Imaging of musculoskeletal tuberculosis.

Tuberculosis (TB) represents a major public health problem worldwide. Any tissue may be infected. Involvement of the musculoskeletal (MSK) system account for 1-3% of all tuberculous infections. MSK TB may manifest as tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue infections. Although TB spondylitis may present with distinctive imaging features compared to pyogenic infections of the spine, the imaging semiology of extra-spinal TB infections is mostly nonspecific and may mimic other lesions. TB infections should therefore always be considered in the differential diagnosis, particularly in immunocompromised patients. The aim of this article is to review the imaging features of spinal and extra-spinal MSK TB. Magnetic resonance imaging is considered the modality of choice to make the diagnosis and to evaluate the extent of the disease.

[Capsular distension and physical therapy in treatment of adhesive capsulitis]. / Association distension capsulaire et rééducation immediate dans la prise en charge de la rétraction capsulaire de l'épaule.

OBJECTIVE: to evaluate the efficacy of capsular distension combined with intraarticular glucocorticoid injections and immediate physical therapy in the treatment of adhesive capsulitis. METHOD: a prospective open study of patients with adhesive capsulitis. Clinical and radiological criteria was used for diagnosis. Clinical evaluation was realized before treatment, at the end of the treatment, after 1 month, 3 months and 6 months. It carried on: the measure of pain and handicap intensity by an Visual Analogue Scale, the algo-functional score of Constant, the measure of passive articular mobilities. We ended in a success of the treatment when the visual analogue scale of handicap < 30, the score of Constant >70, the passive abduction >90 and the external rotation (RE) >45 degrees. RESULTS: 19 patients were included, mean aged 56 years with capsular retraction evolving on average for 8.5 months. The parameters of evaluation of pain function and handicap improved significantly since the end of treatment. This improvement continued until 6 months after the treatment. Earning in articular amplitudes was significant since the end of treatment for forward extension and internal rotation. However, the improvement in abduction and internal rotation was significant only at 3 months. In spite of this early significant improvement in external rotation, 6 patients had an important limitation of the RE (<20 degrees). A subacromial bursography with steroid injection was proposed to them because subacromial bursa is almost consistently involved by retraction. Only, 4 patients among them accepted it. Out come was favorable in every case with a external rotation >45 degrees at I month of the treatment. The rate of success which was only 47.3% at the end of the treatment, is crossed in 73.6% at 1 month and reaches 89.4% at 6 months. CONCLUSION: The therapeutic association capsular distension, intraarticular steroid injections and physical therapy allows to shorten the course of adhesive capsulitis. Burso-infiltration seems to be effective as therapeutic complement in case of persistence of an articular limitation.

Primary leiomyosarcoma of bone: report of 4 cases.

Primary leiomyosarcoma of bone is a very rare tumor. Four cases are reported: 3 tumors were located in the femur and 1 in the talus. Clinical and imaging findings including radiographs, CT, and MRI are described. The final diagnosis was made by histopathological, immunohistochemical, and/or ultrastructural study after biopsy.