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PubMed1999

Ultrasonography in the diagnosis and management of psoriatic dactylitis.

OBJECTIVE: To determine the ultrasonographic features of dactylitis in psoriatic arthritis (PsA). METHODS: Seventeen patients with PsA presenting with a total of 25 dactylitic fingers and toes underwent ultrasonographic examination of the digits with a 7.5 or 10 MHz transducer. RESULTS: Flexor tenosynovitis was present in 96% (24/25) of dactylitic digits. Articular synovitis was present in 52% (13/25) of dactylitic digits. Subcutaneous soft tissue enlargement was present in all digits. The presence of articular synovitis in a dactylitic finger on ultrasonography correlated with the presence of joint space narrowing and periostitis on plain radiography. CONCLUSION: Dactylitis in PsA is due to both flexor tenosynovitis and articular synovitis. Dactylitis in PsA has an increased incidence of articular synovitis, which was associated with the development of articular damage as assessed by plain radiography.

Adolescent↗

PubMedDate not supplied

[Os trigonum tarsi syndrome. Role of magnetic resonance].

INTRODUCTION: The os trigonum tarsi is an accessory bone of the foot localized posterolateral to the lateral tubercle of talus. It is usually an asymptomatic condition. However, particular activities such as ballet, soccer, or football may cause repeated stress and chronic microtraumas to the hindfoot, resulting in the os trigonum syndrome. Pain is typically localized anterior to the Achilles tendon; nevertheless, diagnosis may be very difficult because other conditions may show the same symptoms. Radiography can only demonstrate the os trigonum and its morphostructural changes, while MR imaging can also depict associated soft tissue damage. We report on 9 cases of os trigonum tarsi syndrome studied with MR imaging. MATERIAL AND METHODS: Nine patients with the os trigonum tarsi syndrome were submitted to MRI. All the examinations were performed with the patients in supine recumbency with the injured foot in neutral position and then in forced plantar flexion. Axial and sagittal T1 SE, T2* GE and FIR images were acquired. We evaluated os trigonum location and shape, signal intensity of bone, cartilages and adjacent soft tissues, and possible associated tendon injuries. RESULTS: No changes were found in the os trigonum location and shape. Signal intensity changes were seen in 2/9 cases. Particularly, a small area of very high signal intensity, due to necrosis, was depicted on the talar aspect in 1 case; a subchondral spot of slightly increased signal intensity, with a low-signal outline, was seen on the calcanear aspect in another case. Disruption of the cartilaginous synchondrosis between the accessory navicular bone and the posterior tibial aspect was observed in 7/9 patients. Tenosynovitis of the flexor hallucis longus was associated in 6/9 patients. Pseudoarthrosis with irregular bone margins and high-signal spots within the cartilage was found in 3 cases. Finally, fluid effusion surrounding the os trigonum and adjacent soft tissues was always detected. DISCUSSION AND CONCLUSIONS: The os trigonum syndrome may result from chronic microtraumas. Indeed, forced plantar flexion may cause os trigonum compression between the posterior aspect of the tibial malleolus and the calcaneus, with disruption of the synchondrosis with the lateral tubercle of talus. Joint inflammation may be associated with possible development of pseudoarthrosis. Other possible complications are related to vascular changes which may lead to bone necrosis. Furthermore, the particular anatomical site of the os trigonum may sometimes cause compression to the flexor hallucis longus tendon, resulting in severe tenosynovitis. MR imaging allows complete morphostructural assessment because it depicts the margins and the signal intensity of bone and ligaments on the 3 spatial planes. Particularly, sagittal T2 images best demonstrate the cartilage changes indicating synchondrosis disruption. This condition may cause abnormal mobility of the accessory bone with possible impingement with the posterior aspect of the tibia, or hypomobility due to pseudoarthrosis. Forced plantar flexion acquisitions are particularly useful in this condition because they can demonstrate the mechanism of injury.

Adult↗

PubMed2002

Mycobacterium marinum infection in Taiwan.

