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1.
Br J Radiol ; 94(1120): 20201389, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33617297

RESUMO

OBJECTIVE: To determine the differential diagnosis of intra-articular tumours and tumour-like lesions in a paediatric population compared to adults. METHODS: Retrospective review of children up to the age of 18 years with suspected intra-articular tumours and tumour-like lesions referred to a specialist musculoskeletal oncology service from January 2019 to August 2020. Data recorded included patient age and gender, lesion location and morphology (based on the classification system of Adams et al.), and the final diagnosis made either by image-guided biopsy/resection or by clinical and imaging features. Comparison was then made with a group of adults presenting during the same period. RESULTS: 28 paediatric patients were included (12 males and 16 females with mean age 11.2 years, range 3-18 years). Joints involved were the knee (n = 22; 78.6%), ankle (n = 4; 14.3%), hip (n = 1; 3.6%) and elbow (n = 1; 3.6%). Lesion morphology was Type 1 (n = 18; 64.3%), Type 2 (n = 3; 10.7%), Type 3 (n = 1; 3.6%) and Type 4 (n = 5; 17.9%). Final diagnosis was made by image-guided biopsy/resection in 18 (64.3%) patients. The commonest neoplastic lesion was tenosynovial giant cell tumour (n = 11; 39.3%), followed by synovial haemangioma (n = 5; 17.9%). There was only a single malignant lesion, a case of synovial sarcoma. Of eight (28.6%) non-neoplastic lesions, three were diagnosed as juvenile idiopathic arthritis and three as non-specific synovitis. There was no difference compared to adults regarding gender, joint involved or lesion morphology, but there was a significant difference in final diagnoses (p < 0.001). The range of intra-articular tumours and tumour-like lesions in children differs from that in adults, although tenosynovial giant cell tumour is the commonest diagnosis in both groups and malignant lesions are rare. ADVANCES IN KNOWLEDGEART: In our series, ~16% of tumours and tumour-like lesions of joints occur in the paediatric population. Tenosynovial giant cell tumour remains the commonest diagnosis in children as in adults. Synovial haemangioma and juvenile idiopathic arthritis were the next commonest diagnoses in children, while primary synovial chondromatosis and reactive synovitis were the next commonest diagnoses in adults. Malignant lesions are rare in both groups.


Assuntos
Artropatias/diagnóstico por imagem , Artropatias/patologia , Imagem por Ressonância Magnética/métodos , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
2.
Oper Orthop Traumatol ; 33(1): 55-76, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33533950

RESUMO

OBJECTIVE: Arthroscopy of the central and peripheral compartment is an obligatory part of hip arthroscopy to evaluate, confirm or find pathologies and their treatment. INDICATIONS: Loose bodies, lesions of the labrum and ligamentum capitis femoris, cartilage damage, femoroacetabular impingement, synovial diseases, initial osteoarthritis, femoral head necrosis (ARCO stage 1-2) and adhesions. CONTRAINDICATIONS: Local infections, bone tumors near the joint, extensive peri-articular ossification, severe arthrofibrosis with peri-articular involvement, advanced osteoarthritis, protrusio acetabuli, advanced femoral head necrosis (from ARCO stage 3-4 extended), recent fracture of the acetabulum and extensive joint capsule tears. SURGICAL TECHNIQUE: Precise positioning of the patient on a fracture table is essential to avoid complications. Central and peripheral compartment arthroscopy requires at least 2, in some cases more than 3 portals. Arthroscopy of the central compartment is carried out under traction by an anterolateral (AL) and anterior portal (A). A posterolateral (PL) portal and distal ventrolateral portal (DVL) may also be required. For peripheral compartment arthroscopy, an anterolateral (AL) and anterior (A), alternatively/additively a proximal ventrolateral portal (PVL) and/or and distal ventrolateral (DVL) portal are established in 45° flexion and no traction of the hip joint. POSTOPERATIVE MANAGEMENT: Mobilization with full weight bearing from the day of the operation, crutches are optional. After stimulating cartilage surgery or autologous chondrocyte transplantation, partial weight bearing of 10 kg on crutches is indicated until the end of postoperative week 6. Physiotherapy with full range of motion allowed, except for labrum refixation, should take place from postoperative day 1. RESULTS: From 01/2010-12/2019, 2815 hip arthroscopies were performed; average patient age 43 (12-81) years. All procedures include a diagnostic arthroscopy of the hip. Two to 5 portals were used. Average operation time was 70 (18-48) min. In 26 cases (0.9%), arthroscopy of the central compartment at a high CE angle was not possible or not performed, even after previous arthroscopy of the peripheral compartment with capsule release. Intraoperative or directly postoperative problems and complications were rare, e.g., damage to the skin/genitals due to contact pressure (0.7%), instrument breakage (0.5%), transient lesions of the pudendus nerve (<1.5%).


