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PubMed2004

Diagnostic value of magnetic resonance imaging of the forefeet in early rheumatoid arthritis when findings on imaging of the metacarpophalangeal joints of the hands remain normal.

OBJECTIVE: To investigate the diagnostic role of magnetic resonance imaging (MRI) of the forefeet in patients with early rheumatoid arthritis (RA) in whom findings on MR images of the hands are normal and conventional radiographs of the hands and feet do not show erosions. METHODS: The study group comprised 25 patients with early RA (disease duration of <12 months) in whom erosions were not demonstrated on conventional radiographs of the hands and feet. These patients underwent MRI of the clinically dominant hand to detect signs of arthritis. If results of MRI of the hand were normal according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA-MRI scoring system (RAMRIS), MRI of the dominant forefoot was performed. The MRI protocol comprised coronal and sagittal T1-weighted spin-echo (before and after administration of contrast medium), coronal fat-suppressed short tau inversion recovery sequences, coronal and sagittal T2-weighted turbo spin-echo sequences, and axial fat-suppressed T1-weighted spin-echo sequences after administration of contrast medium. MRI of the forefeet was analyzed on the basis of a modified RAMRIS. RESULTS: MRI revealed pathologic findings in the hands of 15 of 25 patients (edema in 9 patients, synovitis in 12, erosions in 6, defects in 3). In 10 patients with a mean disease duration of 9.4 weeks, hand MRI scans were normal according to RAMRIS. Four of these 10 patients had tenosynovitis of the finger flexor tendons (there was no OMERACT criterion for tenosynovitis). RAMRIS analysis of the corresponding MRI scans of the forefeet of these patients revealed signs of edema in 7 patients, synovitis in all 10 patients (at the third metatarsophalangeal [MTP] joint in 7, at the fourth MTP joint in 6, at the first MTP joint in 4, and at the fifth MTP joint in 2 patients), tenosynovitis of the foot flexor tendons in 2 patients, erosions at the second and third MTP joints in 1 patient, and a single defect at the first MTP joint in 1 patient. CONCLUSION: RAMRIS analysis of MRI scans of the forefeet detected synovitis and bone edema in patients with early RA in whom MRI of the finger joints was normal. MRI of the forefeet contributes an additional tool aimed at earlier and more accurate diagnosis and thus might allow an earlier decision to start appropriate medication in patients with early RA.

Adult↗

PubMed2005

Role of toe flexor tendoscopy in management of an unusual cause of metatarsalgia.

The purpose of this study is to describe an endoscopic approach to toe flexor tendons at the level of metatarsal head region. And this study is a kind of retrospective case series. Three patients with toe flexor tenosynovitis were evaluated after a follow-up of 2 years after toe flexor tendoscopy. One patient suffered from infective toe flexor tendosynovitis resulting from a penetrating injury and other two patients suffered from idiopathic focal toe flexor tenosynovitis. Pre-operative metatarsalgia subsided after toe flexor tendoscopy. No endoscopy-related complication was observed. Toe flexor tendoscopy can be an effective operative means in the management of focal toe flexor tenosynovitis.

Adult↗

PubMed2002

[Technique and value of arthrosonography in rheumatologic diagnosis--3: Ultrasound diagnosis of the ankle joint, foot and toes].

The clinical investigation of ankles, feet, and toes is frequently equivocal in rheumatology. Sonography can distinguish between underlying pathologies. We suggest following standard scans: 1) anterior longitudinal scan to diagnose effusions in the ankle and talonavicular joints, to display erosive and osteoarthrotic pathologies, and to diagnose tenosynovitis of the extensor tendons; 2) anterior transverse scan to document the findings in an additional dimension; 3) lateral transverse scan and 4) lateral longitudinal scan to diagnose tenosynovitis of the peroneus tendons; 5) medial transverse scan and 6) medial longitudinal scan to diagnose tenosynovitis of the flexor tendons; 7) posterior longitudinal scan and 8) posterior transverse scan to evaluate the Achilles tendon, the retrocalcaneal bursa, and the posterior recess of the ankle joint. Additionally we suggest optional scans: 9) plantar longitudinal scan for the plantar fascia and the plantar calcaneal surface; 10) distal anterior longitudinal scan to evaluate the midtalar joints; 11) distal anterior longitudinal scan to evaluate the toes; and 12) plantar, distal transverse scan to evaluate the flexor tendons of the toes. Additionally, the correlating longitudinal and transverse scans can be used to confirm the findings. The frequency of the transducer should be about 7.5 MHz for ankles and the peroneus, flexor, and extensor tendons. Ten to over 20 MHz are possible for more superficially located structures. Using modern equipment with higher resolution a hypoechoic border may be normal up to 3 mm in the ankle joints, the MTP joints, and around the peroneus tendons, and up to 4 mm around the tibialis posterior tendons.