Mycobacterium marinum often causes skin infections, tenosynovitis, arthritis, and osteomyelitis, and occasionally results in severe disseminated infections in immunocompromised patients. In this study, the clinical features of 14 cases of M. marinum infection were retrospectively analyzed. One patient had septic arthritis, the other 13 had skin infections and/or tenosynovitis. It usually took 2 months or longer for a definite diagnosis to be made in these patients. Three of the 14 patients were cured using clarithromycin alone or in combination with rifampin plus ethambutol. Most patients did not respond to conventional antituberculosis agents. Pulsed-field gel electrophoresis and infrequent-restriction-site polymerase chain reaction are efficient tools for the molecular typing of M. marinum. Both methods yielded a concordant result, and 4 of 12 isolates were genetically closely related to each other based on their banding patterns. This study indicates that these isolates were derived from the same clone. Because M. marinum infection is curable, early diagnosis is important. Poor healing of wounds after exposure to aquatic animals appears to be the most important clinical clue indicating the need for culture and inclusion of M. marinum infection in the differential diagnosis.

Adolescent↗

PubMed1992

IL-1 receptor antagonist protein production and gene expression in rheumatoid arthritis and osteoarthritis synovium.

IL-1 can participate in the perpetuation of arthritis through direct stimulation of synoviocytes and augmentation of matrix degradation. Hence, local production of the IL-1R antagonist protein (IRAP) might be an important negative feedback signal that regulates synovitis. We assessed synovial IRAP production in synovia from 30 individuals, by using a specific mAb and the immunoperoxidase staining method. IRAP was detected in 11 of 12 rheumatoid arthritis (RA) synovial tissues (ST) and was located primarily in the sublining, particularly in perivascular regions enriched for macrophages. Some staining was observed in the intimal lining of the synovium, although this was significantly less than in the sublining (p less than 0.05). Nine of 12 osteoarthritis (OA) tissues were positive for IRAP. In contrast to RA, the staining was observed primarily in the synovial lining in OA, with only minimal sublining IRAP being detected. Synovia from four patients without arthritis were negative (three autopsy specimens and one post-traumatic sample). Of the other two patients with miscellaneous diagnoses, one sample was negative (tenosynovitis) and one was positive (seronegative inflammatory arthritis) (sublining). Studies of serial sections and double-immunostaining experiments indicated that macrophages are the major cells containing immunoreactive IRAP. IRAP gene expression in vivo was determined by performing in situ hybridization on ST from 17 arthritis patients. RNA sense IRAP probes did not hybridize to any tissues. Anti-sense IRAP probes bound to two of nine RA tissues, two of six OA tissues, one of one seronegative inflammatory arthropathy tissue, and none of one flexor tenosynovitis tissue. As with immunoreactive protein, IRAP mRNA was primarily localized to cells in the synovial lining in OA but was more prominent in perivascular lymphoid aggregates in RA and seronegative inflammatory arthropathy. Northern blot analysis was performed on RNA isolated from nine ST. The appropriately sized IRAP band was identified in six of nine samples (five of six RA and one of three OA). Supernatants from cultured RA and OA ST cells contained immunoreactive and biologically active IRAP. Hence, IRAP gene expression and protein production occur in RA and OA synovium, albeit in different distributions.

Amino Acid Sequence↗

PubMed2003

Common acute hand infections.

Hand infections can result in significant morbidity if not appropriately diagnosed and treated. Host factors, location, and circumstances of the infection are important guides to initial treatment strategies. Many hand infections improve with early splinting, elevation, appropriate antibiotics and, if an abscess is present, incision and drainage. Tetanus prophylaxis is indicated in patients who have at-risk infections. Paronychia, an infection of the epidermis bordering the nail, commonly is precipitated by localized trauma. Treatment consists of incision and drainage, warm-water soaks and, sometimes, oral antibiotics. A felon is an abscess of the distal pulp of the fingertip. An early felon may be amenable to elevation, oral antibiotics, and warm water or saline soaks. A more advanced felon requires incision and drainage. Herpetic whitlow is a painful infection caused by the herpes simplex virus. Early treatment with oral antiviral agents may hasten healing. Pyogenic flexor tenosynovitis and clenched-fist injuries are more serious infections that often require surgical intervention. Pyogenic flexor tenosynovitis is an acute synovial space infection involving a flexor tendon sheath. Treatment consists of parenteral antibiotics and sheath irrigation. A clenched-fist injury usually is the result of an altercation and often involves injury to the extensor tendon, joint capsule, and bone. Wound exploration, copious irrigation, and appropriate antibiotics can prevent undesired outcomes.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Treatment of infected wounds and abscesses in bovine limbs with Ligasano-polyurethane-soft foam dressing material].

