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PubMed1996

Diagnosis and management of tendon disorders in cattle.

Diagnosis and treatment of congenital and acquired tendon disorders in cattle are discussed. A brief discussion of tendon structure, anatomy, biomechanics, and healing is included. Congenital abnormalities presented include hyperextension deformities, flexural deformities, arthrogryposis, and spastic paresis. Acquired abnormalities discussed include tendon displacement, tendinitis, tendon disruption, and tenosynovitis. Antibiotic selection for musculoskeletal infections is briefly discussed.

Animals↗

PubMed1997

Tendoscopy of the posterior tibial tendon.

An anatomic cadaver study was performed and subsequently, in a prospective study, diagnostic and therapeutic tendoscopy (tendon sheath endoscopy) was performed in 16 consecutive patients with a history of persistent posteromedial ankle pain for at least 6 months. All patients had pain on palpation over the posterior tibial tendon, a positive tibial tendon resistance test, and local swelling. The indications were diagnostic procedure after surgery in 5 patients, diagnostic procedure after fracture in 5, diagnostic after trauma in 1, chronic tenosynovitis in 2, screw removal in 1, and posterior ankle arthrotomy in 2 patients. Inspection and surgery of the complete tendon and its tendon sheath can be performed by a standard two-portal technique. A new finding is the vincula that was consistently present in all our autopsy specimens as well as all our patients. At 1-year follow-up, 3 of the 4 patients in whom resection of a pathological thickened vincula, and 2 patients in whom tenosynovectomy and tendon sheath release were performed, were free of symptoms. Other procedures such as removal of adhesions and screw removal could well be performed. In 2 patients with a posteromedially located loose body, successful removal took place by means of a posterior tibial tendoscopic approach. There were no complications.

Adolescent↗

PubMed1993

[Locking of the metacarpophalangeal joint of articular origin. Review of the literature and case report].

We report a case and review concerning literature of intrinsic locking of the metacarpophalangeal joint. These lockings are usually due commonly to degenerative arthritis of the joint, rarely to an abnormal shape of the head of metacarpal or intraarticular loose bodies. They should be differentiated from the extension lag of proximal interphalangeal joint usually encountered in "trigger finger" due to stenosing tenosynovitis. Conservative treatment must be careful and may fail or be complicated. Surgical treatment is effective, best done via an anatomical approach depending on the pathologic findings and the metacarpophalangeal joint locking etiology.

Adult↗

PubMed2000

Sonography of the hand and wrist.

Not only is the anatomy of the hand and wrist complex, but also its pathologic conditions are quite diverse. Although plain radiographs, CT, arthrography, and MRI have traditionally been used to evaluate the hand and wrist, ultrasound is beginning to take its place alongside these more traditional imaging modalities and is being ordered with increasing frequency by orthopedic surgeons. This article reviews the pertinent gross anatomy and sonographic technique used to scan the hand and wrist and also describes the sonographic findings associated with the most common hand and wrist pathologic conditions. These include soft tissue tumors, tenosynovitis, tendinous and ligamentous injuries of the hand, Dupuytren's contracture, foreign bodies, and carpal tunnel syndrome (CTS).

Carpal Tunnel Syndrome↗

PubMed1996

Connective tissue and joint disease in diabetes mellitus.

Connective tissue is ubiquitous and subject to alterations that result in changes in the extracellular matrix of vessels and tissues leading to the long-term complications of diabetes. This article reviews only those abnormalities of interstitial connective tissue involving skeleton, joints, skin, and periarticular tissues. Abnormalities in the skin and periarticular tissues result in syndromes limiting joint movement, including limited joint mobility, Dupuytren disease, flexor tenosynovitis, carpal tunnel syndrome, stiff-hand syndrome, and shoulder-hand reflex dystrophy. Of these, only limited joint mobility and stiff-hand syndrome occur exclusively in patients with diabetes. In all of these conditions, advanced glycation end products are thought to form as a result of nonenzymatic reaction of glucose with proteins, causing stiffening.

Adult↗

PubMed1999

Imaging of the painful shoulder.

