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PubMed2003

[Imaging techniques in rheumatology: sonography in rheumatoid arthritis].

Musculoskeletal ultrasonography has become an important diagnostic tool in rheumatoid arthritis. In Germany it is part of the rheumatology training, and many ultrasound courses provide further education. Only in the last five years the international importance of ultrasound in rheumatology has increased dramatically. Sonography can be performed as a bedside procedure and as an extension of the clinical investigation. It is easily tolerated by the patients, and it can be repeated any time. Sonography can have a great impact on therapeutic decisions. A > or = 5 MHz linear transducer is needed. Most transducers that are used for musculoskeletal ultrasound have about 7.5 MHz. Modern transducers with higher frequencies (>7.5 MHz) and high resolution improve the diagnostic value of the investigation. Sonography is superior to plain radiography to detect erosions as far as the region is accessible by ultrasound. It is more sensitive than the clinical investigation for the detection of synovitis, tenosynovitis, tendinitis, and bursitis as well as for the differentiation of these lesions. Color Doppler sonography aids in evaluating the activity of inflammation and in differentiating intraarticular structures. Carpal- and ulnar neuropathy occur secondary to rheumatoid arthritis and may lead to characteristic nerve swelling. Ultrasound-guided injections into joints and tendon sheets can be performed.

Arthritis, Rheumatoid↗
PubMed2002

[Value of arthrosonography in early arthritis diagnosis].

Sonography of joints and peri-articular soft tissue has become an established imaging technique for the diagnosis and follow-up of patients with rheumatic diseases. Sonography allows a good differentiation of exsudative and proliferative changes of synovialis as well as tenosynovitis. Superficial cartilage and bony lesions may be seen before they are apparent on x-rays. Sonography is helpful in the diagnosis of early arthritis. Dynamical examination of joints allows the detection of structural abnormalities. Sonography can also be used for interventional procedures such as joint aspirations, guidance of therapy and needle biopsy.

Arthritis, Rheumatoid↗
PubMed1988

Results of surgery for trigger finger.

Forty-three patients were reviewed between 17 and 113 months (mean of 47 months) following surgery for acquired stenosing tenosynovitis of the fingers or thumbs. 32 (60.4%) of the 53 operations were completely successful. Of the remaining 21 operations, 26% either failed to relieve all symptoms, or symptoms had recurred at review. 15 operations led to complications that bothered the patient to some extent. Three procedures resulted in significant functional deficit of the hand, two because of nerve damage and one because of stiffness following infection. The three major complications all followed operations performed by junior surgeons. The importance of an adequate trial of conservative therapy to avoid unnecessary surgery is emphasised.

Female↗
PubMed1991

Synovial histology in carpal tunnel syndrome.

This study investigates the relationship between idiopathic carpal tunnel syndrome and tenosynovial histology, specifically inflammation. Tenosynovial biopsy specimens from 177 wrists were obtained from patients at carpal tunnel release, and a control group of 19 specimens was also obtained. Inflammation was present in only 10% of the patient specimens and was correlated with only one of the clinical and histologic factors studied, i.e., nerve conduction impairment. Edema, observed frequently (85%), was not correlated with inflammation. Vascular sclerosis was also found consistently (98%) and was correlated with patient age and degree of edema. Edema and vascular sclerosis occurred with significantly greater frequency and severity in the specimens of patients than in the control group. Fibrosis (3%) and synovial hyperplasia (1%) were uncommon findings. It is concluded that tenosynovitis is uncommon in patients undergoing surgery for treatment of idiopathic carpal tunnel syndrome.

Adult↗
PubMed2006

The ever-expanding association between rheumatologic diseases and tuberculosis.