Ankle Joint↗

PubMedDate not supplied

Catheter irrigation for treatment of pyogenic closed space infections of the hand.

We studied 29 patients admitted to San Francisco General Hospital with flexor tenosynovitis (6 patients), pyogenic arthritis (17 patients), and deep space infections (6 patients). All patients underwent catheter irrigation of the infected space for at least 48 hours postoperatively. In 23 patients no further operative procedures were required. Infection was controlled without amputation in all patients. Median hospital stay was the same for patients with tenosynovitis, pyogenic arthritis, and deep space infections (8 days). Thirteen of 17 patients followed for at least one month, including 7 of 9 patients with pyogenic arthritis, were found to have regained at least 50% of baseline motion. In this series the outcome of treatment for pyogenic arthritis was comparable to that for tenosynovitis. We believe that catheter irrigation should be considered as a treatment option in pyogenic arthritis. A prospective trial comparing the efficacy of treatment modalities for pyogenic arthritis is indicated.

Adolescent↗

PubMed1994

A comparison of single and repeated oral infection of chicks with two avian reoviruses.

Groups of specific pathogen-free light hybrid chicks were inoculated with one dose or repeated doses on alternate days of avian reovirus strain R2 isolated from tenosynovitis, or strain 49/82, isolated from infectious stunting. Strain 49/82 induced significant reductions in weight gain after infection by either method, as did strain R2 after repeated doses. Neither virus induced clinical signs or gross lesions of stunting or tenosynovitis in the five weeks of observation. Both viruses and methods of infection induced similar microscopic changes of reovirus tenosynovitis in the hock joints. Repeated doses caused a more prolonged persistence of virus in the intestine than a single dose. Cloacal swabbing indicated that strain 49/82 was more persistent in the gut after repeated doses than virus R2. For both strains, the persistence of virus in the liver was short-lived and the proportions of birds with virus in the hock joints were similar after both methods of infection. Repeated inoculations did not exacerbate the joint lesions or heighten the neutralising antibody response. However, for certain studies of reovirus infections, repeated inoculations with the virus may give a more accurate simulation of a natural infection.

Animals↗

PubMed2005

[The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease].

The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease. The De Quervain tenosynovitis is an inadequacy into the first extensor compartment between the osteo-fibrous tunnel and the tendons. This mechanical conflict generates a tenosynovitis of the extensor pollicis brevis and the abductor pollicis longus tendons. This is generally expressed by a tenderness on the radial side of the wrist over the radial styloid process. The medical management consists on corticoids infiltrations of the first extensor compartment, the avoidance of repetitive and stress movements of the first ray with the use of a rest splint. The surgical approach is considered with the recurrence of the painful symptoms. This well-known pathology is reputated to require a simple section of the pulley. Our post-operative complications have been reported in the literature of this classical surgical solution. These complications concern an incomplete release of the extensor pollicis brevis and the abductor pollicis longus tendons particularly when an extensor sub-compartment exists and was overlooked, an irritation of the collateral branches of the sensitive radial nerve or the occurrence of a nevroma after a nerve injury and the most serious complication is a palmar subluxation of the extensor tendons which can occur with the thumb extended and the wrist flexed. In rare cases, this subluxation can be really painful and requires a surgical management with secondary reconstruction of the pulley. This reconstruction necessitates distal pedicle flaps from the dorsal retinaculum or the brachioradialis tendon. To prevent these complications, Codega and Kapandji described techniques of reconstruction of the pulley after its release. More recently, Le Viet reported a procedure using the anterior flap of the pulley; fixed to the dermis it will work as a barrier and maintain the tendons sliding on the radial styloid groove. These techniques require to divide the pulley and to reconstruct it suturing the different flaps. It can generate adherences between the extensor tendons, the overlying skin and the collateral branches of the radial nerve. The authors present a new and original plasty procedure of the first extensor compartment pulley, the "Omega" Omega plasty. It consists to liberate the anterior attachment of the pulley over the anterior lip of the styloïd process respecting its continuity with the periosteum flap. This conservative procedure is very interesting; it permits enough expansion of the tunnel volume decompressing the extensor tendons as a treatment of the De Quervain disease and respecting the anatomy and the continuity of the osteo-fibrous tunnel. This technique is simple, reliable and respects the first ray extensor tendons gliding physiology and biodynamic. In spite of our short clinical experience with only ten cases, all the patients retrieve a normal function of the thumb with complete disappearance of the first ray tenderness and pain without any complications. These preliminary results are encouraging and push us to consider the "Omega" plasty as a first choice for the surgical treatment of the De Quervain tenosynovitis.