A variety of imaging techniques are available for evaluating shoulder pathology. The common disorders of impingement, rotator cuff tears, biceps tenosynovitis and instability are discussed along with the role of various imaging modalities in establishing their diagnosis. Plain radiographs can provide useful information particularly with a history of trauma but give limited information on the soft tissue structures around the shoulder. Ultrasound is a useful and inexpensive means of assessing the biceps tendon and rotator cuff but has a number of limitations and varying reports on its accuracy. Computed tomography (CT) is most helpful in the evaluation of shoulder trauma but gives limited information on the soft tissues. When performed with intra-articular contrast, CT can be used to evaluate shoulder instability particularly in cases where magnetic resonance imaging (MRI) is not available or contraindicated. MRI with or without intra-articular contrast is the most accurate imaging modality for evaluating shoulder pathology allowing visualization of the soft tissues that are often the source of pain.

Diagnostic Imaging↗

PubMed2000

Sonography of tendons.

Recent advances in ultrasound technology and the development of high-resolution ultrasound transducers have enabled detailed depiction of superficial musculoskeletal structures. While in the past considered as complementary to magnetic resonance (MR) imaging, modern ultrasound has clearly become competitive. It is now the imaging modality of choice for evaluating tendon pathology. The major advantages of ultrasound include dynamic evaluation of structures, low cost and wide availability. The main disadvantage is a high degree of operator dependency. This article discusses the current ultrasound characteristics of normal tendon, the artefacts that may mimic tendon disease and reviews the applications of ultrasound to the evaluation of tendon disorders, including tendon tears, tendinitis, tenosynovitis, ganglion cysts and bursitis.

Ankle↗

PubMedDate not supplied

Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation.

PURPOSE: To report a new technique of arthroscopic biceps tenodesis using bioabsorbable interference screw fixation and the early results. TYPE OF STUDY: Prospective, nonrandomized study. METHODS TECHNIQUE: The principle of arthroscopic biceps tenodesis is simple: after biceps tenotomy, the tendon is exteriorized and doubled on a suture; the biceps tendon is then pulled into a humeral socket (7 or 8 mm x 25 mm) drilled at the top of the bicipital groove, and fixed using a bioabsorbable interference screw (8 or 9 mm x 25 mm) under arthroscopic control. PATIENTS: 43 patients treated with this technique between 1997 and 1999 were followed-up for at least 1 year. The technique was indicated in 3 clinical situations: (1) with arthroscopic cuff repair (3 cases), (2) in case of isolated pathology of the biceps tendon with an intact cuff (6 cases), and (3) as an alternative to biceps tenotomy in patients with massive, degenerative and irreparable cuff tears (34 cases). The biceps pathology was tenosynovitis (4 cases), prerupture (15 cases), subluxation (11 cases), and luxation (13 cases). RESULTS: The absolute Constant score improved from 43 points preoperatively to 79 points at review (P <.005). There was no loss of elbow movement and biceps strength was 90% of the strength of the other side. Two patients, operated on early in the series, presented with a rupture of the tenodesis. In both cases the bicipital tendon was very friable and the diameter of the screw proved to be insufficient (7 mm). No neurologic or vascular complications occurred. CONCLUSIONS: Arthroscopic biceps tenodesis using bioabsorbable screw fixation is technically possible and gives good clinical results. This technique can be used in cases of isolated pathologic biceps tendon or a cuff tear. A very thin, fragile, almost ruptured biceps tendon is the technical limit of this arthroscopic technique.

Absorbable Implants↗

PubMedDate not supplied

Ultrasonography for the diagnosis of diseases of the tendon and tendon sheath of the biceps brachii muscle.

