Arthroscopic transosseous anchorless rotator cuff repair reduces bone defects related to peri-implant cyst formation: a comparison with conventional suture anchors using propensity score matching

Background@#The transosseous anchorless repair (ToR) technique was recently introduced to avoid suture anchor-related problems. While favorable outcomes of the ToR technique have been reported, no previous studies on peri-implant cyst formation with the ToR technique exist. Therefore, this study compared the clinical outcomes and prevalence of peri-implant cyst formation between the ToR technique and the conventional transosseous equivalent technique using suture anchors (SA). @*Methods@#Cases with arthroscopic rotator cuff repair (ARCR) between 2016 and 2018 treated with the double-row suture bridge technique were retrospectively reviewed. Patients were divided into ToR and SA groups. To compare clinical outcomes, 19 ToR and 57 SA cases without intraoperative implant failure were selected using propensity score matching (PSM). While intraoperative implant failure rate was analyzed before PSM, retear rate, peri-implant cyst formation rate, and functional outcomes were compared after PSM. @*Results@#The intraoperative implant failure rate (ToR, 8% vs. SA, 15.3%) and retear rate (ToR, 5.3% vs. SA, 19.3%) did not differ between the two groups (all P>0.05). However, peri-implant cysts were not observed in the ToR group, while they were observed in 16.7% of the SA group (P=0.008). Postoperative functional outcomes were not significantly different between the two groups (all P>0.05). @*Conclusions@#The ToR technique produced comparable clinical outcomes to conventional techniques. Considering the prospect of potential additional surgeries, the absence of peri-implant cyst formation might be an advantage of ToR. Furthermore, ToR might reduce the medical costs related to suture anchors and, thereby, could be a useful option for ARCR.Level of evidence: III.

Synovial Osteochondromatosis: Clinical Characteristics Unique to the Shoulder

Background@#Synovial osteochondromatosis (SOC) of the shoulder is a rare condition with unclear characteristics. This study evaluated the clinical features and postoperative functional outcomes of SOC of the shoulder that are distinct from SOC of other joints. @*Methods@#The characteristics of 28 shoulders with SOC that underwent arthroscopy were retrospectively assessed. Ten shoulders (35.7%) had rotator cuff tears (RCTs) and underwent concomitant arthroscopic rotator cuff repair. The mean follow-up period was 83.6 months (range, 24–154 months). Demographic characteristics and loose bodies localized under arthroscopy were compared between cases with and without concomitant RCTs. Radiography, ultrasonography, or magnetic resonance imaging were performed preoperatively and postoperatively. Visual analog scale (VAS) scores for pain and satisfaction were evaluated for all cases, and functional scores were assessed in shoulders with concomitant RCTs. @*Results@#The average age was 36.2 ± 15.6 years among patients without RCTs and 58.3 ± 7.2 years among patients with RCTs.Seven shoulders (7%) had osteoarthritis. Arthroscopy revealed loose bodies in multiple spaces, including the glenohumeral joint, subacromial (SA) space, and biceps tendon sheath. Overall, loose bodies were found in multiple spaces in 12 shoulders (42.9%). Loose bodies were found in the SA space only in 4 shoulders (22.2%) without RCTs and in 7 shoulders (70.0%) with RCTs. VAS for pain decreased significantly from 3.9 ± 2.3 to 1.1 ± 1.3 (p < 0.001). The functional scores increased significantly after arthroscopic management for patients with concurrent RCTs (all p < 0.05). Recurrence of SOC occurred in 3 of the 22 shoulders (13.6%) who underwent postoperative imaging, but no patient had a recurrent RCT. @*Conclusions@#Pain relief and patient satisfaction were achieved via arthroscopic management. Unlike in other joints, loose bodies can occur simultaneously in several spaces in the shoulder, including the glenohumeral joint, SA space, and biceps tendon sheath. Early diagnosis of SOC of the SA space can help prevent osteoarthritis and RCT progression.

