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PubMed1999

High-frequency ultrasound examination of the wrist and hand.

High-frequency ultrasound (US) is an efficient, rapid and inexpensive altenative to magnetic resonance imaging (MRI) for investigation of diseases in the soft tissues of the wrist and hand. US allows detection of foreign bodies and the reliable identification of a variety of traumatic lesions affecting tendons, annular pulleys, ligaments, vessels and nerves. Inflammatory diseases of tendons, including acute and chronic tenosynovitis and some degenerative conditions in the wrist and hand, can also be diagnosed. In entrapment neuropathies, US is able to identify nerve shape changes and possible extrinsic space-occupying lesions that may cause nerve compression within the tunnels. In patients with localized swelling of the hand or wrist, US is able to assess the presence of an expansile lesion and to characterize its nature in most cases. The objective of this article is to review the main findings and the primary indications of US in the investigation of disorders of the hand and wrist.

Diagnosis, Differential↗

PubMed1999

Posteromedial subtalar coalition: imaging appearances in three cases.

OBJECTIVE: To define the imaging appearances in three cases of posteromedial subtalar coalition. DESIGN: Three patients who presented with hindfoot pain were found to have non-osseous coalition involving the posteromedial hindfoot. This entity is distinct from conventional middle facet coalition as the sustentaculum is uninvolved. RESULTS: Plain radiographs, available in two cases, demonstrated subtle irregularity of the posterior facet. MRI (three cases) demonstrated a mixed bony and cartilaginous mass lying posterior to the sustentaculum. There was trabecular oedema within the mass and adjacent talus, and narrowing of the space between the middle and posterior facets. Prominence and dilatation of the posterior tibial veins with tenosynovitis of the adjacent tibialis posterior tendon was seen. CT demonstrated the bony mass but did not detect the adjacent bony oedema. CONCLUSION: Posteromedial subtalar coalition may present with hindfoot pain and stiffness. The presence of a pseudarthrosis posterior to a normal middle facet is characteristic. The abnormality can be difficult to detect on plain radiographs.

Adolescent↗

PubMed2005

Novel transdermal photodynamic therapy using ATX-S10.Na(II) induces apoptosis of synovial fibroblasts and ameliorates collagen antibody-induced arthritis in mice.

We aimed to test the effect of transdermal photodynamic therapy (PDT) on synovial proliferation in vitro and in vivo, using a novel photosensitizer, ATX-S10.Na(II). Synovial fibroblasts were obtained from patients with RA (RASF). Cell viability with or without PDT was determined by MTT assay. Cell morphology was examined by light and transmission electron microscopy. DNA fragmentation was labeled by TUNEL stain. Collagen antibody-induced arthritis (CAIA) was induced in DBA/1 mice, and the effects of transdermal PDT were evaluated by clinical and histological examination. PDT showed drug concentration-dependent and laser dose-dependent cytotoxicity on RASF. TUNEL stain and TEM study revealed the induction of apoptotic cell death of RASF. Transdermal PDT significantly reduced clinical arthritis and synovial inflammation in this model of arthritis. These results suggest that transdermal PDT using ATX-S10.Na(II) might be a novel less invasive treatment strategy for small joint arthritis and tenosynovitis.

Animals↗

PubMed2002

MR imaging assessment of clinical problems in rheumatoid arthritis.

Although MR imaging has been increasingly recognized as a useful tool in the diagnosis of early rheumatoid arthritis (RA) and in the assessment of disease activity, these applications have not yet been usually included in the routine management of this condition. Our goal is to review the current role of MRI in the everyday clinical management of patients with RA. The usefulness of MRI in the evaluation of articular and para-articular changes in specific locations, mainly the craniocervical region and the temporomandibular joint, are reviewed. Clinical problems derived from local extra-articular involvement, such as tenosynovitis, "rice-bodies" bursitis, and Baker's cyst rupture, are also described. Finally, we also review the value of MRI in evaluation of some complications of RA such as tendinous rupture, osteonecrosis, stress fracture, and septic arthritis/osteomyelitis.

Adult↗

PubMed2002

[Technique and diagnostic value of musculoskelatal ultrasonography in rheumatology. Part 5: Ultrasonography of the shoulder].