The objective of this report is to present the most important indications for the use of Ligasano-polyurethane-soft-foam dressing material in the treatment of infected wounds in cattle. For this study, 28 cattle were selected, which were treated at the clinic (2000-2003) for infected cut, puncture and laceration wounds on the limbs, purulent tarsal hygromas, large abscesses in the tarsal, crural and thigh regions, and purulent tenosynovitis of the digital flexor tendon sheath caused by penetrating puncture wounds. After routine wound cleansing, debridement or adequate surgery with wound lavage, Ligasano-polyurethane-soft-foam (Ligamed Medical Produkte, Cadolzburg-Wachendorf, Germany) was applied as a primary wound dressing instead of the conventional cotton gauze swabs or as drainage material in all these wounds. The porous surface structure of this material caused subtle wound debridement and mechanical stimulation of the wound surface increasing exudation and decreasing fibrinous adhesions. The pores ensured good drainage, reduced infection, avoided the accumulation of exudate and the following destruction of the wound surface. In all these indications, except abscesses and purulent hygromas, no or only slight purulent exudation of the treated wounds was observed. Especially in the treatment of purulent tenosynovitis of the digital flexor tendon sheath with tendon resection a rapid healing of these large surgical wounds--often within 2 weeks--was found. The therapeutic effect of Ligasano-polyurethane-soft-foam as a primary wound dressing was so convincing in these bovine patients, that it is now used exclusively as primary wound dressing material for treatment of infected wounds.

Abscess↗

PubMedDate not supplied

Biological characters and bacteriophage typing of Staphylococcus aureus isolated from chicken staphylococcosis and commercial balanced chicken food in Argentine.

During 1976-78, 33 S. aureus strains were isolated from chickens suffering from dermatitis and septicemia, omphalitis, pneumonia, arthritis and tenosynovitis; and from a commercial balanced chicken food. All the strains were classified into the biotype B of Hájek and Marsálek. Twenty-nine (87.8%) strains could be classified into Sato et al biological type 4 although they differed from it in its ability to grow at 45 degrees C. The remaining 4 strains differed from the others because they failed in producing hemolysis in bovine and ovine blood agar, egg yolk reaction and splitting of Tween 80. Thirty (90.9%) strains were lysed by avian phages: 28 strains at 1 x RTD and 2 at 100 x RTD. Twenty seven (93.1% strains of the Sato et al biotype 4 were sensitive to the phages CH42/CH43/CH63/CH37 of avian group II, and 2 strains to the phage CHA1 at 100 x RTD. Only one of the 4 unclassified strains could be typed by phage CH4 of avian group I at 1 x RTD. Twenty seven (81,8%) strains were typable at 100 x RTD by the basic set of human phages: 26 strains belonged to group III (53 and 53/77) and 1 to a mixed group I/III (79/53/77). The typable strains belonged only to Sato et al biotype 4. None of 33 strains were sensitive to any of the bovine phages. The biological characters and bacteriophage typing of the S. aureus showed that almost all the strains belong to chicken types. The strains isolated from food belong to the same chicken biotype and phagetype as the strains isolated from dermatitis, septicemia, omphalitis and pneumonia. The strains isolated from arthritis and tenosynovitis were different from the ones isolated from other pathologies.

Animal Feed↗

PubMed2005

Complications and functional outcome following fixation of complex, intra-articular fractures of the distal radius with the AO Pi-Plate.