We summarized most of the rheumatologic manifestations of tuberculosis (TB) and the occurrence of Mycobacterium tuberculosis disease associated with rheumatologic diseases. We established 4 different categories: (1) direct musculoskeletal involvement of M. tuberculosis, including spondylitis, osteomyelitis, septic arthritis, and tenosynovitis; (2) M. tuberculosis as an infectious pathogen in rheumatologic diseases, particularly with the use of newer agents such as tumor necrosis factor-alpha inhibitors; (3) antimycobacterial drug-induced rheumatologic syndromes, including tendinopathy, drug-induced lupus, and others; and (4) reactive immunologic phenomena caused by TB, such as reactive arthritis, erythema nodosum, and others. In addition, Bacille-Calmette-Guérin vaccination used for the prevention of TB or as a chemotherapeutic agent for bladder carcinoma also may be associated with musculoskeletal adverse events. We conclude that M. tuberculosis can directly or indirectly affect the musculoskeletal system.

Antitubercular Agents↗
PubMed2004

Tuberculous arthritis of the appendicular skeleton: MR imaging appearances.

Tuberculosis [TB] of the appendicular skeleton is an uncommon infection caused by the tuberculous bacilli and constitutes only 1-3% of all tuberculosis infections. MR imaging features of tuberculous arthritis include bone marrow oedema, cortical erosions, synovitis, joint effusion, tenosynovitis, soft tissue collections, and myositis. These imaging features are at times non-specific, but in the correct clinical context help in diagnosis of tuberculosis. We present the various pathological manifestations of TB arthritis involving the different joints of appendicular skeleton and discuss their MR imaging appearances.

Adolescent↗
PubMed2005

MR imaging features of foot involvement in ankylosing spondylitis.

OBJECTIVE: To determine alterations of the soft tissue, tendon, cartilage, joint space, and bone of the foot using magnetic resonance (MR) imaging in ankylosing spondylitis (AS) patients. MATERIALS AND METHOD: Clinical and MR examination of the foot was performed in 23 AS patients (46 feet). Ten asymptomatic volunteers (20 feet) were studied on MR imaging, as a control group. MR imaging protocol included; T1-weighted spin-echo, T2-weighted fast-field echo (FFE) and fat-suppressed short tau inversion recovery (STIR) sequences in sagittal, sagittal oblique, and coronal planes using a head coil. Specifically, we examined: bone erosions, tendinitis (acute and chronic), para-articular enthesophyte, joint effusion, plantar fasciitis, joint space narrowing, soft tissue edema, bone marrow edema, enthesopathy in the Achilles tendon and plantar fascia attachment, subchondral signal intensity abnormalities (edema and sclerosis), tenosynovitis, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and bony ankylosis. Midfoot, hindfoot, and ankle were included in examined anatomic regions. RESULTS: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in 3 (13%) of the patients while frequency of involvement was 21 (91%) with MR imaging assessment. The MR imaging findings were bone erosions (65%), Achilles tendinitis (acute and chronic) (61%), para-articular enthesophyte (48%), joint effusion (43%), plantar fasciitis (40%), joint space narrowing (40%), subchondral sclerosis (35%), soft tissue edema (30%), bone marrow edema (30%), enthesopathy of the Achilles attachment (30%), subchondral edema (26%), enthesopathy in the plantar fascia attachment (22%), retrocalcaneal bursitis (22%), subchondral cysts (17%), subchondral fissures (17%), tendinitis and enthesopathy of the plantar ligament (13%), and bony ankylosis (9%). The most common involved anatomical region was the hindfoot (83%) following by midfoot (69% ) and ankle (22%). CONCLUSION: In our experience, MR imaging may detect inflammatory and/or erosive bone, soft tissue, cartilage, tendon, and joint abnormalities in AS patients, even if AS patients did not have clinical signs and symptoms of foot involvement. If these data prove to be confirmed in further MR studies, MR imaging may be of importance especially in early diagnosis of inflammatory changes in the foot.

Achilles Tendon↗
PubMed2006

Extrasynovial ultrasound abnormalities in the psoriatic finger. Prospective comparative power-doppler study versus rheumatoid arthritis.

