone injections, the patient was taken for open A1 pulley release. Intraoperatively, the triggering was found to be attributable to a partial attritional rupture of the small finger flexor digitorum profundus tendon. Tendon debridement, tubularization, and A1 and partial A2 pulley releases were performed with subsequent resolution of triggering. Conclusion. We present the rare case of subclinical atraumatic attritional rupture of the FDP tendon to the small finger as a cause of clinically apparent trigger finger. This is an important consideration as the hand surgeon must be prepared to address more atypical pathologies.

  19. Lupus Flare: An Uncommon Presentation of Disseminated Gonorrhea

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    Uyen To

    2014-01-01

    Full Text Available Gonorrhea is one of the most common sexually transmitted diseases in the US with 700,000 annual cases. Although most cases of gonorrhea are localized, approximately 0.5–3% become disseminated. Here we discuss a rare case of a patient with systemic lupus erythematosus (SLE who developed septic shock from disseminated gonorrhea infection (DGI. Our patient is a 24-year-old woman with SLE, mixed connective tissue disease with cutaneous vasculitis, and lupus nephritis who presented with several weeks of malaise and generalized body aches associated with a diffuse rash along her fingers, palms, and trunk. Infectious workup was unrevealing with the exception of a positive gonorrhea test obtained from a cervical swab. Given her symptoms of tenosynovitis, the appearance of her skin lesions, and her positive gonorrhea test, she was diagnosed with septic shock secondary to DGI. With antibiotic treatment, the patient reported a dramatic improvement of the pain in her swollen joints and her rash receded. Patients diagnosed with SLE carry an increased risk of gonorrhea regardless of whether or not they are being treated for their SLE. Although it is well-documented that SLE is associated with severe DGI, few describe it resulting in overt septic shock.

  20. An Unusual Stress Fracture in an Archer with Hypophosphatasia

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    Umut Yavuz

    2013-01-01

    Full Text Available We report a 45-year-old male archer with stress fracture in his left ulna on the background of adult type of hypophosphatasia. The patient presented to several medical centers for pain around the left elbow and received medical treatment upon diagnosis of tenosynovitis. History of the patient revealed that he had had diagnosis of hypophosphatasia ten years ago and underwent percutaneous screwing for stress fracture on both of his femoral necks. Upon finding nondisplaced stress fracture on proximal metaphysis of the ulna on X-ray, the patient underwent magnetic resonance imaging (MRI in order to exclude pathological causes. No additional pathology was observed in MRI scanning. The patient’s sportive activities were restricted for 6 weeks and he received conservative management with arm slings. Adult type of hypophosphatasia is a disease manifesting with widespread osteoporosis and presenting with low serum level of alkali phosphatase (ALP. Stress fracture should definitely be considered in the patients with history of hypophosphatasia and refractory extremity pain.

  1. The Role of Wrist Magnetic Resonance Imaging in the Differential Diagnosis of the Carpal Tunnel Syndrome.

    Science.gov (United States)

    Onen, Mehmet Resid; Kayalar, Ali Erhan; Ilbas, Elif Nurbegum; Gokcan, Recai; Gulec, Ilker; Naderi, Sait

    2015-01-01

    The carpal tunnel syndrome (CTS) is the commonest compressive neuropathy. Electromyography (EMG) is accepted as gold standard in diagnosis of CTS. However, pathologies and variations that are associated with a various findings may lead to failure. Magnetic resonance Imaging (MRI) was applied to 69 wrists of 55 patients, who received a diagnosis of CTS by means of clinical and electrodiagnostic testing (EDT) during the years 2011 and 2013. We detected a total of 71 additional pathologies in MRI analyses: 29 degenerative bone cysts, 28 ganglion cysts, 8 tenosynovitis, and 6 avascular necroses. While the MRI detected 44 (59.5%) additional radiological pathologies in 39 wrists diagnosed with mid-level CTS by means of EMG, the number of detected additional pathologies was 27 (36.5%) in 30 wrists diagnosed with advanced-level CTS. Wrist MRI is an effective means to reveal associated pathologies in patients diagnosed with CTS by means of clinical testing and EDT. Additional pathologies may not only change the applicable type of surgery, but also decrease the number of postoperative failures. Wrist MRI is recommended, especially for young cases with unilateral CTS history accompanied by dubious clinical symptoms and lacking any pronounced predisposing factors.

  2. Ultrasound Guidance in Performing a Tendoscopic Surgery to Treat Posterior Tibial Tendinitis: A Useful Tool?

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    Akinobu Nishimura

    2016-01-01

    Full Text Available A 25-year-old man with a pronation-external rotation type of fracture was surgically treated using a fibular plate. Five years later, he underwent resection of bone hyperplasia because of the ankle pain and limitation of range of motion. Thereafter, the left ankle became intermittently painful, which persisted for about one year. He presented at the age of 43 with persistent ankle pain. Physical and image analysis findings indicated a diagnosis of posttraumatic posterior tibial tendinitis, which we surgically treated using tendoscopy. Endoscopic findings showed tenosynovitis and fibrillation on the tendon surface. We cleaned and removed the synovium surrounding the tendon and deepened the posterior tibial tendon groove to allow sufficient space for the posterior tibial tendon. Full weight-bearing ambulation was permitted one day after surgery and he returned to his occupation in the construction industry six weeks after surgery. The medial aspect of the ankle was free of pain and symptoms at a review two years after surgery. Although tendoscopic surgery for stage 1 posterior tibial tendon dysfunction has been reported, tendoscopic surgery to treat posttraumatic posterior tibial tendinitis has not. Our experience with this patient showed that tendoscopic surgery is useful not only for stage 1 posterior tibial dysfunction, but also for posttraumatic posterior tibial tendinitis.

  3. Pigmented villonodular synovitis of the hip in systemic lupus erythematosus: a case report

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    Anders Hans-Joachim

    2011-09-01

    Full Text Available Abstract Introduction Pigmented villonodular synovitis is a rare disease of unknown etiology mostly affecting the knee and foot. Until now an association with autoimmune diseases has not been reported. Case presentation The diagnosis of systemic lupus erythematosus was made in a 15-year-old Caucasian girl based on otherwise unexplained fatigue, arthralgia, tenosynovitis, leukopenia, low platelets and the presence of antinuclear and deoxyribonucleic antibodies. At the age of 20 a renal biopsy revealed lupus nephritis class IV and she went into complete remission with mycophenolate mofetil and steroids. She was kept on mycophenolate mofetil for maintenance therapy. At the age of 24 she experienced a flare-up of lupus nephritis with nephrotic syndrome and new onset of pain in her right hip. Magnetic resonance imaging, arthroscopy and subtotal synovectomy identified pigmented villonodular synovitis as the underlying diagnosis. Although her systemic lupus erythematosus went into remission with another course of steroids and higher doses of mycophenolate mofetil, the pigmented villonodular synovitis persisted and she had to undergo open synovectomy to control her symptoms. Conclusion Systemic lupus erythematosus is associated with many different musculoskeletal manifestations including synovitis and arthritis. Pigmented villonodular synovitis has not previously been reported in association with systemic lupus erythematosus, but as its etiology is still unknown, the present case raises the question about a causal relationship between systemic lupus erythematosus and pigmented villonodular synovitis.

  4. Reducing thumb extensor risk in laboratory rat gavage.

    Science.gov (United States)

    Nimunkar, Amit J; Chun, Keum San; Phung, Ngoc; Wreksoatmodjo, Kevin; Yen, Thomas Y; Radwin, Robert G

    2017-01-01

    Gavage is a common technique for orally administering compounds to small laboratory animals using a syringe. It involves highly repetitive thumb extensor exertions for filling the syringe, a risk factor for DeQuervain's tenosynovitis. As an intervention, a series of bench tests were performed varying fluid viscosity, syringe size and needle size to determine the forces required for drawing fluid. Forces up to 28 N were observed for a viscosity of 0.29 Pa s. A guide is presented to minimize thumb forces for a particular combination of syringe (3 mL, 5 mL and 10 mL), fluid viscosity (0.001 Pa s, 0.065 Pa s, 0.21 and 0.29 Pa s), and needle length (52 mm, 78 mm and 100 mm) based on maximum acceptable exertion levels. In general, a small syringe and large needle size had a greater number of acceptable rat gavages per day due to the lower forces experienced as compared to all other syringe and needle combinations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability.

    Science.gov (United States)

    Bruyn, George A W; Hanova, Petra; Iagnocco, Annamaria; d'Agostino, Maria-Antonietta; Möller, Ingrid; Terslev, Lene; Backhaus, Marina; Balint, Peter V; Filippucci, Emilio; Baudoin, Paul; van Vugt, Richard; Pineda, Carlos; Wakefield, Richard; Garrido, Jesus; Pecha, Ondrej; Naredo, Esperanza

    2014-11-01

    To develop the first ultrasound scoring system of tendon damage in rheumatoid arthritis (RA) and assess its intraobserver and interobserver reliability. We conducted a Delphi study on ultrasound-defined tendon damage and ultrasound scoring system of tendon damage in RA among 35 international rheumatologists with experience in musculoskeletal ultrasound. Twelve patients with RA were included and assessed twice by 12 rheumatologists-sonographers. Ultrasound examination for tendon damage in B mode of five wrist extensor compartments (extensor carpi radialis brevis and longus; extensor pollicis longus; extensor digitorum communis; extensor digiti minimi; extensor carpi ulnaris) and one ankle tendon (tibialis posterior) was performed blindly, independently and bilaterally in each patient. Intraobserver and interobserver reliability were calculated by κ coefficients. A three-grade semiquantitative scoring system was agreed for scoring tendon damage in B mode. The mean intraobserver reliability for tendon damage scoring was excellent (κ value 0.91). The mean interobserver reliability assessment showed good κ values (κ value 0.75). The most reliable were the extensor digiti minimi, the extensor carpi ulnaris, and the tibialis posterior tendons. An ultrasound reference image atlas of tenosynovitis and tendon damage was also developed. Ultrasound is a reproducible tool for evaluating tendon damage in RA. This study strongly supports a new reliable ultrasound scoring system for tendon damage. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Right Ring Finger Volar Mass in a 14-Year-Old Boy.

    Science.gov (United States)

    Fox, Mary P; McKay, Jack E; Craver, Randall D; Pappas, Nicholas D

    2017-09-01

    A trigger digit is relatively uncommon in adolescents and often has a different etiology in that age group vs adults. In the pediatric population, trigger digits frequently arise from a variety of underlying anatomic situations, including thickening of the flexor digitorum superficialis or flexor digitorum profundus tendons, an abnormal relationship between the flexor digitorum superficialis and flexor digitorum profundus tendons, a proximal flexor digitorum superficialis decussation, or constriction of the pulleys. In addition, underlying conditions such as mucopolysaccharidosis, juvenile rheumatoid arthritis, Ehlers-Danlos syndrome, and central nervous system disorders such as delayed motor development have been associated with triggering. Less commonly, triggering secondary to intratendinous or peritendinous calcifications or granulations has been described, which is what occurred in the current case. This report describes a case of tenosynovitis with psammomatous calcification treated with excision of the mass from the flexor digitorum superficialis tendon and release of both the A1 and palmar aponeurosis pulleys in an adolescent patient. [Orthopedics. 2017; 40(5):e918-e920.]. Copyright 2017, SLACK Incorporated.

  7. JUVENILE RHEUMATOID ARTHRITIS

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    I N Sartika

    2012-11-01

    Full Text Available Juvenile rheumatoid arthritis (JRA is the most common rheumatic condition in children. JRA is defined as persistent arthritis in 1 or more joints for at least 6 weeks, with the onset before age 16 years. The etiology of JRA is unknown. Antigen activated CD4+ T cell stimulate monocytes, macrophages, and synovial fibroblasts to produce the cytokines Interleukin-1 (IL-1, IL-6, and tumor necrosis factor ? (TNF-? and to secrete matrix metalloproteinases, which lead to chronic inflammation due to infiltration of inflammatory cell, angiogenesis, destruction of cartilage and bone with pannus formation. The 3 major subtypes of JRA are based on the symptoms at disease onset and are designated systemic onset, pauciarticular onset, and polyarticular onset. For all patients, the goals of therapy are to decrease chronic joint pain and suppress the inflammatory process. Poor prognostic have been observed in patients with polyarticular onset, rheumatoid factor, persistent morning stiffness, tenosynovitis, involvement of the small joints, rapid appearance of erosions, active late onset childhood, subcutaneous nodules, or antinuclear antibody.