The effect of postoperatively applied far-infrared radiation on pain and tendon-to-bone healing after arthroscopic rotator cuff repair:a clinical prospective randomized comparative study

Background@#The effects of far-infrared radiation (FIR) on the treatment of rotator cuff diseases remains unknown. We evaluated the safety and efficacy of FIR after arthroscopic rotator cuff repair with regard to postoperative pain and healing. @*Methods@#This prospective randomized comparative study included 38 patients who underwent arthroscopic rotator cuff repair due to a medium-sized tear. Patients were randomly divided into the FIR or control group (n = 19 per group). In the FIR group, FIR with an FIR radiator started 1 week postoperatively for 30 minutes per session twice daily. It lasted until abduction brace weaning at 5 weeks postoperatively. We assessed pain using a pain visual analogue scale (pVAS) and measured the range of motion (ROM) of the shoulder at 5 weeks, and 3 and 6 months, postoperatively. The anatomical outcome was evaluated using magnetic resonance imaging at 6 months postoperatively. @*Results@#At 5 weeks postoperatively, the average pVAS score was lower in the FIR group than in the control group (1.5 ± 0.8 vs. 2.7 ± 1.7; P = 0.019). At 3 months postoperatively, the average forward flexion was higher in the FIR group (151.6° ± 15.3° vs. 132.9° ± 27.8°;P = 0.045), but there was no significant difference at 6 months postoperatively. There was no significant difference in healing failure between the groups (P = 0.999). @*Conclusions@#FIR after arthroscopic rotator cuff repair could be an effective and safe procedure to reduce postoperative pain, thereby facilitating rehabilitation and better ROM in the early postoperative period.

Clinical Outcomes after Reverse Total Shoulder Arthroplasty According to Primary Diagnosis

Background@#To compare the clinical outcomes of reverse total shoulder arthroplasty (RTSA) according to the primary diagnosis. @*Methods@#In 98 shoulders (97 patients), RTSA was performed for cuff tear arthropathy (45), massive rotator cuff tear without glenohumeral arthritis (31), posttraumatic arthritis (9), primary osteoarthritis (6), rheumatoid arthritis (4), and arthritis due to infection sequelae (3). The average age of the patients at surgery was 68.9 years (range, 46–84 years). The mean follow-up duration was 48.4 months (range, 24–85 months). @*Results@#In the overall series, the mean subjective pain score (visual analog scale) during motion decreased from 5.2 preoperatively to 1.8 at 2 years of follow-up. There were significant improvements in active forward flexion (preoperatively 51.5° to 121.8° at 2 years of follow-up). The average Constant score improved from 35.4 points to 57.8 points and UCLA score improved from 13.4 points to 28.8 points. The Constant score and UCLA score were 60.8 and 31.0 points, respectively, in patients with rheumatoid arthritis. The Constant score and UCLA score were 58.4 and 29.1 points, respectively, in patients with cuff tear disease and 55.7 and 27.7 points, respectively, in patients with posttraumatic arthritis. Patients’ subjective satisfaction was 86.8 points in the overall series; highest in the patients with arthritis by infection sequelae (96.7 points) and lowest in the patients with posttraumatic arthritis (82.2 points). In terms of complications, there were 17 cases (17.3%) of scapular notching and 2 patients with suprascapular nerve irritation symptom, but no patients with permanent neuropathy. @*Conclusions@#The range of forward flexion and abduction motion, pain relief, and functionality were improved after RTSA in not only patients with cuff tear disease but also those with other arthritic diseases. There was no difference in the clinical outcomes of RTSA between patients with cuff tear disease and those with other arthritic diseases.

Outcomes of arthroscopic capsulolabral reconstruction for anterior instability with greater than 20% glenoid bone defects: are Latarjet procedures absolutely indicated for these patients?

Background@#Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. @*Methods@#Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. @*Results@#The mean glenoid bone defect size was 25.8% ± 4.2% (range, 20.4%–37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24–86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. @*Conclusions@#Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

Rationale for Small Glenoid Baseplate: Position of Central Cage within Glenoid Vault (Exactech® Equinoxe® Reverse System)