Humans↗

PubMed2004

The accuracy of high-resolution ultrasound for evaluating focal lesions of the hand and wrist.

PURPOSE: Although several articles have described the sonographic features of solid and cystic lesions of the hand and wrist, few have investigated its accuracy for diagnosing such lesions. The purposes of this retrospective study were to determine the accuracy of sonography for diagnosing focal lesions of the hand and wrist against the standard of histologic examination of the resected specimen and to compare the accuracy of sonography against the recorded initial clinical impression. METHODS: A medical record search for all sonographic studies of the hand and wrist at our institution was performed. Eighty-four patients had correlative surgery and made up the study group. All sonogram reports were reviewed for the absence or presence of focal lesions and specific diagnoses and all medical records were reviewed for the initial clinical impression. Both were compared with histologic findings and tested for agreement with the kappa statistic and for significant differences with the McNemar test RESULTS: Seventy-six of the 84 patients had focal lesions of the hand and wrist and 8 had normal sonograms. Overall, ultrasound correctly diagnosed 83% of the lesions and the initial clinical impression was correct in 54%. Of the 76 lesions ultrasound correctly diagnosed 87% of cystic lesions, 73% of solid lesions, 75% of tenosynovitis cases and the single-vessel thrombosis. The initial clinical impression was correct in 67% of cystic lesions and 75% of tenosynovitis cases. The solid or cystic nature of the 15 solid lesions and the single-vessel thrombosis could not be determined by history or physical examination alone. Of the 35 cases in which the recorded clinical impression was incorrect or not recorded ultrasound provided the correct diagnoses in 71% of these cases. Agreement with the kappa statistical analysis was only fair and the recorded initial clinical impression was less accurate than ultrasound. CONCLUSIONS: Ultrasound was statistically more accurate than the initial clinical impression for distinguishing solid from cystic lesions of the hand and wrist. Ultrasound was very accurate for specifically diagnosing ganglions and slightly less for solid lesions and tenosynovitis.

Adolescent↗

PubMed2000

Mycobacterium terrae: case reports, literature review, and in vitro antibiotic susceptibility testing.

Mycobacterium terrae infection can cause debilitating disease that is relatively resistant to antibiotic therapy. Two cases are presented, and data from an additional 52 reports from the literature are reviewed. Tenosynovitis of the upper extremity, often following trauma, was the most commonly reported presentation (59% of cases), with pulmonary disease occurring in an additional 26% of cases. Underlying medical problems were absent (44%) or not reported (28%) in 72% of the cases. One-half of the patients with upper extremity tenosynovitis were treated with local or systemic corticosteroids, before microbiological identification. Only one-half of the patients with tenosynovitis who were followed up for 6 months had clinical improvement or were cured. The other one-half of the patients required repeated debridement, tendon extirpation, or amputation. The best antimicrobial therapy for M. terrae infection is unknown but might include a macrolide antibiotic plus ethambutol and one other effective drug for at least 12 months after clinical response. Parenteral treatment with an aminoglycoside and surgery may be useful in selected cases.

Adult↗

PubMedDate not supplied

Potential MR signs of recurrent carpal tunnel syndrome: initial experience.