  8. Magnetic resonance imaging of hindfoot involvement in patients with spondyloarthritides: Comparison of low-field and high-field strength units

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    Eshed, Iris; Althoff, Christian E. [Department of Radiology, Charite Medical School, Berlin (Germany); Feist, Eugen [Department of Rheumatology and Clinical Immunology, Charite Medical School, Berlin (Germany); Minden, Kirsten [Helios Clinics, 2nd Children' s Hospital Berlin-Buch, Rheumatology Unit, Berlin (Germany); German Rheumatology Research Center, Berlin (Germany); Schink, Tania [Department of Medical Biometry, Charite Medical School, Berlin (Germany); Hamm, Bernd [Department of Radiology, Charite Medical School, Berlin (Germany); Hermann, Kay-Geert A. [Department of Radiology, Charite Medical School, Berlin (Germany)], E-mail: kgh@charite.de

    2008-01-15

    Objective: To compare MRI evaluation of a painful hindfoot of patients with spondyloarthritides (SpA) on low-field (0.2 T) versus high-field (1.5 T) MRI. Materials and methods: Patients with SpA and hindfoot pain were randomly referred to either high-field or low-field MRI. Twenty-seven patients were evaluated (male/female: 17:10; mean age: 39 {+-} 1.4 years). Fifteen patients were examined by low-field and 12 by high-field MRI. Two patients (evaluated by high-field MRI) were excluded. Images were separately read by two radiologists who later reached a consensus. In each patient the prevalence of erosions, fluid, synovitis or bone marrow edema of the hindfoot joints, tendinosis or tenosynovitis of tendons, enthesitis of the plantar fascia and Achilles tendon and retrocalcaneal bursitis were recorded. Clinical and demographic parameters were comparable between both groups. Results: MRI evaluation of joints and tendons of the hindfoot revealed no significant differences in patients with SpA groups for all parameters. Analyzing all joints or tendons together, there was no statistically significant difference between the two groups. Conclusion: Low-field and high-field MRI provide comparable information for evaluation of inflammatory hindfoot involvement. Thus, low-field MRI can be considered as a reliable diagnostic tool for the detection of hindfoot abnormalities in SpA patients.

  9. Stigmatization of repetitive hand use in newspaper reports of hand illness.

    Science.gov (United States)

    Anthony, Shawn; Lozano-Calderon, Santiago; Ring, David

    2008-03-01

    Failure to provide a balanced evidence-based consideration of the role of activity in illness can stigmatize individuals and their activities. We assessed the prevalence of language that stigmatized repetitive hand use and those that use their hand repetitively in newspaper coverage of common hand illnesses. The LexisNexis Academic database was used to search five major US newspapers for articles containing keywords about common hand illnesses during a 3-year period. Article language was assessed for stigmatization of activities involving repetitive hand use as well as for stigmatization of patients who use their hand repetitively. One hundred and twenty-four articles on hand illnesses were identified. Of these, 65.3% of articles stigmatized activities involving repetitive hand use, including 96.6% of articles discussing overuse injury of the hand, 90% of articles discussing tendonitis or tenosynovitis, and 51.8% of articles discussing carpal tunnel syndrome. Patient stigmatization was documented in 30.6% of the newspaper articles. Stigmatizing statements were most commonly made by journalists (94.8%), followed by patients (3.1%), and physicians (2.1%). Language that stigmatizes repetitive hand use and patients who use their hand repetitively is prevalent among US newspaper articles. Both health professionals and journalists reporting health-related news should be more sensitive to the use of stigmatizing language and provide a more balanced, measured, and evidenced-based account of hand illnesses.

  10. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

    Directory of Open Access Journals (Sweden)

    Jorge Pablo Batista

    2015-01-01

    Full Text Available Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion.

  11. Reduction in ulnar pressure distribution when walking with forearm crutches with a novel cuff design: Cross-sectional intervention study on the biomechanical efficacy of an ulnar recess.

    Science.gov (United States)

    Molteni, Pascal; Hügle, Thomas; Hügle, Maria; Nüesch, Corina; Mündermann, Annegret

    2018-01-01

    Walking with crutches is an effective way of reducing the load on the lower extremity and is often indicated after injury or surgery. However, walking with forearm crutches with conventional cuffs can trigger symptoms including tenosynovitis in the biceps tendon, ulnar neuropraxia at the wrist, pain, or skin hematoma. The purpose of this study was to test the hypothesis that a crutch cuff design with an ulnar recess reduces ulnar pressure during walking with forearm crutches. The pressure distribution between the forearm and crutch cuff was measured in 15 healthy participants for crutch walking with conventional and novel cuffs, respectively. Relative peak pressure in the proximal medial region compared to the overall peak pressure was reduced by 8.6% when walking with crutches with the novel cuff design compared to conventional cuffs (p < 0.001). Relative peak pressure in the distal intermediate and lateral regions were increased by 3.3% and 3.7% for the novel compared with conventional cuffs, respectively (p < 0.001 for both). Hence, the novel crutch cuffs shifted regions of high pressure away from the proximal ulnar region towards more distal regions that are covered by more soft tissue.

  12. Magnetic resonance imaging appearance of the hands and feet in patients with early rheumatoid arthritis.

    Science.gov (United States)

    Boutry, Nathalie; Lardé, Anne; Lapègue, Franck; Solau-Gervais, Elizabeth; Flipo, René-Marc; Cotten, Anne

    2003-04-01

    To describe the magnetic resonance (MRI) imaging findings of the feet in patients with early rheumatoid arthritis (RA), and to compare MRI appearance of the feet with that of the hands. Thirty consecutive patients (18 women, 12 men; age range 19-64 yrs) with early RA underwent MRI of hands and feet. Axial fat suppressed gadolinium enhanced T1 weighted spin-echo and gadolinium enhanced 3-dimensional gradient-echo (FLASH) images were obtained. In the hands, MRI findings suggested active synovitis of the wrist and metacarpophalangeal (MCP) joints in 28 (93%) and 27 (90%) patients, respectively. In the feet, active synovitis was observed in 29 (97%) patients. Bone erosions were seen in the wrist joints in 24 (80%) patients. Observers found as many bony changes in the MCP as in the metatarsophalangeal joints [23 (77%) patients]. MRI detected tenosynovitis in 16 (53%) patients in the hands, and in 18 (60%) patients in the feet. Bursitis located between or beneath the metatarsal heads was a common MRI finding [19 (63%) patients]. Additional MRI of the feet may be useful when evaluation of the hands does not help identify early RA.

  13. A new volar plate made of carbon-fiber-reinforced polyetheretherketon for distal radius fracture: analysis of 40 cases.

    Science.gov (United States)

    Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Zambianchi, Francesco; Catani, Fabio

    2014-12-01

    Implants based on the polyetheretherketon (PEEK) polymer have been developed in the last decade as an alternative to conventional metallic devices. PEEK devices may provide several advantages over the use of conventional orthopedic materials, including the lack of metal allergies, radiolucency, low artifacts on magnetic resonance imaging scans and the possibility of tailoring mechanical properties. The purpose of this study was to evaluate the clinical results at 12-month follow-up using a new plate made of carbon-fiber-reinforced polyetheretherketon for the treatment of distal radius fractures. We included 40 consecutive fractures of AO types B and C that remained displaced after an initial attempt at reduction. The fractures were classified according to the AO classification: 21 fractures were type C1, 9 were type C2, 2 were type C3, 2 were type B1 and 6 were type B2. At a 12-month follow-up no cases of hardware breakage or loss of the surgically achieved fracture reduction were documented. All fractures healed, and radiographic union was observed at an average of 6 weeks. The final Disabilities of Arm, Shoulder and Hand score was 6.0 points. The average grip strength, expressed as a percentage of the contralateral limb, was 92 %. Hardware removal was performed only in one case, for the occurrence of extensor tenosynovitis. At early follow-up this device showed good clinical results and allowed maintenance of reduction in complex, AO fractures. Therapeutic IV.

  14. The feet in systemic lupus erythematosus; are we underestimating their involvement and functional impact?

    Science.gov (United States)

    Morales-Lozano, Rosario; Martínez-Barrio, Julia; González-Fernández, María Luz; López-Longo, Francisco Javier; Ovalles-Bonilla, Juan Gabriel; Valor, Lara; Janta, Iustina; Nieto, Juan Carlos; Hernández-Flórez, Diana; González, Carlos M; Monteagudo, Indalecio; Garrido, Jesús; Carreño, Luis; Naredo, Esperanza

    2016-01-01

    To evaluate biomechanical and ultrasound (US) abnormalities in SLE patients as compared with controls and to assess the relationship between these abnormalities and SLE activity. Fifty-four consecutive female patients with SLE with and without foot pain and 60 female controls (30 with foot pain and 30 without foot pain) were recruited. SLE activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). SLE patients and controls blindly underwent a comprehensive podiatric, biomechanical and US evaluation of the feet. US assessment included detection of B-mode synovitis, tenosynovitis, enthesopathy, bone changes and synovial, tenosynovial and entheseal power Doppler (PD) signal. Thirty-one (57.4%) SLE patients had bilateral foot pain and 5 (9.3%) had unilateral foot pain. Metatarsalgia was the most common location for pain but without significant difference between groups (p=0.284). Toe joint deformities were significantly more common in SLE feet as compared with control feet (pfeet showed significantly more biomechanical abnormalities than control feet (pfeet of SLE patients. SLEDAI was significantly higher in patients with foot pain than in those with painless feet (p=0.008). However, SLEDAI did not discriminate between patients with and without biomechanical or US abnormalities. SLE patients showed more biomechanical and US abnormalities in the feet than controls, which were not captured by standardised assessment of the disease activity.

  15. Musculoskeletal Ultrasonography in CRPS: Assessment of Muscles Before and After Motor Function Recovery with Dry Needling as the Sole Treatment.

    Science.gov (United States)

    Vas, Lakshmi Champak; Pai, Renuka; Pattnaik, Manorama

    2016-01-01

    tenosynovitis causing the CDC and return of normal myoarchitecture.

  16. Effectiveness of physical treatment at De Quervain᾽s disease

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    Bakir Katana

    2012-04-01

    Full Text Available Introduction: De Quervain᾽s disease is a stenosing tenosynovitis of common tendon sheath of abducktor policis longus and extensor policis brevis muscles. Due to the superficial positions it can easily lead tomechanical injuries of tendons and their sheaths. The disease more often affects women over 40 years old and people with certain professions who intensively use hand and fingers in their daily work. Pathologicalchanges consist of sheath᾽s fibrous layer thickening. The clinical condition develops gradually with the pain of varying intensity. It is localized above the radial styloid process and radiates from the back side of thethumb. The aim is to determine the efficacy of physical therapy at De Quervain᾽s disease.Methods: The study was conducted on 50 patients with De Quervain's disease who were reported to the CBR "Praxis" Sarajevo. With retrospective analysis the data was processed for the period from 01.01.2001. to 31.12.2011. year. Before the initiation of physical therapy assessment of functional status scored from 0 to 6 was performed. In the chronic phase physical therapy was performed, after which it underwent assessment of therapy success scores of 0-5. Criteria for inclusion in the study were patients with confirmed De Quervain's disease, patients of both sex and of all ages, and criterion for exclusion was non-compliance withtreatment protocols.Results: In the CBR "Praxis" with De Quervain᾽s disease total of 50 patients were treated in that period, of which 34 women and 16 men. 38% of respondents received a score of 4, while 56% of patients at the end oftreatment received a score of 5.Conslusion: Physical therapy and kinesiotherapeutical procedures have greatly contributed to the elimination of symptoms and consequences of De Quervainove disease.