Assuntos
Impacto Femoroacetabular , Artropatias , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
3.
AJR Am J Roentgenol ; 216(2): 446, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33356430

RESUMO

OBJECTIVE. The purpose of this video article is to review the dynamic sonographic assessment of snapping hip syndrome. The video focuses on the extraarticular forms of snapping hip and discusses their possible causes, ultrasound features, and treatment options. The dynamic sonographic technique for evaluating snapping hip syndrome is shown with live scanning videos. CONCLUSION. Dynamic ultrasound is well suited for the assessment of snapping hip syndrome and is essential for confirming the clinical diagnosis of the condition.


Assuntos
Articulação do Quadril/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Ultrassonografia , Humanos , Síndrome
4.
Medicine (Baltimore) ; 99(50): e23595, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327323

RESUMO

INTRODUCTION: Lipoma Arborescens is a rare pathology that mainly affects the knee. Occurrences in the elbow are even more uncommon and mainly involve the bicipitoradial bursa. CASE'S DESCRIPTION: We describe the case of a 54-year-old patient known for rheumatoid arthritis, who consulted for chronic elbow pain associated with swelling and limited extension. DIAGNOSIS: The diagnosis of a lipoma arborescens of the elbow involving the whole joint was made using magnetic resonance imaging and confirmed during arthroscopy. INTERVENTIONS: After a failed nonoperative treatment consisting in intra-articular cortisone injections and physiotherapy, the patient underwent arthroscopic synovectomy and arthrolysis. OUTCOME: At 1-year follow-up, he reported no pain, satisfactory range of motion, and major improvements in clinical scores. CONCLUSION: This is the first illustrated case report about lipoma arborescens involving the whole elbow joint. Even though it is a rare disease, awareness of its presentation, imaging patterns, and treatment options is therefore important for clinicians, radiologists, and surgeons. In this case, arthroscopic treatment resulted in satisfactory and long-lasting pain relief and functional results. It may be considered as a safe and effective option in case of failed nonoperative measures.


Assuntos
Artrite Reumatoide , Articulação do Cotovelo , Artropatias/diagnóstico , Lipoma/diagnóstico , Artralgia/etiologia , Artroscopia , Diagnóstico Diferencial , Humanos , Artropatias/complicações , Artropatias/diagnóstico por imagem , Artropatias/cirurgia , Lipoma/complicações , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Sinovectomia
5.
Bone Joint J ; 102-B(10): 1331-1340, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993344

RESUMO

AIMS: Stiffness is a common complication after total knee arthroplasty (TKA). Pathogenesis is not understood, treatment options are limited, and diagnosis is challenging. The aim of this study was to investigate if MRI can be used to visualize intra-articular scarring in patients with stiff, painful knee arthroplasties. METHODS: Well-functioning primary TKAs (n = 11), failed non-fibrotic TKAs (n = 5), and patients with a clinical diagnosis of fibrosis1 (n = 8) underwent an MRI scan with advanced metal suppression (Slice Encoding for Metal Artefact Correction, SEMAC) with gadolinium contrast. Fibrotic tissue (low intensity on T1 and T2, low-moderate post-contrast enhancement) was quantified (presence and tissue thickness) in six compartments: supra/infrapatella, medial/lateral gutters, and posterior medial/lateral. RESULTS: Fibrotic tissue was identified in all patients studied. However, tissue was significantly thicker in fibrotic patients (4.4 mm ± 0.2 mm) versus non-fibrotic (2.5 mm ± 0.4 mm) and normal TKAs (1.9 mm ± 0.2 mm, p = < 0.05). Significant (> 4 mm thick) tissue was seen in 26/48 (54%) of compartments examined in the fibrotic group, compared with 17/30 (57%) non-fibrotic, and 10/66 (15%) normal TKAs. Although revision surgery did improve range of movement (ROM) in all fibrotic patients, clinically significant restriction remained post-surgery. CONCLUSION: Stiff TKAs contain intra-articular fibrotic tissue that is identifiable by MRI. Studies should evaluate whether MRI is useful for surgical planning of debridement, and as a non-invasive measurement tool following interventions for stiffness caused by fibrosis. Revision for stiffness can improve ROM, but outcomes are sub-optimal and new treatments are required. Cite this article: Bone Joint J 2020;102-B(10):1331-1340.