OBJECTIVE: In nonoperated patients, the MR diagnosis of carpal tunnel syndrome (CTS) is difficult. In the postoperative patient this difficulty is compounded. Consequently, we sought to evaluate for potential MR signs of postoperative CTS. METHODS: At 1.5 T, 41 wrists in 37 patients with previous CTS release were evaluated by two observers for 1) flexor retinacular regrowth; 2) median nerve: a) high T2 signal, b) proximal enlargement, c) fibrous fixation, d) neuroma, and e) entrapment; 3) flexor tenosynovitis; 4) mass, bursitis, accessory muscle, distal belly progression, or excessive deep fat; 5) hamate fracture; and 6) volar nerve migration. Electromyography (EMG), operative findings, and clinical follow-up were used to determine the presence of recurrent CTS. RESULTS: Fifteen of 41 wrists had recurrent CTS. Retinacular regrowth was seen in 4/15 (27%) with and 7/26 (27%) without recurrent CTS (P=0.7). Excessive fat was seen in 1/15 (7%) with and 2/26 (8%) without CTS (P=0.19). No patient had incomplete resection of flexor retinaculum, scarring, neuroma of nerve, or tendon laceration; bursitis, accessory or distal muscle progression of muscle belly, or hamate fracture. Nerve edema with high T2 signal was seen in 4/15 (27%) with and 3/26 (12%) without CTS (P=0.16); proximal enlargement was seen in 6/15 (40%) with CTS and 2/26 (8%) without CTS (P=0.007). Also, 1 patient with recurrent disease demonstrated a mass and 1 other patient without CTS had nerve entrapment. Tenosynovitis was seen in 9/15 (60%) with and 9/26 (35%) without recurrent CTS (P=0.02). Counterintuitively, the nerve was more palmar with recurrent CTS than without (mean 6.9/8.9 mm). CONCLUSION: Only proximal enlargement, tenosynovitis, and the rare mass may help to diagnose recurrent CTS by MR. However, there appears to be a subgroup of patients with recurrent neuropathy related to an excessively superficial median nerve.

Adolescent↗

PubMed1997

Immune response to avian reovirus in chickens and protection against experimental infection.

OBJECTIVES: To assess the efficacy of the vaccination procedure and the effect of the transfer of maternal antibodies to progeny chickens on reovirus pathogenicity. DESIGN: To vaccinate chickens and challenge progeny chickens with high doses of homologous and heterologous viruses. PROCEDURE: High doses of reovirus strains RAM-1, 1091 and 724 were used to induce tenosynovitis lesions. High doses were produced by concentration of viruses grown in cell culture. Then similar doses of viruses were used to challenge immunised chickens progeny. RESULT: Vaccination of breeding hens with the RAM-1 strain of avian reovirus, which resulted in the passive transfer of neutralising antibody to progeny chickens, completely prevented the development of tenosynovitis in 80% of progeny chickens infected with the homologous virus. Even though multiple injections of hens resulted in broadening of the normal type-specificity of the neutralising antibody response against heterologous serotypes of avian reovirus, only marginal protection against strains of two heterologous serotypes of avian reovirus was obtained. CONCLUSIONS: A model for assessing the efficacy of vaccination against avian reovirus strains on clinical sign such as tenosynovitis was developed that overcome the normal low virulence of Australian strains of avian reovirus. Breeding hens can be immunised with Australian strain of avian reovirus with passive transfer of antibody via the yolk to the progeny chickens. Although the neutralising antibody response to three injections of inactivated virus decreased the specificity of the neutralising antibody response against antigenically heterologous strains of avian reovirus, the protective immunity appeared to retain type-specificity.

Animals↗

PubMed2000

Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. The TIRA Group.

OBJECTIVES: To evaluate synovial membrane hypertrophy, tenosynovitis, and erosion development of the 2nd to 5th metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints by magnetic resonance imaging in a group of patients with rheumatoid arthritis (RA) or suspected RA followed up for one year. Additionally, to compare the results with radiography, bone scintigraphy, and clinical findings. PATIENTS AND METHODS: Fifty five patients were examined at baseline, of whom 34 were followed up for one year. Twenty one patients already fulfilled the American College of Rheumatology (ACR) criteria for RA at baseline, five fulfilled the criteria only after one year's follow up, whereas eight maintained the original diagnosis of early unclassified polyarthritis. The following MRI variables were assessed at baseline and one year: synovial membrane hypertrophy score, number of erosions, and tenosynovitis score. RESULTS: MRI detected progression of erosions earlier and more often than did radiography of the same joints; at baseline the MRI to radiography ratio was 28:4. Erosions were exclusively found in patients with RA at baseline or fulfilling the ACR criteria at one year. At one year follow up, scores of MR synovial membrane hypertrophy, tenosynovitis, and scintigraphic tracer accumulation had not changed significantly from baseline; in contrast, swollen and tender joint counts had declined significantly (p<0.05). CONCLUSIONS: MRI detected more erosions than radiography. MR synovial membrane hypertrophy and scintigraphy scores did not parallel the changes seen over time in clinically assessed swollen and tender joint counts. Although joint disease activity may be assessed as quiescent by conventional clinical methods, a more detailed evaluation by MRI may show that a pathological condition is still present within the synovium.

Adult↗

PubMed1996

Release of the flexor hallucis longus tendon in ballet dancers.