  17. MRI findings on de Quervain`s disease

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    Murase, Tsuyoshi [Osaka National Hospital (Japan); Kitano, Keiji; Shimada, Kozo; Tokumaru, Hiroshi; Komi, Katsumi

    1996-08-01

    de Quervain`s disease is a stenosing tenosynovitis affecting the first extensor compartment of the wrist. Conservative treatment including steroid injection is primarily indicated and satisfactory result can be obtained in most cases. However, it often fails in cases where fibrocartilagenous septum exists within the first compartment. Surgical release of the compartment and resection of the septum is recommended for these instances. The incidence of the septum in the compartment is reported to be about 30 to 40 per cent in normal population, though over 90 per cent in operative cases. In this study, MRI was employed to evaluate the anatomical variation in the first extensor compartment of the wrist in de Quervain`s disease. There were 13 hands in 5 men and 10 women. Their average age was 49.5 years old (19 to 76 y.o.). Axial T1 weighted MR images around the radial styloid process were obtained. Eight hands which resisted conservative treatment were operated on and first compartment was directly inspected. The other 5 were well treated with one or two steroid injection. In all operative cases, MRI revealed that the EPB tendon exists apart from the APL tendon surrounded with thick high intensity area. That finding correspond to the operative findings. That were fibrocartilagenous septum dividing the first compartment and dense synovium around the EPB tendon. On the other hands, in 5 hands which responded to steroid injection, EPB was identified only in 2 on MRI and could not be distinguished from APL in the other 3. Consequently, MRI provides useful information to make a strategy for treating de Quervain`s disease. In cases whose MRI show that EPB and APL are accommodated in one common canal non-surgical treatment should be continued while in the cases of separate EPB tunnel with surrounding proliferating synovium early operation might be considered. (author)

  18. Acute felon and paronychia: Antibiotics not necessary after surgical treatment. Prospective study of 46 patients.

    Science.gov (United States)

    Pierrart, Jérôme; Delgrande, Damien; Mamane, William; Tordjman, Daniel; Masmejean, Emmanuel H

    2016-02-01

    Paronychia and felon are the most common infections of the hand. Surgical treatment is required once an abscess develops, but systematic use of postoperative antibiotic therapy remains open for discussion. Antibiotics both favor the selection of resistant bacteria and increase the cost of treatment. To our knowledge, no study has demonstrated their benefit following excision, yet many practitioners prescribe them systematically and empirically. In our current practices, we do not use antibiotic coverage following excision of uncomplicated paronychia or felon (no signs of arthritis, osteitis, flexor tenosynovitis, lymphangitis), except in potentially at-risk patients (immunosuppressed, diabetic, cardiac valve prosthesis recipient). Since this approach seems to lead to good outcomes, our objective was to evaluate them clinically in this study. Our prospective study included 46 patients who were not considered at risk. There were 26 cases of paronychia, 3 cases of felon and 17 patients presenting both paronychia and felon. All cases were abscessed and uncomplicated. All patients underwent surgical excision, and none received postoperative antibiotics. Follow-up took place on the day after surgery, at days 7, 14, 21 and 45. The main criterion for evaluation was healing of the infection and the wound. We recorded 45 cases of healing with no complications and a single case of recurrence. Surgical excision of paronychia or felon without antibiotic coverage gives excellent results with only rare recurrence. The single failure can be attributed to inadequate excision. Antibiotic therapy has no role in managing uncomplicated felon or paronychia in patients who are otherwise not at risk. Successful treatment depends above all on the completeness of the surgical excision. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  19. Hand function in rheumatic diseases: patient and physician evaluations.

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    López López, Carlos Omar; Alvarez-Hernández, Everardo; Medrano Ramirez, Gabriel; Montes Castillo, Ma Luz; Hernández-Díaz, Cristina; Ventura Rios, Lucio; Arreguin Lopez, Roberto; Vázquez-Mellado, Janitzia

    2014-11-01

    Rheumatic diseases have repercussions in hand function. The m-SACRAH (modified Score for the Assessment and quantification of Chronic Rheumatoid Affections of the Hands) questionnaire evaluates hand function according to the patient's opinion. Our aim was to look for the clinical and para-clinical variables that correlate with m-SACRAH in rheumatic diseases. Consecutive patients with diagnoses of rheumatoid arthritis (RA), osteoarthritis (OA), gout, and systemic sclerosis (SS) with hand involvement and who agreed to participate, answered the m-SACRAH and Health Assessment Questionnaire Disability Index (HAQ-DI) and underwent blinded and independent rheumatologist and physiatrist evaluations. Nerve conduction studies (NCS) and hand ultrasonography (USG) were performed. Spearman's correlation and the Mann-Whitney U-test. Forty patients were included. There were 72% women and mean age of 49.25 ± 14.2 years. According to m-SACRAH patients were dived into two groups (mild vs. moderate-severe), only the number limited to motion joints were different among them (median 2 vs. 8 P = 0.036). Patients' perspective variables had a good correlation (HAQ-DI/mSACRAH: r = 0.43, P hand function with physiatrist evaluations: passive range of motion (r = -0.49, P = 0.001), sum of affected pinches (r = 0.66, P = 0.001), limited to motion joints (r = 0.34, P < 0.05) and palm-finger distance (r = 0.50, P = 0.05). Regarding para-clinical evaluations, only tenosynovitis by ultrasonography correlated with HAQ-Di (r = 0.357, P < 0.05). Patients' perspectives correlated with the number of limited motion joints but with none of the other physicians' and para-clinical evaluations. The patients' opinion about their function should play a major role in their management. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  20. Cuboid oedema due to peroneus longus tendinopathy: a report of four cases

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    O' Donnell, Paul; Saifuddin, Asif [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom)

    2005-07-01

    To highlight focal bone abnormality in the cuboid due to tendinopathy of the adjacent peroneus longus. A retrospective review was carried out of the relevant clinical and imaging features. Two male and two female patients were studied, mean age 51.5 years (range 32 - 67 years), referred with foot pain and imaging showing an abnormal cuboid thought to represent either tumour or infection. A long history of foot pain was usual with a maximum of 8 years. Radiographs were normal in two cases and showed erosion in two, one of which exhibited periosteal new bone formation affecting the cuboid. Bone scintigraphy was undertaken in two patients, both of whom showed increased uptake of isotope. MRI, performed in all patients, showed oedema in the cuboid adjacent to the peroneus longus tendon. The tendon and/or paratendinous tissues were abnormal in all cases, but no tendon discontinuity was identified. One patient possessed an os peroneum. Unequivocal evidence of bone erosion was seen using MRI in three patients, but with greater clarity in two cases using CT. Additional findings of tenosynovitis of tibialis posterior, oedema in the adjacent medial malleolus and synovitis of multiple joints in the foot were seen in one patient. Imaging diagnosis was made in all cases avoiding bone biopsy, but surgical exploration of the peroneal tendons was performed in two cases and biopsy of ankle synovium in one. Oedema with erosion of the cuboid bone, simulating a bone lesion (cuboid ''pseudotumour''), may be caused by adjacent tendinopathy of peroneus longus. It is vital to be aware of this entity to avoid unnecessary biopsy of the cuboid. (orig.)

  1. Evaluation of lesser metatarsophalangeal joint plantar plate tears with contrast-enhanced and fat-suppressed MRI

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    Dinoa, Vanessa; Ranke, Felipe von; Costa, Flavia; Marchiori, Edson [Federal University of Rio de Janeiro, Rio de Janeiro (Brazil)

    2016-05-15

    To present findings of plantar plate (PP) lesions from MRI with administration of gadolinium and to differentiate PP lesions from others causes of metatarsalgia. Two musculoskeletal radiologists reviewed 249 contrast-enhanced forefoot MRI scans from patients with metatarsalgia between June 2012 and June 2013. Evaluations focused on hyper-vascularized/fibrous tissue and other findings associated with PP tears. Fifty-nine patients had PP tears, 59 % were female. Most of these patients, 48/59 (81.4 %), had a single metatarsophalangeal (MTP) PP lesion in one foot, although 7/59 patients had one lesion in each foot, 3/59 (5.1 %) had two in one foot, and 1/59 (1.7 %) had three lesions in one foot. The second MTP joint was the most common location for PP tears (n = 56), followed by the third (n = 12) and fourth (n = 3) MTP joints. Lateral (n = 33) and full thickness (n = 28) PP lesions were the most frequent, and central (n = 3) and lateral/central (n = 7) tears were less prevalent. Fifty (70.5 %) PP lesions showed pericapsular fibrosis in pre-contrast sequences, and 21 (29.5 %) were visible only after administration of gadolinium. All PP lesions had collateral ligament involvement. Others findings included interosseous tendon lesions (n = 29), interosseous tendon rupture (n = 29), synovitis (n = 49), flexor tenosynovitis (n = 28), crossover toe (n = 2), hammertoe (n = 1), intermetatarsal space (IS) neuromas (n = 11), and third IS neuromas (n = 12). PP tears are a common cause of metatarsalgia, accounting for more than 20 % of cases in our sample. A substantial portion of the lesions (29.5 %) became visible only after the administration of gadolinium. (orig.)

  2. Metástase cutânea rara de provável carcinoma basaloide de cólon simulando granuloma piogênico Rare cutaneous metastasis from a probable basaloid carcinoma of the colon mimicking pyogenic granuloma

    Directory of Open Access Journals (Sweden)

    Gustavo Costa Verardino

    2011-06-01

    Full Text Available As acrometástases, principalmente para as mãos, são incomuns e representam cerca de 0,0070,2% de todas as lesões metastáticas. O pulmão é o sítio de origem mais comum, colaborando com 4050% dos casos relatados na literatura. Os rins e mamas são outras localizações também relacionadas a neoplasias que metastatizam para as mãos, além de, mais raramente, trato gastrointestinal, outros tumores sistêmicos e sarcomas. Seu diagnóstico precoce é difícil, pois pode ser assintomático, se assemelhar a tenossinovite, artrite, paroníquia, granuloma piogênico ou infecção local. No presente relato, os autores apresentam paciente com diagnóstico de acrometástase, em ambos os quartos quirodáctilos, oriunda de carcinoma basaloide de canal anal, com pobre resposta à radioterapiaAcrometastasis is a rare occurrence, especially when affecting the hands. It represents around 0.007-0.2% of all metastatic lesions. The most common site of origin is the lung, accounting for 40-50% of all cases reported in the literature. Kidneys and breasts are other sites also associated with neoplastic lesions that disseminate to the hands. More rarely, the site of origin may be the gastrointestinal tract or other systemic tumors or sarcomas. Early diagnosis is difficult, since the condition may be asymptomatic or may mimic tenosynovitis, arthritis, paronychia, pyogenic granuloma or a local infection. In the present paper, the authors report on a patient with the diagnosis of acrometastasis on both hands originating from a basaloid carcinoma of the anal canal. Response to radiotherapy was poor

  3. A Newly Emergent Turkey Arthritis Reovirus Shows Dominant Enteric Tropism and Induces Significantly Elevated Innate Antiviral and T Helper-1 Cytokine Responses.

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    Tamer A Sharafeldin

    Full Text Available Newly emergent turkey arthritis reoviruses (TARV were isolated from tendons of lame 15-week-old tom turkeys that occasionally had ruptured leg tendons. Experimentally, these TARVs induced remarkable tenosynovitis in gastrocnemius tendons of turkey poults. The current study aimed to characterize the location and the extent of virus replication as well as the cytokine response induced by TARV during the first two weeks of infection. One-week-old male turkeys were inoculated orally with TARV (O'Neil strain. Copy numbers of viral genes were estimated in intestines, internal organs and tendons at ½, 1, 2, 3, 4, 7, 14 days Post inoculation (dpi. Cytokine profile was measured in intestines, spleen and leg tendons at 0, 4, 7 and 14 dpi. Viral copy number peaked in jejunum, cecum and bursa of Fabricius at 4 dpi. Copy numbers increased dramatically in leg tendons at 7 and 14 dpi while minimal copies were detected in internal organs and blood during the same period. Virus was detected in cloacal swabs at 1-2 dpi, and peaked at 14 dpi indicating enterotropism of the virus and its early shedding in feces. Elevation of IFN-α and IFN-β was observed in intestines at 7 dpi as well as a prominent T helper-1 response (IFN-γ at 7 and 14 dpi. IFN-γ and IL-6 were elevated in gastrocnemius tendons at 14 dpi. Elevation of antiviral cytokines in intestines occurred at 7dpi when a significant decline of viral replication in intestines was observed. T helper-1 response in intestines and leg tendons was the dominant T-helper response. These results suggest the possible correlation between viral replication and cytokine response in early infection of TARV in turkeys. Our findings provide novel insights which help elucidate viral pathogenesis in turkey tendons infected with TARV.