Assuntos
Artroplastia do Joelho , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Imagem por Ressonância Magnética/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Fibrose , Humanos , Aumento da Imagem , Masculino , Metais , Pessoa de Meia-Idade
6.
PLoS One ; 15(8): e0237634, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813729

RESUMO

INTRODUCTION: Subtalar joint (STJ) dysfunction can contribute to movement disturbances. Vibration energy with color Doppler imaging (VECDI) may be useful for detecting STJ stiffness changes. OBJECTIVES: (1) Support proof-of-concept that VECDI could detect STJ stiffness differences; (2) Establish STJ stiffness range in asymptomatic volunteers; (3) Examine relationships between STJ stiffness and foot mobility; and (4) Assess VECDI precision and reliability for examining STJ stiffness. METHODS: After establishing cadaveric testing model proof-of-concept, STJ stiffness (threshold units, ΔTU), ankle complex passive range-of-motion (PROM) and midfoot-width-difference (MFWDiff) data were collected in 28 asymptomatic subjects in vivo. Three reliability measurements were collected per variable; Rater-1 collected on all subjects and rater-2 on the first ten subjects. Subjects were classified into three STJ stiffness groups. RESULTS: Cadaveric VECDI measurement intra-rater reliability was 0.80. A significantly lower STJ ΔTU (p = .002) and ankle complex PROM (p < .001) was observed during the screw fixation versus normal condition. A fair correlation (r = 0.660) was observed between cadaveric ΔTU and ankle complex PROM. In vivo VECDI measurements demonstrated good intra-rater (0.76-0.84) versus poor inter-rater (-3.11) reliability. Significant positive correlations were found between STJ stiffness and both dorsum (r = .440) and posterior (r = .390) PROM. MFWDiff exhibited poor relationships with stiffness (r = .103) and either dorsum (r = .256) or posterior (r = .301) PROM. STJ stiffness ranged from 2.33 to 7.50 ΔTUs, categorizing subjects' STJ stiffness as increased (n = 6), normal (n = 15), or decreased (n = 7). Significant ANOVA main effects for classification were found based on ΔTU (p< .001), dorsum PROM (p = .017), and posterior PROM (p = .036). Post-hoc tests revealed significant: (1) ΔTU differences between all stiffness groups (p < .001); (2) dorsum PROM differences between the increased versus normal (p = .044) and decreased (p = .017) stiffness groups; and (3) posterior PROM differences between the increased versus decreased stiffness groups (p = .044). A good relationship was found between STJ stiffness and dorsum PROM in the increased stiffness group (r = .853) versus poor, nonsignificant relationships in the normal (r = -.042) or decreased stiffness (r = -.014) groups. CONCLUSION: PROM may not clinically explain all aspects of joint mobility. Joint VECDI stiffness assessment should be considered as a complimentary measurement technique.


Assuntos
Pé/fisiopatologia , Artropatias/fisiopatologia , Articulação Talocalcânea/fisiopatologia , Ultrassonografia Doppler em Cores/métodos , Adulto , Fenômenos Biomecânicos , Feminino , Pé/diagnóstico por imagem , Humanos , Artropatias/diagnóstico por imagem , Masculino , Movimento , Estudo de Prova de Conceito , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Articulação Talocalcânea/diagnóstico por imagem , Vibração , Adulto Jovem
7.
AJR Am J Roentgenol ; 215(3): 545-558, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32507017