BACKGROUND: Glenoid baseplate location is important to good clinical outcomes of reverse total shoulder arthroplasty (RTSA). The glenoid vault is the determining factor for glenoid baseplate location, but, to date, there are no reports on the effect of central cage location within the glenoid vault on RTSA outcomes when using the Exactech® Equinoxe® Reverse System. The purpose of this study was to determine the appropriate cage location in relation to the glenoid vault and monitor for vault and/or cortex penetration by the cage. METHODS: Data were retrospectively collected from the Samsung Medical Center (SMC) and Seoul National University Bundang Hospital (SNUBH). Patients who underwent RTSA between November 2016 and February 2018 were enrolled. Glenoid vault depth, central cage location within the vault were examined. Inferior glenoid rim-center distance, inferior glenoid rim-cage distance, and center-cage center distances were collected. RESULTS: Twenty-two patients were enrolled. Three SNUBH patients had inappropriate central cage fixation (33.3%) versus 4 SMC patients (30.8%). All cage exposures were superior and posterior to the glenoid vault. Mean center-cage distance was 5.0 mm in the SNUBH group and 5.21 mm in the SMC group. Center-prosthesis distance was significantly longer in the inappropriate fixation group than in the appropriate fixation group (p<0.024). CONCLUSIONS: To ensure appropriate glenoid baseplate fixation within the glenoid vault, especially in a small glenoid, the surgeon should place the cage lower than usually targeted, and it should overhang the inferior glenoid rim.

Prognostic Radiological Factors Affecting Clinical Outcomes of Reverse Shoulder Arthroplasty in the Korean Population

BACKGROUND: Despite the growing use of reverse shoulder arthroplasty (RSA), it is associated with relatively frequent complications and uncertain clinical outcomes. We investigated radiological factors affecting clinical outcomes of RSA in the Korean population. METHODS: We evaluated physical findings, radiographic findings, visual analog scale scores for pain and satisfaction, and several functional scores in 179 consecutive patients who underwent RSA at two centers between 2008 and 2014. RESULTS: In 146 included RSAs, pain and forward flexion improved with deltoid lengthening (average, 23.5 ± 9.1 mm; p = 0.039). External rotation decreased with medialization (average, 16.8 ± 6.0 mm, p = 0.025), whereas internal rotation showed no correlation with humeral retroversion. Scapular notching (n = 44, 30%) significantly decreased with greater inferior glenosphere overhang (average, 2.94 ± 3.0 mm; p = 0.001), greater prosthesis scapular neck angle (average, 104° ± 10.3°; p = 0.001), greater glenoid neck length (average, 9.8 ± 2.54 mm; p = 0.012), lower inferior baseplate tilt angle (average, 105.5° ± 9.2°; p = 0.009), and varus humeral neck-shaft angle (p = 0.046), and it did not affect ranges of motion and pain, satisfaction, and functional scores. At the final follow-up, medialization was related to improvement in pain and satisfaction, and inferior glenosphere overhang to functional scores. CONCLUSIONS: Proper amount of deltoid lengthening (mean, 2.3 cm) and inferior glenosphere overhang (mean, 2.9 mm) should be chosen for the better outcomes, while the center of rotation should be individualized according to patient characteristics in the Korean population.

Non-Operative Management of Musculoskeletal Diseases and Regenerative Medicine / 대한정형외과학회잡지

Recently, due to the unsatisfactory outcomes of several orthopedic surgical procedures, non-operative management of musculoskeletal diseases, including regenerative medicine, is becoming more attractive to orthopedic surgeons. Regarding the healing of musculoskeletal tissues, such as bone, cartilage and tendons, regenerative medicine aims to replace or promote tissue regeneration. Among them, therapy using stem cells, prolotherapy, platelet-rich plasma, and extracorporeal shockwave therapy are taking center stage. Numerous animal and clinical studies have been published and the number has increased exponentially in recent years. On the other hand, because regenerative medicine in the orthopedic field is still in the early stages, no definite methods for the procedures have been made and there is some controversy regarding their application to musculoskeletal disease. Therefore, more high quality studies including randomized studies should be performed to establish standards and evaluate their value in the orthopedic field.

