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PubMedDate not supplied

Endoscopically assisted annular ligament release in horses.

An endoscopically assisted technique for internally dividing the palmar or plantar annular ligament was developed in six cadaver limb specimens and two anesthetized horses. Under arthroscopic view, a slotted cannula was inserted into the digital sheath through a stab wound proximal to the annular ligament and advanced through the fetlock canal superficial to the flexor tendons with the slot oriented toward the fibers of the annular ligament. Division of the annular ligament by 90-degree tipped open and guarded blades was observed and verified by direct arthroscopic view. At necropsy, complete division of the annular ligament without iatrogenic damage to the neurovascular structures was confirmed by dissection. Annular ligament division was performed in seven horses with complex tenosynovitis conditions. Tenoscopic examination and removal of tendon and digital sheath adhesions, masses, and bands was followed by endoscopically assisted annular ligament transection. At follow-up, five horses were sound athletes without recurrent digital sheath problems, one horse had residual lameness, and one horse was still convalescing.

Animals↗
PubMed1992

A retrospective study of 192 horses affected with septic arthritis/tenosynovitis.

The medical records of 192 horses with septic arthritis/tenosynovitis 1979-1989 were reviewed. Forty-three horses developed infection after an intra-articular injection, 46 following a penetrating wound, 25 following surgery, 66 were foals less than 6 months old, and 12 were adult horses without a known aetiology. Haematogenous infection of a joint occurs in adult horses and should be considered as a differential diagnosis in horses with an acute onset of severe lameness. The aetiology of the infection had a significant effect on the type of bacteria identified by culture. Staphylococcus was cultured from most of the horses that developed infection following a joint injection or surgery, 69% of the horses from which an organism was identified. Horses that developed infection secondary to a penetrating wound frequently provided cultures of more than one organism; Enterobacteriaceae and anaerobes were more frequently isolated in this group. The most common organisms isolated from foals were Enterobacteriaceae; E. coli was identified in more than 27% of the foals. The hock was the most frequently involved joint. Multiple treatments were used over the 10-year period of study. Survival rates were lowest in foals; only 45% survived to be released from the hospital. Survival was greater in adult horses; 85% of the horses that were treated were released from the hospital. Survival was significantly greater in horses with septic tenosynovitis; all 14 of the horses that were treated survived. Survival was not significantly affected by the joint involved or by the type of bacteria cultured from the synovial fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Mycobacterium haemophilum infection in a patient with acquired immune deficiency syndrome.

Mycobacterium haemophilum was isolated from wrist and ankle aspirates as the organism responsible for tenosynovitis in a patient with acquired immune deficiency syndrome. Mycobacterium isolates recovered from synovial fluid were identified as hemin requiring by their failure to grow on subculture unless the medium was supplemented with hemin. M. haemophilum is of low virulence and rarely associated with infections in humans. This is the first documented case of M. haemophilum infection in a patient with acquired immune deficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease.

OBJECTIVE: To determine the prevalence of subclinical synovitis using ultrasound (US) imaging of both painful and asymptomatic joints, in patients with early (<12 months), untreated oligoarthritis (</=5 joints). METHODS: Eighty patients underwent a detailed clinical assessment by two physicians. All painful joints were identified, which were immediately scanned by a sonographer. In the last 40 patients, an additional standard group of joints was scanned to establish the prevalence of synovitis in asymptomatic joints. RESULTS: In 80 patients, 644 painful joints (with and without clinical synovitis) were identified and each underwent a US assessment. Of these joints, 185 had clinical synovitis, of which, US detected synovitis in only 79% (147/185). In the other 38 joints US demonstrated tenosynovitis instead of synovitis in 12 joints and possible, but not definite, synovitis in 11 joints. Fifteen joints were, however, normal on US. In 459 joints that were not clinically synovitic, US detected synovitis in 33% (150/459). In 64% (51/80) of patients, US detected synovitis in more joints than clinical examination and in 36% (29/80) of patients, US detected a polyarthritis (>6 joints). Of the 826 asymptomatic (non-painful) joints scanned, 13% (107/826) had US detected synovitis. CONCLUSION: Sonography detected more synovitis than clinical examination in patients with oligoarthritis. In almost two thirds of patients there was evidence of subclinical disease while one third could be reclassified as polyarticular. These findings suggest that a definition of oligoarthritis based purely on clinical findings may be inappropriate, which may have important implications for disease management.

