A Pulsed Electrical Joint Stimulator for the Treatment of Osteoarthritis of the Hand and Wrist.

The hand is commonly affected by osteoarthritis (OA). The development and progression of OA are believed to involve inflammation, even in the early stages of the disease. Inflammatory and proinflammatory cytokines have also been shown to be elevated in the flexor tenosynovium of idiopathic carpal tunnel syndrome (CTS). A large percentage of patients with hand OA also have a concomitant CTS. This study evaluated the results of a pulsed electrical joint stimulator in patients who had hand OA with or without CTS. Pain, tenderness, and swelling; grip strength and pinch force; and Patient and Physician Global Assessment and Disabilities of the Arm, Shoulder and Hand (DASH) results were evaluated. The primary efficacy outcome was pain due to OA in the study hand in the past 48 hours. Secondary outcomes consisted of OA pain in the study thumb in the past 48 hours, grip strength, pinch force, and Patient and Physician Global Assessment and DASH results. All 7 outcome parameters improved in OA patients. On physical examination, individual finger and wrist joints had also improved regarding pain, swelling, and tenderness. In the subset of patients with CTS, CTS pain, paresthesia, weakness, and all CTS symptoms had significantly improved. Patient and Physician Global Assessment and DASH results and pinch force were also significantly improved. This pulsed electrical joint stimulator is effective in providing clinically relevant and statistically significant reductions in the signs and symptoms of OA of the hand and CTS. It could be a useful modality for the treatment of patients who have one of these conditions or both. [Orthopedics. 2018; 41(4):e550-e556.].

Cryptococcal immune reconstitution syndrome during steroid withdrawal treated with hydroxychloroquine.

We present a case report of cryptococcal immune reconstitution syndrome (IRS), in a non HIV infected patient, which we treated with hydroxychloroquine with successful results. We briefly review cryptococcal IRS, possible mechanisms of action of hydroxychloroquine as an immunomodulatory agent, and its potential role in management of IRS.

Retropharyngeal calcific tendinitis: case report and review of the literature.

OBJECTIVES: Retropharyngeal calcific tendinitis (RCT) is an under-recognized benign condition that results in significant neck pain and may mimic a retropharyngeal abscess (RPA). We describe the clinical presentation, diagnosis, and treatment of RCT as well as features that differentiate it from RPA. METHODS: We present a case report and analyze the clinical features, diagnosis, and treatment of 71 additional patients with RCT identified through a PubMed literature review between 1964 and early 2008. We then compared these findings with those of RPA. RESULTS: The most common symptoms of RCT at presentation were neck pain (94%), limited range of motion (45%), odynophagia (45%), neck stiffness (42%), dysphagia (27%), sore throat (17%), and neck spasm (11%). Other frequent findings include low-grade fever, mild leukocytosis, and a slightly elevated erythrocyte sedimentation rate. Seventy-five percent of patients with RPA present with similar symptoms and cervical radiographic abnormalities are comparable in the majority of cases with either pathology. CONCLUSIONS: RCT frequently mimics the clinical features of RPA and recognizing the key symptoms and signs of RCT versus RPA can be challenging but important in avoiding unnecessary interventions. We recommend that computed tomography of the neck be considered as a first step in differentiating the 2 conditions. The presence of an amorphous calcification anterior to the C1 and/or C2 vertebral body(s) with a non-ring-enhancing fluid collection in the prevertebral space should be considered highly suspicious for RCT. RCT can be self-limiting and will usually resolve in 2 weeks. Effective treatment typically consists of nonsteroidal anti-inflammatory drugs, steroids, or opiate analgesics.