RESUMO

OBJECTIVE. The purpose of this study is to clarify which imaging parameters of patellofemoral maltracking are associated with superolateral Hoffa fat pad (SHFP) edema. MATERIALS AND METHODS. A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed to identify studies evaluating the relationship between SHFP edema and patellofemoral maltracking. Parameters for assessing patellofemoral maltracking on MRI were reviewed for each study. Two reviewers performed study selection, methodologic quality assessment, and data extraction. RESULTS. Nine studies were eligible for inclusion in the present study. From the included studies, nine parameters assessing patellofemoral maltracking were analyzed: lateral patellofemoral angle, patellar tilt, patellar lateralization, trochlear depth, sulcus depth, sulcus angle, lateral trochlear inclination, distance between the tibial tuberosity and trochlear groove, and the Insall-Salvati ratio. Patients with SHFP edema had greater patellar tilt (standardized mean difference, 0.89°; 95% CI, 0.38-1.40°; p = 0.0006), greater patellar lateralization (standardized mean difference, 0.78 mm; 95% CI, 0.21-1.36 mm; p = 0.008), greater distance between the tibial tuberosity and trochlear groove (standardized mean difference, 0.96 mm; 95% CI, 0.48-1.44 mm; p < 0.0001), and higher Insall-Salvati ratio (standardized mean difference, 1.94; 95% CI, 1.29-2.60; p < 0.00001) than patients without SHFP edema. CONCLUSION. Patellofemoral maltracking imaging parameters, such as a more laterally displaced patella, greater TTTG distance, and patella alta, are correlated with SHFP edema.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Doenças do Tecido Conjuntivo/diagnóstico por imagem , Edema/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/fisiopatologia , Tecido Adiposo/fisiopatologia , Doenças do Tecido Conjuntivo/fisiopatologia , Edema/fisiopatologia , Humanos , Artropatias/fisiopatologia
8.
Zhonghua Wai Ke Za Zhi ; 58(6): 435-440, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32498482

RESUMO

Objective: To investigate the sagittal and torsional changes in the tibia after a medial open wedge high tibial osteotomy (OWHTO) and their correlation with the corrective angle of proximal tibial coronal plane. Methods: A prospective analysis was conducted on patients who underwent OWHTO at Department of Orthopaedic Surgery, Beijing Chaoyang Emergency Medical Center from March 2019 to July 2019.The operation were performed by the same surgeon. X-ray and CT were performed before and 3 days after the operation. The mechanical axis angle (mFTA), medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and tibial torsion angle (TTA) were measured and compared by paired t-test. Pearson correlation coefficient was used to analyze the correlation between the changes of PTS and TTA and the correction angle of MPTA. Results: A total of 13 patients (19 knees) were recruited. There were 9 males (13 knees) and 4 females (6 knees), aged (39.4±14.4) years (range:20 to 60 years). The mFTA improved from (8.1±2.8) degrees preoperatively to (-1.4±1.6) degrees postoperatively (t=14.819, P=0.000). The MPTA was changed from (81.1±2.4) degrees pre-operatively to (90.4±3.4) degrees postoperatively (t=-15.579, P=0.000). The PTS decreased from (79.6±3.2) degrees to (76.8±3.1) degrees (t=9.709, P=0.000). The differences of mFTA, MPTA and PTS were statistically significant. There was no significant difference in TTA between before and after operation ((28.2±1.5) ° vs. (27.3±6.3) °,t=1.925, P=0.070). There was no correlation between the correction angle of MPTA and the change of PTS and TTA (r=0.384, P=0.105; r=0.321, P=0.181). Conclusions: Even if the intra-operative measures were used to control tibial slope, the PTS still increased significantly after OWHTO, while the TTA has no significant change. No correlation was seen between the change of sagittal and torsional and the corrective angle of proximal tibial coronal plane.


Assuntos
Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Osteotomia/métodos , Tíbia/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Adulto , Feminino , Humanos , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Período Pós-Operatório , Estudos Prospectivos , Tíbia/cirurgia , Anormalidade Torcional/etiologia , Adulto Jovem
9.
Orthop Clin North Am ; 51(3): 383-389, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498957

RESUMO

Traditionally, total shoulder arthroplasty is performed through the deltopectoral approach with violation of the subscapularis tendon. In order to reduce the incidence of postoperative subscapularis dysfunction, the subscapularis-sparing approach, performed entirely through the rotator interval, was developed. This technique allows earlier rehabilitation and may potentially prevent subsequent subscapularis insufficiency and clinical failures.