Thirteen female ballet dancers had an operative release of the flexor hallucis longus tendon because of isolated stenosing tenosynovitis, and the results were reviewed after a mean duration of follow-up of six years and six months (range, two to ten years). All of the patients danced at the advanced or professional level, and all had failed to respond to non-operative management. The mean age of the patients at the time of the operation was twenty years (range, thirteen to twenty-six years). Symptoms, which included pain and tenderness over the medial aspect of the subtalar joint, had been present for a mean of six months (range, two to twelve months) preoperatively and were exacerbated by jumping and by attempts to perform en pointe work. Crepitus was present in six patients, and triggering was present in three. No patient had evidence of a symptomatic os trigonum. Postoperatively, all patients participated in a formal physical-therapy program for a mean of nine weeks (range, four to thirteen weeks). All patients returned to dancing, within a mean of five months (range, two to nine months), and eleven reached a level of full participation in dancing without restriction. At the time of the most recent follow-up, all patients noted improvement compared with the pre-operative condition. Eight patients were professional ballet dancers, four were students at advanced ballet schools, and one had stopped performing ballet for reasons unrelated to the tenosynovitis of the flexor hallucis longus. In addition, two of the students had decided not to pursue careers in dancing because of persistent, but greatly diminished, symptoms. No complications were noted in this series. We concluded that an operative release of the flexor hallucis longus is effective for the treatment of isolated stenosing tenosynovitis in female ballet dancers who place high demands on the foot and ankle and for whom non-operative treatment has failed.

Adolescent↗

PubMed1981

Clinical manifestations of disseminated infection caused by Neisseria gonorrhoeae are linked to differences in bactericidal reactivity of infecting strains.

Twenty-nine patients with disseminated gonococcal infection were classified into two clinical groups at the time of hospitalization: 13 with suppurative arthritis and 16 with only tenosynovitis, dermatitis, or both. Patients with suppurative arthritis had significantly less tenosynovitis and dermatitis (p less than 0.02). Strains of Neisseria gonorrhoeae isolated from the two groups of patients were each repetitively tested in a bactericidal assay using fresh frozen sera obtained from 10 normal human volunteers. Although strains causing disseminated gonococcal infection in general are serum resistant, those isolated from patients with suppurative arthritis were significantly less resistant (p less than 0.01) than those isolated from patients with only tenosynovitis and dermatitis. Differences in strains as reflected by variation in resistance to normal human sera may cause these strains to produce diverse clinical manifestations.

Arthritis, Infectious↗

PubMed2003

Diagnostic and therapeutic injection of the wrist and hand region.

Joint injection of the wrist and hand region is a useful diagnostic and therapeutic tool for the family physician. In this article, the injection procedures for carpal tunnel syndrome, de Quervain's tenosynovitis, osteoarthritis of the first carpometacarpal joint, wrist ganglion cysts, and digital flexor tenosynovitis (trigger finger) are reviewed. Indications for carpal tunnel syndrome injection include median nerve compression resulting from osteoarthritis, rheumatoid arthritis, diabetes mellitus, hypothyroidism, repetitive use injury, and other traumatic injuries to the area. For the first carpometacarpal joint, injection may be used to treat pain secondary to osteoarthritis and rheumatoid arthritis. Pain associated with de Quervain's tenosynovitis is treated effectively by therapeutic injection. If complicated by pain or paresthesias, wrist ganglion cysts respond to aspiration and injection. Painful limitation of motion occurring in trigger fingers of patients with diabetes or rheumatoid arthritis also improves with injection. The proper technique, choice and quantity of pharmaceuticals, and appropriate follow-up are essential for effective outcomes.

Anesthetics, Local↗

PubMed1989

Flexor tendon ruptures in rheumatoid arthritis.

Flexor tendon ruptures in rheumatoid arthritis are caused by either attrition on bone spurs or by direct invasion of the tendon by hypertrophic tenosynovium. All attrition ruptures occur within the carpal canal and represent the most common cause of tendon rupture. Removal of the causative bone spur is imperative in the treatment of this condition. Ruptures due to invasive tenosynovitis also are frequently found within the carpal canal. These ruptures may be unanticipated, and may be discovered as an incidental finding during flexor tenosynovectomy. Ruptures due to invasive tenosynovitis within the digit carry an unfavorable prognosis. The prognosis for restoring flexion in the event of a flexor tendon rupture is determined by the location of the rupture, the etiology, the degree of articular involvement from the rheumatoid disease, and to a lesser extent, by the number of ruptured tendons. In general, isolated or double ruptures within the carpal canal due to attrition have a better prognosis than those caused by invasive tenosynovitis since the condition of the tendons is more favorable for reconstruction; however, as the number of ruptures increases, the prognosis in both conditions worsens. Rupture of both tendons within the digital sheath is quite difficult to treat, with ruptures in zone 2 carrying the worst prognosis for the restoration of flexion. The severity of the patient's rheumatoid arthritis and articular disease has a great effect on the outcome of the reconstructive surgery. Prevention of tendon ruptures by early tenosynovectomy and the removal of bone spurs should be the goal of the surgeon.

