Novel joint cupping clinical maneuver for ultrasonographic detection of knee joint effusions.

INTRODUCTION: Knee effusions occur due to traumatic and atraumatic causes. Clinical diagnosis currently relies on several provocative techniques to demonstrate knee joint effusions. Portable bedside ultrasonography (US) is becoming an adjunct to diagnosis of effusions. We hypothesized that a US approach with a clinical joint cupping maneuver increases sensitivity in identifying effusions as compared to US alone. METHODS: Using unembalmed cadaver knees, we injected fluid to create effusions up to 10 mL. Each effusion volume was measured in a lateral transverse location with respect to the patella. For each effusion we applied a joint cupping maneuver from an inferior approach, and re-measured the effusion. RESULTS: With increased volume of saline infusion, the mean depth of effusion on ultrasound imaging increased as well. Using a 2-mm cutoff, we visualized an effusion without the joint cupping maneuver at 2.5 mL and with the joint cupping technique at 1 mL. Mean effusion diameter increased on average 0.26 cm for the joint cupping maneuver as compared to without the maneuver. The effusion depth was statistically different at 2.5 and 7.5 mL (P < .05). CONCLUSIONS: Utilizing a joint cupping technique in combination with US is a valuable tool in assessing knee effusions, especially those of subclinical levels. Effusion measurements are complicated by uneven distribution of effusion fluid. A clinical joint cupping maneuver concentrates the fluid in one recess of the joint, increasing the likelihood of fluid detection using US.

Fibromyalgia: unspeakable suffering, a prevalence study of alexithymia.

BACKGROUND: Fibromyalgia patients often present with multiple somatic concerns in a pattern suggestive of underlying depression. The psychological construct of alexithymia complicates the recognition of psychiatric disorders. OBJECTIVE: To measure the prevalence of alexithymia among fibromyalgia patients and compare this with the prevalence among general medicine and rheumatoid arthritis patients. METHODS: The Toronto alexithymia scale (TAS-20) and the Beck depression inventory (BDI) were administered to 50 patients in each of three experimental groups: fibromyalgia, general medicine and rheumatoid arthritis. Logistic regression was used to test for differences in the prevalence of alexithymia among experimental groups, first unadjusted and then adjusted for baseline and demographic variables. In addition, ANOVA was used to analyze the numeric scores of the TAS-20, the BDI and the three alexithymia components measured by the TAS-20. RESULTS: The prevalence of alexithymia in fibromyalgia patients (44%) was significantly higher than in either the general medicine group (8%; P=0.001) or the rheumatoid arthritis group (21%; P=0.023). Alexithymia was strongly associated with moderate to severe depression χ2=49.3, P<0.001), and when the mood disturbance was controlled for, no group differences were detected. CONCLUSION: Fibromyalgia patients are more likely than general medicine patients or patients with rheumatoid arthritis to have difficulty identifying and describing feelings, and to have higher alexithymia scores. Moderate to severe depression is also more prevalent in fibromyalgia patients, and, when controlled for, the difference in alexithymia scores becomes insignificant.