Assuntos
Artroplastia do Ombro/métodos , Artropatias/cirurgia , Articulação do Ombro/cirurgia , Artroplastia do Ombro/reabilitação , Humanos , Artropatias/diagnóstico por imagem , Manguito Rotador/cirurgia , Articulação do Ombro/diagnóstico por imagem
10.
Acta Vet Scand ; 62(1): 19, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398017

RESUMO

BACKGROUND: English bulldogs are known to be prone to skeletal problems, but knowledge is lacking of the effect of these problems on locomotion and function. This study was undertaken to report the conformational, orthopaedic and radiographic findings in a cohort of English bulldogs in Finland and to evaluate how these findings affect weight bearing and locomotion of the dogs. Twenty-eight English bulldogs were prospectively recruited to this cross-sectional study. An orthopaedic examination, measurements of conformation, static and dynamic weight bearing, and radiographic examinations of elbow, hip, stifle joints and spine were done. RESULTS: The English bulldogs carried a mean of 67.3% and 62.1% of their body weight in front limbs while standing and trotting, respectively. Front and hind limb lameness was seen in 20.8% (5/24) and 12.5% (3/24) of dogs, respectively. At orthopaedic examination, abnormal palpation findings (i.e. pain response, crepitation, swelling or subjectively decreased range of motion) were observed in a median of one joint (range 0-5) in each dog. Medial patellar luxation was diagnosed in 33.0% (8/24) of the evaluated dogs. At radiographic examination, elbow dysplasia was diagnosed in 48.2% (27/56) of elbow joints and severe hip dysplasia in 55.4% (31/56) of hip joints. The grade of elbow dysplasia was negatively associated with the ratio of static weight bearing between the front and hind limbs (slope estimate - 1.46, 95% CI - 2.75 to - 0.16, P = 0.03) and in dynamic weight bearing the ratio of total pressure index between the front and hind limbs (slope estimate - 0.088, 95% CI - 0.164 to 0.025, P = 0.03). The severity of hip dysplasia or hip osteoarthritis was not associated with the amount of static or dynamic weight bearing, but all except one dog were diagnosed with Fédération Cynologique Internationale grade C, D or E hips (dysplastic). In the spine, 78.6% (22/28) of the dogs had at least one malformed vertebra. CONCLUSIONS: Orthopaedic diseases and abnormal radiographic findings were common in the English bulldogs studied. The static weight bearing of the dogs was heavily distributed to the front limbs. With increasing severity of elbow dysplasia, the static and dynamic weight bearing shifted from dysplastic elbows to hind limbs.


Assuntos
Doenças do Cão/diagnóstico por imagem , Artropatias/veterinária , Locomoção , Suporte de Carga , Animais , Estudos Transversais , Cães , Feminino , Finlândia , Marcha , Artropatias/complicações , Artropatias/diagnóstico por imagem , Coxeadura Animal/complicações , Coxeadura Animal/diagnóstico por imagem , Masculino , Radiografia
11.
Clin Podiatr Med Surg ; 37(3): 489-504, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32471614

RESUMO

Revision surgery for failed total ankle replacement is a challenge to the revision surgeon. Deformity, presence of infection, segmental bone defects, patient comorbidities, and soft tissue compromise all are significant considerations when determining appropriate procedures. Revision total ankle replacement, explant and fusion with or without lengthening, use of a trabecular metal cage, placement of an antibiotic cement spacer, grafting, and amputation all are viable options to treat patients with failed ankle arthroplasty.


Assuntos
Articulação do Tornozelo/cirurgia , Artroplastia de Substituição do Tornozelo/efeitos adversos , Artropatias/cirurgia , Amputação , Artrodese , Remoção de Dispositivo , Feminino , Humanos , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Pessoa de Meia-Idade , Seleção de Pacientes , Reoperação , Falha de Tratamento
12.
FP Essent ; 491: 27-32, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32315146

RESUMO

The clavicle is the most commonly fractured bone, and the most frequently fractured part of the clavicle is the middle third (ie, midshaft). X-ray usually is the first-line imaging modality for clavicle injuries. Conservative management is preferred for patients with uncomplicated and nondisplaced clavicular fractures. Typically, immobilization should last 4 weeks, then range-of-motion exercises should begin after 4 weeks, with full return to activities by 12 weeks. Distal clavicle osteolysis is a relatively uncommon pathologic bone resorption that occurs with repetitive overhead activities. Conservative management includes activity modification, nonsteroidal anti-inflammatory drugs, and injection. Surgical options also are available. Acute acromioclavicular (AC) joint injuries usually are the result of a direct blow to the superolateral shoulder with the humerus in adduction. The Rockwood classification system of AC joint injuries describes types I to VI, classified by the ligaments injured and degree of displacement. Low-grade AC joint injuries (ie, types I to III) typically can be managed nonsurgically, whereas high-grade injuries are managed with surgery. Osteoarthrosis of the AC joint manifests similarly to distal clavicle osteolysis and may be posttraumatic or idiopathic. Osteoarthrosis typically is managed with activity modification, nonsteroidal anti-inflammatory drugs, and injections but also may be managed surgically.