We prospectively compared power Doppler ultrasound findings in 25 fingers with rheumatoid arthritis (RA) and 25 fingers with psoriatic arthritis (PsA). Erosive synovitis and tenosynovitis were seen in both groups. Extrasynovial changes were found in 21/24 (84%) fingers with PsA versus none of the fingers with RA. Of the 21 PsA fingers exhibiting extrasynovial changes, 15 (15/25, 60%) also had synovial changes. The extrasynovial changes reflected enthesitis or soft tissue inflammation, with the main patterns being capsular enthesophyte, juxtaarticular periosteal reaction, enthesopathy at the site of deep flexor tendon insertion on the distal phalanx, and subcutaneous soft tissue thickening of the finger pad or entire finger. In four fingers, ultrasonograhy showed pseudotenosynovitis, an underrecognized abnormality characterized by diffuse inflammation of the digital soft tissues. Pseudotenosynovitis may play a pivotal role in dactylitis (sausage digit), which is defined as diffuse uniform swelling of the entire finger. Our findings suggest that inflammation of the fibrous skeleton of the finger may lead to the clinical and radiological features that distinguish PsA from RA of the finger.

Adult↗
PubMed2006

Trigger digits: principles, management, and complications.

Stenosing tenosynovitis, or trigger finger, is an entity seen commonly by hand surgeons. This problem generally is caused by a size mismatch between the flexor tendon and the first annular (A-1) pulley. Conservative management includes splinting, corticosteroid injection, and other adjuvant modalities. Surgical treatment consists of release of the A-1 pulley by open or percutaneous techniques. Complications are rare but include bowstringing, digital nerve injury, and continued triggering. Some patients require more extensive procedures to reduce the size of the flexor tendon. Comorbid conditions affect how trigger finger is treated. Patients with rheumatoid arthritis require tenosynovectomy instead of A-1 pulley release. In children trigger thumb resolves reliably with A-1 pulley release but other digits may require more extensive surgery. In diabetic patients trigger finger often is less responsive to conservative measures. An understanding of the pathomechanics, risk factors, and varied treatments for trigger finger is essential for appropriate care.

Adrenal Cortex Hormones↗
PubMed2005

Extensor carpi ulnaris problems at the wrist--classification, surgical treatment and results.

Twenty-eight extensor carpi ulnaris lesions at the wrist were treated surgically between 1990 and 2002. Fifteen patients had an isolated extensor carpi ulnaris tenosynovitis or tendinopathy, five had extensor carpi ulnaris dislocation, four had an extensor carpi ulnaris subluxation and four had an extensor carpi ulnaris rupture. Seventeen patients first developed their symptoms while playing sports. At a mean follow-up of 23 months, twenty-two patients had returned to their previous activities. Seven of the 27 patients had lost more than 30% of their grip strength and five had restricted wrist motion. Two needed an extensor carpi ulnaris tenolysis. Pure isolated extensor carpi ulnaris lesions are rare and associated ulnar sided lesions (eleven triangular fibrocartilage complex tears and four lunotriquetral ligament tears), as well as possible predisposing factors (seven anomalous tendon slips, four ulnar styloid non-unions and one flat extensor carpi ulnaris tendon groove), were frequent. A classification of extensor carpi ulnaris tendon and subsheath lesions was developed to allow the surgeon to adequately evaluate the different components of these lesions.

Adolescent↗
PubMed2005

[The rheumatoid wrist].

Wrist involvement in Rheumatoid Arthritis (RA) is frequent, variable in its presentation, heterogeneous in its evolution and has an important impact on the function of the affected hand. Surgery must be indicated within the framework of a structured medical and surgical approach that considers the whole patient. Surgical treatment at the wrist level is indicated in cases of resistant chronic pain, persistent articular synovitis, or chronic tenosynovitis and also in cases of painful limitation of supination, risk of complications due to wrist deformity and tendinous or neurological complications. The surgical goal in RA is to restore correct function but not neccessarily normal anatomy, with the goal of achieving a painless, stable wrist, correctly positioned. Motion depends on the status of the different joints and on the bone stock. Knowledge of the natural progression of the disease helps in the surgical decision making process. The pathogenesis and patterns of deformity, the clinical and X-ray appearances and the various techniques applied to the surgery of the rheumatoid wrist are studied and discussed including palmar wrist and dorsal wrist procedures, conservative and non-conservative options.

