Association of calcific rotator cuff tendinopathy with nephrolithiasis and/or cholelithiasis: A case-control study.

This study aimed to examine the association between calcific rotator cuff tendinopathy (RCT) and nephrolithiasis and/or cholelithiasis. A case-control study was conducted on patients diagnosed with RCT between June 2016 and June 2022. RCT was confirmed by ultrasound, and patients were divided into 2 groups: calcific RCT (case) and non-calcific RCT (control). Data were collected retrospectively from electronic medical records and completed by phone calls, looking for a history of nephrolithiasis and/or cholelithiasis; based on clinical features or incidental findings on abdominal and pelvic imaging. A total of 210 patients with RCT were included. Among the 95 cases of calcific RCT, 43 had a history of lithiasis (45.3%) against 23 (20%) from the non-calcific RCT group (P < .001); 21 patients suffered from nephrolithiasis (22.1%) and 26 had cholelithiasis (27.4%) versus 10 (8.7%) (P = .006) and 16 (13.9%) (P = .015) in the non-calcific RCT group, respectively. Logistic regression showed that the independent predictors of calcific RCT included a history of nephrolithiasis (OR, 4.38; 95% CI: 1.61-11.92, P = .004) and a history of cholelithiasis (OR, 3.83; 95% CI: 1.64-8.94, P = .002). In patients with calcific RCT, the occurrence of lithiasis was significantly associated in the bivariate analysis with higher age, body mass index, fasting blood sugar, and HbA1c (all with P < .05), but only with the presence of another site of calcific tendinopathy than the shoulder (OR, 3.11; 95% CI: 1.12-8.65, P = .03) in the multivariate analysis. Nephrolithiasis and/or cholelithiasis are associated with calcific RCT, and their presence predicts calcific RCT at least 3 times. Further research is required to determine the common risk factors and preventive measures against lithogenesis in patients with calcific RCT, nephrolithiasis, and cholelithiasis.

Youth Athletes With Sever's Disease Exhibit Altered Achilles Tendon Ultrasound Characteristics: A Retrospective Case-Control Study.

OBJECTIVES: Calcaneal apophysitis (Sever's disease) is an overuse condition caused by repetitive traction stress to the calcaneal apophysis. Whether Achilles tendon morphology is altered in this young patient population remains unknown. Therefore, we aimed to identify differences in Achilles tendon morphology between youth athletes diagnosed with calcaneal apophysitis and healthy controls. METHODS: This retrospective chart review included 46 patients (n = 23 Sever's disease, 15F/8M, 12.4 ± 2.3 years old) and (n = 23 healthy controls, 13F/10M, 15.9 ± 1.5 years old) who sought care in a Children's Hospital Sports Medicine/Orthopedics Department between 2012 and 2022. We measured ultrasound-derived degree of tendon thickening, Achilles tendon thickness (cm), and cross-sectional area (CSA [cm2]). Separate multivariate analyses of covariance (MANCOVAs) were used to compare degree of thickening, mass-normalized Achilles tendon thickness, and CSA between participant groups, covarying for age. Cohen's d effect sizes were used to assess the magnitude of mean differences and standard error (MDSE) between groups. RESULTS: Young athletes with Sever's disease had a significantly greater degree of tendon thickening with a large effect compared with healthy controls (MDSE: 0.07 [0.01] mm P < .001, d = 1.39). Achilles tendon thickness and CSA did not statistically differ between groups; however, the magnitude of between-group differences for these measures (MDSE: 0.18 [0.05] cm, MDSE: 0.27 [0.07] cm2, respectively) were moderate. CONCLUSIONS: Our findings demonstrate previously unrecognized differences in Achilles tendon morphology between young athletes with clinically diagnosed Sever's disease and healthy controls. Our study supports incorporating diagnostic ultrasound as part of a comprehensive examination to ensure appropriate diagnosis and clinical management for adolescents with heel pain.

Minimal Clinically Important Change of Movement Pain in Musculoskeletal Pain Conditions.

