Accuracy of intra-articular injections for osteoarthritis of the trapeziometacarpal joint.

A study was conducted to determine the accuracy of intra-articular injections for osteoarthritis (OA) of the trapeziometacarpal joint (TMCJ). Over a period of 12 months intra-articular injections on 60 TMCJs (12 males and 48 females) were carried out. All the injections were performed in the operating theatre. The operator inserted the needle into the position clinically assessed to be the TMCJ and the position was assessed using biplanar fluoroscopy. In 42% of cases, the needle was incorrectly placed and its position had to be adjusted, using fluoroscopy, to ensure correct intra-articular placement. Entry into an osteoarthritic TMCJ with a blind passage of the needle is not straightforward. A proper injection technique must be employed to enter the correct joint. Using an image intensifier greatly facilitates accurate needle placement.

Radial nerve palsy in an elite bodybuilder.

A case is reported of high radial nerve palsy in an elite bodybuilder caused by an extrinsic mass effect of muscular hypertrophy. Surgical decompression resulted in complete clinical resolution.

Arthroscopic removal of a shotgun pellet from the elbow joint.

A case of arthroscopic identification and removal of a shotgun pellet from the elbow joint is presented. The pellet had entered the soft tissues over the dorsum of the joint and had migrated to an intra-articular position, causing interference with movement of the elbow. Arthroscopy of the joint was performed using standard portals. The pellet was discovered anterior to the coronoid process of the ulna in the anterior recess of the joint and was removed using forceps. At follow-up, the patient reported a symptom-free elbow with full range of movement.

Revision total elbow replacement using the Souter-Strathclyde prosthesis.

The Souter-Strathclyde prosthesis was used in 52 evisions of total elbow replacements (TERs) between August 1986 and May 1997. Of these, 50, carried out in 45 patients, were prospectively followed for a mean of 53 months (14 to 139). The procedure produced reliable relief of pain, and the range of movement was preserved. There was a considerable incidence of adverse events associated with revision (30%), and 12 further procedures have been required. Nonetheless, a revision is the preferred salvage procedure for failed primary arthroplasty in the absence of sepsis.

Patterns of articular wear in the cadaveric elbow joint.

Thirty-two fixed cadaveric elbow specimens from an elderly population were examined photographically after staining of the articular cartilage. The photographic images of the articular wear areas observed were calibrated and superimposed to determine the overall pattern of articular wear in the elbow. In this group, the radiohumeral compartment showed the most frequent degenerative changes. A pattern of involvement could have been identified, proceeding from the posteromedial region of the radial head and the apex of the capitellum. Eventually, the entire lateral compartment is involved, but in most specimens examined the ulnohumeral and radioulnar articulations are preserved.

Enchondroma of the scaphoid.

Enchondroma is a common benign cartilaginous tumour which arises from the medullary cavity, most commonly in the phalanges of the hands and feet. Enchondroma involving the carpal bones, however, is rare; only three cases of scaphoid enchondromata and one patient with multiple carpal enchondromata have been reported in the English literature. We report the diagnosis and treatment of a case of scaphoid enchondroma presenting as chronic wrist pain after relatively trivial injury.

Sensory and sympathetic innervation of the vertebral endplate in patients with degenerative disc disease.

We obtained intervertebral discs with cartilage endplates and underlying cancellous bone at operation from patients with degenerative disc disease and then used immunohistochemical techniques to localise the nerves and nerve endings in the specimens. We used antibodies for the ubiquitous neuronal protein gene product 9.5 (PGP 9.5). Immunoreactivity to neuropeptide Y was used to identify autonomic nerves and calcitonin gene-related peptide (CGRP) and substance P to identify sensory nerves. Blood vessels were identified by immunoreactivity with platelet-endothelial cell-adhesion molecule (CD31; PECAM). In a control group with no known history of chronic back pain, nerve fibres immunoreactive to PGP 9.5 and neuropeptide Y were most closely related to blood vessels, with occasional substance P and CGRP immunoreactivity. In patients with severe back pain and markedly reduced disc height, proliferation of blood vessels and accompanying nerve fibres was observed in the endplate region and underlying vertebral bodies. Many of these nerves were immunoreactive to substance P or CGRP, and in addition, substance P- and CGRP-immunoreactive nociceptors were seen unrelated to blood vessels. Quantification by image analysis showed a marked increase in CGRP-containing sensory nerve fibres compared with normal control subjects. We speculate that a chemotactic response to products of disc breakdown is responsible for the proliferation of vascularity and CGRP-containing sensory nerves found in the endplate region and vertebral body adjacent to degenerate discs. The neuropeptides substance P and CGRP have potent vasodilatory as well as pain-transmitting effects. The increase in sensory nerve endings suggests increase in blood flow, perhaps as an attempt to augment the nutrition of the degenerate disc. The increase in the density of sensory nerves, and the presence of endplate cartilage defects, strongly suggest that the endplates and vertebral bodies are sources of pain; this may explain the severe pain on movement experienced by some patients with degenerative disc disease.

Human and viral gene detection in routine paraffin embedded tissue by in situ hybridisation with biotinylated probes: viral localisation in herpes encephalitis.

A simple reproducible protocol for detecting multiple copy human genes and viral DNA in routine formalin fixed paraffin embedded tonsil and brain, by in situ hybridisation with biotinylated probes, is described. The protocol consists of digestion of formalin fixed paraffin sections, with 0.4% pepsin in 0.01 M hydrochloric acid for one hour at 37 degrees C, followed by hybridisation with biotinylated probes. The biotinylated probes used for establishing the conditions for in situ localisation of DNA were total placental DNA (TG1), pHY 2.1 (a Y chromosome probe), and herpes simplex virus I and II. In human male tonsil TG1 labelled all nuclei and pHY 2.1 reacted only with nuclear Y bodies. In herpes encephalitis the virus was detected in some glial cells and neurones.