Arthritis, Rheumatoid↗

PubMed1983

Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms.

Forty-nine patients with disseminated gonococcal infection (DGI) hospitalized at Boston City and University Hospitals over a 7-year period were studied. Patients with clinical manifestations of DGI and with cervical, urethral, rectal, pharyngeal, synovial or blood cultures positive for Neisseria gonorrhoeae were separated into two groups based on the presence or absence of suppurative arthritis. There were 19 cases of suppurative arthritis (Group II) and 30 cases with only tenosynovitis, skin lesions, or both (Group I). Blood cultures were positive only in Group I patients (43%) and synovial fluid cultures only in Group II patients (47%). Polyarthralgia was the most common initial symptom in both groups of patients. Twenty-six Group I patients had tenosynovitis (87%), while only 4 Group II patients (21%) had tenosynovitis (p less than 0.001). The knee was the most commonly involved suppurated joint. Twenty-seven Group I patients (90%) had skin lesions compared to 8 Group II patients (42%) (p less than 0.001). Some of these lesions progressed on treatment; some patients were unaware of their lesions. Genitourinary symptoms were unusual in both groups of patients. Eleven women (33%) were menstruating or were pregnant at the onset of DGI. Thirteen patients had histories suggestive of previous gonococcal infections; one had recurrent DGI. This patient and one other were found to have complement abnormalities. There were no cases of endocarditis or meningitis. Four patients had unexplained liver function abnormalities. All patients recovered uneventfully. Strains isolated from disseminated sites were predominantly of the transparent phenotype (90%). Many strains (58%) required arginine, hypoxanthine and uracil for growth. They were also more susceptible to penicillin than reported strains that cause pelvic inflammatory disease. Most strains were of a single outer membrane protein coagglutination serogroup, WI (85%). These characteristics did not vary between the Group I and Group II isolates. The two groups of strains, however, did vary in their complement-dependent bactericidal reactivity to normal human sera. Eighteen of 24 Group I strains (75%) versus 9 of 19 Group II strains (47%) resisted killing by all normal human sera tested (p less than .05). Likewise, convalescent sera from Group II patients were able to kill their infecting strains more often than did sera from Group I patients (70% vs 17%) (p less than 0.01). Thus, variations in the clinical expression of disease in patients with DGI may be explained, in part, by differences in certain phenotypic and immunologic features of infecting strains.

Arthritis, Infectious↗

PubMed1984

Osseous involvement in de Quervain's disease.

Osseous involvement is usually not appreciated in de Quervain's stenosing tenosynovitis. A case of stenosing tenosynovitis accompanied by significant local osteoporosis in the radial styloid area and a corresponding positive area on a technetium-99m polyphosphonate bone scan provoked the authors' interest in this entity. In seven consecutive patients with de Quervain's disease, six had evidence of osseous involvement of the radial styloid as demonstrated by roentgenographic studies and/or technetium bone scanning. In the process of differential diagnosis of a lytic lesion in the radial styloid area, de Quervain's tenosynovitis should be included.

Adult↗

PubMed1982

The four-in-one arthroplasty for the painful arc syndrome.

The painful arc syndrome of the shoulder is a manifestation of rotator cuff tendinitis associated with tenosynovitis of the long head of the biceps under and just distal to the transverse humeral ligament. Eighty-nine patients with clinical signs of the painful arc syndrome were proven to have an associated biceps tenosynovitis by arthrography and at surgical treatment. The four-in-one arthroplasty consists of: (1) excision of the coracoacromial ligament; (2) acromioclavicular arthroplasty; (3) excision of the anterior inferior area of the acromion process; and (4) transfer and tenodesis of the long head of the biceps. The operation decompresses the acromial arch and also eliminates the biceps tenosynovitis by tenodesis. Almost invariably, there was relief of pain within four to five months of postoperative rehabilitation, and at an average follow-up of two to eight years.

Adult↗