Pulled elbow and hypermobility of joints.

Pulled elbow and hypermobility of joints are frequently seen in young children, the latter occurring in 5% of the general population. A group of 100 children with pulled elbows, composed of 64 girls and 36 boys with a mean age of 25.5 months, and their parents were checked for joint hypermobility in a prospective study over a period of two years. Results were compared with a normal (non-pulled elbow) control group of 30 children. The prevalence of hypermobility among children with pulled elbow was 73%, which is 23% higher than in normal children of similar age. The main differences in hypermobility between the groups were noted in elbows and knees. There was no significant difference between girls and boys. In 48% of the cases of children with pulled elbows, at least one of the parents had hypermobility, whereas only in 10% of the control group were parents hypermobile. The association between pulled elbow and hypermobility indicates that pulled elbow can be considered one of the effects of this condition. Since not all patients with pulled elbows were hypermobile nor did they have parents with hypermobility, other factors may be relevant, such as variations in the anatomy of the radial head and surrounding structures in combination with the degree of violence involved.

The psoas sign in normal subjects without bowel preparation: the influence of scoliosis on visualisation.

The lumbar spine films of 1494 subjects who were examined for low back pain or prior to job placement were studied to assess psoas muscle visualisation. The study group were almost all aged 18-39 years. None of the subjects had prior bowel preparation for a contrast examination. In the subjects without scoliosis only 36% had well seen psoas shadows on both sides. Taking the psoas shadows separately, 72% of left psoas shadows were well seen, while only 40% were seen on the right side. In the scoliotic group, the psoas shadow was seen bilaterally in 30% of subjects while in another 50% the muscle was seen only on the convex side of the curve. In no case was it seen only on the concave side. The direction of the curve to left or right did not influence visualisation. Thus in 80% of subjects with scoliosis of 5 degrees or more, the psoas was seen on the convex side, while in only 30% was it seen on the concave side.

Pneumococcal infection of a prosthetic hip joint.

A case of late haematogenous pneumococcal infection of a prosthetic hip joint is presented. In view of the relatively benign nature of pneumococcal arthritis, the patient was treated with parenteral antibiotics and surgical drainage without removal of the prosthesis. This was followed by complete resolution.

Another look at the pertrochanteric fracture of the femur: the relationship to osteoporosis.

Eighty-seven pertrochanteric fractures consecutively treated between the years 1978 and 1981 are reviewed. External and internal rotation types are described relative to their aetiology. The final typing of the fracture can be made only on reduction. What we have called 'internal rotation fractures' show an excellent correlation with the unstable fracture gradings described by Boyd, as well as very osteoporotic Singh gradings (1-3). It is contended that the latter is the main factor in its production as opposed to the more common external rotation variety. An appeal is made for recognition of the fracture, its reduction by means of external rotation and adequate fixation. Early weight bearing is not advised, in order to prevent subsequent varus deformity with extrusion of the implant.

Relationship of psoas width to osteoporosis.

We have related the radiographic width of the psoas muscle to age, degree of osteoporosis, height, and weight, and to constitution in 234 subjects. The psoas width correlated well with age. When the subjects were grouped according to age, an association was observed between narrowing psoas width and increasing osteoporosis. Narrowing of the psoas was evident some years prior to radiographic evidence of osteoporosis.

Preventing osteoporosis: current practices and problems.

A lateral x-ray of the thoracic and lumbar spine should be part of the routine examination of any woman aged 40 or older. Similarly, an anteroposterior x-ray of the hand as a first assessment may suggest a need for further investigation for osteoporosis. Estrogen treatment reduces the incidence of vertebral compression and has proven protective against central as well as peripheral bone loss. However, rapid bone loss after termination of estrogen therapy implies that the protective effect may last no longer than 2 to 3 years.

Osteoarthritis of the hand and osteoporosis.

The relationship between osteoarthritis and osteoporosis of the hand was examined in a random sample of the Jewish population in Jerusalem. It was found that osteoporosis and osteoarthritis of the hand showed differing prevalences, only rarely coexisted, and that there was neither a positive nor a negative correlation between them (p greater than 0.05). This would strengthen the contention that these are two independent and unrelated disease processes.

The assimilated os sustentaculi.

The assimilated os sustentaculi is a projection of bone from the medial aspect of the sustentaculum tali which is surmounted by a similar projection from the medial tubercle of the talus. The accessory joint so formed may develop secondary osteoarthritis changes. This congenital anomaly is very rare. The present report is of 2 additional cases.