Movement pain, which is distinct from resting pain, is frequently reported by individuals with musculoskeletal pain. There is growing interest in measuring movement pain as a primary outcome in clinical trials, but no minimally clinically important change (MCIC) has been established, limiting interpretations. We analyzed data from 315 participants who participated in previous clinical trials (65 with chronic Achilles tendinopathy; 250 with fibromyalgia) to establish an MCIC for movement pain. A composite movement pain score was defined as the average pain (Numeric Rating Scale: 0-10) during 2 clinically relevant activities. The change in movement pain was calculated as the change in movement pain from pre-intervention to post-intervention. A Global Scale (GS: 1-7) was completed after the intervention on perceived change in health status. Participants were dichotomized into non-responders (GS ≥4) and responders (GS <3). Receiver operating characteristic curves were calculated to determine threshold values and corresponding sensitivity and specificity. We used the Euclidean method to determine the optimal threshold point of the Receiver operating characteristic curve to determine the MCIC. The MCIC for raw change in movement pain was 1.1 (95% confidence interval [CI]: .9-1.6) with a sensitivity of .83 (95% CI: .75-.92) and specificity of .79 (95% CI: .72-.86). For percent change in movement pain the MCIC was 27% (95% CI: 10-44%) with a sensitivity of .79 (95% CI: .70-.88) and a specificity of .82 (95% CI: .72-.90). Establishing an MCIC for movement pain will improve interpretations in clinical practice and research. PERSPECTIVE: A minimal clinically important change (MCIC) of 1.1- points (95% CI: .9-1.6) for movement pain discriminates between responders and non-responders to rehabilitation. This MCIC provides context for interpreting the meaningfulness of improvement in pain specific to movement tasks.

Calcific Peritendinitis in the Gluteus Maximus Tendon.

BACKGROUND: Calcific tendinitis is classically a painful condition that most commonly affects the rotator cuff, but may infrequently involve other tendons. CASE REPORT: We discuss a 57-year-old man who presented to the emergency department with a 4-day history of right hip pain, described as the "worst pain in (his) life." The pain was first noticed at night and had progressively worsened. History, physical examination, and initial laboratory workup indicated an inflammatory vs. infectious process. Continued investigations with imaging techniques revealed the source of pain as calcific tendinitis involving the gluteus maximus tendon. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Symptoms of musculoskeletal pain in the emergency department are ubiquitous. In the proper clinical context, the diagnosis of calcific tendinitis, although uncommon, should be considered once emergent conditions are ruled out. Proper imaging techniques will facilitate accurate diagnosis, expedited pain management, and proper outpatient follow-up.

Editorial Commentary: For Post-Hip Arthroplasty Iliopsoas Tendonitis, Psoas Tenotomy Is the Preferred First-Line Treatment, Even in Cases of Cup Overhang.

Iliopsoas impingement pathology is one of the causes of persistent pain after total hip arthroplasty. It is reported as occurring in approximately 4% of cases; this may be significantly greater (in cases of postarthroplasty pain of unknown etiology). Inflammation is a result of impingement of the tendon against the acetabular component. This may occur with anteroinferior prominence when the cup is properly positioned in anteversion or when the cup is oversized. Other causes of impingement include a cup-reinforcement ring or acetabular cage, a collared femoral component, screws penetrating through the ilium, cement extrusion, anterior wall hypoplasia, or increased femoral offset. When conservative treatment does not achieve the best outcome, the 2 main therapeutic options are psoas tenotomy or revision of the cup component. Tenotomy can be performed either arthroscopically or by an open approach and may be considered the best option for many patients, even in cases with anterior component prominence, as it is less invasive, presents fewer complications, and has faster recovery. The debate is open. The level of tenotomy remains controversial, with risks and benefits of both a lesser trochanter and transcapsular approach.

Effectiveness of non-surgical management in rotator cuff calcific tendinopathy (the effect trial): protocol for a randomised clinical trial.