  4. Surgical Demographics of Carpal Tunnel Syndrome and Cubital Tunnel Syndrome Over 5 Years at a Single Institution.

    Science.gov (United States)

    Zhang, Dafang; Collins, Jamie E; Earp, Brandon E; Blazar, Philip

    2017-08-12

    Carpal tunnel and cubital tunnel syndrome are the 2 most common upper-limb compressive neuropathies. However, whether the characteristics of patient populations undergoing surgery for these conditions are similar is unclear in terms of demographics and concomitant pathologies. Our null hypothesis was that there are no identifiable differences between these patient populations. A retrospective cohort study was performed by billing system query using Common Procedural Terminology (CPT) codes for all patients who underwent open carpal tunnel release (CTR) (CPT code 64721) and/or open cubital tunnel surgery (CPT code 64718) by 1 of 4 hand surgeons from August 2008 to July 2013. Application of exclusion criteria of acute trauma, revision surgery, neoplasm, age less than 18 years, and inaccurate or insufficient records resulted in identification of 1,114 patients who underwent CTR, 264 patients who underwent cubital tunnel surgery, and 76 patients who underwent both. Computerized medical records were analyzed for demographic variables, medical comorbidities, and other procedures performed under the same anesthetic. In the multivariable analysis, older age, female sex, higher body mass index, trigger finger, and de Quervain tenosynovitis were associated with CTR. Prior trauma to the anatomic site was more common in the cubital tunnel group. Diabetes mellitus was associated with patients who had both procedures. The populations of patients who undergo surgery for different upper-extremity compressive neuropathies are not homogenous: CTR is associated with older age, female sex, higher body mass index, and hand tendinopathies. Cubital tunnel decompression is associated with prior trauma to the anatomic site. Diabetic patients are more likely to have both procedures. Diabetic patients undergoing either procedure should be evaluated for other peripheral nerve compression pathologies. Diagnostic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by

  5. Psoriasis and associated variables in classification and outcome of juvenile idiopathic arthritis - an eight-year follow-up study.

    Science.gov (United States)

    Ekelund, Maria; Aalto, Kristiina; Fasth, Anders; Herlin, Troels; Nielsen, Susan; Nordal, Ellen; Peltoniemi, Suvi; Rygg, Marite; Zak, Marek; Berntson, Lillemor

    2017-02-22

    To study the impact of psoriasis and features associated with psoriasis on classification and outcome in a population-based follow-up cohort of children with juvenile idiopathic arthritis (JIA). In all, 440 children with JIA were followed for a median of 8 years in a prospective Nordic population-based cohort study. Data for remission was available for 427 of these children. The presence of psoriasis, psoriasis-like rash, dactylitis, nail pitting, enthesitis, tenosynovitis and heredity was assessed in relation to ILAR classification and remission. Clinical findings associated with psoriasis developed consecutively during the 8-year period. Six of 14 children with psoriasis were not classified as juvenile psoriatic arthritis according to the ILAR criteria at 8 year follow-up. Dactylitis was more common in children with early onset of JIA. After 8 years we found a cumulative median number of eleven arthritic joints in children with psoriasis or psoriasis-like rash compared with six in the rest of the cohort (p = 0.02). Also, the chance for not being in remission after 8 years increased significantly in patients with psoriasis, psoriasis-like rash or at least two of: 1) first-degree heredity for psoriasis or psoriatic arthritis, 2) dactylitis or 3) nail pitting, compared with the rest of the group (OR 3.32, p = 0.010). Our results indicate a more severe disease over time in psoriasis-associated JIA, as features of psoriasis develop during the disease course. This group is a major challenge to encompass in a future JIA classification in order to facilitate early tailored treatment.

  6. IMPINGEMENT-SYNDROME OF PERONEUS BREVIS TENDON AFTER CALCANEAL FRACTURES (MORPHOLOGICAL ASPECTS

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    N. S. Konovalchuk

    2017-01-01

    Full Text Available Background. One of the main causes of pain in patients with consequences of calcaneal fractures is the lateral impingement syndrome. This term means lateral displacement of outer calcaneal wall at the moment of fracture, narrowing of anatomical space under the lateral malleolus and compression of soft tissues in this region, including tendons of short and long peroneal muscles. This leads to chronic traumatization of tendons, alteration of their normal tracking and development of tendinitis and tenosynovitis. At this moment there are no articles in foreign or Russian literature describing how prolonged traumatization influences the internal structure of the tendons. The purpose of this study was to evaluate the morphological changes in structure of peroneus brevis tendon after different duration of compression between outer wall of calcaneus and the tip of the lateral malleolus in patients with calcaneal malunion.Materials and methods. Fifteen patients with calcaneal malunion and lateral impingement syndrome were treated operatively between 2016 and 2017. To confirm the lateral impingement syndrome, the authors performed clinical examination and AP x-rays of ankle joint. Two peroneus brevis tendon specimens were obtained intraoperatively in each of 15 patients: one specimen from compressed and one from non-compressed area. Obtained specimens were histologically examined according to standard protocol.Results. Microscopically all specimens showed separation of collagen bundles with loose connective tissue degeneration, increase of vascularization and inflammation. The degree of these changes differed according to the compression duration. This allowed us to analyze the dynamics of these changes.Conclusion. The morphological changes in structure of peroneus brevis tendon during the compression between outer wall of calcaneus and the tip of the lateral malleolus correspond with dynamics of common pathologic reactions. Early stages showed signs of

  7. IMAGING OF PSORIATIC ARTHRITIS

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    S. D'Angelo

    2011-09-01

    Full Text Available Imaging of psoriatic arthritis (PsA is important for two reasons: the differential diagnosis from other arthritides and the assessment of structural damage that can be inhibited by the new drugs such as the anti-TNFα agents. Plain film radiographic findings of peripheral arthritis have been important in elaborating the concept of PsA as a separate disease entity. Characteristic aspects of psoriatic peripheral arthritis help the differentiation from rheumatoid arthritis. High-resolution ultrasonography (US, US combined with power Doppler (PDUS and magnetic resonance imaging (MRI can be used to image joint synovitis of PsA. Radiologic features of spondylitis associated with psoriasis are similar to spondylitis associated with reactive arthritis and differ from those of primary ankylosing spondylitis (AS and the spondylitis associated with inflammatory bowel disease. MRI is very sensitive for the early diagnosis of sacroiliitis. There have been no MRI studies on the spine of patients with PsA. In primary AS bone oedema in the vertebral bodies is an indicator of active disease and can ameliorate during anti-TNFα therapy. Historically, plain film radiography have played a pivotal role in defining enthesitis lesions of SpA. However, entheseal bone changes appear late. US and MRI have proved to be a highly sensitive and non invasive tools. Recent US and MRI studies on both finger and toe dactylitis have established that dactylitis is due to flexor tenosynovitis and marked adjacent soft tissue swelling with a variable degree of small joint synovitis. There is no evidence of enthesitis of the insertion of the flexor digitorum tendons and of the attachment of the caspsule of the digit joints. Key words: Enthesitis, dactylitis, spondyloarthritis, ultrasound, magnetic resonance, imaging

  8. MR Imaging in symptomatic osteochondromas

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    Kim, Soo Young; Kim, Jee Young; Kim, Sang Heum; Chun, Kyung Ah; Park, Young Ha [Catholic University of Korea, Seoul (Korea, Republic of)

    1998-06-01

    The purpose of this study is to assess the MR findings of symptomatic osteochondromas. We evaluated 31 patients who between July, 1994 and May, 1997 underwent MR imaging for symptomatic osteochondroma. Fourteen were males and 17 were females, and their ages ranged from 8 to 49 (mean, 23) years. Using T1WI, T2WI and gadolinium-DTPA-enhanced T1WI, images were analysed according to signal intensity in the osseous component of the osteochondroma, thickness of the cartilage cap, and associated change in surrounding soft tissue. Clinical manifestation included a palpable mass or tendency to grow (n=22) and pain on movement (n=9). Complications were of three types : that which followed change in the osseous component of the tumor, associated change in surrounding soft tissue, and malignant transformation. In the osseous component, bone marrow edema or contusion was seen in 21 cases (67.7%), and in two (65%), fracture was observed. In surrounding soft tissue, muscle impingement was seen in 21 cases (67.7%), bursitis was in 7 cases (22.6 %), tenosynovitis in seven (22.6 %), and vascular compression in five (16.1 %). In three cases (9.7%), transformation to chondrosarcoma had occurred; two of these were derived from osteochondromatosis and one from a single osteochondroma. The thickness of the cartilage cap was as follow : < 5 mm (n=16), 5-10 mm (n=12), and > 10 mm (n=3). In patients with symptomatic osteochondroma, MR imaging is useful for detecting both complications and malignant transformation. (author). 21 refs., 1 tab., 6 figs.

  9. Predicting serious complications and high cost of treatment of tooth-knuckle injuries: a systematic literature review.

    Science.gov (United States)

    Smith, H R; Hartman, H; Loveridge, J; Gunnarsson, R

    2016-12-01

    The tooth-knuckle injury (TKI) is a serious and potentially costly injury seen in orthopaedic practice. The aim was to conduct a systematic literature review on the factors associated with serious complications and high treatment costs in tooth-knuckle injuries. MEDLINE, Scopus and CINAHL were used as the literature sources. Original research papers that reported on factors predicting serious complications and high treatment costs in TKIs were included. There were no restrictions placed on study size, language, study design or date of publication. Case studies, case series and review articles were not included. After duplicates were removed, 403 unique studies remained; after titles and abstracts were screened, 48 titles remained and were retrieved in full text. Of these, 14 titles met the inclusion criteria and were included in the data synthesis. Tenosynovitis, septic arthritis, osteomyelitis and residual stiffness were common serious complications occurring in up to 36.3, 70.0, 47.6 and 65.3 % of cases, respectively. Amputation was also common in up to 18.0 % of injuries. Treatment costs were measured by length of hospital stay and the number of debridements required. On average, patients required 3.8-8 days of admission and 1.3-2.7 debridements each. Increased time delay from injury to treatment, deeply penetrating injuries, proximal interphalangeal joint (PIPJ) injuries and, possibly, E. corrodens infections were associated with serious complications in TKIs. Delayed treatment, inadequate treatment, PIPJ injuries and deeply penetrating injuries predicted higher treatment costs. PROSPERO CRD42016029949 ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016029949 ).

  10. Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy: A prospective observational study

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    Bakkegaard, Mads, E-mail: mbakkegaard@hotmail.com [Department of Rheumatology, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk (Denmark); Johannsen, Finn E., E-mail: f.e.johannsen@dadlnet.dk [Private Department of Rheumatology, Furesø-reumatologerne, Farum and ISMC, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Bispebjerg Bakke 23, 2. Tværvej, Indgang 8, 1. sal, 2400 København NV (Denmark); Højgaard, Betina, E-mail: beho@kora.dk [Danish Institute for Local and Regional Government Research, Købmagergade 22, 1150 København K (Denmark); Langberg, Henning, E-mail: henninglangberg@gmail.com [Institute of Social Medicine, Department of Public Health and Centre for Healthy Ageing, Faculty of Heath Sciences, University of Copenhagen, Øster Farimagsgade 5, bygn. 24, postboks 2099, 1014 København (Denmark)

    2015-03-15

    Objectives: To study prospectively whether structural changes determined by ultrasound scanning (US) can be used as prognostic markers for outcome in patients with symptomatic Achilles tendinopathy (AT) and to investigate whether there exists an association between US findings and pain measured by visual analog scale (VAS) and a general assessment score (GA). Methods: 92 consecutive patients with AT symptoms were recruited from two outpatient clinics in rheumatology. The patients underwent a conservative treatment protocol consisting of reduced activities, controlled rehabilitation including eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow intra- or peritendinous). The clinical and US examination were performed at entry, 1, 2, 3 and at 6 month. Results: 42 women and 50 men were included (mean age of 47 years). They had symptoms for more than 13 months and a symptomatic Achilles tendon mean thickness of 7.4 ± 2.3 mm. Heterogeneity at the initial examination was found to be a prognostic marker for the clinical outcome. Tendon thickness, hypoechogenicity and increased flow at any time point were significantly correlated to pain at function, palpatory pain and morning pain at the same time points. A reduction in tendon thickness was statistically associated with a decrease in palpatory pain. Conclusion: Heterogeneity is a prognostic marker in AT. Tendon thickness, hypoechogenicity and increased Doppler activity can be used as objective outcome parameters for the treatment effect of AT.

