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PubMedDate not supplied

Increased prevalence of soft tissue hand lesions in type 1 and type 2 diabetes mellitus: various entities and associated significance.

Sixty Type 1 (insulin dependent) and sixty Type 2 (non insulin dependent) diabetic patients attending a diabetology unit were examined in search of limited joint mobility, Dupuytren's disease, flexor tenosynovitis and carpal tunnel syndrome, in comparison with two populations of 60 non diabetic controls matched for sex and age with the Type 1 and the Type 2 diabetic patients. Microangiopathic and neuropathic complications, glycaemic control, blood pressure and tobacco consumption were simultaneously assessed in 39 of the 60 type 1 and in all the type 2 diabetic patients. The prevalence of the various soft tissue hand lesions was higher in both diabetic populations (respectively Type 1 and Type 2) than in their control populations: Limited joint mobility: 33.3 and 26.7% vs 5.0 and 8.3% (both p < 0.01); Dupuytren's disease: 35.0 and 30.0% vs 6.7 and 10.0% (both p < 0.01); flexor tenosynovitis: 23.3 and 16.7% vs 0.0 and 3.3% (p < 0.01 and p < 0.05); carpal tunnel syndrome: 26.7 and 15.0% vs 3.3 and 5% (p < 0.01 and NS). The prevalence of limited joint mobility in Type 1 diabetes was independently associated with increasing age (p < 0.05) and to lower extent with increasing duration of diabetes (p = 0.05), whereas the prevalence of Dupuytren's disease only correlated with increasing age in both types of diabetes (p < 0.05). In Type 2 diabetes, the prevalence of flexor tenosynovitis also increased independently with age (p < 0.05), and the prevalence of limited joint mobility increased in the opposite way to the body mass index after adjustment on age, duration of diabetes and sex (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

The current role of high-resolution ultrasonography of the hand and wrist in rheumatic diseases.

OBJECTIVE: To assess the current role of ultrasound in the diagnosis and treatment of pathological changes in the wrist and hand. METHODS: 39 patients (14 male and 25 female, mean age 35 yrs.) with ill-defined pain and/or swelling of the wrist or hand were examined using a high-definition ultrasound (US) instrument. RESULTS: 18 patients had tenosynovitis, which in one patient was due to a previously unsuspected foreign body. 10 patients had arthritis involving the wrist and 5 the fingers; 2 patients had a ganglion; one had a neuroma of the median nerve and one patient with a previous tenorrhaphy suffered from the recurrent rupture of this tendon. Two patients had carpal tunnel syndrome, one due to tenosynovitis and one due to the formation of a post-operative fibrotic sheath around the median nerve. 7 patients with synovitis of the wrist underwent US-guided synovial biopsy. 12 patients with tenosynovitis and 6 with arthritis received injections of corticosteroids plus anaesthetic under US-guidance. The spreading of the steroid crystals around the tendon and throughout the joint could be easily monitored. No complications were encountered. CONCLUSION: High-definition ultrasound is a valuable technique for the imaging of pathologic changes of the wrist and hand and for injection therapy.

Adolescent↗
PubMed1996

Diagnosis and treatment of heel pain in chronic inflammatory arthritis using ultrasound.

The authors examined the role of ultrasound (US) in diagnosis and management of heel pain in chronic inflammatory arthritis. Nineteen patients underwent US examination. Eight patients (2 with previously unsuccessful nonguided injections), had 11 US-guided corticosteroid injections for treatment of retrocalcaneal bursitis (n = 6), plantar fasciitis (n = 3), and posterior tibial tenosynovitis (n = 2). US-demonstrated Achilles tendon rupture (n = 2), Achilles tendinitis (n = 8), posterior tibial tenosynovitis (n = 6), peroneus longus tenosynovitis (n = 2), retrocalcaneal bursitis (n = 13), and plantar fasciitis (n = 4). Loss of smooth bone contour (n = 13) correlated with bone erosions on plain radiographs in all but one case. Ten of 11 guided injections resulted in full resolution of heel pain. The diverse causes of heel pain are highlighted, and the ability of US to provide information with management implications is confirmed. US-guided corticosteroid injection is beneficial, especially after failure of nonguided injection.

Achilles Tendon↗
PubMed1997

Sports-related and other soft-tissue injuries, tendinitis, bursitis, and occupation-related syndromes.