This study investigates the efficacy of the AO Pi-plate in the treatment of complex, intra-articular fractures of the distal radius. We retrospectively analysed the clinical and radiological results of 19 consecutive patients who underwent open reduction and internal fixation for dorsally displaced, intra-articular fractures of the distal radius using the AO Pi-plate. The final functional outcome was assessed using the Gartland & Werley scoring system. The average follow-up period was 34.3 months. Wrist movement was restored to a near normal range in all the patients. The functional outcome as measured by the Gartland & Werley scoring system showed excellent and good results in 15 (88%) of the patients. The implant was removed in 4 (23%) of the patients due to extensor tenosynovitis and restriction of flexion. This study demonstrates that although the functional outcome following fixation of complex distal radius fractures with the AO Pi-plate is good, there is a risk of developing extensor tenosynovitis and limitation of flexion. We recommend that the implant be used sparingly and if used then elective removal of the implant should be considered after fracture union.

Adult↗

PubMedDate not supplied

Ultrasonography of the hand in rheumatoid arthritis.

High resolution ultrasonography of the hand and wrist was performed on 20 patients with definite or probable rheumatoid arthritis (ARA standard criteria) in its early stage. In all the patients, swelling of the soft tissues of the fingers corresponded to an enlargement of the joint capsule containing a hypoechoic exudate. The rheumatoid nodules appeared as fluid-filled rounded cavities with sharp borders. Rheumatoid tenosynovitis was observed in 18/20 patients. This corresponded to oval or spindle-shaped cavities with a hypoechoic (10/18 cases) or anechoic content (8/18 cases) and with the tendon ribbon inside. Rupture of a tendon was diagnosed in 8/20 cases and it was always confirmed at surgery. Tenosynovitis of the flexor carpi ulnaris at the wrist level was observed in 10/20 patients. Ultrasonography is proposed as an effective first-line approach and as a periodical follow-up survey in early stage rheumatoid arthritis, in combination with standard radiography.

Arthritis, Rheumatoid↗

PubMed1988

Management of a severely comminuted fracture of the third metacarpal bone in a horse.

A 4-year-old Standardbred stallion sustained a severely comminuted fracture involving the second, third, and fourth metacarpal bones. The fracture was repaired using two 14-hole broad dynamic compression plates positioned at 90 degrees to one another, allowing one plate to protect the other in the bending mode. An autologous cancellous bone graft obtained from the tuber coxae was added at the site of the defect in the mid- to upper third of the third metacarpal bone. Complications associated with the fixation included a Staphylococcus aureus infection 5 months after surgery, laminitis that developed in the opposite forelimb 6 months after the fracture, and septic tenosynovitis in the contralateral hind limb. The septic tenosynovitis prolonged hospitalization for a total of 20 months. Both postoperative problems resolved when the stallion returned to breeding use.

Animals↗

PubMed1994

Chymotrypsin and trypsin sensitivities of avian reoviruses.

Experiments were undertaken to examine the chymotrypsin sensitivity and trypsin sensitivity of 13 avian reoviruses, and to determine if there was any correlation with pathogenicity of some chicken reoviruses. A wide variation in the degree of sensitivity of avian reoviruses to chymotrypsin and trypsin was observed. Overall, the infectivity of the 13 avian reoviruses for Vero cells was markedly reduced by treatment with 0.01% chymotrypsin (the lowest concentration tested) while 0.5% trypsin significantly reduced the infectivity of 9 of 13 strains. Comparison of four avian reoviruses, three resistant and one sensitive to trypsin, for pathogenicity in day old chicks following oral inoculation showed the strains that were resistant to trypsin to be more pathogenic. Tenosynovitis and virus persistence in intestines, liver, heart and hock joint tissues occurred only in chickens inoculated with the trypsin resistant strains. It is concluded that the degree of sensitivity to chymotrypsin and trypsin among avian reoviruses is heterogenous. Sensitivity to trypsin influenced the development of tenosynovitis based on microscopic lesions and virus persistence in tissues.

Animals↗

PubMed1993

Soft tissue infections.