  11. MR-imaging of anterior tibiotalar impingement syndrome: Agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography

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    Haller, Joerg [Department of Radiology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Ludwig Boltzmann Institute for Osteology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Bernt, Reinhard [Department of Radiology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria)]. E-mail: reinhard.bernt@wgkk.sozvers.at; Seeger, Thomas [Department of Trauma Surgery, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Weissenbaeck, Alexander [Department of Trauma Surgery, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Tuechler, Heinrich [Ludwig Boltzmann Institute for Hematology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Resnick, Donald [Department of Radiology, VA Medical Center, UCSD, 3350 La Jolla Village Dr, San Diego, CA 92161 (United States)

    2006-06-15

    Objective: To clarify the role of MR-imaging in the diagnosis of anterior ankle impingement syndromes. Materials and methods: We prospectively examined 51 consecutive patients with chronic ankle pain by MR-imaging. Arthroscopy was performed in 29 patients who previously underwent non-enhanced MR-imaging; in 11 patients, indirect MR-arthrography additionally was performed. MR-examinations were correlated with clinical findings; MR and arthroscopy scores were statistically compared, agreement was measured. Results: Arthroscopy demonstrated granulation tissue in the lateral gutter (38%) and anterior recess (31%), lesions of the anterior tibiofibular (31%) and the anterior talofibular ligament (21%) as well as intraarticular bodies (10%). Stenosing tenosynovitis and a ganglionic cyst were revealed as extraarticular causes for chronic ankle pain by MR-examination (17%). Agreement of MR-imaging and arthroscopy was fair for the anterior talofibular ligament and the anterior joint cavity (kappa 0.40). Major discrepancy was found for non-enhanced MR scans (kappa 0.49) when compared with indirect MR-arthrography (kappa 0.03) in the anterior cavity. The sensitivity for lesions of the anterior talofibular and calcaneofibular ligament and the anterior cavity (0.91-0.87) detected by MR-imaging was superior in comparison to lesions of the anterior tibiofibular ligament and anteromedial cavity (0.50-0.24). Conclusion: MR-imaging provides additional information about the mechanics of chronic ankle impingement rather than an accurate diagnosis of this clinical entity. The method is helpful in differentiating extra- from intra-articular causes of ankle impingement. Indirect MR-arthrography has little or no additional value in patients with ankle impingement syndrome.

  12. Profile of the subjects with soft tissue injuries attended at an occupational health service and the RSI

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    Camila de Freitas

    2015-07-01

    Full Text Available Aim: To investigate the profile of subjects with soft tissue injuries attended at the Reference Center of Occupational Health – CEREST in the municipality of Santos, Sao Paulo state, in 2010, and the social insurance benefits granted.Materials and Methods: Analysis of medical records of the subjects assisted at CEREST in 2010, surveying data on gender, age, occupation, clinical diagnostics, clinical complaints, retirement, etc. The clinical diagnostics were categorized according to the International Classification of Diseases - ICD-10, subjects with soft tissue injuries were selected, and the diagnostics related to mental health disorders were registered. Data were recorded in Microsoft Excel spreadsheet and analyzed using statistical software R Development Core Team.Results: Of the 206 medical records analyzed, 18.0% (n=37 showed soft tissue injuries, 81.1% were female and 18.9% were male, and the subjects’ mean age was 43.24 years (SD=8.76. Subjects between 31 and 50 years old (70.2% were the most affected. The most affected occupations were cleaners, general service workers, and bank clerks. The most prevalent clinical diagnoses were synovitis and tenosynovitis, shoulder bursitis, and rotator cuff syndrome, with 62.2% of the subjects presenting more than one clinical diagnosis. 13.5% of the subjects also presented mental disorders. Association between retirement from work and the presence of soft tissue injury was observed (p=0.032. Only 13.5% of the diagnoses had some association with the work conditions.Conclusions: The general profile of the workers with soft tissue injuries was obtained: prevalence in women, diseases manifested in productive age, difficulty of association with work conditions, need for interdisciplinary interventions.

  13. Tendinopathy of the long head of the biceps tendon: histopathologic analysis of the extra-articular biceps tendon and tenosynovium

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    Streit JJ

    2015-03-01

    Full Text Available Jonathan J Streit,1 Yousef Shishani,1 Mark Rodgers,2 Reuben Gobezie1 1The Cleveland Shoulder Institute, 2Department of Pathology, University Hospitals of Cleveland, Cleveland, OH, USA Background: Bicipital tendinitis is a common cause of anterior shoulder pain, but there is no evidence that acute inflammation of the extra-articular long head of the biceps (LHB tendon is the root cause of this condition. We evaluated the histologic findings of the extra-articular portion of the LHB tendon and synovial sheath in order to compare those findings to known histologic changes seen in other tendinopathies. Methods: Twenty-six consecutive patients (mean age 45.4±13.7 years underwent an open subpectoral biceps tenodesis for anterior shoulder pain localized to the bicipital groove. Excised tendons were sent for histologic analysis. Specimens were graded using a semiquantitative scoring system to evaluate tenocyte morphology, the presence of ground substance, collagen bundle characteristics, and vascular changes. Results: Chronic inflammation was noted in only two of 26 specimens, and no specimen demonstrated acute inflammation. Tenocyte enlargement and proliferation, characterized by increased roundness and size of the cell and nucleus with proteoglycan matrix expansion and myxoid degenerative changes, was found in all 26 specimens. Abundant ground substance, collagen bundle changes, and increased vascularization were visualized in all samples. Conclusion: Anterior shoulder pain attributed to the biceps tendon does not appear to be due to an inflammatory process in most cases. The histologic findings of the extra-articular portion of the LHB tendon and synovial sheath are similar to the pathologic findings in de Quervain tenosynovitis at the wrist, and may be due to a chronic degenerative process similar to this and other tendinopathies of the body. Keywords: biceps tendinitis, biceps tendinopathy, tenosynovium, anterior shoulder pain, long head biceps

  14. Differentiation between early rheumatoid and early psoriatic arthritis by the ultrasonographic study of the synovio-entheseal complex of the small joints of the hands.

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    Zabotti, Alen; Salvin, Sara; Quartuccio, Luca; De Vita, Salvatore

    2016-01-01

    To determine whether ultrasonographic findings of the synovio-entheseal complex of the hand small joints could be used to differentiate between early rheumatoid and early psoriatic arthritis. Thirty-four early rheumatoid and 26 early psoriatic arthritis patients with a prevalent involvement of the hands were examined with ultrasound (US). All exams were performed at the first visit by evaluating synovitis, peritendon extensor digitorum tendon oedema, enthesitis of the central slip of extensor tendon, flexor tenosynovitis and soft tissue oedema. In the same patient, the two most clinically involved joints, if possible of the same digit, were evaluated. Sixty-eight clinically involved joints were evaluated in 34 early rheumatoid arthritis patients and 52 joints in 26 early psoriatic arthritis patients.Synovitis was significantly more frequently detected in early rheumatoid arthritis compared to early psoriatic arthritis patients (p=0.0001), in 91.1% joints of the former and in 59.6% joints of the latter. At metacarpohalangeal joint, the presence of peritendon extensor digitorum tendon inflammation was observed in 2.5% of the joints in the early rheumatoid arthritis group and in 54.1% of the joints in the early psoriatic arthritis group (p=0.0001). At PIP joints, central slip enthesitis was exclusively observed in EPsA (p=0.0045). When considering the most clinically involved finger per patient, soft tissue oedema was detected almost exclusively in psoriatic arthritis (p=0.0002). The US involvement of synovio-entheseal complex and US extrasynovial features may be helpful in the differential diagnosis between early rheumatoid and early psoriatic arthritis.

  15. The WISTAH hand study: A prospective cohort study of distal upper extremity musculoskeletal disorders

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    Garg Arun

    2012-06-01

    Full Text Available Abstract Background Few prospective cohort studies of distal upper extremity musculoskeletal disorders have been performed. Past studies have provided somewhat conflicting evidence for occupational risk factors and have largely reported data without adjustments for many personal and psychosocial factors. Methods/design A multi-center prospective cohort study was incepted to quantify risk factors for distal upper extremity musculoskeletal disorders and potentially develop improved methods for analyzing jobs. Disorders to analyze included carpal tunnel syndrome, lateral epicondylalgia, medial epicondylalgia, trigger digit, deQuervain’s stenosing tenosynovitis and other tendinoses. Workers have thus far been enrolled from 17 different employment settings in 3 diverse US states and performed widely varying work. At baseline, workers undergo laptop administered questionnaires, structured interviews, two standardized physical examinations and nerve conduction studies to ascertain demographic, medical history, psychosocial factors and current musculoskeletal disorders. All workers’ jobs are individually measured for physical factors and are videotaped. Workers are followed monthly for the development of musculoskeletal disorders. Repeat nerve conduction studies are performed for those with symptoms of tingling and numbness in the prior six months. Changes in jobs necessitate re-measure and re-videotaping of job physical factors. Case definitions have been established. Point prevalence of carpal tunnel syndrome is a combination of paraesthesias in at least two median nerve-served digits plus an abnormal nerve conduction study at baseline. The lifetime cumulative incidence of carpal tunnel syndrome will also include those with a past history of carpal tunnel syndrome. Incident cases will exclude those with either a past history or prevalent cases at baseline. Statistical methods planned include survival analyses and logistic regression. Discussion A

  16. Rowing injuries.

    Science.gov (United States)

    Rumball, Jane S; Lebrun, Constance M; Di Ciacca, Stephen R; Orlando, Karen

    2005-01-01

    Participation in the sport of rowing has been steadily increasing in recent decades, yet few studies address the specific injuries incurred. This article reviews the most common injuries described in the literature, including musculoskeletal problems in the lower back, ribs, shoulder, wrist and knee. A review of basic rowing physiology and equipment is included, along with a description of the mechanics of the rowing stroke. This information is necessary in order to make an accurate diagnosis and treatment protocol for these injuries, which are mainly chronic in nature. The most frequently injured region is the low back, mainly due to excessive hyperflexion and twisting, and can include specific injuries such as spondylolysis, sacroiliac joint dysfunction and disc herniation. Rib stress fractures account for the most time lost from on-water training and competition. Although theories abound for the mechanism of injury, the exact aetiology of rib stress fractures remains unknown. Other injuries discussed within, which are specific to ribs, include costochondritis, costovertebral joint subluxation and intercostal muscle strains. Shoulder pain is quite common in rowers and can be the result of overuse, poor technique, or tension in the upper body. Injuries concerning the forearm and wrist are also common, and can include exertional compartment syndrome, lateral epicondylitis, deQuervain's and intersection syndrome, and tenosynovitis of the wrist extensors. In the lower body, the major injuries reported include generalised patellofemoral pain due to abnormal patellar tracking, and iliotibial band friction syndrome. Lastly, dermatological issues, such as blisters and abrasions, and miscellaneous issues, such as environmental concerns and the female athlete triad, are also included in this article.Pathophysiology, mechanism of injury, assessment and management strategies are outlined in the text for each injury, with special attention given to ways to correct

  17. [Work-related diseases and health-related compensation claims, Northeastern Brazil, 2000].

    Science.gov (United States)

    Souza, Norma Suely Souto; Santana, Vilma Sousa; Albuquerque-Oliveira, Paulo Rogério; Barbosa-Branco, Anadergh

    2008-08-01

    To estimate the contribution of work-related diseases to sick leaves due to general and occupational health problems. Sociodemographic, occupational and health data from 29,658 records of temporary disability benefits, granted on account of health problems by the Instituto Nacional do Seguro Social (National Institute of Social Security) in the state of Bahia (Northeastern Brazil), were analyzed. All constant ICD-10 clinical diagnoses were taken into consideration, except for those referring to external causes and factors that influence contact with health services. The link between diagnosis and occupation was based on the ICD-10 code and whether the type of compensation was due to a "work-related accident/disease" or not. From all the benefits, 3.1% were granted due to work-related diseases: 70% were musculoskeletal system and connective tissue diseases, while 14.5% were related to the nervous system. In general, benefits granted at more than two times the expected frequency were as follows: tenosynovitis in the manufacturing sector (Proportion Ratio-PR=2.70), carpal tunnel syndrome in the financial intermediation sector (PR=2.43), and lumbar disc degeneration in the transportation, postal service and telecommunications sectors (PR=2.17). However, no causal connection could be established for these diseases, in these activity sectors, in a significant percentage of benefits. Results suggest the existence of possible occupational risk factors for diseases in these fields of activity, as well as the underreporting of the link between diseases and work, thus disguising the responsibility of companies and the perspective of prevention through work reorganization.