Shoulder-related symptoms are very common in rheumatic diseases. For the evaluation of the diagnosis as well as for therapy and prognosis, an anatomic assignment is essential. Clinical investigations alone are often not capable to do this. Ultrasonography is a method to delineate bony surfaces as well as the soft tissues around the shoulder joints statically and even dynamically. For the purpose of rheumatic diseases, ultrasound standard scans help to detect the lesions at the biceps tendon, the bursae, the rotator cuff, the humeral head as well as in the acromial and sternoclavicular joints. Considering the limitations of the method (obesity, frozen shoulder, no findings under bony structures) and knowing the pitfalls and errors of the method, ultrasonography is a reliable, quick and low cost method for the diagnosis of rheumatic shoulder joint pathology. Compared to computer tomography and magnetic resonance imaging, ultrasonography should be used as a screening method. The following standard scans are suggested for sonographic evaluation of the shoulder: 1) anterior transverse scan and 2) anterior longitudinal scan at the bicipal groove to detect synovitis and tenosynovitis, 3) anterior transverse scan at the coracoacromiale window in the neutral position, 4) at maximal external rotation and 5) at maximal internal rotation to evaluate the rotator cuff, bursitis, synovitis and erosions, 6) anterior longitudinal scan at 90 degrees to the coracoacomiale window at maximal internal rotation to describe these findings in an additional dimension, 7) anterior-lateral longitudinal scan at the anterior lateral acromion to tuberculum majus to evaluate the distal part of the supraspinatus muscle, 8) posterior transverse scan at the fossa infraspinata lateral under the spina scapulae, 9) axillary longitudinal scan to evaluate synovitis, synovial proliferation, erosions at the humeral head, lesions at the glenoidale labrum, 10) anterior transverse scan at the acromioclavicular joint and 11) anterior oblique scan at the sternoclavicular joint to detect synovitis, synovial proliferation, erosion, osteophytes.

Acromioclavicular Joint↗

PubMed2005

A case of trigger finger following partial laceration of flexor digitorum superficialis and review of the literature.

Trigger finger is a common condition, and the usual cause is stenosing tenosynovitis. Trigger finger caused by trauma is extremely rare. We examined a patient in whom an apparently trivial laceration caused partial laceration of the flexor tendon, leading to trigger finger. In this case, ultrasonography was useful in establishing the presurgical diagnosis. Removal of the impinging tag cured the trigger finger. We also review nine previously reported cases. When triggering occurs after an injury near the base of a finger, partial laceration of the flexor tendon should be kept in mind as the cause. Ultrasonography may be valuable for the diagnosis.

Adolescent↗

PubMed2005

Nonepisodic angioedema with eosinophilia: a report of two cases and a review of the literature.

We report two young female patients who developed sudden-onset nonpitting edema in both hands and lower legs in early autumn with no significant previous or family history. One of these patients showed arthralgia in both wrists and ankles. The clinical symptoms improved without treatment, and they were diagnosed as having nonepisodic angioedema with eosinophilia (NEAE) based on laboratory investigations and the lack of recurrence. The clinical picture of this disease is often similar to that of rheumatologic disorders with tenosynovitis with regard to edema and pain in the distal portion of the extremities. When edema is seen in the bilateral hands and lower legs, particularly in young women, NEAE should be actively considered as a possible diagnosis.

Adult↗

PubMed2006

Extraspinal tuberculous arthritis in HIV era.

A worldwide reemergence of tuberculosis is appreciable. Extrapulmonary tuberculosis has been observed to increase disproportionately from past incidence. One of the main attributing factors is the human immunodeficiency virus (HIV) infection. The objective of this study was to study clinical features, laboratory findings, and association with HIV infection in patients with peripheral tuberculous arthritis. The retrospective study was performed by reviewing the medical records of 27 patients with extraspinal tuberculous arthritis treated from January 1994 to December 2002. The diagnosis was made either by compatible clinical presentation and positive culture for Mycobacterium tuberculosis or histological finding of caseating granuloma in biopsy tissue or both. The average age of the patients' population was 49.3 years (range 27-74 years), made up of a 52% or 14 patients of male subjects. The mean duration of disease before seeking medical treatment was 10.2+11 weeks and from onset to diagnosis was 25 weeks. The most frequently affected joints were knees (36.6%) followed by wrists, ankles, shoulders, hips, sacroiliacs, and elbows, respectively. Monoarthritis was the main feature of this group, except for two patients who had two and three joints involvement, respectively. Dactylitis (tenosynovitis) was also found in two out of the 27 patients. Six patients (24%) had active pulmonary infiltration on chest X-ray. Of 11 patients with synovial polymerase chain reaction (PCR) testing for tuberculosis, seven patients had positive result. Only one patient with extraspinal tuberculous arthritis tested positive for HIV. Therefore, extraspinal tuberculous arthritis is observed to be usually present with chronic monoarthritis. The diagnosis is delayed in most occasions. PCR from synovial fluid may facilitate rapid diagnosis of tuberculous arthritis. Human immunodeficiency virus may not be a main contributing factor for extraspinal tuberculous arthritis.

