ABSTRACT
AIM: To evaluate grading of thumb carpometacarpal joint (CMCJ) osteoarthritis (OA) using ultrasound, correlating findings with disability and treatment response. MATERIALS AND METHODS: Patients with symptomatic thumb OA attending for ultrasound-guided CMCJ steroid injection and a group of asymptomatic controls were recruited prospectively. Thumb CMCJ ultrasound was graded (osteophytes, joint-space narrowing, capsule size, and measured capsule size), and a Disabilities of the Arm Shoulder and Hand (DASH) questionnaire was completed for each patient. Symptomatic patients then underwent injection with DASH repeated 6 weeks post-treatment. Ultrasound features were correlated with the initial DASH disability score and response as defined by change in DASH 6 weeks after treatment. RESULTS: Thirty-one patients with symptomatic OA and 37 asymptomatic controls were recruited. With the exception of osteophytes (p = 0.017), no statistically significant correlation was demonstrated between severity of ultrasound features and patient disability. However, all features demonstrated statistically significant higher grades in the symptomatic group compared to controls. Ultrasound grading did not have statistical correlation with treatment response. CONCLUSION: No correlation was found between the majority of ultrasound features and the clinical severity of OA or likely response to treatment. However, these features are significantly more common in the symptomatic population.
Subject(s)
Carpometacarpal Joints/diagnostic imaging , Disabled Persons , Osteoarthritis/diagnostic imaging , Osteoarthritis/drug therapy , Ultrasonography, Interventional/methods , Adrenal Cortex Hormones/therapeutic use , Analysis of Variance , Carpometacarpal Joints/drug effects , Female , Humans , Male , Middle Aged , Osteoarthritis/complications , Pain/drug therapy , Pain/etiology , Pain Measurement/methods , Pain Measurement/statistics & numerical data , Prospective Studies , Severity of Illness Index , Surveys and Questionnaires , Treatment OutcomeABSTRACT
In this unusual case, accumulation of silver nitrate used to treat over-granulation in a finger injury led to a near-misdiagnosis of a bony tumour on X-ray. This underlines the need to support X-ray results with a full clinical assessment.
Subject(s)
Bone Neoplasms/diagnosis , Chondroma/diagnosis , Diagnostic Errors , Finger Injuries/complications , Granuloma, Pyogenic/diagnosis , Silver Nitrate/adverse effects , Adult , Diagnostic Errors/methods , Diagnostic Errors/prevention & control , Granulation Tissue , Granuloma, Pyogenic/etiology , Granuloma, Pyogenic/surgery , Humans , Male , Medical History Taking , Orthopedics , Wound Infection/drug therapy , Wound Infection/etiologyABSTRACT
We report two similar rare types of fracture of the lower end of the humerus sustained in fit young adults while throwing a ball. Both cases were seen within 1 week in a busy accident and emergency (A&E) department. The types of fracture in each case are unusual and, in the past, have been attributed to fatigue or to a repetitive strain pattern.