Assuntos
Articulação Acromioclavicular , Fraturas Ósseas , Artropatias , Articulação Acromioclavicular/diagnóstico por imagem , Clavícula , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/terapia , Ombro
13.
J Clin Ultrasound ; 48(6): 346-349, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32329518

RESUMO

Snapping hip syndrome, or coxa saltans, can result in significant clinical manifestations in patients including pain and limited mobility. A variety of both intra- and extra-articular pathologies have been implicated in snapping hip, including an anatomic variant known as the bifid iliopsoas tendon which has been briefly described in the literature. We report a case of a bifid iliopsoas tendon leading to internal snapping hip syndrome which was ultimately successfully treated with surgical release, including review of the clinical presentation, pathophysiology, and dynamic sonographic findings.


Assuntos
Articulação do Quadril/patologia , Artropatias/patologia , Tendões/patologia , Adulto , Artroscopia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Artropatias/cirurgia , Masculino , Dor/etiologia , Tendões/diagnóstico por imagem , Tendões/cirurgia , Resultado do Tratamento , Adulto Jovem
14.
Medicine (Baltimore) ; 99(15): e19806, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282746

RESUMO

RATIONALE: Acute lymphoblastic leukemia (ALL) has acute and severe onset characterized by fever, moderate to severe anemia, bone and joint pain, and sternal tenderness. It is easy to be misdiagnosed as rheumatic disease when joint pain is the first symptom. PATIENT CONCERNS: A male Han, 18 years of age was admitted on July 15th, 2016 for multi-joint swelling and pain with intermittent fever for half a year which had aggravated in the last 10 days. DIAGNOSIS: Based on symptoms, imaging, family history, and blood tests, he was first diagnosed with ankylosing spondylitis, but he was refractory to treatment. Bone marrow biopsy then revealed acute B-lymphoblastic leukemia (possibility Pro-B-ALL). INTERVENTIONS: The patient was transferred to the hematology department on July 23rd, 2016 for chemotherapy. OUTCOMES: No joint pain occurred during follow-up, which ended on November 4th, 2018. LESSONS: ALL may present with symptoms suggestive of rheumatic diseases like ankylosing spondylitis. Physicians should be aware of this possibility, especially in young patients.


Assuntos
Artralgia/etiologia , Leucemia Linfocítica Crônica de Células B/patologia , Espondilite Anquilosante/diagnóstico , Adolescente , Antineoplásicos/uso terapêutico , Artralgia/diagnóstico , Biópsia , Medula Óssea/patologia , Diagnóstico Diferencial , Erros de Diagnóstico , Febre/diagnóstico , Febre/etiologia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/patologia , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Masculino , Espondilite Anquilosante/sangue , Espondilite Anquilosante/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
15.
Reumatol. clín. (Barc.) ; 16(2,pt.1): 122-124, mar.-abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194332

RESUMO

Se expone el caso clínico de un paciente varón de 64 años con hemocromatosis (homocigoto C282Y) y artropatía microcristalina mostrando las características radiológicas más comunes que se encuentran en este trastorno metabólico y las diferencias que pueden existir al compararla con otros procesos degenerativos primarios u otras patologías inflamatorias


I present a clinical case of a 64-year-old male patient with hemochromatosis (homozygous C282Y) and crystal induced arthropathy showing the most common radiological features found in this metabolic disorder and the differences that may exist when compared to other primary degenerative processes or other inflammatory pathologies


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Artroplastia/métodos , Hemocromatose/complicações , Hemocromatose/genética , Homozigoto , Hormônio Foliculoestimulante/genética , Diagnóstico Diferencial , Tenossinovite/complicações , Tenossinovite/genética , Transferrinas/genética , Artropatias/diagnóstico por imagem , Artroplastia Subcondral/métodos , Condrocalcinose/diagnóstico por imagem
16.
Reumatol. clín. (Barc.) ; 16(2,pt.2): 177-179, mar.-abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194344

RESUMO

En los apicultores se ha descrito una artropatía inflamatoria de etiología desconocida pero relacionada con su actividad profesional. Se expone el caso de un apicultor que tras la picadura de abeja presentó una artritis de la articulación interfalángica del primer dedo de la mano izquierda. Aunque el curso clínico subagudo y los hallazgos de la RMN obligaban a plantear el diagnóstico diferencial con un proceso infeccioso, el resto de pruebas analíticas, de imagen y la evolución, junto al antecedente de episodio similar unos años antes en un dedo de otra mano tras la picadura de abeja, permitió el diagnóstico de esta entidad