Extraskeletal soft-tissue chondrosarcoma. Case report and review of the literature.

A rare extraskeletal soft-tissue chondrosarcoma of the foot occurred in a 50-year-old man. Adequate en-bloc excision or amputation was the indicated method of treatment.

Soft-tissue thickness of the wrist.

Increase in the soft-tissue thickness of the wrist is said to be a sensitive indicator of early oedema due to generalised or local arthritic disease. No normal values are available. Measurement of the soft-tissue thickness opposite the radial and ulnar styloid processes in a random population demonstrated a large normal range which was not related to obesity. This large normal variation calls into question the accuracy of radiological evaluation of early wrist oedema.

The effect of intra-articular colchicine on the knee joint of the rat.

The effect of intra-articular injections of colchicine on the normal joint of the rat was investigated. Colchicine in varying doses was injected into the knee, while the contralateral knee was used as a control. Colchicine mainly affected articular cartilage, causing degenerative changes that appeared to be dose-dependent. It is assumed that colchicine produces an increase in the rate of synthesis of collagenase, which alters the nature of articular cartilage, making it more susceptible to wear and tear and thus producing the lesions of early osteoarthritis.

The normal width of the adult hip joint: the relationship to age, sex, and obesity.

The articular cartilage thickness of the weight-bearing segment of the hip joint, in standard pelvic radiography, of 240 male and female subjects between the ages of 45-84 years was measured in a random sample of a Jerusalem population. The average value was approximately 4.0 mm and no sex or age difference was found. There was no correlation either between joint width and body build as estimated by the weight to height ratio. It is thus concluded that a narrow joint space should not be expected either in elderly or obese subjects other than as a concomitant finding of arthritic change.

Radiogrammetry of the metacarpal: a critical reappraisal.

The precise estimation of osteoporosis is hampered by the lack of a generally accepted method of evaluation. Measurement of the combined cortical thickness (CCT) of the centre point of the second metacarpal has been widely used for this purpose, but the wide normal variation found in population studies has reduced its value in the diagnosis of this condition in the individual. The factors leading this normal variability are discussed and the three centre metacarpals are compared with each other. It is concluded that simple CCT measurement is preferable to any of the indices so far devised, but that a single measurement of a given metacarpal is too imprecise to be of real value. If a single metacarpal is to be chosen, three measurements of the third metacarpal gives a coefficient of variation lower than those of the second or fourth, and an average of nine measurements of the three centre metacarpals produces a further useful reduction in variability.

Frontal lobe calcification in hypoparathyroid states.

Basal ganglion calcification is common in hypoparathyroid states. However, cerebral cortical calcification is rarely seen. Of the six cases previously recorded, five were in patients with idiopathic hypoparathyroidism and only one in a patient with pseudohypoparathyroidism. The present report is of a second case of pseudohypoparathyroidism with cerebral cortical calcification. It is stressed that cortical calcification occurs predominantly in the frontal lobes.

The hypermobility syndrome. Musculoskeletal complaints in 100 consecutive cases of generalized joint hypermobility.

The hypermobility syndrome, also known as congenital laxity of ligaments and joints, occurs as an isolated condition. The genetic background is distinct from that found in other connective tissues disorders. Although joint hypermobility is relatively common in the general population, reports of musculoskeletal complaints are infrequent. An analysis of 100 consecutive cases with various musculoskeletal complaints associated with joint hypermobility demonstrated differing patterns of presentation. One group had mild musculoskeletal complaints of long duration, while another had acute episodes of pain at various sites. A third group had combined features of the first two groups. Many of the patients had complaints referable to feet and calves, while a number related to problems due to patellar hypermobility. The treatment is exercise to develop protective reflex reactions and to strengthen the surrounding musculature. Surgery must be advocated with care and is reserved for patients with secondary arthrosis.

Osteoarthritis of the hip joint and osteoporosis: a radiological study in a random population sample in Jerusalem.

The prevalence of osteoarthritis of the hip and osteoporosis of the pelvis were examined in a random population sample in Jerusalem. Of the subjects reviewed, 16.1% showed osteoporosis of the pelvis, while osteoarthritis was noted in 4.1%. In only 0.5% did osteoarthritis and osteoporosis coexist in the same individual. Osteoporosis was more prevalent in the Far East population, while osteoarthritis appeared to bear no relationship to ethnic origin. It is suggested that osteoarthritis may be associated with high levels of physical activity, a characteristic of some Eastern populations.