INTRODUCTION: Rotator cuff calcific tendinopathy (RCCT) involves calcific deposits in the rotator cuff. Non-surgical interventions such as extracorporeal shockwave therapy (ESWT) and ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) are recommended for its early management. Exercise therapy (ET) has shown to be an effective intervention for people with rotator cuff tendinopathy, but it has not been formally tested in RCCT. The main objective of this study is to compare the effectiveness of an ET programme with ESWT and US-PICT in people with RCCT. As a secondary aim, this study aims to describe the natural history of RCCT. METHODS AND ANALYSIS: A randomised, single-blinded four-group clinical trial will be conducted. Adults from 30 to 75 years diagnosed with RCCT who accomplish eligibility criteria will be recruited. Participants (n=116) will be randomised into four groups: ET group will receive a 12-week rehabilitation programme; ESWT group will receive four sessions with 1 week rest between sessions during 1 month; US-PICT group will receive two sessions with 3 months of rest between sessions; and (actual) wait-and-see group will not receive any intervention during the 12-month follow-up. The primary outcome will be shoulder pain assessed with the Shoulder Pain and Disability Index at baseline, 2 weeks, 4 months, 6 months and 12 months from baseline. The primary analysis will be performed at 12 months from baseline. Secondary outcomes will include pain, range of motion, patient satisfaction and imaging-related variables. Moreover, the following psychosocial questionnaires with their corresponding outcome measure will be assessed: Central Sensitization Inventory (symptoms related to central sensitization); Pain Catastrophizing Scale (pain catastrophizing); Tampa Scale for Kinesiophobia 11 items (fear of movement); Fear Avoidance Belief Questionnaire (fear avoidance behaviour); Hospital Anxiety and Depression Scale (anxiety and depression); Pittsburgh Sleep Quality Index (sleep quality); and the EuroQol-5D (quality of life). An intention-to-treat analysis will be performed to reduce the risk of bias using a worst-case and best-case scenario analysis. ETHICS AND DISSEMINATION: Ethics committee approval for this study has been obtained (reference number: 1718862). The results of the main trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05478902.

Effects of a Conventional Treatment Plus Scapular Exercises Program in Patients With Chronic Lateral Elbow Tendinopathy: A Pre-Post Single-Group Study.

BACKGROUND: Weakness of the shoulder girdle muscles has been reported in patients with chronic lateral elbow tendinopathy. The aim of this study was to assess the short- and long-term effects of a conventional treatment plus scapular exercises program in patients with chronic lateral elbow tendinopathy. METHODS: A single-group prestudy and poststudy were conducted. The primary outcome was the Patient-Rated Tennis Elbow Evaluation questionnaire score. Secondary outcomes were grip strength; Disabilities of the Arm, Shoulder, and Hand questionnaire score; Visual Analogue Scale score at rest and at grip, and presence of scapular dyskinesis. RESULTS: A total of 65 patients (72.3% females), with a mean age of 41.8 years, were analyzed. At the end of 6 weeks, the results showed clinically and statistically significant differences (P < .05). At 1-year follow-up, the differences were: Patient-Rated Tennis Elbow Evaluation -31 points (P < .001); grip strength +33.6% (P < .001); Disabilities of the Arm, Shoulder, and Hand -34.2 points (P < .001); Visual Analogue Scale at rest -2.5 cm (P < .001); and Visual Analogue Scale at grip -2.3 cm (P < .001). CONCLUSION: At the end of 6 weeks and at 1-year follow-up, conventional treatment plus scapular exercises program showed statistically and clinically significant differences in all functional outcomes assessed in patients with lateral elbow tendinopathy.

Common Painful Foot and Ankle Conditions: A Review.