An acute inflammatory arthritis of unknown cause has been described in beekeepers in relation to their work with the hives. We present the case of a beekeeper who, after a bee sting, developed arthritis of the interphalangeal joint of the first finger of his left hand. Although the subacute clinical course and the magnetic resonance imaging findings required the differential diagnosis with an infectious process, the rest of the laboratory tests. other imaging studies and the course, together with a history of a similar episode a few years earlier on a finger of the other hand after a bee sting, enabled us to diagnosis this condition


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Abelhas , Mordeduras e Picadas de Insetos/complicações , Anti-Inflamatórios não Esteroides/administração & dosagem , Artrite/complicações , Articulação da Mão/diagnóstico por imagem , Articulação da Mão/patologia , Antibacterianos/uso terapêutico , Manejo da Dor , Diagnóstico Diferencial
17.
Phys Ther ; 100(6): 917-932, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32128572

RESUMO

BACKGROUND: Physical therapy and surgery are viable treatment options for nonarthritic hip disease (NAHD). Interdisciplinary collaboration can help patients make informed treatment decisions. Understanding how each provider can contribute is a critical first step in developing collaborative evaluation efforts. OBJECTIVE: The objective of this study was to describe the current evaluation of NAHD by both physical therapists and physicians, and evaluate national use of expert-recommended evaluation guidelines. DESIGN: A national survey study distributed in the United States was implemented to accomplish the objective. METHODS: A survey was distributed to 25,027 potential physical therapist and physician respondents. Respondents detailed their evaluation content for patients with NAHD across the following domains: patient-reported outcomes, patient history, special tests, movement assessment, clinical tests, and imaging. Respondents ranked importance of each domain using a 5-point Likert scale (not important, slightly important, important, very important, or extremely important). Odds ratios (ORs [95% CIs]) were calculated to identify the odds that physical therapists, compared with physicians, would report each evaluation domain as at least very important. Fisher exact tests were performed to identify statistically significant ORs. RESULTS: Nine hundred and fourteen participants (3.6%) completed the survey. Physical therapists were more likely to indicate movement assessment (OR: 4.23 [2.99-6.02]) and patient-reported outcomes (OR: 2.56 [1.67-3.99]) as at least very important for determining a diagnosis and plan of care. Physical therapists had lower odds of rating imaging (OR: 0.09 [0.06-0.14]) and special tests (OR: 0.72 [0.53-0.98]) as at least very important compared with physicians. LIMITATIONS: This survey study did not include many orthopedic surgeons and thus, primarily represents evaluation practices of physical therapists and nonsurgical physicians. CONCLUSIONS: Physical therapists were more likely to consider movement assessment very important for the evaluation of patients with NAHD, whereas physicians were more likely to consider imaging and special testing very important.


Assuntos
Articulação do Quadril , Artropatias/diagnóstico , Ortopedia , Fisioterapeutas , Medicina Esportiva , Competência Clínica , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Articulação do Quadril/diagnóstico por imagem , Humanos , Artropatias/diagnóstico por imagem , Anamnese , Movimento , Razão de Chances , Ortopedia/educação , Ortopedia/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Exame Físico/métodos , Fisioterapeutas/educação , Fisioterapeutas/estatística & dados numéricos , Projetos Piloto , Medicina Esportiva/educação , Medicina Esportiva/estatística & dados numéricos , Estados Unidos
18.
Vet Radiol Ultrasound ; 61(3): 329-335, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32141167

RESUMO

Elbow incongruity is a form of elbow dysplasia that causes osteoarthritis, pain, and lameness, and it is common in chondrodystrophic dog breeds. The objective of this retrospective secondary analysis study was to evaluate the intra- and interobserver repeatability of a novel radiographic incongruity grading system for assessing elbow incongruity in three chondrodystrophic dog breeds-the dachshund, Skye Terrier, and Glen of Imaal Terrier. We conducted an observer agreement study that included 220 mediolateral antebrachial radiographs from 110 dogs with the elbow in 90° flexion. The radiographs were independently assessed by three observers at three time points, using a four-stepped grading scale. The proportion of agreement and Kappa coefficient were calculated. Both the intra- and interobserver proportions of agreement were substantial when three grades were required to be identical (.705-.777 and .609, respectively), and almost perfect for two identical grades (.991-1.000 and .991, respectively). Some differences in repeatability between breeds were noted; specifically, the intraobserver repeatability was higher in the dachshund, and the interobserver repeatability was lower in the Glen of Imaal Terrier. Our study showed that the radiographic imaging protocol and incongruity grading system have high repeatability when assessing elbow incongruity in chondrodystrophic dog breeds.