Adolescent↗

PubMed2006

Dactylitis: pathogenesis and clinical considerations.

Dactylitis is considered a hallmark feature of psoriatic arthritis (PsA), but it is found in other spondyloarthropathies, especially reactive arthritis, and other conditions (eg, sarcoidosis, gout, sickle cell disease, and a variety of infections). Dactylitis is difficult to define and assess with any level of consensus and consistency in PsA. A new objective measure has been developed to make assessment more uniform for clinical trials. The underlying pathophysiology has also been difficult to determine in spondyloarthropathy: synovitis, tenosynovitis, and enthesitis have all been recognized. The pathophysiology in other conditions varies but usually involves soft tissue and sometimes involves bone or joint. In non-spondyloarthropathies,treatment is determined by the underlying cause. Research on dactylitis treatment in PsA suffers from a paucity of trials and inconsistent outcome measurement. The only drug with good evidence of benefit from randomized controlled trials thus far is infliximab.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1994

Changes in the mechanical properties of patellar tendon preparations of spontaneously diabetic dogs under long-term insulin therapy.

Diabetes mellitus is known to involve a wide range of musculoskeletal disorders including tendon contracture, tenosynovitis, joint stiffness, and osteoporosis. Recent studies with experimentally induced models of diabetes show that insulin therapy mitigates such alterations. These data are from relatively short-term experiments. This manuscript reports the results of tensile failure experiments on the canine patella-patellar tendon-tibia complex from a group of juvenile diabetic animals that received insulin therapy. The duration of the disease was 4-9 yr. The stiffness of the diabetic preparations in a physiological range of loading was approximately 13% greater than controls (P < 0.05). On the other hand, the strength of the tendon preparation from the diabetic population was not different from controls, but the mode of structural failure for controls was by substance and avulsion fractures while the diabetics failed by tensile fracture of the patella.

Aging↗

PubMed1992

Acute inflammatory response to cowpox virus infection of the chorioallantoic membrane of the chick embryo.

The chick embryo chorioallantoic membrane was used to study the acute inflammatory response in the absence of contributions from the immune system. In preliminary experiments, lesions of wild-type cowpox virus strain Brighton (CPV-BR) and a 38K gene deletion mutant of CPV-BR (CPV-BR.D1) were compared with vaccinia virus (strains WR and Copenhagen), fowlpox virus, laryngotracheitis virus, and infectious tenosynovitis virus, and were ranked for degree of induced inflammation. The maximal and minimal inflammatory responses were observed with CPV-BR.D1 and CPV-BR viruses, respectively. CPV-BR.D1 lacks a 38K gene which encodes an anti-inflammatory 38-kDa protein that has homology to SERPINs. The kinetics and character of the inflammatory response were examined further in the wild-type CPV-BR and mutant CPV-BR.D1 infections using cell counts, electron microscopy, and assays for inflammatory cell activation. CPV-BR virus infection rapidly spread through the ectoderm, uniformly infecting all cells with the production of large amounts of virions and viral-induced cytopathic effect, but evoking little or no inflammatory response until 144 hr p.i. The CPV-BR.D1 infection, on the other hand, was rapidly contained by a dexamethasone-sensitive inflammatory response mainly of activated heterophils which was advanced by 36 hr p.i. Both infections resulted in disseminated disease with similar numbers of liver lesions and only a slight difference in the LD50, with the CPV-BR.D1 values being higher than that for CPV-BR virus. In this model, the acute inflammatory response alone is unable to prevent disseminated disease and associated mortality.

Acute Disease↗

PubMed1983

Hemophilus influenzae septic arthritis in adults.