Importance: Morton neuroma, plantar fasciitis, and Achilles tendinopathy are foot and ankle conditions that are associated with pain and disability, but they can respond to nonoperative treatment. Observations: Morton neuroma, consisting of interdigital neuronal thickening and fibrosis, is characterized by burning pain in the ball of the foot and numbness or burning pain that may radiate to the affected toes (commonly the third and fourth toes). First-line nonoperative therapy consists of reducing activities that cause pain, orthotics, and interdigital corticosteroid injection; however, approximately 30% of patients may not respond to conservative treatment. Plantar fasciitis accounts for more than 1 million patient visits per year in the US and typically presents with plantar heel pain. Fifteen years after diagnosis, approximately 44% of patients continue to have pain. First-line nonoperative therapy includes stretching of the plantar fascia and foot orthotics, followed by extracorporeal shockwave therapy, corticosteroid injection, or platelet-rich plasma injection. Midportion Achilles tendinopathy presents with pain approximately 2 to 6 cm proximal to the Achilles insertion on the heel. The primary nonoperative treatment involves eccentric strengthening exercises, but extracorporeal shockwave therapy may be used. Conclusions and Relevance: Morton neuroma, plantar fasciitis, and Achilles tendinopathy are painful foot and ankle conditions. First-line therapies are activity restriction, orthotics, and corticosteroid injection for Morton neuroma; stretching and foot orthotics for plantar fasciitis; and eccentric strengthening exercises for Achilles tendinopathy.

Tendinitis cálcica atraumática de tendón extensor común del dedo medio: un caso infrecuente de dolor metacarpofalángico / Atraumatic calcium tendonitis of common extensor tendon of the middle finger: a rare case of metacarpophalangeal pain

Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.

Reduction of recurrent tendinitis scar using autologous mesenchymal stem cells derived from adipose tissue from the base of the tail in Holsteiner horses (Equus ferus caballus) / Reducción de la cicatriz de tendinitis recidivante mediante células madre mesenquimales autólogas derivadas de tejido adiposo de la base de la cola en equinos Holsteiner (Equus ferus caballus)

As a result of their intense physical activity, racehorses suffer high tendon stress which may result in various pathologies. One of these is tendonitis in the tendon of the superficial digital flexor muscle (TSDFM). Conventional treatment with rest, has not shown to be very effective, and regenerative medicine through the application mesenchymal stem cells appears to be a promising therapy. The objective of this work was to assess the effect of the application of autologous MSC on reduction of the scar length in recurrent TSDFM tendinitis in Holsteiner horses, using image analysis. This study included two groups of five animals each: A control group that received conventional treatment (CG) and an experimental group which was also treated with intralesional injections of MSC (EG). Scar evolution was assessed by echographic analysis, with measurements taken of the scar length over a four month period; the length at month zero, was taken as the initial value of 100 %. During the first month, the mean scar length diminished to 81.14 % (EG) and 95.85 % (CG); after the second month, lengths were 64.4 % (EG) and 92.3 % (CG); following the third month lengths were 51.92 % (EG) and 87.42 % (CG); finally at the end of the fourth month the lengths recorded were 26.7 % (EG) and 83.92 % (CG). These results show that treatment with autologous MSC helps TSDFM scar length was significantly reduced, as compared to conventional treatment.

Reducción de la cicatriz de tendinitis recidivante mediante células Madre mesenquimales autólogas derivadas de tejido adiposo de la base de la cola en equinos Holsteiner (Equus ferus caballus). En equinos deportistas, la actividad física intensa ocasiona gran estrés en los tendones, pudiendo ocasionar diversas patologías como la tendinitis del tendón del músculo flexor digital superficial (TMFDS). El tratamiento convencional con reposo es poco eficaz, siendo la medicina regenerativa a través de la aplicación de células madres mesenquimáticas (MSC) una promisoria terapia. El objetivo de este trabajo, fue evaluar el efecto de la aplicación de MSC autólogas, sobre la reducción de la longitud de la cicatriz en tendinopatías recidivantes del TMFDS en equinos Holsteiner, a través del análisis de imagen. Este estudio conto con dos grupos de cinco animales cada uno, el grupo control mantuvo el tratamiento convencional (GC) y el grupo experimental fue tratado adicionalmente con inyección interlesional de MSC (GE). El análisis ecográfico permitió evaluar la evolución de la cicatriz, a través de la medición de su longitud durante los cuatros meses, tomando la longitud del mes cero como la medición inicial del 100 %. Durante el primer mes, la longitud de la cicatriz se redujo a un 81,14 % (GE) y 95,85 % (GC), al segundo mes la longitud fue de un 64,4 % (GE) y de 92,3 % (GC), al tercer mes, la longitud fue de 51,92 (GE) y un 87,42 (GC), finalmente al cuarto mes la longitud fue de 26,7 % (GE) y del 83,92 % (GC). Estos resultados muestran que el tratamiento con MSC autólogas favorece a la disminución de la longitud de la cicatriz del TMFDS de forma significativa respecto al tratamiento convencional.