Assuntos
Doenças do Cão/diagnóstico por imagem , Membro Anterior/diagnóstico por imagem , Artropatias/veterinária , Radiografia/veterinária , Animais , Cães , Membro Anterior/patologia , Artropatias/diagnóstico por imagem , Variações Dependentes do Observador , Radiografia/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos
19.
Vet Radiol Ultrasound ; 61(3): 336-345, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32162431

RESUMO

Foot pain is a common presenting complaint in Warmblood horses. The aim of this retrospective, cross-sectional study was to determine the spectrum of foot lesions detected by magnetic resonance imaging (MRI) in Warmblood horses used for dressage, jumping, and eventing. The medical records of 550 Warmblood horses with foot pain that were scanned using standing MRI were reviewed and the following data were recorded: signalment, occupation, lameness, diagnostic analgesia, imaging results, treatments, and follow-up assessments. Associations between standing MRI lesions and chronic lameness following treatment were tested. Abnormalities of the navicular bone (409 horses, 74%), distal interphalangeal joint (362 horses, 65%), and deep digital flexor (DDF) tendon (260 horses, 47%) occurred with the highest frequency. The following abnormalities were significantly associated (P < .05) with chronic lameness following conservative therapy: moderate to severe MRI lesions in the trabecular bone of the navicular bone, mild or severe erosions of the flexor surface of the navicular bone, moderate sagittal/parasagittal DDF tendinopathies, and moderate collateral sesamoidean desmopathies. Also, identification of concurrent lesions of the DDF tendon, navicular bone, navicular bursa, and distal sesamoidean impar ligament was associated with chronic lameness after conservative therapy. Development of effective treatment options for foot lesions that respond poorly to conservative therapy is necessary.


Assuntos
Doenças do Pé/veterinária , Doenças dos Cavalos/diagnóstico por imagem , Artropatias/veterinária , Imagem por Ressonância Magnética/veterinária , Animais , Bolsa Sinovial , Estudos Transversais , Doenças do Pé/diagnóstico por imagem , Membro Anterior/diagnóstico por imagem , Cavalos , Artropatias/diagnóstico por imagem , Artropatias/patologia , Ligamentos/diagnóstico por imagem , Ligamentos/patologia , Dor/veterinária , Estudos Retrospectivos , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/patologia , Tendões/diagnóstico por imagem , Tendões/patologia
20.
Knee ; 27(3): 930-933, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32089394

RESUMO

BACKGROUND: To investigate the morphological changes in the tibiofibular joint following open wedge high tibial osteotomy (OWHTO). METHODS: We studied 397 joints in 341 patients. Standing femorotibial angle (FTA), %mechanical axis (%MA), corrected tibial angle, distance (D) to tibial joint surface (T) and fibular head (F) and angle (A; proximal, distal), proximal tibiofibular joint (PTFJ) osteoarthritis (OA) onset, and tibiofibular joint-related complications were the parameters assessed. RESULTS: FTA improved from 181.1° to 168.8° and %MA from 28.7 to 68.7, whereas the mean tibia corrected angle was 10.4°. Proximal TFD changed from 9.4 mm preoperatively to 7.8 mm during the investigation. The fibular head was displaced 1.6 mm upwards, and proximal tibial femoral angle (TFA) moved approximately 10° in the valgus direction from 82.5° to 92.4°. However, no significant changes were noted for the distal TFD or TFA. PTFJ OA was observed in 57 cases (14.7%), and lateroposterior knee pain in 11 cases (2.8%). Additional resection of the fibula was performed in cases with marked pain. CONCLUSIONS: With OWHTO, increased load is placed on the PTFJ postoperatively. In rare cases, this can cause pain and is therefore a complication that physicians should be aware of.


Assuntos
Fíbula/cirurgia , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Osteotomia/efeitos adversos , Tíbia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fíbula/diagnóstico por imagem , Fíbula/patologia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Artropatias/patologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Tíbia/diagnóstico por imagem , Tíbia/patologia , Adulto Jovem
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