In this review, four areas are discussed: fluoroquinolone-induced tendinitis, volar flexor tenosynovitis (trigger finger), Achilles tendon lesions, and occupational medicine issues. The relationship of fluoroquinolone treatment to musculoskeletal lesions, especially Achilles tendinitis and tear, is most intriguing. The steady increase in reports of the association cannot be ignored. Although Achilles tendinitis and rupture have comprised the most frequently seen lesions, articles on additional sites of involvement, such as in lateral epicondylitis and De Quervain's tenosynovitis, are reviewed. Volar flexor tenosynovitis and trigger finger are among the most common musculoskeletal problems, and additional studies support the success of corticosteroid injections. Although the value of injections was reported well over 25 years ago, surgery is still unfortunately the first-choice treatment of some physicians. We review three studies on Achilles tendinopathy. In one of the reports, diagnostic ultrasonography is again demonstrated to be of value in assessing tendon lesions. The push to use the term tendinosis rather than tendinitis continues as a result of histologic studies of tendinitis that lack the usual findings of inflammation. However, the presence or absence of chemical inflammation is yet to be ascertained. We review an article that fails to show that work activities are the sole cause of such musculoskeletal syndromes as cumulative trauma or repetitive use. Further studies are needed in the area of work-related upper extremity disorders.

Athletic Injuries↗
PubMed1999

Clinical application of ultrasonography for detection of septic arthritis in children.

For early detection of the effusion of infected joint, 40 children were examined by ultrasound scanner for suspected septic arthritis. Thirty-one patients were found with joint effusion, and the needle aspirations of these 31 joints confirmed septic arthritis in 22 patients. In 3 patients, in addition to the joint effusion, the joint surrounding subperiosteal abscess and cortical erosion also were found on sonography, resulting in a diagnosis of concurrent osteomyelitis. In two patients, sonography confirmed only soft tissue swelling and abscess formation on the buttock, but without hip joint effusion. These findings excluded the diagnosis of septic arthritis and helped us obviate the unnecessary attempts at joint aspiration. In one patient, sonography revealed only flexor tenosynovitis without wrist joint effusion. This case was later treated by tenosynovectomy rather than wrist arthrotomy and the pathological examination showed to be a tuberculous tenosynovitis. From the preliminary results, we find ultrasonography has the following advantages for the diagnosis of septic arthritis: 1.) ultrasonography is very sensitive in detecting the joint effusion of septic arthritis; 2.) ultrasonography can clearly define the pathological extent of septic arthritis and help clinicians to treat the concurrent osteomyelitis by appropriate surgical debridement; and 3.) ultrasonography can differentiate soft tissue abscess or tenosynovitis from septic arthritis and help clinicians obviate unnecessary needle joint aspiration.

Adolescent↗
PubMed2001

Lack of association with spondyloarthritis and HLA-B27 in Italian patients with Whipple's disease.

OBJECTIVE: To examine consecutive patients with Whipple's disease (WD) for the full clinical spectrum of spondyloarthritis. METHODS: Nine consecutive patients, 8 men, 1 woman, with WD were clinically evaluated and examined for clinical and radiological manifestations of spondyloarthritis by 2 rheumatologists with special interest in spondyloarthritis. The mean age of the patients at the time of study and at the time of their initial diagnosis of WD by duodenal biopsy was 62.4 years (range 42-71) and 54.4 years (range 40-62), respectively. Each patient had an anteroposterior radiographic view of the pelvis and also had HLA typing for class I and II alleles. Pelvis radiographs were read blindly for evidence of sacroiliitis. RESULTS: All but one patient had rheumatologic manifestations related to WD. The mean interval between the onset of these symptoms and the diagnosis of WD was 6.1 years (range 1-15). One had recurrent polyarthritis, 1 recurrent oligoarthritis, 3 recurrent monoarthritis, 2 recurrent synovitis with pitting edema of the dorsum of hands and/or feet, and 1 isolated De Quervain's tenosynovitis. Of the 5 patients with arthritis, 3 also had episodes of swelling with pitting edema over the dorsum of hands and/or feet together with flexor digit tenosynovitis, 2 also had olecranon bursitis, and 1 tibial tenosynovitis. No patient had clinical or radiological manifestations of spondyloarthritis. None had the HLA-B27. CONCLUSION: In Italian Caucasian patients with WD there was no association with spondyloarthritis and HLA-B27.

Adult↗
PubMed1988

Special radiographic techniques in the evaluation of arthritic disease.