Is Anatomical Healing Essential for Better Clinical Outcome in Type II SLAP Repair? Clinico-Radiological Outcome after Type II SLAP Repair

BACKGROUND: We hypothesized that anatomical healing in superior labrum anterior to posterior (SLAP) repair is associated with good clinical outcome. The purposes of this study were to assess the failure rate of anatomical healing after arthroscopic repair of SLAP lesions using computed tomography arthrography (CTA), investigate correlation of the rate with clinical outcomes, and identify prognostic factors for anatomical failure following SLAP repair. METHODS: We retrospectively evaluated the outcome of 43 patients at a minimum follow-up of 1 year after arthroscopic surgery for SLAP lesions or SLAP lesions associated with Bankart lesions. Twenty-eight patients underwent isolated SLAP repair and 15 patients underwent Bankart repair with SLAP repair. The anatomical outcome was assessed using CTA at 1 year after surgery. Clinical outcomes including visual analogue scale for pain and satisfaction and Constant score were assessed at the final follow-up. We investigated clinical failure that was defined as stiffness, loss of maximum rotation, deterioration of pain, and/or need for revision of surgery. RESULTS: Anatomical failure occurred in 32.6% of patients (14/43), whereas 16.3% of patients (7/43) had clinical failure. Clinicoradiological assessment revealed that clinical failure occurred only in 7.1% of patients (1/14) with unhealed SLAP lesions, whereas it occurred in 20.7% of patients (6/29) with healed SLAP lesions. Isolated SLAP repair resulted in a higher risk of anatomical failure (risk ratio, 7.0) than combined SLAP repair (p = 0.015). Nonoverhead activities were associated with higher risk of anatomical failure (risk ratio, 2.9; p = 0.041). Patients above 35 years of age had more risk of anatomical failure (risk ratio, 3.5; p = 0.010). Clinical outcomes significantly improved regardless of anatomical failure (p 0.05). CONCLUSIONS: Since patients with unhealed SLAP lesions had less clinical failure than patients with healed SLAP lesions, anatomical healing does not seem essential for better clinical outcome of SLAP II repair, especially in patients with higher healing failure risk (isolated SLAP repair, nonoverhead activities, and above 35 years of age). Therefore, we believe the indications of SLAP repair should be narrowed to avoid overtreatment.

Treatment Strategy for Irreparable Rotator Cuff Tears

Recently, patients with shoulder pain have increased rapidly. Of all shoulder disorders, rotator cuff tears (RCTs) are most prevalent in the middle-aged and older adults, which is the primary reason for shoulder surgery in the population. Some authors have reported that up to 30% of total RCTs can be classified as irreparable due to the massive tear size and severe muscle atrophy. In this review article, we provide an overview of treatment methods for irreparable massive RCTs and discuss proper surgical strategies for RCTs that require operative management.

A Correlation Study of Clinical Outcomes by Quantification of Fatty Degeneration of the Subscapularis: Partial vs. Whole Cross-section

BACKGROUND: Fatty degeneration of rotator cuff is a well-known predictor of postoperative outcome. The purpose of this study was to evaluate the clinical features of rotator cuff tears involving subscapularis, and investigate whether fatty degeneration quantified from only the upper subscapularis correlates better with clinical outcomes than quantified from the whole subscapularis. METHODS: We retrospectively analyzed 315 consecutive patients who underwent arthroscopic repair for rotator cuff tears involving subscapularis with a minimum follow-up of 1 year. Preoperative and postoperative visual analogue score for pain, range of motion and functional scores were assessed. Integrity of the repaired tendon was assessed at the 1-year follow-up with either magnetic resonance imaging or ultrasonography. RESULTS: The mean Goutallier grade of whole cross-section was significantly lower than that of upper cross-section (1.59 vs. 1.71, p<0.05), but significantly higher than that of lower cross-section (1.59 vs. 1.01, p<0.05). In analysis of 37 re-tears, the occupancy of severe fatty degeneration in upper cross-section was 86.5%, which was significantly higher than that seen in whole cross-section (56.8%, p<0.05). We calculated the cut-off tear size for prediction of re-tears as 19.0 mm for retraction and 11.0 mm for superior-inferior. The cut-off Goutallier grade was 2.5 for both whole and upper cross-sections, but area under the curve was greater in the upper cross-section than the whole (0.911 vs. 0.807). CONCLUSIONS: As fatty degeneration of upper subscapularis demonstrated a more distinct spectrum than whole subscapularis, we suggest that measuring fatty degeneration of upper subscapularis can be a more useful method to predict clinical prognosis.