Tendinitis del tendón largo del cuello: un imitador inusual del ictus isquémico / Longus colli tendinitis: An unusual stroke mimic

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Rotura distal del tendón de la porción larga del bíceps braquial. ¿Por qué está aumentado su incidencia? ¿Cuándo se debe reparar? / Rupture of the distal biceps tendon. Why is increasing its incidence? When it should be repaired?

Introducción y objetivos: La rotura del tendón distal del bíceps braquial es poco frecuente y representa sólo el 3% de todas las roturas de este tendón, aunque en la última década ha aumentado hasta un 10%. Son características en varones de edad media con predominio del brazo dominante. Se asocian factores de riesgo locales (alta demanda funcional) y sistémicos (tabaco, dislipemia, corticoides, anabolizantes, obesidad). Nuestro objetivo es analizar los factores de riesgos asociados a esta patología y evaluar los resultados tras la reparación quirúrgica de dicho tendón. Material y métodos: Estudio retrospectivo de 13 pacientes diagnosticados de rotura de bíceps distal en nuestro servicio desde mayo de 2012 hasta enero de 2014. Todos fueron tratados quirúrgicamente con reinserción anatómica con vía única (69,23% con técnica Endobutton y 30,77% con reanclaje mediante arpones. Se ha valorado los posibles factores de riego, movilidad articular, complicaciones precoces y tardías y satisfacción del paciente (escala de Karunakar). Su seguimiento clínico ha sido de al menos 6 meses. Resultados: Todos fueron varones con edad media de 42,69 años en brazo dominante en el 92,3%. El 76,92% realizaban deportes para ejercitar el bíceps y el 53,84% tomaba medicación por dislipemia. El resultado obtenido tras el tratamiento fue excelente estando satisfechos la totalidad de los pacientes Conclusiones y discusión: Los factores de riesgo conocidos hasta la fecha son el tabaco, dislipemia, corticoides, anabolizantes y obesidad que no justifican el aumento de la incidencia actual. La práctica deportiva habitual que implique tonificar y muscular el músculo braquial en pacientes con factores de riesgo aumenta la probabilidad de rotura del tendón distal de bíceps y su reinserción anatómica por vía anterior es una correcta opción terapéutica

Introduction and objectives: The breaking of the distal biceps tendon is rare and represents only 3% of all breakings of this tendon. However, for the last decade this percentage has increased up to 10%. They are characteristic of middle-aged men with a predominance of the dominant arm. Local risk factor (high functional demand) and systemic ones (smoking, dyslipidemia, steroids, analogies, obesity) are associated with this pathology. Our goal is to analyze the risk factors which are associated with this condition and evaluate the results after surgical repair of the tendon. Materials and methods: Retrospective study of 13 patients diagnosed with distal biceps tendon breaking in our hospital from May 2012 to January 2014. All patients were treated surgically with anatomic reattachment single trak (69,23 % with Endobutton’s technique and 30,77 % remembering using harpoons). There have been assessed factors such us potential risk factors, joint mobility, early and late complications and the patient’s degree of satisfaction (scale Karunakar). Their clinical follow-up was carried out for at least 6 months after the surgery. Result: All patients were male, with an average age of 42,69 years, the 92,3 % were in the dominant arm, 76,92 % of the patients usually exercised the biceps while training and 53,84 % were taking medication for dyslipidemia. The results obtained after the treatment were excellent, shawing that all patients were satisfied with it. Conclusion: The risk factors that are known so far such us smoking, dyslipidemia, steroids, anabolics and obesity do not justify the increase in the currents incidence rate. Regular exercise involving the biceps brachial muscle in patients with risk factors increases the probability of breaking the distal biceps tendon and anatomic reattachment anterior approach is a correct treatment option