OBJECTIVE: To describe the ultrasonographic appearance of the normal and diseased biceps brachii tendon and its tendon sheath in dogs. STUDY DESIGN: A prospective clinical study. ANIMALS: One hundred twenty client-owned dogs. METHODS: In the first part of the study, the ultrasonographic appearance of the normal biceps brachii muscle and the surrounding soft tissue was determined in 27 healthy dogs. Standard views were described and established. In the second part, 120 dogs with suspected pathology of the biceps brachii muscle were examined ultrasonographically. Fifty-five of these dogs had no sonographic changes, and 65 dogs had sonographically detectable pathologic changes of the tendon or the tendon sheath or both. The mean age of the affected dogs was 3.7 years. The ratio of males to females was 1.95:1. Sedation or anesthesia of the dogs was required because of the extreme movements of the leg necessary for the examination. To achieve a perpendicular view of the tendon and the tendon sheath, the area of the shoulder joint was rotated outward and abducted as far as possible. Examination of the muscle-tendon apparatus of the biceps brachii muscle was divided into 4 main sections. RESULTS: Linear transducers (7.5-10 MHz) allowed the soft tissue structures to be easily visualized with ultrasonography. Pathologic changes of the tendon and tendon sheath were visualized sonographically by using high-frequency linear probes. Partial or complete tendon rupture, medial luxation of the tendon, corpora libera in the tendon sheath, and tenosynovitis were clearly shown. CONCLUSIONS: High-frequency ultrasonography using linear transducers allows the examiner to accurately define the pathologic changes in the region of the biceps brachii tendon in dogs. CLINICAL RELEVANCE: The use of sonography for diagnosis of disease processes of the tendon and tendon sheath of the biceps brachii muscle complements clinical and radiographic examination findings.

Animals↗

PubMed2001

Sonographically guided procedures in rheumatology.

OBJECTIVE: To provide some representative examples of sonographically guided arthrocentesis and intralesional injection therapy. METHODS: Sonographic evaluation was performed with high-frequency linear (13 MHz) and mechanical sector (20 MHz) transducers. The images were obtained in representative patients with rheumatoid arthritis and posttraumatic subacromial bursitis. RESULTS: Sonographically guided intralesional injection is a rapid and reliable procedure, especially in patients with arthritis, tenosynovitis, and bursitis. After target localization, needle placement can be performed under continuous sonographic monitoring. Sonographic guidance is particularly useful when fluid collections are small (less than 5 mm) and deep or when the inflammatory process is adjacent to anatomic structures that could be seriously damaged by the injection. CONCLUSIONS: Over the last few years, the rapid technologic advancements in ultrasonography have dramatically increased the potential applications of sonographically guided procedures. The simplicity and reliability of the technique might warrant rheumatologists to undergo sonographic training.

Arthroscopy↗

PubMed1999

Closed continuous irrigation in the treatment of hand infections.

We report our experience with a closed continuous irrigation system in 12 patients with hand infections: six cases of flexor tenosynovitis, three cases of septic arthritis and three palmar abscesses. Four of these patients had undergone previous surgical debridement and peroperative washout without elimination of the infection. The continuous irrigation system consists of two fenestrated tubes placed within the infected space, with the tip of the smaller calibre inlet tube positioned just inside the larger outlet tube. Resolution of infection was achieved in all 12 cases and all regained complete functional recovery. The closed continuous irrigation system is easy to manage, with no leakage of fluid; hand therapy may be started early and the patient is mobile throughout.

Abscess↗

PubMed2005

MR imaging appearance of rheumatoid arthritis in the foot.

Although conventional radiographs remain the initial mainstay for imaging of the foot in patients with rheumatoid arthritis (RA), magnetic resonance (MR) imaging has afforded the ability to detect early signs of the disease (i.e., synovitis, tenosynovitis, bone lesions, and bursitis), especially at the forefoot. In addition, the relatively symmetric distribution of the imaging abnormalities depicted in the metatarsophalangeal joints and the frequent involvement of the retro-calcaneal bursitis are almost specific for RA. In more advanced stages of the disease, MR imaging is well suited to evaluation of the hindfoot joints and tendons as well as the musculoskeletal complications of RA (e.g., tendon disruption, rheumatoid nodules, sinus tarsi syndrome).

Arthritis, Rheumatoid↗

PubMed1990

[Therapy-resistant heel pain--an indication for surgery in sports traumatology].

Posterior heel pain can be caused by inflammation or pathology of the achilles tendon, the tendon sheath, the retrocalcaneal and subcutaneous tendoachilles bursa, can be caused by osteophytes or stress fracture of the os calcis and by rheumatoid or metabolic diseases. The majority of patients can be treated successful nonoperatively; however, there is a small group of patients who are refractory to nonoperative managements. In the years 1984 to 422 patients with posterior heel pain were treated conservatively, 26 of these patients were refractory to that management. There were 9 cases of achilles tendinitis and/or tenosynovitis, 7 cases of bursitis, 3 cases of osteophyte of the os calcis. In 7 cases there was seen a combination of these three diseases. The following operative procedures were performed: discision of the tendon sheath, excision of thickened parts by inflammation, excision of degenerative and necrotic pain-producing areas in the achilles tendon, excision of bursa and ostectomy of osteophyte at the posterior-superior angle of the os calcis. The mean follow-up was 2.7 years (range, 1/2 to 5 years). Overall there were 79% good results. In our opinion cases of posterior heel pain refractory to non-operative treatment are an indication of sports surgery, especially in patients who like to continue sports without pain.