Acute Rotator Cuff Tears due to Low Voltage Electrical Injury: A Case Report

Since shoulder have a higher proportion of muscle which would have low electrical resistance, there could be more electrical damage to the rotator cuff muscles. We present a patient with acute rotator cuff tear by sudden uncontrolled jerking contractions caused by an electrical shock. A case of 42-year-old man with acute rotator cuff tear due to electrical injury to the shoulder was presented. Magnetic resonance imaging showed a full thickness tear and an undulating appearance of the peripheral end of the torn supraspinatus and infraspinatus muscle, suggesting an acute complete rupture. By arthroscopic surgery, the torn rotator cuff tendons were repaired with a suture bridge technique. At the final follow-up, the patient had a full, pain-free range of motion and had fully recovered shoulder muscle power.

Do Knots Matter in Superior Labrum Anterior to Posterior Lesions Repair?

BACKGROUND: In general, the outcomes of arthroscopic repair for superior labrum anterior to posterior lesions (SLAP) are favorable, however, persistent pain and limitation of motion are not rare complications. One of the possible cause is a “knot-ache”. This study evaluated the results of reoperation of symptomatic recurrent SLAP lesions and asked whether the knot is associated with postoperative complications. METHODS: Between 2005 and 2015, a total of 11 patients who had undergone arthroscopic SLAP repair were reoperated for recurrent symptomatic SLAP lesion. By retrospective chart review, operative findings, the visual analogue scale for pain (pVAS), the range of motion (ROM), and functional scores were analyzed. RESULTS: The mean age of the study participants was 38.3 years, and the mean follow-up period was 42.5 months. In the primary operation, there were nine cases of repairs with conventional knot-tying anchors and three cases with knotless anchors. Impingement of the knots during abduction and external rotation of the shoulder was observed in the all cases with knot-tying anchors. The mean pVAS, ROM, and functional scores significantly improved with reoperation. At the final follow-up, the mean satisfaction VAS was 8.3. CONCLUSIONS: The knots of suture anchor maybe a possible etiology of the pain, which we termed a “knot-ache”. Considering that reoperation is performed due to pain after primary repair, the use of knotless suture anchor may have benefits of eliminating one of possible cause, “knot-ache”. Therefore, authors suggest the use of knotless anchors during reoperation for recurrent or recalcitrant pain after primary SLAP repair.

Bridging Graft in Irreparable Massive Rotator Cuff Tears: Autogenic Biceps Graft versus Allogenic Dermal Patch Graft

BACKGROUND: Few comparative studies have reported on the use of biologic grafts for irreparable massive rotator cuff tears. The purpose of this study was to assess the results of arthroscopic bridging graft in irreparable massive rotator cuff tears using an autogenic long head of biceps tendon (LHBT) or an allogenic dermal patch (ADP). METHODS: We retrospectively reviewed 24 patients treated using the LHBT (group I) and eight patients with complete rupture of the LHBT treated using an ADP (group II) since 2011. Preoperative Goutallier's fatty degeneration, range of motion (ROM), visual analogue scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score were assessed and healing failure was evaluated at 1 year after surgery by ultrasonography or magnetic resonance imaging. RESULTS: The mean fatty degeneration in groups I and II was 3.9 and 3.6 for the supraspinatus (p = 0.288), 2.7 and 2.9 for the infraspinatus (p = 0.685), 0.9 and 1.3 for the subscapularis (p = 0.314), and 1.3 and 3.0 for the teres minor (p = 0.005), respectively. Subscapularis tears were found in 8 patients (33.3%) in group I and in 7 patients (87.5%) in group II (p = 0.023). Mean ROMs and functional scores improved significantly in group I (forward flexion: 121.7° to 153.3°, p = 0.010; external rotation: 32.7° to 52.7°, p = 0.001; external rotation at 90°: 63.3° to 74.5°, p = 0.031; internal rotation: T10.5 to T9.3, p = 0.045; VAS: 7.0 to 1.1, p < 0.001; ASES score: 45.4 to 81.6, p = 0.028; and Quick DASH score: 50.0 to 14.2, p = 0.017), whereas only VAS showed significant improvement in group II (from 5.9 to 2.0, p = 0.025) and ROMs and other functional scores increased without statistical significance in the group. Healing failure was found in 13 patients (54.2%) in group I and in 6 patients (75.0%) in group II (p = 0.404). CONCLUSIONS: The surgeon should prudently choose surgical options for irreparable massive rotator cuff tears, especially in patients with severe fatty degeneration in the teres minor or combined biceps and subscapularis tears.