Test de Distensión en Rotación Externa Pasiva (TDREP): validación de una nueva prueba clínica para el diagnóstico precoz de la capsulitis adhesiva de hombro / Distension test in passive external rotation: Validation of a new clinical test for the early diagnosis of shoulder adhesive capsulitis

Objetivo. El propósito de este estudio es evaluar la validez interna de una prueba clínica descrita para el diagnóstico precoz de la capsulitis adhesiva de hombro: el Test de Distensión en Rotación Externa Pasiva (TDREP). Material y método. El TDREP se realiza con el paciente de pie, el brazo adducido y el codo flexionado a 90°. Desde esta posición, se inicia un movimiento suave de rotación externa pasiva, sosteniendo el brazo afectado con una mano del examinador en la muñeca y otra manteniendo el codo abducido hasta que se alcanza el punto máximo de rotación indolora. Desde este punto de máxima rotación externa con el brazo en aducción y sin dolor, se realiza un movimiento brusco de distensión, incrementando la rotación externa, causando dolor en el hombro si la prueba es positiva. Es test se realizó en un grupo de 155 pacientes con dolor de hombro de múltiples orígenes para analizar los valores predictivos, la sensibilidad, especificidad y razón de verosimilitud. Resultados. El TDREP mostró una sensibilidad de 100% (IC 95%, de 91,8 a 100%) y una especificidad del 90% (IC 95%, de 82,4 a 94,8%). El valor predictivo positivo fue de 0,62 y la razón de verosimilitud de 10,22 (IC 95%: 5,5 a 19,01). Los falsos positivos se encontraron solo en enfermos con tendinopatías del subescapular o con artrosis glenohumeral. Discusión. El TDREP tiene una alta sensibilidad para diagnosticar CA y cuando es negativo prácticamente la excluye. Los falsos positivos se pueden identificar fácilmente si existe una rotación externa sin limitación (tendinopatía subescapular) o con una radiografía simple de hombro (artrosis glenohumeral) (AU)

Objective. The aim of this study is to evaluate the internal validity of a clinical test for the early diagnosis of shoulder adhesive capsulitis, called the Distension Test in Passive External Rotation (DTPER). Material and method. The DTPER is performed with the patient standing up, the arm adducted, and the elbow bent at 90°. From this position, a smooth passive external rotation is started, the affected arm being supporting at the wrist with one hand of the examiner and the other maintaining the adducted elbow until the maximum painless point of the rotation is reached. From this point of maximum external rotation with the arm in adduction and with no pain, an abrupt distension movement is made, increasing the external rotation, causing pain in the shoulder if the test is positive. This term was performed on a group of patients with shoulder pain of many origins, in order to analyse the predictive values, sensitivity, specificity, and the likelihood ratio. Results. The DTPER showed a sensitivity of 100% (95% CI; 91.8 to 100%) and a specificity of 90% (95% CI; 82.4 to 94.8%). The positive predictive value was 0.62 and a likelihood ratio of 10.22 (95% CI; 5.5 to 19.01). False positives were only found in patients with subscapular tendinopathies or glenohumeral arthrosis. Discussion. The DTPER has a high sensitivity for the diagnosis of adhesive capsulitis, and is excluded when it is practically negative. False positives can easily be identified if there is external rotation with no limits (subscapular tendinopathy) or with a simple shoulder X-ray (glenohumeral arthrosis) (AU)