Adult↗
PubMed1977

Musculoskeletal manifestations of bacterial endocarditis.

The records of 180 patients out of 247 with bacterial endocarditis were examined. 50 patients had rheumatic manifestations. In 10 there was arthritis of 2-12 weeks' duration before diagnosis; 19 had myalgia/arthralgia; 17 had back or neck pain; 14 had demonstrable arthritis; and 2 tenosynovitis of the foot. Of the 14 patients with arthritis, 8 had monarticular arthritis and 6 polyarticular. All but one patient had a raised erythrocyte sedimentation rate, and in one patient rheumatoid factor was positive. The rheumatic features responded when the endocarditis was treated. Some of the symptoms undoubtedly resulted from the infection and fever of the endocarditis, and emboli may have caused the transient aches but there was no evidence that they caused the synovitis in the patients with arthritis. The rheumatic manifestations of bacterial endocarditis can mimic other rheumatic diseases and disguise the underlying disease.

Adolescent↗
PubMed1981

Sausage digit due to radish bacillus.

We wish to draw attention to a very characteristic but little known syndrome. An elderly woman presented with a 'sausage finger', rheumatological jargon used to describe diffuse swelling of the digit. This proved to be a proliferative tenosynovitis caused by an atypical mycobacterium, Mycobacterium terrae, or the radish bacillus.

Aged↗
PubMed1988

Prediction of erosiveness and rate of development of new erosions in early rheumatoid arthritis.

Fifty eight patients suffering from a recent onset of rheumatoid arthritis (RA) were studied. Fifty six patients were followed up for 24 months and two for 18 months. Erosions were detected in 17 patients at the onset and at the end of the follow up period the number of patients with erosions was 44. The erosiveness in the joint groups studied was as follows: metatarsophalangeal (MTP) (36 patients), metacarpophalangeal (MCP) (22), proximal interphalangeal (PIP) (21), interphalangeal (IP) joints of first toes and wrists (13), elbows and knees (two), and shoulders, ankles, and hips (one). Erosiveness in the feet was twice that in the fingers, and the erosions in the feet appeared at an earlier phase of disease. Destructions favoured the dominant hand. Swelling in the PIP joints appeared to be a better predictor of erosiveness than joint tenderness. The number of joints to become eroded was significantly increased in the patients with flexor tenosynovitis in the hands. Erythrocyte sedimentation rate (ESR) was more closely related to progression of joint damage than C reactive protein (CRP) or haemoglobin. The rate of development of new erosions was the same in seronegative and seropositive patients. In addition, HLA-DR4 allele did not correlate either with seropositivity or with erosiveness. Adequate antirheumatic drug treatment (gold in most instances) was not able to restrain the erosive process despite decreased rheumatoid disease activity.

Adolescent↗
PubMed1993

Acquired Brown's syndrome in a patient with systemic lupus erythematosus.

A 27 year old woman with systemic lupus erythematosus (SLE) developed vertical diplopia with an apparent bilateral inferior oblique muscle palsy, resulting in a limitation of elevation of the globe in adduction. It resolved with systemic steroid treatment. A transient tenosynovitis affecting the superior oblique tendons was the probable underlying pathological mechanism. This is the first described case of Brown's syndrome associated with SLE.

Adult↗
PubMed2002

Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints.