Arthritis, Rheumatoid↗
PubMed2005

New surgical approach to the plantar fetlock joint through the digital flexor tendon sheath wall and suspensory ligament apparatus in cases of concurrent septic synovitis in two cattle.

A new surgical approach to the infected fetlock joint is described in two cattle suffering from septic tenosynovitis of the lateral digital flexor tendon sheaths of the right lateral hind-digits with concurrent septic serofibrinous arthritis of the adjoining fetlock joints, caused by penetrating wounds. In both patients, the infected sheaths were opened and the superficial and deep digital flexor tendons were removed. Intraoperatively, a small entry through the fetlock joint capsule was detected, directly distal to the lateral proximal sesamoid bone. The tract was surgically enlarged and a second approach into the plantar fetlock joint pouch was created proximally by making a 3 cm long and 0.5 cm wide incision between the two lateral suspensory ligament branches. This allowed easy access to the plantar joint pouch, removal of fibrin clots and an effective joint lavage using 5L of sterile saline solution. The incisions of the fetlock joint capsules remained unsutured and were drained using soft polyurethane foam to preclude premature closure. The tendon sheath wounds remained unsutured. In both patients, the digital flexor tendon sheath and the fetlock joint were lavaged daily for the following three days. The infection was eliminated in both cattle and both fully recovered without residual lameness.

Animals↗
PubMed1993

Sonographic findings in examination of digital ganglia: retrospective study.

A retrospective sonographic study of soft tissue masses of the hand was undertaken. A spherical fluid-filled structure with a well-defined wall was seen in 13 patients and the cases were diagnosed as ganglia. This diagnosis had been generally suspected clinically in the presence of a firm nonpainful lump. This study indicates that ultrasound is a valuable diagnostic tool for the study of soft-tissue masses of the hand and in the differential diagnosis of other soft tissue lesions, such as pigmented villonodular synovitis or tenosynovitis.

Adolescent↗
PubMed1993

Pictorial review: the sonographic diagnosis of pathology in the Achilles tendon.

This pictorial essay details Achilles tendon pathology using real-time sonography. Characteristic diagnostic images for tenosynovitis, acute and chronic tendinitis, peritendinitis, nodular tendinitis and complete and partial tendon ruptures are described. The anatomy of the Achilles tendon in relation to these diagnoses is discussed. Ultrasound is recommended as a useful first-line approach in imaging the Achilles tendon.

Achilles Tendon↗
PubMed1998

Ankle tenography. A therapeutic imaging modality.

Ankle tenography is an easily learned technique for the treatment of tenosynovitis. This article describes the procedure in detail and discusses the indications and contraindications for tenography. The anatomy of the ankle tendons is briefly reviewed. This article familiarizes radiologists with this minimally-invasive therapeutic modality so that they can offer it as an option for their referring physicians, who often have few other choices when it comes to managing patients with chronic ankle pain.

Ankle Injuries↗
PubMed1980

Anomalous flexor pollicis longus muscle.

This paper presents a case in which an anomalous tendon from the flexor pollicis longus to the flexor indicis profundus caused limitation of independent flexion of the thumb. The anomaly was accompanied by chronic tenosynovitis.

Adolescent↗
PubMed1980

Pigmented villonodular synovitis in the hand.

The related disorders of pigmented villonodular synovitis and pigmented villonodular tenosynovitis have very different clinical presentations. The synovial form occurs most frequently in the knee although other lower extremity joints including the hip, ankle and subtalar joints can be involved. Rarely, the shoulder, elbow and wrist have been the joint of origin. In contrast, the tenosynovial form is one of the most common masses in the hand and is found very much less frequently elsewhere. This report documents the synovial origin of four cases involving the small joints of the hands.

Adolescent↗