Hemophilus influenzae is an important but uncommon cause of adult septic arthritis. We report two cases and review 23 previously published cases. Two-thirds of the patients had systemic diseases, local factors, or both which predisposed them to septic arthritis. The acute disease was monarticular in 48%, polyarticular in 24%, and accompanied by tenosynovitis and/or bursitis in 28% of cases. Extraarticular sites of H. influenzae infection were found in 60% of cases. These sites represented either likely portals of bacterial entry or foci of infection resulting from hematogenous dissemination of H. influenzae. The most characteristic synovial fluid finding was the presence of Gram-negative pleomorphic microorganism. However, misinterpretation of the Gram-stained smear was common and led to an erroneous initial diagnosis in several instances. Prompt sterilization of the infected synovial fluid was the rule once an appropriate antimicrobial agent was administered. A favorable outcome was reported in 88% of cases.

Adult↗

PubMed1992

Posterior tibial tendon dysfunction.

Posterior tibial tendon dysfunction, a common entity, frequently is unrecognized and inappropriately managed. Acutely, pain and swelling are present over the medial ankle and longitudinal arch. Long-standing inflammation can lead to tendon rupture, resulting in a progressive planovalgus or "flat foot" deformity. Plain radiographs illustrate the changes in bony anatomy associated with chronic posterior tibial deficiency, while magnetic resonance imaging scans can identify the three stages of posterior tibial tendon pathology. Most cases are amenable to conservative therapy, including rest and administration of nonsteroidal antiflammatory agents. Often a short period of immobilization in a cast or the use of an orthosis is beneficial. In cases with persistent tenosynovitis, complete tendon rupture, or progressive deformity, surgical intervention is indicated.

Biomechanical Phenomena↗

PubMed1986

Acute carpal tunnel syndrome resulting from haemorrhage into the carpal tunnel in a patient on warfarin.

A case of acute compression neuropathy of the median nerve associated with haemorrhage into the carpal tunnel is presented. The condition occurred spontaneously in a patient on Warfarin for previous deep venous thrombosis. The signs and symptoms were those of acute tenosynovitis originating in the common flexor synovial sheath at the wrist with associated paraesthesia in the distribution area of the median nerve in the hand. The patient was afebrile and blood tests were normal.

Carpal Tunnel Syndrome↗

PubMed1988

Septic arthritis of the hand due to Mycobacterium marinum.

Mycobacterium marinum infections of the hand are very rare in the United Kingdom and we found only one case of involvement of deep structures (tenosynovitis) in the British literature. We report a case of septic arthritis due to the organism.

Adult↗

PubMed1990

The hand in psoriasis.

Fifty-six patients with psoriatic arthropathy have been reviewed to asses the extent and severity of their hand involvement. The hand was affected in 84% of cases. Although the distal interphalangeal joints are said to be classically affected, we found the proximal interphalangeal and metacarpophalangeal to be more frequently involved. Many other findings often associated with rheumatoid arthritis (e.g. boutonniere and swan-neck deformities, or tenosynovitis) can be seen in psoriatic arthropathy.

Adolescent↗

PubMed1990

Predictive factors in the non-surgical treatment of carpal tunnel syndrome.

To identify which patients are likely to respond the medical management of carpal tunnel syndrome, 331 hands in 229 patients were evaluated. They were then treated with a wrist splint and anti-inflammatory medication. Follow-up averaged 15.4 months (minimum six months). Treatment was successful in 18.4%. Statistical evaluation identified five factors which were important in predicting response to treatment: age over 50 years, duration over ten months, constant paraesthesiae, stenosing flexor tenosynovitis, and a Phalen's test positive in less than 30 seconds. When none of these factors was present, two-thirds of patients were cured by medical therapy. 59.6% of patients with one factor, 83.3% with two factors, and 93.2% with three factors failed. No patient with four or five factors present was cured by medical management.

Adrenal Cortex Hormones↗

PubMed1990

Acute ischaemia of the hand following accidental radial artery infusion of Depo-Medrone.

Acute ischaemia of the hand following the accidental intra-arterial injection of steroid has not, to our knowledge, been previously reported. We present such a case of the injection of Depo-Medrone with Lidocaine (Upjohn) into the right radial artery during attempted treatment of stenosing tenosynovitis of the right thumb. The resultant acute ischaemia was successfully managed after 20 hours by a combination of surgical thrombectomy, intra-arterial streptokinase and intravenous heparin and thymoxamine.

Acute Disease↗