The prevalence of monosodium urate and calcium pyrophosphate crystals in synovial fluid from wrist and finger joints.

The aim of this study was to assess the frequency of monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals in synovial fluids (SFs) aspirated from wrist and finger joints of patients with previously diagnosed joint diseases. We reviewed the results of SF analysis of 1593 samples and identified 126 patients with effusions in the small joints of the hands and wrists. We reported from patients' medical files data about sex, age, diagnosis, disease duration and the microscopic SF results. The prevalence of CPP crystals in SF was 85.71% in CPP-crystals arthritis (CPP-CA), 19.35% in rheumatoid arthritis (RA), 13.89% in osteoarthritis (OA) and 0% in psoriatic arthritis (PsA), spondyloarthritis (SpA), gout and miscellanea. The prevalence of MSU crystals in SF was 83.3% in gout, 10% in PsA, 2.8% in OA and 0% in RA, SpA, miscellanea and CPP-CA. Consistent with previously reported data concerning the big joints, microcrystals can be frequently found also in the small joints of patients with previous diagnosis. The finding underlines the importance of analyzing SF from the hand and wrist joints in the attempt to identify comorbidities associated with the presence of crystals and to develop targeted treatment strategies.

Ultrasound-Guided Perineural Injection at Guyon's Tunnel: An Anatomic Feasibility Study.

Compression of the ulnar nerve (UN) at the wrist causes neuropathy in the ulnar tunnel (UT), or Guyon's tunnel. In the absence of trauma and motor syndromes, primarily conservative treatment is considered. As in carpal tunnel syndrome, a perineural injection of corticosteroids may be beneficial. The aim of this study was to investigate the feasibility of ultrasound-guided injections at the UT. We performed ultrasound-guided injections of ink at the UN within the UT in 21 limbs from 11 non-embalmed cadavers. In all cases, we stained the perineural sheath of the superficial branch of the ulnar nerve within the UT. No ink was found inside the nerve or in adjacent structures such as blood vessels and tendons. In conclusion, perineural injection of the UN in the UT seems to be a technically feasible procedure. On the basis of these anatomic data, clinical trials are needed to prove the concept for routine use.

Forearm muscle size, strength, force, and power in relation to pQCT-derived bone strength at the radius in adults.

We aimed to examine the relationship between forearm muscle cross-sectional area (MCSA), muscle force, or rate of torque development (RTD) and 2 estimated radius bone strength indices - compressive bone strength index (BSI) at the wrist and strength strain index in torsion (SSI(p)) at the shaft - in healthy middle-aged males and females. Distal (4%) and shaft (65%) sites of nondominant forearms were scanned using peripheral quantitative computed tomography (pQCT) in a sample of 48 adults (mean age ± SD, 49.4 ± 2.4 y) to obtain estimated bone strength indices and MCSA. Muscle force, measured by grip dynamometry and wrist flexion RTD, was obtained using an isokinetic dynamometer. Hierarchical linear regressions, adjusted for weight, explained 27% and 36% of the BSI variance at the 4% site in males and premenopausal females, respectively (p < 0.05). At the radius shaft, weight explained 26% (p < 0.05) and 83% (p < 0.01) of SSI(p) variance. The unique variance of BSI explained by MCSA was 16% in males (p < 0.05) and 31% in females (p < 0.01). Grip force predicted variance in SSI(p) in males (p < 0.01) and BSI in females (p < 0.05). RTD did not explain any variance in BSI or SSI(p). Body weight was the only significant predictor (p < 0.05) of SSI(p) in females. Although forearm muscle size and grip strength are associated with estimates of radius bone strength at midlife, this relationship appears to be sex dependent. The differences observed between muscle size and strength properties and bone strength at distal and shaft sites of the radius suggest a property-, sex-, and site-specific relationship between muscle and bone in the forearm.

Property analysis of ectopic calcification in the carpal tunnel identification of apatite crystals: a case report.

INTRODUCTION: A 64-year-old woman presented with symptoms of subacute exacerbation of a year-long carpal tunnel syndrome that was caused by a large calcified mass in the tunnel. CONCLUSION: The resected mass consisted of very tiny rods, and x-ray diffraction analysis, as well as the component analysis using energy dispersive x-ray microanalysis, revealed the mass to be most compatible with apatite. The back-scattered electron images suggested that precipitation might be a mechanism for development of the calcified mass.

Quantifying sodium in the human wrist in vivo by using MR imaging.

The authors quantified sodium content in the wrist joints of six healthy volunteers with no known history of arthritis or pain. Average sodium concentrations ranged from 115 to 150 mmol/L in noncartilaginous regions and from 200 to 210 mmol/L in cartilaginous regions. The feasibility of quantifying sodium in vivo was demonstrated. This method has potential applications in monitoring the integrity of cartilaginous tissue in vivo.

Erosive amyloidosis of the wrist and knee associated with oligoclonal bands.

We report on a patient who presented with an inflammatory arthropathy clinically, though without a raised erythrocyte sedimentation rate, and in whom investigation subsequently showed erosive amyloidosis with an oligoclonal band. There was no evidence of rheumatoid disease and she has not developed any haematological malignancy. The only other case reported in the literature had an elevated erythrocyte sedimentation rate and went on to develop a lymphoplasmacytoid lymphoma.