OBJECTIVE: To carry out a prospective two year follow up study comparing conventional radiography, three-phase bone scintigraphy, ultrasonography (US), and three dimensional (3D) magnetic resonance imaging (MRI) with precontrast and dynamic postcontrast examination in detecting early arthritis. The aim of the follow up study was to monitor the course of erosions during treatment with disease modifying antirheumatic drugs by different modalities and to determine whether the radiographically occult changes like erosive bone lesions of the finger joints detected by MRI and US in the initial study would show up on conventional radiographs two years later. Additionally, to study the course of soft tissue lesions depicted in the initial study in comparison with the clinical findings. METHODS: The metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints (14 joints) of the clinically more severely affected hand (soft tissue swelling and joint tenderness) as determined in the initial study of 49 patients with various forms of arthritis were examined twice. The patients had initially been divided into two groups. The follow up group I included 28 subjects (392 joints) without radiographic signs of destructive arthritis (Larsen grades 0-1) of the investigated hand and wrist, and group II (control group) included 21 patients (294 joints) with radiographs showing erosions (Larsen grade 2) of the investigated hand or wrist, or both, at the initial examination. RESULTS: (1) Radiography at the two year follow up detected only two erosions (two patients) in group I and 10 (nine patients) additional erosions in group II. Initial MRI had already detected both erosions in group I and seven (seven patients) of the 10 erosions in group II. Initial US had depicted one erosion in group I and four of the 10 erosions in group II. (2) In contrast with conventional radiography, 3D MRI and US demonstrated an increase in erosions in comparison with the initial investigation. (3) The abnormal findings detected by scintigraphy were decreased at the two year follow up. (4) Both groups showed a marked clinical improvement of synovitis and tenosynovitis, as also shown by MRI and US. (5) There was a striking discrepancy between the decrease in the soft tissue lesions as demonstrated by clinical findings, MRI, and US, and the significant increase in erosive bone lesions, which were primarily evident at MRI and US. CONCLUSIONS: Despite clinical improvement and a regression of inflammatory soft tissue lesions, erosive bone lesions were increased at the two year follow up, which were more pronounced with 3D MRI and less pronounced with US. The results of our study suggest that owing to the inadequate depiction of erosions and soft tissue lesions, conventional radiography alone has limitations in the intermediate term follow up of treatment. US has a high sensitivity for depicting inflammatory soft tissue lesions, but dynamic 3D MRI is more sensitive in differentiating minute erosions.

Adult↗
PubMed1998

Surveillance case definitions for work related upper limb pain syndromes.

OBJECTIVES: To establish consensus case definitions for several common work related upper limb pain syndromes for use in surveillance or studies of the aetiology of these conditions. METHODS: A group of healthcare professionals from the disciplines interested in the prevention and management of upper limb disorders were recruited for a Delphi exercise. A questionnaire was used to establish case definitions from the participants, followed by a consensus conference involving the core group of 29 people. The draft conclusions were recirculated for review. RESULTS: Consensus case definitions were agreed for carpal tunnel syndrome, tenosynovitis of the wrist, de Quervain's disease of the wrist, epicondylitis, shoulder capsulitis (frozen shoulder), and shoulder tendonitis. The consensus group also identified a condition defined as "non-specific diffuse forearm pain" although this is essentially a diagnosis made by exclusion. The group did not have enough experience of the thoracic outlet syndrome to make recommendations. CONCLUSIONS: There was enough consensus between several health professionals from different disciplines to establish case definitions suitable for use in the studies of several work related upper limb pain syndromes. The use of these criteria should allow comparability between studies and centres and facilitate research in this field. The criteria may also be useful in surveillance programmes and as aids to case management.

Arm↗
PubMed1994

An unusual outbreak of Streptococcus bovis septicaemia in racing pigeons (Columba livia).

In December 1991, an outbreak of Streptococcus bovis septicaemia occurred in a Belgian pigeon loft where 25 male and 25 female racing pigeons were housed. The main clinical signs included inability to fly and poor breeding results. None of the female pigeons and only one male pigeon was able to fly. Nine affected pigeons were necropsied. Histologically a tenosynovitis of the tendon of the deep pectoral muscle was observed in most of them and S bovis was isolated from the canalis triosseus or the shoulder joints of five of the nine pigeons. The pigeons were successfully treated with ampicillin administered in the drinking water for seven days.

Animals↗
PubMed2000

Resection of the common digital extensor tendon in a gelding.

A four-year-old gelding was lame owing to a chronic septic common digital extensor tendon and sheath. The horse had been treated by open surgical lavage but the sepsis had recurred after three months. Physical, ultrasonographic, cytological and histological examinations confirmed chronic septic tenosynovitis and tendonitis. The entire intrathecal component of the common digital extensor tendon was resected under general anaesthesia and the synovial lining of the sheath was ablated. Postoperatively the horse regained good limb function and became sound.

Animals↗
PubMed2005

Report of an unusual case of trigger finger secondary to phalangeal exostosis.

Trigger finger is commonly secondary to stenosing tenosynovitis. Space occupying lesions in the tendon bed, although uncommon, may prevent smooth tendon gliding. These include lipoma, anomalous muscle insertions, tumours of the tendon sheath and haemangiomas. We describe a patient who had triggering of the left middle finger at the proximal interphalangeal joint due to an exostosis blocking the flexor tendons gliding. Removal of the exostosis relieved the problem. The clinician must be aware that there are other causes for triggering. These may be identified with pertinent findings in the history and physical examination.

Adult↗
PubMed1996

MR imaging of the wrist: normal findings that may simulate disease.