The radiographic modalities discussed in this article are useful adjunctive techniques in the evaluation of arthritic disease. None of these modalities should be considered for baseline study. Rather, they should be considered following plain film examination when further information is required. The one modality that may be considered for a screening examination is radionuclide imaging. It is most useful when early diagnostic information regarding the extent of pathology is required. A pattern of activity can provide important information to the clinician, enabling an accurate diagnosis. Arthrography is best reserved for the evaluation of articular cartilage of a particular joint. A double-contrast arthrogram should be performed in this case. The technique has little application in the evaluation of polyarticular disease. Tenography is most useful in differentiating tenosynovitis from stenosing tenosynovitis. The differentiation is important because a diagnosis of stenosing tenosynovitis usually necessitates surgical intervention. Spontaneous rupture can be evaluated with tenography, but is is probably best evaluated with MRI. CT may be used in the evaluation of both soft-tissue and articular pathology. It is perhaps best employed in the evaluation of articular pathology of the rearfoot. This technique should not be used as a screening examination for vague foot pain. MRI is the newest and most exciting imaging modality available. The excellent soft-tissue contrast provides an accurate means of evaluating the extraarticular manifestations of arthritic disease. MRI may aid in differentiating rheumatoid nodules from neuromas in rheumatoid patients with excessive forefoot disease. It is also useful in the evaluation of tendon pathology, particularly spontaneous ruptures. This technique is only in its infancy, but technologic advances are rapidly making it a major force in the field of diagnostic imaging.

Ankle Joint↗
PubMed1978

Acquired Brown's syndrome of inflammatory origin. Response to locally injected steroids.

In a recent large series of tendon sheath syndrome, Brown reported only five cases of the pure acquired type that were not intermittent and in which the patients did not undergo spontaneous recovery. The origin of acquired Brown's syndrome is varied and includes trauma of the orbit, direct trochlear trauma, orbital or muscle surgery, frontal sinusitis or sinus surgery, and inflammation of the superior oblique tendon and sheath, namely a stenosing tenosynovitis. The differential diagnosis and possible causes of the acquired Brown's syndrome were reviewed, and two cases of presumptive tenosynovitis of the superior oblique tendon and sheath are presented in detail. In both cases, the condition of each patient was notably improved by a series of direct injections of methylprednisolone acetate into the trochlear region. This form of treatment for acquired Brown's syndrome of inflammatory origin has never, to my knowledge, been reported in the literature.

Adolescent↗
PubMed1979

Chronic tenosynovial hand infection from Mycobacterium terrae.

A 23-year-old healthy man suffered a puncture wound from the fin of a catfish. Chronic tenosynovitis subsequently developed. Synovectomy was performed and cultures yielded Mycobacterium terrae. This organism, usually considered nonpathogenic, has only rarely been associated with human disease. This case further supports the role of this organism as a potential human pathogen and further suggests that M terrae should be considered in aquatic-associated hand tenosynovitis.

Adult↗
PubMed1990

The diabetic foot: magnetic resonance imaging evaluation.

Fourteen diabetic patients with suspected foot infection and/or neuropathic joint (Charcot Joint) were evaluated with magnetic resonance imaging (MRI) in an attempt to assess the extent of the infection and also to distinguish infection from the changes seen with neuroarthropathy. The majority of patients with infection had more than one site of involvement and the following diagnoses were made by MRI evaluation: osteomyelitis (n = 8), abscess (n = 7), neuropathic joint (n = 5), septic arthritis (n = 4), and tenosynovitis (n = 4). Clinical or surgical/pathological confirmation of the MRI diagnoses was obtained in all but nine sites of infection or cases of neuropathic joint. If the two diagnostic categories of septic arthritis and tenosynovitis are excluded, all but four of the MRI diagnoses were confirmed. A distinctive pattern for neuroarthropathy was identified in five cases, consisting of low signal intensity on T1- and T2-weighted images within the bone marrow space adjacent to the involved joint. We conclude that MRI is a valuable adjunct in the evaluation of the diabetic foot, and that it provides accurate information regarding the presence and extent of infection in this subset of patients. MRI has proven particularly helpful in differentiating neuroarthropathy from osteomyelitis.

Abscess↗
PubMed2003

Mycobacterium marinum infections of the distal upper extremities: clinical course and imaging findings in two cases with delayed diagnosis.

Mycobacterium marinum infections cause tenosynovitis of the distal upper extremities and develop as a consequence of skin abrasions acquired in contaminated water. We report on two patients whose MR imaging studies showed tenosynovitis of the distal upper extremity secondary to M. marinum. In one patient sequential MR imaging showed development of bony erosions. Appropriate treatment was delayed in both patients because the diagnosis was not considered. We report on and discuss the clinical course and MR imaging findings in two patients with M. marinum infection.

Adult↗
PubMed2004

Recurrent extensor tendon rupture in adult-onset dermatomyositis: a case report.

We report on a case in which recurrent extensor tendon rupture was caused by tenosynovitis without skin ulcer and calcinosis in adult-onset dermatomyositis involving the hand. Proliferative tenosynovitis of the extensor tendons led to recurrent elongation or rupture of the extensor tendons, and tendon graft produced the good postoperative result in this case.