Do Knots Matter in Superior Labrum Anterior to Posterior Lesions Repair?

BACKGROUND: In general, the outcomes of arthroscopic repair for superior labrum anterior to posterior lesions (SLAP) are favorable, however, persistent pain and limitation of motion are not rare complications. One of the possible cause is a “knot-ache”. This study evaluated the results of reoperation of symptomatic recurrent SLAP lesions and asked whether the knot is associated with postoperative complications. METHODS: Between 2005 and 2015, a total of 11 patients who had undergone arthroscopic SLAP repair were reoperated for recurrent symptomatic SLAP lesion. By retrospective chart review, operative findings, the visual analogue scale for pain (pVAS), the range of motion (ROM), and functional scores were analyzed. RESULTS: The mean age of the study participants was 38.3 years, and the mean follow-up period was 42.5 months. In the primary operation, there were nine cases of repairs with conventional knot-tying anchors and three cases with knotless anchors. Impingement of the knots during abduction and external rotation of the shoulder was observed in the all cases with knot-tying anchors. The mean pVAS, ROM, and functional scores significantly improved with reoperation. At the final follow-up, the mean satisfaction VAS was 8.3. CONCLUSIONS: The knots of suture anchor maybe a possible etiology of the pain, which we termed a “knot-ache”. Considering that reoperation is performed due to pain after primary repair, the use of knotless suture anchor may have benefits of eliminating one of possible cause, “knot-ache”. Therefore, authors suggest the use of knotless anchors during reoperation for recurrent or recalcitrant pain after primary SLAP repair.

Arthroscopic Treatment of Symptomatic Internal Snapping Hip with Combined Pathologies

BACKGROUND: Arthroscopic iliopsoas tendon release was introduced in 2000. The purpose of this study was to evaluate clinical outcomes of arthroscopic iliopsoas tendon release for painful internal snapping hip with concomitant hip pathologies. METHODS: Between January 2009 and December 2011, we performed arthroscopic iliopsoas tendon release and related surgeries in 25 patients (20 men and 5 women; mean age, 32 years; range, 17 to 53 years) with combined intraarticular hip pathologies. The patients were followed for a minimum of 2 years postoperatively. Clinical and radiological evaluations were performed. RESULTS: Snapping sounds had disappeared by the 2-year follow-up in 24 of the 25 patients. All patients who had presented with loss of flexion strength postoperatively showed recovery at postoperative week 6 to 10. Harris hip score improved from 65 points (range, 46 to 86 points) preoperatively to 84 points (range, 67 to 98 points) postoperatively (p < 0.001). Seven hips (28%) had an excellent score, 15 hips (60%) a good score, 2 hips (8%) a fair score, and one hip (4%) a poor score (p < 0.001). The Tonnis grade of osteoarthritis did not change in any of the patients at the last follow-up. CONCLUSIONS: Patients with painful internal snapping hip have combined hip pathologies. Therefore, the surgeon should keep in mind that painful internal snapping hips are frequently combined with concomitant intraarticular pathologies.

Hypertrophic Osteoarthropathy in Patient with Crohn's Disease: A Case Report

Numerous causes of hypertrophic osteoarthropathy (HOA) have been reported. Commonly, secondary osteoarthropathy accompanies pulmonary diseases such as carcinoma of the lung, pleural tumors, lung abscesses, and bronchiectasis. However, HOA in inflammatory bowel disease is a rare complication. There are only a few reports of secondary HOA with Crohn's disease. Our purpose was to report another case of HOA in Crohn's disease. We describe a case of a 27-year-old man with underlying Crohn's disease presenting with 2 years of pain in multiple joints. Radiographic findings suggested HOA in extremities. We performed a conservative treatment including medication and rehabilitations. The patient's symptoms were much improved at the latest follow-up. Although numerous studies on HOA have been published, the pathogenesis of HOA is still unclear. Various treatment modalities were recommended but further studies to uncover the pathogenesis of HOA with Crohn's disease and to establish a treatment modality are needed.