  18. Volar plating for unstable proximal interphalangeal joint dorsal fracture-dislocations.

    Science.gov (United States)

    Cheah, Andre E J; Tan, David M K; Chong, Alphonsus K S; Chew, Winston Y C

    2012-01-01

    To report our results of open reduction internal fixation with volar mini plate and screw fixation for unstable dorsal fracture dislocations (DFDs) of the proximal interphalangeal (PIP) joint. We performed a retrospective review of 13 consecutive DFDs of the PIP joint treated with volar mini plate and screw fixation, measuring both clinical and radiological outcomes. The age range of our patients was 15 to 56 years (average, 33 y). Six injuries were related to work, 5 to sports, and 2 to motor vehicle accidents. Of the 13 DFDs, 6 were comminuted. Articular involvement ranged from 30% to 70% (average, 44%). The average time to surgery was 7 days (range, 0-23 d). Patients had follow-up of 12 to 60 months (average, 25 mo). Four patients had a postoperative course complicated by plate and screw removal at an average of 4 months later, either as part of a secondary procedure to improve range of motion or owing to patient request. All patients returned to their original occupation. Of the 13 patients, 11 were satisfied with the result, and 12 of 13 had either no or mild pain. All 13 DFDs united in good alignment but 3 showed degenerative changes. Average grip strength was 85% of the unaffected side, and average active PIP joint and distal interphalangeal joint motion arcs were 75° and 65°, respectively. Average Quick Disabilities of Arm, Shoulder, and Hand score was 4 (range, 0-9). All patients had non-tender swelling of the proximal interphalangeal joints but no signs of flexor tenosynovitis or infection. Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws. This treatment allows early active range of motion and provides good objective and subjective outcomes; however, noteworthy complications occurred in 39% of patients. Therapeutic IV. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes.

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    McGuine, Timothy A; Post, Eric G; Hetzel, Scott J; Brooks, M Alison; Trigsted, Stephanie; Bell, David R

    2017-10-01

    Sport specialization is associated with an increased risk of musculoskeletal lower extremity injuries (LEIs) in adolescent athletes presenting in clinical settings. However, sport specialization and the incidence of LEIs have not been investigated prospectively in a large population of adolescent athletes. To determine if sport specialization was associated with an increased risk of LEIs in high school athletes. Cohort study; Level of evidence, 2. Participants (interscholastic athletes in grades 9-12) were recruited from 29 Wisconsin high schools during the 2015-2016 school year. Participants completed a questionnaire identifying their sport participation and history of LEIs. Sport specialization of low, moderate, or high was determined using a previously published 3-point scale. Athletic trainers reported all LEIs that occurred during the school year. Analyses included group proportions, odds ratios (ORs) and 95% CIs, and days lost due to injury (median and interquartile range [IQR]). Multivariate Cox proportional hazard ratios (HRs) with 95% CIs were calculated to investigate the association between the incidence of LEIs and sport specialization level. A total of 1544 participants (50.5% female; mean age, 16.1 ± 1.1 years) enrolled in the study, competed in 2843 athletic seasons, and participated in 167,349 athlete-exposures. Sport specialization was classified as low (59.5%), moderate (27.1%), or high (13.4%). Two hundred thirty-five participants (15.2%) sustained a total of 276 LEIs that caused them to miss a median of 7.0 days (IQR, 2.0-22.8). Injuries occurred most often to the ankle (34.4%), knee (25.0%), and upper leg (12.7%) and included ligament sprains (40.9%), muscle/tendon strains (25.4%), and tendinitis/tenosynovitis (19.6%). The incidence of LEIs for moderate participants was higher than for low participants (HR, 1.51 [95% CI, 1.04-2.20]; P = .03). The incidence of LEIs for high participants was higher than for low participants (HR, 1.85 [95% CI, 1

  20. Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes.

    Science.gov (United States)

    Ramchurn, Navdha; Mashamba, Chiedza; Leitch, Elizabeth; Arutchelvam, Vijayaraman; Narayanan, Kilimangalam; Weaver, Jola; Hamilton, Jennifer; Heycock, Carol; Saravanan, Vadivelu; Kelly, Clive

    2009-11-01

    An increased prevalence of musculoskeletal disease is recognised in diabetes and is a common source of disability. It is known to predominantly affect the upper limbs especially the hand and shoulder. The relationship with other complications of diabetes and glycaemic control is uncertain. We designed this study to clarify these relationships, and to assess differences between types 1 and 2 diabetes. We identified a group of 96 people with established diabetes and examined them for the presence of locomotor disease focussing on the upper limbs. We recorded the mean HbA1c and the presence of diabetic complications, together with the health assessment questionnaire (HAQ) score. We explored correlations between locomotor disease and these variables using logistic regression. We compared data between type 1 and type 2 diabetics and contrasted the amalgamated data with that of a matched control population of medical out patients using Students t tests. Locomotor disease was present in 75% of diabetics with the upper limb the commonest site for abnormalities. This prevalence was significantly higher than that seen in the controls (53%) [p=0.02]. Shoulder capsulitis (25%), carpal tunnel syndrome (20%), tenosynovitis (29%), limited joint mobility (28%) and Dupuytrens contracture (13%) were the most frequent findings and were much commoner than in controls. Capsulitis usually coexisted with other upper limb abnormalities and best predicted the presence of retinopathy and/or neuropathy. The mean HbA1c was significantly higher in patients with combined shoulder and hand problems (9.1%) than in those with no upper limb problems (8.0%) [p=0.018]. The pattern of results was similar in type 1 and type 2 diabetes, although the prevalence of abnormalities and mean HAQ were significantly greater in type 2 patients, which may be in part a function of their greater mean age. Upper limb locomotor abnormalities are very common in diabetes and are associated with worse glycaemic control

  1. Develop and Manufacture an Ergonomically Sound Glovebox Glove Report

    Energy Technology Data Exchange (ETDEWEB)

    Lawton, Cindy M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-10-18

    Ergonomic injury and radiation exposure are two safety concerns for the Plutonium Facility at Los Alamos National Laboratory (LANL). This facility employs the largest number of gloveboxes (GB) at LANL with approximately 6000 gloves installed. The current GB glove design dates back to the 1960’s and is not based on true hand anatomy, revealing several issues: short fingers, inappropriate length from the wrist to finger webbing, nonexistent joint angles and incorrect thumb placement. These design flaws are directly related to elbow (lateral epicondylitis) and thumb (DeQuervain’s tenosynovitis) injuries. The current design also contributes to increased wear on the glove, causing unplanned glove openings (failures) which places workers at risk of exposure. An improved glovebox glove design has three significant benefits: 1) it will reduce the risk of injury, 2) it will improve comfort and productivity, and 3) it will reduce the risk of a glovebox failures. The combination of these three benefits has estimated savings of several million dollars. The new glove design incorporated the varied physical attributes of workers ranging from the 5th percentile female to the 95th percentile male. Anthropometric hand dimensions along with current GB worker dimensions were used to develop the most comprehensive design specifications for the new glove. Collaboration with orthopedic hand surgeons also provided major contributtions to the design. The new glovebox glove was developed and manufactured incorporating over forty dimensions producing the most comprehensive ergonomically sound design. The new design received a LANL patent (patent attorney docket No: LANS 36USD1 “Protective Glove”, one of 20 highest patents awarded by the Richard P. Feynman Center for Innovation. The glove dimensions were inputed into a solid works model which was used to produce molds. The molds were then shipped to a glove manufacturer for production of the new glovebox gloves. The new

  2. Self-reported upper extremity health status correlates with depression.

    Science.gov (United States)

    Ring, David; Kadzielski, John; Fabian, Lauren; Zurakowski, David; Malhotra, Leah R; Jupiter, Jesse B

    2006-09-01

    The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most widely used upper extremity-specific health-status measure. The DASH score often demonstrates greater variability than would be expected on the basis of objective pathology. This variability may be related to psychosocial factors. The purpose of the present study was to investigate the correlation between the DASH score and psychological factors for specific diagnoses with relatively limited variation in objective pathology. Two hundred and thirty-five patients with a single, common, discrete hand problem known to have limited variations in objective pathology completed the DASH questionnaire, the Eysenck Personality Questionnaire-Revised (EPQ-R) to assess neuroticism, the Center for Epidemiologic Studies-Depression (CES-D) scale to quantify depressive symptoms, and the Pain Anxiety Symptoms Scale (PASS). Forty-five patients had carpal tunnel syndrome, forty-four had de Quervain tenosynovitis, forty-eight had lateral elbow pain, and seventy-one had a single trigger finger. In addition, twenty-seven patients were evaluated six weeks after a nonoperatively treated fracture of the distal part of the radius. Relationships between psychosocial factors and the DASH score were determined. A significant positive correlation between the DASH score and depression was noted for all diagnoses (r = 0.38 to 0.52; p Quervain tendinitis, r = 0.46; lateral elbow pain, r = 0.42; and trigger finger, r = 0.24) (p < 0.05 for all). The DASH score was not correlated with neuroticism for any diagnosis. There was a highly significant effect of depression (as measured with the CES-D score) on the DASH score for all diagnoses. Both the CES-D score (F = 62.68, p < 0.0001) and gender (F = 11.36, p < 0.001) were independent predictors of the DASH score. Self-reported upper extremity-specific health status as measured with the DASH score correlates with depression and pain anxiety but not neuroticism. These data

  3. Understanding work-related upper extremity disorders: clinical findings in 485 computer users, musicians, and others.

    Science.gov (United States)

    Pascarelli, E F; Hsu, Y P

    2001-03-01

    Four hundred eighty five patients whose chief complaints were work related pain and other symptoms received a comprehensive upper-body clinical evaluation to determine the extent of their illness. The group had a mean age of 38.5 years. Sixty-three percent of patients were females. Seventy percent were computer users, 28% were musicians, and 2% were others engaged in repetitive work. The time between the onset of symptoms and our initial visit ranged from 2 weeks to over 17 years. A majority sought care within 30 months with the greatest number of them seeking care before 12 months. Fifty nine percent of subjects were still working when seen despite increasing pain and symptoms such as weakness, numbness, tingling, and stiffness. Following a history, a physical assessment utilizing commonly employed clinical tests were performed including evaluation of joint range of motion, hyperlaxity, muscle tenderness, pain, strength, and imbalance. Neurologic tests included Tinel's sign performed in wrist, elbow, tricipital sulcus, and neck and tests for thoracic out syndrome (TOS). Specific tests such as Finkelstein's test for deQuervain's tenosynovitis, Phalen's test for carpal tunnel syndrome and grip strengths were included in the examination protocol. Significant findings included postural misalignment with protracted shoulders (78%), head forward position (71%), neurogenic TOS (70%), cervical radiculopathy (0.03%), evidence of sympathetic dysfunction (20%), and complex regional pain syndrome (RSD) (0.6%). Hyperlaxity of fingers and elbows was found in over 50%, carpal tunnel syndrome in 8%, radial tunnel syndrome in 7%, cubital tunnel in 64%, shoulder impingement in 13%, medial epicondylitis in 60%, lateral epicondylitis in 33%, and peripheral muscle weakness in 70%. We conclude that despite initial presentation distally, work-related upper-extremity disorders are a diffuse neuromuscular illness with significant proximal upper-body findings that affect distal function

  4. Ultrasonographic assessment reveals detailed distribution of synovial inflammation in Blau syndrome.

    Science.gov (United States)

    Ikeda, Kei; Kambe, Naotomo; Takei, Syuji; Nakano, Taiji; Inoue, Yuzaburo; Tomiita, Minako; Oyake, Natsuko; Satoh, Takashi; Yamatou, Tsuyoshi; Kubota, Tomohiro; Okafuji, Ikuo; Kanazawa, Nobuo; Nishikomori, Ryuta; Shimojo, Naoki; Matsue, Hiroyuki; Nakajima, Hiroshi