Adult↗
PubMed1980

Arthritis associated with a crystallizing cryoprecipitable IgG paraprotein.

A crystallizing IgG-lambda cryoprotein was found in the synovial fluid of a patient with peripheral erosive arthritis and tenosynovitis. The same crystallizing paraprotein could be demonstrated in serum incubated at 4 degrees C, but its formation could be inhibited by the in vitro addition of D-penicillamine. Crystals were present in synovial tissue and appeared to be initiating an inflammatory reaction via complement activation. Slit lamp examination showed crystals in Bowman's membrane. Plasmapheresis led to temporary improvement in the synovitis and tenosynovitis.

Arthritis↗
PubMed1993

Closed continuous irrigation as a treatment for infection in the hand.

A method of closed irrigation has been devised to treat infections in the hand. After adequate débridement, two tubes are placed in the infected area, an inlet tube and an outlet tube. For a small infection, one tube serves both purposes. The wound is closed completely. Irrigation with saline and antibiotic solution is continued for 1 week, extended up to 3 weeks in cases of severe infection. This method has been applied in 31 cases including pyogenic tenosynovitis, tuberculous tenosynovitis, pyogenic arthritis, osteomyelitis, bite injury, crush injury and amputation stump infection. Infection healed primarily in 29 cases. Further surgery was needed in two cases which healed finally.

Adolescent↗
PubMed2005

Musculoskeletal infections: ultrasound appearances.

Musculoskeletal infections are commonly encountered in clinical practice. This review will discuss the ultrasound appearances of a variety of musculoskeletal infections such as cellulitis, infective tenosynovitis, pyomyositis, soft-tissue abscesses, septic arthritis, acute and chronic osteomyelitis, and post-operative infection. The peculiar sonographic features of less common musculoskeletal infections, such as necrotizing fasciitis, and rice body formation in atypical mycobacterial tenosynovitis, and bursitis will also be presented.

Abscess↗
PubMed2006

Volar dislocation of the extensor carpi ulnaris tendon on magnetic resonance imaging is associated with extensor digitorum communis tendon rupture in rheumatoid wrists.

PURPOSE: Extensor tendon rupture in rheumatoid wrists is a common problem and causes immediate dysfunction of the digits. The best treatment for tendon rupture may be prophylactic management, although the factors associated with tendon rupture must first be identified. The purpose of this study was to evaluate structures around rheumatoid wrists using magnetic resonance imaging with forearm rotation and to identify factors associated with extensor tendon rupture as indications for prophylactic surgery. METHODS: The subjects were 34 patients (40 wrists) with active rheumatoid arthritis. The extensor digitorum communis (EDC) tendons were ruptured in 15 wrists. Magnetic resonance imaging of the wrists was performed in maximally pronated and supinated positions of the forearm. Axial images of the distal radioulnar joints (DRUJs) were selected to evaluate DRUJ synovitis, dorsal tenosynovitis, volar dislocation of the extensor carpi ulnaris (ECU) tendon, sigmoid notch angle, and the radioulnar ratio (RUR) (ie, the degree of DRUJ subluxation). RESULTS: No significant correlations were found between EDC tendon rupture and DRUJ synovitis, dorsal tenosynovitis, or RUR in pronation. Extensor digitorum communis tendon rupture correlated significantly with volar ECU tendon dislocation, sigmoid notch angle, and RUR in supination. Radioulnar ratio correlated significantly with volar ECU tendon dislocation only in supination and not in pronation. Thus, DRUJ subluxation was advanced even in the supinated wrist with volar ECU tendon dislocation. As a factor associated with EDC tendon rupture, volar ECU tendon dislocation had 87% sensitivity and 76% specificity. CONCLUSIONS: Volar ECU tendon dislocation is associated with increased RUR in supination and EDC tendon rupture. Volar ECU tendon dislocation can thus be considered a factor associated with EDC tendon rupture, and its presence may indicate the need for prophylactic surgical intervention in a subset of rheumatoid arthritis patients.

Adolescent↗
PubMed1996

Overuse syndromes of the hand and wrist.

Overuse syndromes are one of the most common occupational illnesses treated by primary care providers. Their pathophysiology parallels that of tenosynovitis. Occupational risk factors for overuse syndromes include repetition, high force, awkward joint posture, direct pressure, and vibration. Initial treatment is aimed at preventing fibrosis through rest, immobilization, and anti-inflammatory agents. Treatment must include identification and adjustment of occupational risk factors. Specific overuse syndromes are discussed, including tenosynovitis of the dorsal wrist extensor compartments and flexor tendons of the wrist, trigger finger, and carpal tunnel syndrome.

Carpal Tunnel Syndrome↗