Several infectious processes ranging in severity from mild to overwhelming that affect the soft tissues are reviewed. Superficial infections such as impetigo, erysipelas, cellulitis, and subcutaneous bursitis are common and, for the most part, can be easily treated. Because suppurative tenosynovitis has the potential to destroy tendons, consultation with a hand surgeon should be obtained immediately. Mycobacterial and fungal tenosynovitis is usually chronic and patients present with a mass which, when excised and examined with appropriate stain and culture, reveals the unexpected diagnosis. Tropical myositis (muscle abscesses) is seen in temperate climates, primarily as a complication of AIDS. Necrotizing fasciitis and gas gangrene represent the hyperacute end of the spectrum of soft tissue restrictions. Although in most cases a history of trauma is present, spontaneous gas gangrene may arise from occult and colonic cancer. Patients do poorly unless immediate and extensive surgery is performed and appropriate antibiotics are given.

Bacterial Infections↗

PubMed1996

Hepatitis C infection presenting with rheumatic manifestations: a mimic of rheumatoid arthritis.

OBJECTIVE: To describe the clinical features of a group of patients presenting with rheumatic manifestations who were subsequently determined to have hepatitis C infection. METHODS: A case study of 19 consecutive patients referred to private practitioners in Tacoma and Federal Way, Washington, because of polyarthritis, polyarthralgia, or positive rheumatoid factor (RF) who were subsequently found to have hepatitis C. Patients were tested for hepatitis C when they met the following screening criteria: abnormal liver biochemical studies or history of transfusion, jaundice, or hepatitis. RESULTS: Risk factors for hepatitis C infection were present in 14 patients, including transfusions (8) or intravenous drug use (6). Eight patients gave a history of previous jaundice or hepatitis predating their articular complaints by intervals ranging from 3 mos to 23 yrs. Liver biochemical tests were normal in 6 patients. Serologic evidence of hepatitis B or human T lymphotrophic virus type II was present in 3 of 19 and 2 or 14 patients, respectively. Carpal tunnel syndrome (8 patients), palmar tenosynovitis (7 patients), fibromyalgia (6 patients), and nonerosive, nonprogressive arthritis typified the articular manifestations. Fifteen patients fulfilled diagnostic criteria for rheumatoid arthritis (RA). Three patients had small vessel skin vasculitis. The arthritis responded well to treatment with low dose prednisone and hydroxychloroquine. CONCLUSION: Hepatitis C infection can present with rheumatic manifestations indistinguishable from RA. The predominant clinical findings include palmar tenosynovitis, small joint synovitis, and carpal tunnel syndrome. Risk factors such as transfusions and IV drug abuse or a history of hepatitis or jaundice should be included in the history of present illness of any patient with acute or chronic polyarthritis or unexplained positive RF. In such patients, gammaglutamyl aminotransferase, serologic studies for hepatitis C, and other tests appropriate for chronic liver disease should be performed.

Adult↗

PubMed1996

Occupational injury and illness of the thumb. Causes and solutions.

1. The special functions of the thumb (opposition, retroposition, palmar abduction, and radial abduction) account for up 50% of overall hand use. 2. Knowledge of specific questions to ask on history taking and proper initial evaluation can help with timely and appropriate referrals for suspected thumb fracture, dislocations, and/or torn ligaments. 3. Repetitive and/or forceful thumb movements can aggravate or cause the following cumulative trauma disorders: stenosing tenosynovitis ("trigger thumb"), de Quervain's tenosynovitis, and carpometacarpal joint arthritis. 4. The occupational health nurse can suggest many ergonomic solutions to decrease thumb motions and forceful thumb pressures encountered at work.

Cumulative Trauma Disorders↗

PubMed1998

[Tendinitis of the knee].

Tendinitis of the knee occurs principally in those playing at competition level or for pleasure. Localisation of the tendinitis depends upon the type of sport; amongst those who jump the patellar tendinitis is predominant, with long distance runners tenosynovitis of the iliotibial tract are more often found, for activities involving lateral and brusque++ movements tendinitis of the biceps femoris and tenosynovitis of the "patted'oie" tend to occur. Whilst tendinitis is relatively easy to diagnose, its treatment is more difficult. Of the numerous treatments available, specific physiotherapy-massage, local infiltration, and correction of technical errors are often efficient.