Twenty-six normal wrists in young adults were studied with magnetic resonance (MR) imaging. The following conclusions were drawn regarding normal anatomic features: (a) Multiple slips of the abductor pollicis longus tendon simulate longitudinal tears; (b) the extensor pollicis longus and extensor carpi ulnaris tendons normally demonstrate increased signal intensity simulating tendinitis; (c) small quantities of fluid in the extensor tendon sheaths may be normal and not indicative of tenosynovitis; (d) the triangular fibrocartilage normally demonstrates increased signal intensity simulating tears at its radial and ulnar attachment sites; (e) the volar ulnocarpal ligaments are often indistinct, thereby simulating injury; and (f) the median nerve has signal intensity equivalent to that of fat, nor of muscle as commonly believed. Awareness of these normal features is critical in making the correct interpretation of MR images of the wrist.

Adult↗
PubMedDate not supplied

Painful heel: MR imaging findings.

Heel pain is a common and frequently disabling clinical complaint that may be caused by a broad spectrum of osseous or soft-tissue disorders. These disorders are classified on the basis of anatomic origin and predominant location of heel pain to foster a better understanding of this complaint. The disorders include plantar fascial lesions (fasciitis, rupture, fibromatosis, xanthoma), tendinous lesions (tendinitis, tenosynovitis), osseous lesions (fractures, bone bruises, osteomyelitis, tumors), bursal lesions (retrocalcaneal bursitis, retroachilleal bursitis), tarsal tunnel syndrome, and heel plantar fat pad abnormalities. With its superior soft-tissue contrast resolution and multiplanar capability, magnetic resonance (MR) imaging can help determine the cause of heel pain and help assess the extent and severity of the disease in ambiguous or clinically equivocal cases. Careful analysis of MR imaging findings and correlation of these findings with patient history and findings at physical examination can suggest a specific diagnosis in most cases. The majority of patients with heel pain can be successfully treated conservatively, but in cases requiring surgery (eg, plantar fascia rupture in competitive athletes, deeply infiltrating plantar fibromatosis, masses causing tarsal tunnel syndrome), MR imaging is especially useful in planning surgical treatment by showing the exact location and extent of the lesion.

Adipose Tissue↗
PubMed2000

US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs.

The diagnosis of nerve entrapment at osteofibrous tunnels relies primarily on clinical and electrodiagnostic findings. Recently, the refinement of high-frequency broadband transducers with a range of 5-15 MHz, sophisticated focusing in the near field, and sensitive color and power Doppler technology have improved the ability to evaluate peripheral nerve entrapment in osteofibrous tunnels with ultrasonography (US). In the upper limb, osteofibrous tunnels amenable to US examination include the carpal tunnel for the median nerve and the cubital and Guyon tunnels for the ulnar nerve. In the lower limb, these tunnels include the fibular neck for the common peroneal nerve, the tarsal tunnel for the posterior tibial nerve, and the intermetatarsal spaces for the interdigital nerves. High-resolution US allows direct imaging of the involved nerves, as well as documentation of changes in nerve shape and echotexture that occur in compressive syndromes. A spectrum of extrinsic causes of entrapment, such as tenosynovitis, ganglia, soft-tissue tumors, bone and joint abnormalities, and anomalous muscles, can also be diagnosed with US. With continued experience, it is likely that this technique will be increasingly used to evaluate nerve entrapment syndromes.

Arm↗
PubMed1989

Soft-tissue changes in the hand in rheumatoid arthritis: evaluation with US.

High-frequency (5.0 and 7.5 MHz) ultrasonography (US) was performed in 16 patients with rheumatoid involvement of soft tissues in the hand or wrist; surgery was performed in 11. In 15 (94%) patients, a hypoechoic thickening of one or several tendon sheaths was noted. The thickening ranged from 2 to 13 mm (mean, 5.2 mm +/- 3.0). Complete or partial flexor tendon ruptures were correctly suspected preoperatively at real-time dynamic US examination in three patients. A discrete, elongated, hypoechoic soft-tissue nodule was demonstrated in five patients; one nodule was intra-tendinous. In 10 of 11 patients, US findings correlated well with those of surgery. Real-time US proved highly accurate in demonstrating rheumatoid soft-tissue changes in the hand. A hypoechoic rim around a tendon in the hand or wrist in a patient with rheumatoid arthritis is highly suggestive of rheumatoid tenosynovitis. US also provides surgeons with an accurate preoperative map of the lesions.

Adult↗