Tratamiento artroscópico de la condromatosis sinovial, una inusual causa de omalgia / Arthroscopic treatment of synovial chondromatosis, an unusual cause of shoulder pain

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Fractura bilateral de pelvis por estrés / Bilateral pelvic stress fracture

Se define como fractura por estrés aquella que aparece en un hueso de resistencia elástica normal como consecuencia de traumatismos repetidos de baja intensidad. Originalmente estas fueron descritas en los metatarsianos de los soldados, posteriormente en atletas y actualmente debemos considerarlas también en la población general sometida a un estrés excesivo. Estadísticamente las mujeres son más proclives a sufrirlas (sobre todo en la menopausia) y las localizaciones más frecuentes son los metatarsianos, la tibia y el peroné. El interés del caso radica en la orientación diagnóstica por una doble presentación en una mujer sin factores de riesgo ni aumento de la actividad física y en una localización menos frecuente como es la pelvis. Una anamnesis detallada, así como una exploración compatible son la base para el diagnóstico de dicha entidad (AU)

A stress fracture is defined as that which occurs as a consequence of many low intensity traumas. These were originally described in the metatarsals of soldiers, and later on in athletes, and now we should consider them in general population subjected to excessive stress. Statistically, it generally occurs in women and in weight-bearing bones, such as the tibia, fibula and metatarsals. This case is of interest due to the diagnosis a double fracture in a woman without risk factors or increase in physical activity, and in an unusual location such as the pelvis. A detailed clinical history and examination are essential for the diagnosis (AU)

Afección musculoesquelética asociada a amputados de miembro inferior / Musculoskeletal diseases associated with leg amputees

Introducción. La amputación de miembros inferiores supone nuevos patrones biomecánicos de carga y marcha, pudiendo aparecer lesiones por sobrecarga o desuso. Objetivo. Describir la prevalencia y el tratamiento de estas lesiones en la Unidad de Amputados de un hospital de tercer nivel y compararlos con la bibliografía. Material y método. Se realizó un estudio descriptivo transversal (n=46) de 6 meses de duración usando un cuestionario propio en el que se incluían los datos demográficos, la fecha y etiología de amputación, uso o no de prótesis, existencia de «síndrome del dolor del miembro fantasma (MF)», crisis de lumbalgias recientes, osteoporosis, fracturas y/o caídas en los últimos 6 meses, artrosis en miembros inferiores, osificaciones anómalas y tendinitis. Se recogió la localización, frecuencia, intensidad del dolor (medida con Escala Visual Analógica, EVA) y el tratamiento de cada uno de ellos. Los datos se analizaron con SPSS Stadistics 18.0, en conjunto y por estratos de nivel de amputación y protetización y se compararon con la bibliografía. Resultados. La edad media de los encuestados era de 60,15±14,07 años, con predominio de varones (86,95%) y etiología vascular (61%).El tiempo de amputación medio era de 5 años y el 56% de ellos estaba protetizado. La afección dolorosa predominante fue el «síndrome del dolor del MF». En cuanto a la afección traumática, hallamos el 15,2% de tendinitis, el 61,3% de caídas y el 6,5% de fracturas en los últimos 6 meses. El 21,6% presentaban alteraciones óseas no traumáticas tales como osteoporosis y osificaciones anómalas. Conclusiones. En la planificación del tratamiento integral de amputados es importante atender a las afecciones musculoesqueléticas por su frecuente asociación (AU)