    2014-04-08

    Arthritis is the most frequent manifestation of Blau syndrome, an autoinflammatory disorder caused by the genetic mutation of NOD2. However, detailed information on arthritis in Blau syndrome on which the therapeutic strategy should be based on is lacking. This multi-center study aimed to accurately characterize the articular manifestation of Blau syndrome and also to demonstrate the utility of musculoskeletal ultrasound in Blau syndrome. Patients who had been diagnosed with Blau syndrome by genetic analysis of NOD2 were recruited. A total of 102 synovial sites in 40 joints were assessed semiquantitatively by ultrasound for gray-scale synovitis and synovial power Doppler (PD) signal. In total, 10 patients whose age ranged from 10 months to 37 years enrolled in this study. Although only 4 joints (0.8%) were tender on physical examination, 81 joints (16.9%) were clinically swollen. Moreover, 240 (50.0%), and 124 (25.8%) joints showed gray-scale (GS) synovitis and synovial PD signal on ultrasound, respectively. Importantly, GS synovitis was present in 168 out of 399 non-swollen joints, in which 61 also exhibited synovial PD signal. Among 40 joint regions, the ankle, the wrist, and the proximal interphalangeal joints were the most frequently and severely affected joints. Comparisons between different synovial tissues demonstrated a significantly higher proportion of the joints with tenosynovitis as compared with that with intra-articular synovitis (41.5% versus 27.9%, P < 0.0001). In respect of age and treatment, synovial PD signals were minimal in the youngest patient and in the oldest two patients, and were relatively mild in patients receiving treatment with methotrexate plus TNF antagonists. In two patients who underwent the second ultrasound examination, total PD scores markedly decreased after initiating the treatment with a tumor necrosis factor (TNF) antagonist. The detailed information on synovial inflammation obtained by ultrasound confirms the

  5. Real-life effectiveness of spa therapy in rheumatic and musculoskeletal diseases: a retrospective study of 819 patients

    Science.gov (United States)

    Karagülle, Mine; Kardeş, Sinan; Karagülle, Müfit Zeki

    2017-11-01

    The objective of this study is to determine the use and efficacy of spa therapy in patients with a wide spectrum of rheumatic and musculoskeletal diseases under real-life clinical practice circumstances. In this retrospective observational study at the Medical Ecology and Hydroclimatology Department of Istanbul Faculty of Medicine, the records of all adult patients with rheumatic and musculoskeletal diseases who were prescribed a spa therapy in various health resorts in Turkey between 2002 and 2012 were analyzed. Patients sojourned to and stayed at a health resort and followed a usual 2-week course of spa therapy. The patients were examined within a week before and after the spa therapy at the department by the physicians and outcome measures were pain intensity (visual analog scale, VAS), patient's general evaluation (VAS), physician's general evaluation (VAS), Health Assessment Questionnaire (HAQ), Lequesne's Functional Index (LFI), Western Ontario and McMaster Universities Index (WOMAC), Waddell Index (WI), Neck Pain and Disability Scale (NPDS), Shoulder Disability Questionnaire (SDQ), Fibromyalgia Impact Questionnaire (FIQ), and Beck's Depression Inventory (BDI). In total, 819 patients were included in the analysis. The diagnoses were 536 osteoarthritis; 115 fibromyalgia; 50 lumbar disc herniation; 34 cervical disc herniation; 23 nonspecific low back pain; 22 ankylosing spondylitis; 16 rheumatoid arthritis; 9 rotator cuff tendinitis; and 14 other conditions/diseases including scoliosis, stenosing flexor tenosynovitis, congenital hip dislocation in adult, Behçet's disease, de Quervain tendinopathy, psoriatic arthritis, osteoporosis, fracture rehabilitation, and diffuse idiopathic skeletal hyperostosis. Statistically significant decrease in pain scores was found in all patients except hip osteoarthritis ( p = 0.063) and rheumatoid arthritis ( p = 0.134) subgroups; and statistically significant improvement in function in all patients except hip osteoarthritis ( p

  6. Real-life effectiveness of spa therapy in rheumatic and musculoskeletal diseases: a retrospective study of 819 patients.

    Science.gov (United States)

    Karagülle, Mine; Kardeş, Sinan; Karagülle, Müfit Zeki

    2017-11-01

    The objective of this study is to determine the use and efficacy of spa therapy in patients with a wide spectrum of rheumatic and musculoskeletal diseases under real-life clinical practice circumstances. In this retrospective observational study at the Medical Ecology and Hydroclimatology Department of Istanbul Faculty of Medicine, the records of all adult patients with rheumatic and musculoskeletal diseases who were prescribed a spa therapy in various health resorts in Turkey between 2002 and 2012 were analyzed. Patients sojourned to and stayed at a health resort and followed a usual 2-week course of spa therapy. The patients were examined within a week before and after the spa therapy at the department by the physicians and outcome measures were pain intensity (visual analog scale, VAS), patient's general evaluation (VAS), physician's general evaluation (VAS), Health Assessment Questionnaire (HAQ), Lequesne's Functional Index (LFI), Western Ontario and McMaster Universities Index (WOMAC), Waddell Index (WI), Neck Pain and Disability Scale (NPDS), Shoulder Disability Questionnaire (SDQ), Fibromyalgia Impact Questionnaire (FIQ), and Beck's Depression Inventory (BDI). In total, 819 patients were included in the analysis. The diagnoses were 536 osteoarthritis; 115 fibromyalgia; 50 lumbar disc herniation; 34 cervical disc herniation; 23 nonspecific low back pain; 22 ankylosing spondylitis; 16 rheumatoid arthritis; 9 rotator cuff tendinitis; and 14 other conditions/diseases including scoliosis, stenosing flexor tenosynovitis, congenital hip dislocation in adult, Behçet's disease, de Quervain tendinopathy, psoriatic arthritis, osteoporosis, fracture rehabilitation, and diffuse idiopathic skeletal hyperostosis. Statistically significant decrease in pain scores was found in all patients except hip osteoarthritis (p = 0.063) and rheumatoid arthritis (p = 0.134) subgroups; and statistically significant improvement in function in all patients except hip osteoarthritis

  7. Medical claims-based case–control study of temporal relationship between clinical visits for hand syndromes and subsequent diabetes diagnosis: implications for identifying patients with undiagnosed type 2 diabetes mellitus

    Science.gov (United States)

    Hou, Wen-Hsuan; Li, Chung-Yi; Chen, Lu-Hsuan; Wang, Liang-Yi; Kuo, Li-Chieh; Kuo, Ken N; Shen, Hsiu-Nien; Chiu, Chang-Ta

    2016-01-01

    Objectives To investigate whether a temporal relationship is present between clinical visits for diabetes-related hand syndromes (DHSs) and subsequent type 2 diabetes mellitus (T2DM) diagnosis and, accordingly, whether DHSs can be used for identifying patients with undiagnosed T2DM. Design This study had a case–control design nested within a cohort of 1 million people from the general population, which was followed from 2005 to 2010. The odds of prior clinical visits for DHSs, namely carpal tunnel syndrome (CTS), flexor tenosynovitis, limited joint mobility and Dupuytren's disease, were estimated for cases and controls. We used a conditional logistic regression model to estimate the OR and 95% CI of T2DM in association with a history of DHSs. The validity and predictive value of using the history of DHSs in predicting T2DM diagnosis were calculated. Setting Taiwan National Health Insurance medical claims. Participants We identified 33 571 patients receiving a new diagnosis of T2DM (cases) between 2005 and 2010. Each T2DM case was matched with 5 controls who had the same sex and birth year and were alive on the date of T2DM diagnosis. Primary and secondary outcome measures The primary outcome measure was T2DM diagnosis. Results The OR of T2DM in association with prior clinical visits was significantly increased for overall DHS and CTS, being 1.15 (95% CI 1.10 to 1.20) and 1.22 (95% CI 1.16 to 1.29), respectively. Moreover, 11% of patients with T2DM made clinical visits for CTS within 3 months prior to T2DM diagnosis. The history of DHSs had low sensitivity (<0.1% to 5.2%) and a positive predictive value (9.9% to 11.7%) in predicting T2DM. Conclusions Despite the unsatisfactory validity and performance of DHSs as a clinical tool for detecting patients with undiagnosed T2DM, this study provided evidence that clinical visits for DHSs, particularly for CTS, can be a sign of undiagnosed T2DM. PMID:27798003

  8. Dupuytren’s disease digital radius IV right hand and carpal tunnel syndrome on ipsilateral hand

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    Teona Sebe Ioana

    2015-11-01

    Full Text Available Dupuytren’s contracture is a fibroproliferative disease whose etiology and pathophysiology are unclear and controversial. It is a connective tissue disorder, which takes part in the palmar’s fibromatosis category and has common characteristics with the healing process. Dupuytren’s disease is characterized by the flexion contracture of the hand due to palmar and digital aponevrosis. It generally affects the 4th digital radius, followed by the 5th one. Without surgery, it leads to functional impotence of those digital rays and/or hand. It is associated with other diseases and situational conditions like Peyronie’s disease, the Lederhose disease (plantar fibromatosis, Garrod’s digital knuckle-pads, diabetes, epilepsy, alcoholism, micro traumatisms, stenosing tenosynovitis and not the least with carpal tunnel syndrome. The carpal tunnel syndrome is a peripheral neuropathy with the incarceration of the median nerve at the ARC level, expressed clinically by sensory and motor disturbances in the distribution territory of the median nerve, which cause functional limitations of daily activities of the patient. After the failure of the nonsurgical treatment or the appearance of the motor deficit, is established the open or endoscopic surgical treatment with the release of the median nerve. Postoperative recovery in both diseases is crucial to the functionality of the affected upper limb and to the quality of the patient’s life. The patient, a 61 years old man, admitted to the clinic for the functional impotence of the right hand, for the permanent flexion contracture of the metacarpophalangeal joint (MCP and proximal interphalangeal joint (PIP of the 4th finger with extension deficit, for the damage of the thumb pulp clamp of the 4th finger, for nocturnal paresthesia of fingers I-III and pain that radiates into the fingertips. After clinical, paraclinical, imagistic and electrical investigations, surgery is practiced partial aponevrectomy

  9. MR imaging features of foot involvement in ankylosing spondylitis

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    Erdem, C. Zuhal E-mail: sunarerdem@yahoo.com; Sarikaya, Selda; Erdem, L. Oktay; Ozdolap, Senay; Gundogdu, Sadi

    2005-01-01

    Objective: To determine alterations of the soft tissue, tendon, cartilage, joint space, and bone of the foot using magnetic resonance (MR) imaging in ankylosing spondylitis (AS) patients. Materials and Method: Clinical and MR examination of the foot was performed in 23 AS patients (46 feet). Ten asymptomatic volunteers (20 feet) were studied on MR imaging, as a control group. MR imaging protocol included; T1-weighted spin-echo, T2-weighted fast-field echo (FFE) and fat-suppressed short tau inversion recovery (STIR) sequences in sagittal, sagittal oblique, and coronal planes using a head coil. Specifically, we examined: bone erosions, tendinitis (acute and chronic), para-articular enthesophyte, joint effusion, plantar fasciitis, joint space narrowing, soft tissue edema, bone marrow edema, enthesopathy in the Achilles tendon and plantar fascia attachment, subchondral signal intensity abnormalities (edema and sclerosis), tenosynovitis, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and bony ankylosis. Midfoot, hindfoot, and ankle were included in examined anatomic regions. Results: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in 3 (13%) of the patients while frequency of involvement was 21 (91%) with MR imaging assessment. The MR imaging findings were bone erosions (65%), Achilles tendinitis (acute and chronic) (61%), para-articular enthesophyte (48%), joint effusion (43%), plantar fasciitis (40%), joint space narrowing (40%), subchondral sclerosis (35%), soft tissue edema (30%), bone marrow edema (30%), enthesopathy of the Achilles attachment (30%), subchondral edema (26%), enthesopathy in the plantar fascia attachment (22%), retrocalcaneal bursitis (22%), subchondral cysts (17%), subchondral fissures (17%), tendinitis and enthesopathy of the plantar ligament (13%), and bony ankylosis (9%). The most common involved anatomical region was the hindfoot (83%) following by midfoot (69% ) and ankle (22

  10. Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires.

    Science.gov (United States)

    Zong, Shuang-Le; Kan, Shi-Lian; Su, Li-Xin; Wang, Bin

    2015-07-15

    Dorsally displaced distal radius fractures (DDDRF) are frequent injuries in clinical practice. Traditional percutaneous Kirschner wires (K-wire) and open reduction with volar locking plate (VLP) are the two most common surgical fixation techniques used to manage DDDRF. However, there is no current consensual evidence to guide the selection of one technique over the other. Therefore, we undertook a systematic search and meta-analysis to compare clinical outcomes and complications of these two treatment approaches for DDDRF. The following electronic databases were searched by two independent reviewers, up to April 2015: PubMed, ScienceDirect and Wiley Online Library. High-quality randomized controlled trials (RCTs) comparing VLP and percutaneous K-wire fixation for DDDRF were identified. Pooled mean differences were calculated for the following continuous outcome variables: disabilities of the arm, shoulder and hand (DASH) score, grip strength and wrist range of motion. Pooled odds ratios were calculated for rates of total postoperative complications, including superficial infection, deep infection, complex regional pain syndrome (CRPS), carpal tunnel syndrome (CTS), neurological injury, tendon rupture, tenosynovitis, loss of reduction and additional surgery to remove hardware. The meta-analysis was completed using RevMan 5.3 software. Seven RCTs, with a total of 875 patients, were included in our meta-analysis. Open reduction internal fixation (ORIF) with VLP fixation provided statistically lower DASH scores, reduced the incidence of total postoperative complications and specifically lowered the rate of superficial infection, when compared, over a 1-year follow-up, to percutaneous K-wire fixation. VLP fixation also provided significantly better grip strength and range of wrist flexion and supination in the early 6-month postoperative period, compared with percutaneous K-wire fixation. ORIF with VLP fixation provided lower DASH scores and reduced total postoperative

  11. [An imported Chikungunya fever case from New Delhi, India to Ankara, Turkey: the first imported case of Turkey and review of the literature].