Athletic Injuries↗

PubMed2003

Surgical treatment of de Quervain's disease.

OBJECTIVE: The purpose of this study was to evaluate the clinical outcome of surgical treatment of de Quervain's disease. STUDY DESIGN: Prospective study. PLACE AND DURATION OF STUDY: The study was conducted in District Headquarters Hospital, Battagram from December, 2001 to July 2002. SUBJECTS AND METHODS Patients with de Quervain's disease who did not respond to conservative treatment with analgesics, splintage and local steroid injections were operated under local anesthesia and the tendons of abductor pollicis longus and extensor pollicis brevis were released. The patients were followed for a minimum of 3 months to assess the clinical outcome of procedure. RESULTS: Female to male ratio was 9:1. All females were housewives exposed to manual work. Three of them had rheumatoid arthritis. The age range was from 30-50 years with mean age of 38 years. The results of surgical treatment were excellent with 96% patients being completely relieved of symptoms. CONCLUSION: Surgical release of tendons of first dorsal compartment of wrist has excellent results in patients with de quervain's tenosynovitis.

Adult↗

PubMed1998

Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective followup study.

OBJECTIVE: To determine the frequency and the characteristics of distal musculoskeletal manifestations in polymyalgia rheumatica (PMR). METHODS: Prospective followup study of 177 consecutive patients meeting clinical criteria for PMR, diagnosed over a 5-year period in 2 rheumatology secondary referral centers in Italy. RESULTS: Seventy-nine of the 177 patients (45%) had distal musculoskeletal manifestations. Peripheral arthritis occurred in 45 patients (25%), carpal tunnel syndrome in 24 (14%), distal extremity swelling with pitting edema in 21 (12%), and distal tenosynovitis in 5 (3%). These manifestations were usually associated with PMR proximal symptoms (69%); however, 31% of the episodes represented isolated relapse/recurrence at distal sites. Distal symptoms responded promptly to corticosteroids. No evidence of joint deformities, erosions, or development of rheumatoid arthritis was observed during the followup. The group of patients with peripheral arthritis included a higher proportion of females, had a longer duration of therapy, and had more relapses/ recurrences. Patients who had distal extremity swelling with pitting edema had a higher age at disease onset, a shorter duration of therapy, and lower initial and cumulative prednisone doses. CONCLUSION: Inflammatory involvement of distal articular and/or tenosynovial structures occurs in approximately half of the cases of PMR. Peripheral arthritis is associated with more severe disease, while distal extremity swelling with pitting edema appears to identify a more benign disease subset.

Aged↗

PubMed1999

Musculoskeletal manifestations in a population-based cohort of patients with giant cell arteritis.

OBJECTIVE: To define musculoskeletal manifestations occurring in a population-based cohort of patients with giant cell (temporal) arteritis (GCA). METHODS: The records of 128 patients with GCA diagnosed over a 42-year-period (1950-1991) in Olmsted County, MN, were reviewed for the presence and type of musculoskeletal manifestations, their relationship to the onset and course of GCA, and their response to treatment. RESULTS: Fifty-three patients (41%) developed polymyalgia rheumatica: 23 before, 17 concurrently with, and 13 after the diagnosis of GCA. Thirty patients (23%) developed 1 or more peripheral musculoskeletal manifestations. These included peripheral synovitis in 23 patients (6 of whom fulfilled criteria for rheumatoid arthritis), distal extremity swelling with pitting edema in 13, distal swelling without pitting in 5, tenosynovitis in 6, and carpal tunnel syndrome in 2. Fifty-seven episodes of peripheral manifestations occurred in the 30 patients at different times during the course of GCA. In most, the onset of PMR and peripheral manifestations was within 2 years of the diagnosis of GCA. CONCLUSION: Musculoskeletal symptoms in GCA are common and varied. Most appear linked temporally to the underlying GCA, indicating that the nature of this illness and its clinical expression are broader than often considered.

Aged↗