Introduction. Lower limbs amputations and the use of prostheses require new biomechanical walk patterns that can produce injuries. Aim. To describe the prevalence and treatment of these diseases in lower limb amputees in the 'Amputees unit' of a tertiary hospital and to compare these with the literature. Material and methods. A cross-sectional, descriptive study of 6 months duration was conducted on 46 subjects. A self-administered questionnaire was used, which included, demography data, the date and aetiology of amputation, the use or not of a prosthesis, 'Phantom Pain Syndrome', low back pain, osteoporosis, fractures or falls in the last 6 months, osteoarthritis, poor ossifications, and tendon inflammation. We also collected the location, frequency, intensity (EVA) and treatment of all of them. The data were analysed using the program SPSS Statistics 18.0 and then compared with that in the literature. Results. The mean age was 60±14.07 years. The predominant sex was male (86.95%), and the most frequent aetiology was vascular limb damage (61%). The mean time since amputation was 5 years, and 56% of the patients used a prosthesis. The most frequent source of pain was 'phantom'. Traumatic pathology: 15.2% of tendon injuries, 61.3% of falls in the last 6months, and 6.5% of bone fractures. Non-traumatic pathologies: 21.6%. Conclusion. In order to offer an integral treatment to amputees it is important to know these pathologies because of the frequent association (AU)

Ecografia de las lesiones tendinosas complejas / Ultrasound of tendon injuries complex

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Tendinosis calcificante del pectoral mayor con migración intraósea / Calcifying tendinosis of the pectoralis major muscle with intraosseous migration

La tendinosis calcificante es una entidad caracterizada por el depósito macroscópico intratendinoso de hidroxiapatita. La mayoría de los casos afectan a los tendones del manguito rotador, fundamentalmente al supraespinoso, y con menor frecuencia a otros tendones prácticamente en cualquier localización. La erosión cortical con migración intraósea de los depósitos cálcicos es infrecuente. La localización atípica combinada con la afectación ósea hace que con frecuencia se confunda con otros procesos como una infección o un tumor maligno, lo que conduce a biopsias e intervenciones innecesarias. Presentamos el caso de un varón que consultó por dolor e impotencia funcional en el hombro. En la radiografía se observó una erosión de la cortical anteromedial de la diáfisis proximal del húmero con calcificaciones extra- e intraóseas que hicieron sospechar proceso infeccioso o maligno. Los hallazgos en la tomografía computarizada (TC), junto con la evolución clínico-radiológica, fueron claves para reconocer esta presentación atípica de tendinosis calcificante del pectoral mayor (AU)

Calcifying tendinosis is characterized by macroscopic deposits of hydroxyapatite within the tendon. Most cases involve the tendons of the rotator cuff, fundamentally the supraspinous tendon, and less frequently other tendons in practically any location. Cortical erosion with intraosseous migration of calcium deposits is rare. An atypical location combined with bone involvement can often lead to confusion with other processes like an infection or malignant tumor resulting in unnecessary biopsies or interventions. We present the case of a man who presented with pain and loss of function of the shoulder. Plain-film X-rays showed an erosion of the anteromedial cortex of the proximal diaphysis of the humerus with extra- and intra-osseous calcifications that made us suspect an infectious or malignant process. The findings at computed tomography, together with the clinical and radiological course, were key in enabling us to recognize this atypical presentation of calcifying tendinosis of the pectoralis major muscle (AU)

Acute Retropharyngeal Calcific Tendinitis in an Unusual Location: a Case Report in a Patient with Rheumatoid Arthritis and Atlantoaxial Subluxation

Retropharyngeal calcific tendinitis is defined as inflammation of the longus colli muscle and is caused by the deposition of calcium hydroxyapatite crystals, which usually involves the superior oblique fibers of the longus colli muscle from C1-3. Diagnosis is usually made by detecting amorphous calcification and prevertebral soft tissue swelling on radiograph, CT or MRI. In this report, we introduce a case of this disease which was misdiagnosed as a retropharyngeal tuberculous abscess, or a muscle strain of the ongus colli muscle. No calcifications were visible along the vertical fibers of the longus colli muscle. The lesion was located anterior to the C4-5 disc, in a rheumatoid arthritis patient with atlantoaxial subluxation. Calcific tendinitis of the longus colli muscle at this location in a rheumatoid arthritis patient has not been reported in the English literature.