    Science.gov (United States)

    Yağcı Çağlayık, Dilek; Uyar, Yavuz; Korukluoğlu, Gülay; Ertek, Mustafa; Unal, Serhat

    2012-01-01

    Chikungunya virus (CHIKV) is an arthropod-borne alphavirus that causes an acute febrile illness, chikungunya fever. CHIKV virus is geographically distributed in Africa, India, and South-East Asia. Chikungunya fever outbreaks have been reported from India since 2006. The incubation period is 3-7 days, and the disease is characterized by sudden onset of high fever and severe arthralgia. Other symptoms can be rash, headache, fatigue, nausea-vomiting, and myalgias. Here, we report the first Chikungunya case imported from India, New-Delhi to Ankara, Turkey. In December 2010, a 55-year-old female Turkish government employee living in urban area of New Delhi for the last 3 years had sudden onset fever up to 38.4°C for 2 days. Itching rash and arthralgia also developed. Symptomatic treatment was given to patient in New Delhi. She returned to Turkey and was admitted to Hacettepe University Medical Faculty, Department of Internal Medicine, Infectious Diseases Unit, since arthralgia has continued on the 26th day of her complaints. Hepatomegaly and tenosynovitis were detected in her physical examination. Serum sample sent to Refik Saydam National Public Health Agency, Virology Reference and Research Laboratory, yielded negative results for specific IgM and IgG antibodies against Hantavirus and Dengue virus types 1-4; however, the results were positive for CHIKV specific IgM and IgG antibodies by commercial immunofluorescence method (Euroimmun, Germany). CHIKV RNA which was searched by in-house real-time RT-PCR was negative. The second serum sample obtained three weeks later also found positive for CHIKV specific IgM and IgG antibodies. This was the first laboratory confirmed imported Chikungunya case in Turkey. There are predictions regarding the presence of Aedes species mosquitos that can transmit this virus in Turkey. This case report will be an alarming signal for the clinicians in our country to consider Chikungunya fever in the differential diagnosis of patients

  12. A retrospective study on incidence of lameness in domestic animals

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    A. Mohsina

    2014-08-01

    .5%each due to tenosynovitis, arthritis and bone spavin, 7% due to laminitis of right hind and forelimbs and 4.5% due to quittor. Conclusion: The results show that lameness in animals is significantly affected by species, breed, age and sex of the animal. In dogs and cats, HQW is the most common cause of lameness. Among dogs, Mongrel and GSD breeds most affected. Male animals of less than 1 year or above 6 years are affected more. Hip dislocation is found to be more in male GSD and Labrador dogs and bilateral hip dislocation in spitz breeds. Hip dysplasia is also found to be more in GSD breed. Incidence of rickets is more in spitz dogs below 5 months of age. In equine and caprine species, right forelimb lameness, and in cattle right hind limb lameness is more. Hip dislocation, upward luxation of patella and wound are the major lameness causes in buffaloes.

  13. Afecções mais freqüentes do aparelho locomotor dos eqüídeos de tração no município de Belo Horizonte Most frequent pathologies of the locomotor system in equids used for wagon traction in Belo Horizonte

    Directory of Open Access Journals (Sweden)

    R.P.A. Maranhão

    2006-02-01

    Full Text Available Determinaram-se as enfermidades mais comuns do sistema músculo-esquelético dos animais de tração na cidade de Belo Horizonte. Foram utilizados 58 animais (42 eqüinos e 16 muares, sendo 31 machos e 27 fêmeas. O diagnóstico baseou-se no histórico e nos exames físico e radiológico. A freqüência observada para tenossinovite nos membros torácicos e pélvicos foi 55,2%, para tendinite nos membros torácicos, 81,0%, para tendinite nos membros pélvicos, 58,6%, e para desmite do ligamento suspensório nos membros torácicos, 77,6%. Para as lesões osteoarticulares, os resultados foram 13,8%, 12,1%, 27,6% e 12,1% de lesões osteoartríticas para a articulação interfalangeana distal dos membros torácicos e pélvicos e articulação interfalangeana proximal dos membros torácicos e pélvicos, respectivamente. Na articulação metacarpo-falangeana, a incidência foi 41,4% e, nos membros pélvicos, 39,7%. A incidência na articulação cárpica foi 62,1% e, na articulação társica, 96,6%. Os achados dos tecidos moles indicaram sobrecarga nos aparatos flexor e suspensório nesse tipo de atividade. Em ambos os casos, a atividade desenvolvida pelos animais parece ser a principal causa envolvida.The most common conditions of the musculoskeletal system of draft equidae in the city of Belo Horizonte were determined. Fifty-eight animals (42 horses and 16 mules were randomly examined, being 31 males and 27 females. Diagnosis was based on history, clinical and radiological examinations. The frequency observed for tenosynovitis in the fore and hindlimbs was 55.2%, 81.0%, for tendinitis in the forelimbs, 58.6% for tendinitis in the himblimbs, and 77.6% for suspensory ligament desmitis in the forelimbs. The results showed 13.8%, 12.1%, 27.6% and 12.1% of osteoarthritic lesions for distal interphalangeal joint of fore and hindlimbs and proximal interphalangeal joint of fore and hindlimbs, respectively. In the fetlock joints of the forelimbs, the

  14. Doenças do trabalho e benefícios previdenciários relacionados à saúde, Bahia, 2000 Enfermedades del trabajo y beneficios de la previsión relacionados a la salud, Bahia (Brasil, 2000 Work-related diseases and health-related compensation claims, Northeastern Brazil, 2000

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    Norma Suely Souto Souza

    2008-08-01

    and factors that influence contact with health services. The link between diagnosis and occupation was based on the ICD-10 code and whether the type of compensation was due to a "work-related accident/disease" or not. RESULTS: From all the benefits, 3.1% were granted due to work-related diseases: 70% were musculoskeletal system and connective tissue diseases, while 14.5% were related to the nervous system. In general, benefits granted at more than two times the expected frequency were as follows: tenosynovitis in the manufacturing sector (Proportion Ratio-PR=2.70, carpal tunnel syndrome in the financial intermediation sector (PR=2.43, and lumbar disc degeneration in the transportation, postal service and telecommunications sectors (PR=2.17. However, no causal connection could be established for these diseases, in these activity sectors, in a significant percentage of benefits. CONCLUSIONS: Results suggest the existence of possible occupational risk factors for diseases in these fields of activity, as well as the underreporting of the link between diseases and work, thus disguising the responsibility of companies and the perspective of prevention through work reorganization.

  15. MR imaging in the diagnosis of the os trigonum syndrome; Il ruolo della Risonanza Magnetica nella diagnosi della sindrome dell'os trigonum

    Energy Technology Data Exchange (ETDEWEB)

    Tamburrini, O.; Porpiglia, H.; Barresi, D.; Bertucci, B.; Console, D. [Catanzaro Univ. Magna Grecia, Catanzaro (Italy). Radiologia, Dipt. di Medicina Sperimentale e Clinica

    1999-12-01

    In this paper is investigated the yield of Magnetic Resonance Imaging (MRI) in hind foot conditions, particularly the os trigonum syndrome, which are very difficult to diagnose clinically. 7 consecutive patients were examined. They were complaining of hind foot pain for more than 4 months (male:female=1:6; age range 16-22 years, average 18.6). Three patients practiced competitive sports and 4 ballet. It was performed conventional radiography (orthogonal projections) and then MRI with a 0.5 T superconductive unit with surface coils; MR images were acquired with T1-weighted spin-echo (SE), T2-weighted gradient-echo (GRE), and fast inversion recovery (FIR) fat-suppressed sequences with 4 mm thickness and 0 mm gap. In 2 cases the os trigonum had irregular margins with subchondral sclerosis and widened synchondrosis. In 3 patients it was found flessor hallucis longus tenosynovitis, likely caused by tendon compression and displacement within its sheath; there were neither os trigonum marrow edema nor synchondrosis widening. One patient had os trigonum hypertrophy, mild synchondrosis widening and marrow edema, in the os trigonum and the posterior aspect of talus. One patient had the os trigonum, but no signs referable to the os trigonum syndrome. In the posterior impingement syndrome, the objective is to show inflammatory changes in the posterior capsule of the ankle joint, adjacent ligaments, tendons and chondrosynovial surface. MR provides important information on soft tissues involvement, synovial reaction, chondral and subchondral bone injuries and the association of flexor hallucis longus synovitis, if present. MRI also yields detailed information for correct therapeutic approach. In conclusion, MRI appears to be the technique of choice, after conventional radiography, thanks to its non invasiveness, multi planarity, and high spatial and contrast resolution. [Italian] Scopo di questo lavoro e' quello di sottolineare il determinante contributo informativo della

  16. Os trigonum tarsi syndrome. Magnetic Resonance features; Sindrome dell'os trigonum tarsi. Ruolo della Risonanza Magnetica

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    Iovane, A.; Finazzo, M.; Carcione, A.; De Maria, M; Lagalla, R. [Palermo Policlinico Univ. P. Giaccone, Palermo (Italy). Ist. di Radiologia; Midiri, M. [Bari Policlinico Univ., Bari (Italy). Ist. di Radiologia

    2000-02-01

    The os trigonum tarsi is an accessory bone of the foot localized posterolateral to the lateral tubercle of talus. It is usually an asymptomatic condition. However, particular activities such as ballet, soccer, of football may cause repeated stress and chronic microtraumas to the hindfoot, resulting in the os trigonum syndrome. Pain is typically localized anterior to the Achilles tendon; nevertheless, diagnosis may be very difficult because other conditions may show the same symptoms. Radiography can only demonstrate the os trigonum and its morpho structural changes, while MR (Magnetic Resonance) imaging can also depict associated soft tissue damage. It is reported on 9 cases of os trigonum tarsi syndrome studied with MR imaging. Nine patients with the os trigonum syndrome were submitted to MRI. All the examinations were performed with the patients in supine recumbency with the injured foot in neutral position and then in forced plantar flexion. Axial and sagittal T1 SE, T2* GE and FIR images were acquired. It was evaluated os trigonum location and shape, signal intensity of bone, cartilages and adjacent soft tissues, and possible associated tendon injuries. No changes were found in the os trigonum location and shape. Signal intensity changes were seen in 2/9 cases. Disruption of the cartilaginous synchondrosis between the accessory navicular bone and the posterior tibial aspect was observed in 7/9 patients. Tenosynovitis of the flexor hallucis longus was associated in 6/9 patients. Pseudoarthrosis with irregular bone margins and high-signal spots within the cartilage was found in 3 cases. MR imaging allows complete morpho structural assessment because it depicts the margins and the signal intensity of bone and ligaments on the 3 spatial planes. Particularly, sagittal T2 images best demonstrate the cartilage changes indicating synchondrosis disruption. This condition may cause abnormal mobility of the accessory bone with possible impingement with the posterior

  17. Doenças do sistema osteomuscular em trabalhadores de enfermagem Enfermedades del sistema osteomuscular en trabajadores de enfermería Diseases of the osteomuscular system in nursing workers

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    Neide Tiemi Murofuse

    2005-06-01

    limbs. Diseases legally considered as occupational diseases related to the muscle-skeletal system were identified in 255 (35% care sessions, especially back pain (20% and synovitis and tenosynovitis (13.7%, which were grouped as RSI. This research revealed that greater attention must be given to workers' postures in the execution of their work activities and furniture conditions. Furthermore, ergonomically planned instruments and equipment need to be offered with a view to reducing the incidence levels of osteomuscular problems.