Achilles Tendon↗

PubMedDate not supplied

[Diagnosis and therapy of tendovaginitis of the extensor carpi ulnaris (stenosis of the 6th extensor compartment)].

Stenosing tenosynovitis over the dorsum of the wrist in the sixth compartment is seldom mentioned in literature. We have collected 28 cases in a four-year period which demonstrate that the incidence is quite high. This condition should be considered in the differential diagnosis of pain over the dorso-ulnar aspect of the wrist. On examination firm, fusiform swelling in the sixth compartment was present. Pain was elicited by active ulnar deviation against resistance. All 28 patients had local infiltration with cortisone, but only 8 patients obtained complete relief. 18 of 20 patients had complete relief of their symptoms after surgical release of the sixth compartment. We conclude that stenosing tendovaginitis of extensor carpi ulnaris is a relatively common condition. Awareness of the syndrome allows accurate diagnosis and treatment.

Adolescent↗

PubMed1984

[Width of the normal tendon sheath in the 2d to 5th fingers in oblique exposures].

Oblique views of the fingers, using a low kilovolt technique, show a portion of the tendon sheaths which can be regarded as representative of the entire sheath. Because of the varying obliquity of each finger, this proportion differs in the fingers. With increasing age the projected portion of the sheath becomes smaller because it is covered by increasing bone formation in the insertion of the tendon sheath. Normal values have been obtained for adults according to their decades; from these, quite minor degrees of tendon sheath thickening can be determined. In camptodactyly of the fifth finger, which is not uncommon, the tendon sheath may be widened in the absence of a tenosynovitis.

Adult↗

PubMed1984

[Soft-tissue changes in the metacarpal area in chronic polyarthritis].

Rheumatoid arthritis causes changes in the soft tissues in the metacarpal portion of the hand which can be demonstrated by low Kv exposures. Indirect signs of inflammation consist of oedema extending from the synovial compartments to the skin, the subcutaneous tissues, the intermuscular fat septa and the peritendinous tissue. Increased blood flow leads to dilatation of veins. Direct signs of inflammation consists of tenosynovitis and synovitis of the joints, with enlargement of the corresponding compartments. Limited mobility of the hand over a long period, or improvement in motility are paralleled by changes in muscle mass.

Adult↗

PubMed1975

Re-examination of histocompatibility antigens found in patients with juvenile rheumatoid arthritis.

One hundred and twenty-three patients with juvenile rheumatoid arthritis and a similar number of controls were tissue typed for 30 HL-A antigens to determine if there were any associations between particular HL-A antigens and the disease. None were found. However, HL-A7 was found more frequently in patients with juvenile rheumatoid arthritis demonstrating tenosynovitis than in the population with juvenile rheumatoid arthritis as a whole. These observations fail to support the contention of others that HL-A-W27 is found more frequently than expected in such patients.

Adolescent↗

PubMed1995

Upper limb musculoskeletal disorders in highly repetitive industries: precise anatomical physical findings.

Physical assessment of 146 female workers in highly repetitive jobs found 54% to have evidence of musculoskeletal disorders in the upper limb that are potentially work-related. Many workers had multiple problems, and many were affected bilaterally (33% of workers). Muscle pain and tenderness was the largest problem, both in the neck/shoulder area (31%) as expected and in the forearm/hand musculature (23%), a previously unreported site. Most forearm muscle problems were found on the extensor side. Carpal tunnel syndrome was the most common form of neuritis with 16 people affected (7 people affected bilaterally). De Quervain's tenosynovitis and wrist flexor tendinitis were the most commonly found tendon disorders in the distal forearm (12 people affected for each diagnosis). The results suggest that exposure should be measured bilaterally. They also suggest that muscle tissue is highly vulnerable to overuse. Stressors that affect muscle tissue, such as static loading, should be studied in the forearm as well as in the shoulder.

Adult↗