RESUMO
The anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. It is frequently unrecognized and may lead to misdiagnosis and delayed treatment. We report the case of a 77 year old patient complaining of symptoms of an anterior tarsal tunnel syndrome with neuropathic pain located at the dorsal part of the foot, without any sensorimotor loss. The ENMG was in favour of a motor impairment of the deep peroneal nerve. MRI exploration of the ankle showed a millimetric bony overgrowth of the upper pole of the navicular bone, irritative to the deep peroneal nerve. Infiltration at overgrowth of the navicular provided a partial and temporary decrease in pain symptoms. Surgical nerve decompression was then considered.
Assuntos
Nervo Fibular/patologia , Síndrome do Túnel do Tarso/diagnóstico , Idoso , Articulação do Tornozelo/patologia , Diagnóstico Diferencial , Eletromiografia , Humanos , Imageamento por Ressonância Magnética , Masculino , Síndrome do Túnel do Tarso/patologiaRESUMO
In the absence of obvious trauma, the calcifications/ossifications of the bone surface and soft tissues of the wrist, hand and fingers can be challenging and may not be noticed or lead to unnecessary examinations and monitoring. Although these are usually benign conditions and despite a favorable spontaneous outcome, surgical resection may be required and recurrence may occur. In practice, only paraneoplastic syndromes such as secondary hypertrophic osteoarthropathy (Pierre Marie-Bamberger syndrome) may reveal a malignant tumor, most often pulmonary. We suggest a diagnostic approach based on the initial clinical presentation (acute pain, chronic pain, growth±pain) and the radiological features.
Assuntos
Osso e Ossos/patologia , Calcinose/diagnóstico , Tecido Conjuntivo/patologia , Dedos/patologia , Mãos/patologia , Imageamento por Ressonância Magnética/métodos , Ossificação Heterotópica/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Punho/patologia , Calcinose/etiologia , Calcinose/patologia , Diagnóstico Diferencial , Humanos , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/patologia , Síndromes Paraneoplásicas/diagnósticoRESUMO
OBJECTIVES: To assess the diagnostic value of clinical tests for degenerative rotator cuff disease (DRCD) in medical practice. METHODS: Patients with DRCD were prospectively included. Eleven clinical tests of the rotator cuff have been done. One radiologist performed ultrasonography (US) of the shoulder. Results of US were expressed as normal tendon, tendinopathy or full-thickness tear (the reference). For each clinical test and each US criteria, sensitivity, specificity, negative predictive value and positive predictive value, accuracy, negative likelihood ratio (NLR) and positive likelihood ratio (PLR) were calculated. Clinical relevance was defined as PLR ≥2 and NLR ≤0.5. RESULTS: For 35 patients (39 shoulders), Jobe (PLR: 2.08, NLR: 0.31) and full-can (2, 0.5) test results were relevant for diagnosis of supraspinatus tears and resisted lateral rotation (2.42, 0.5) for infraspinatus tears, with weakness as response criteria. The lift-off test (8.50, 0.27) was relevant for subscapularis tears with lag sign as response criteria. Yergason's test (3.7, 0.41) was relevant for tendinopathy of the long head of the biceps with pain as a response criterion. There was no relevant clinical test for diagnosis of tendinopathy of supraspinatus, infraspinatus or subscapularis. CONCLUSIONS: Five of 11 clinical tests were relevant for degenerative rotator cuff disease.
Assuntos
Exame Físico , Lesões do Manguito Rotador , Tendinopatia/diagnóstico , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Manguito Rotador/diagnóstico por imagem , Ruptura/complicações , Ruptura/diagnóstico , Dor de Ombro/etiologia , Tendinopatia/complicações , Tendinopatia/diagnóstico por imagem , UltrassonografiaAssuntos
Osteomielite/microbiologia , Infecções por Salmonella/microbiologia , Salmonella/isolamento & purificação , Tíbia/microbiologia , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Abscesso/cirurgia , Adolescente , Antibacterianos/uso terapêutico , Técnicas de Tipagem Bacteriana , Ceftriaxona/uso terapêutico , Terapia Combinada , Desbridamento , Feminino , Humanos , Imunocompetência , Ofloxacino/uso terapêutico , Osteomielite/tratamento farmacológico , Osteomielite/cirurgia , Salmonella/classificação , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/cirurgia , Tíbia/cirurgiaRESUMO
Periarticular calcific tendinopathy has been well described, but no retropharyngeal locations have been reported in the surgical orthopedic literature. This pathology is a diagnostic pitfall, leading to fruitless invasive examinations and treatment. The clinical aspect is misleading, but pathognomic imaging can establish diagnosis. We report a case of febrile postoperative cervicalgia, initially suggestive of a septic complication, but in which imaging indicated retropharyngeal calcific tendinitis.
Assuntos
Calcinose/complicações , Febre/etiologia , Cervicalgia/etiologia , Doenças Faríngeas/complicações , Tendinopatia/complicações , Calcinose/diagnóstico , Diagnóstico Diferencial , Febre/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Doenças Faríngeas/diagnóstico , Tendinopatia/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
In 1892, J. Wolff, an orthopedic surgeon, stated that the internal architecture and shape of a bone were related to the direction of stresses placed upon it. Conventional radiographs and MRI can demonstrate the adaptability of bones to stresses. Imaging also demonstrates that this adaptability has limitations, and that excessive stress may lead to fracture.
Assuntos
Diagnóstico por Imagem , Fraturas de Estresse/diagnóstico , Processamento de Imagem Assistida por Computador , Fenômenos Biomecânicos , Osso e Ossos/fisiopatologia , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/fisiopatologia , Fraturas de Estresse/fisiopatologia , Humanos , Aumento da Imagem , Músculo Esquelético/fisiopatologia , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/fisiopatologia , Sensibilidade e EspecificidadeRESUMO
Soft tissue masses around the foot and ankle are frequent. While benign lesions are two times more frequent than malignant lesions, the latter still represent one third of all lesions. The main purpose of this article is to propose a systematic approach to the differential diagnosis of soft tissue tumors of the foot and ankle based on a combination of 5 elements: clinical history and physical examination, top 10 most frequent diagnoses, patient age, lesion location, and MRI features of the mass. Selected soft tissue tumors will be described and illustrated with emphasis on these 5 elements.