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PubMed2005

Golf and racquet sports injuries.

There are specific injuries that are common in golf and racquet sports. These abnormalities have a predilection for specific structures as well and can be divided into two categories on the basis of etiology as either chronic repetitive injury or acute trauma. With golf injuries, upper extremity abnormalities prevail and include rotator cuff disease, epicondylitis, wrist tenosynovitis, and hamate hook fracture. Thoracolumbar spine pain can also occur. The order of frequency of these ailments is different for professional and recreational athletes. With racquet injuries, as in tennis, lower extremity injuries are more common and include medial gastrocnemius and Achilles tendon abnormalities, although shoulder, elbow, and wrist abnormalities may also occur. Knowledge of the biomechanics behind each sport is also helpful in understanding the pathophysiology of injury and in part explains the findings seen at imaging.

Athletic Injuries↗

PubMed2005

Rowing injuries.

The sport of rowing has gained considerable momentum in recent years. It appeals to many age groups and is an endurance activity with no sudden accelerations or ballistic impact forces. It is associated with several injuries that are so typical that they are easily recognized by the enthusiast and in many cases do not require imaging. These include wrist tenosynovitis, intersection syndrome, and rib fracture. Other injuries may be the result of strenuous training programs or faulty rowing technique and include low back injuries and patellar maltracking. The etiology, biomechanics, imaging, and treatment of rowing-related disorders are discussed.

Athletic Injuries↗

PubMed1989

[Lesions of the long head of the biceps--their pathogenesis and demonstration by imaging procedures (sonography, x-ray, arthrography and computed tomography)].

Because of unusual anatomy and function the long head of the biceps brachii (LHB) is often subject to pathologic changes. On reviewing 354 sonographies of the shoulder (7.5 MHz), it was found that 61 (= 17%) abnormal findings of the LHB were reported such as degenerative changes accompanying impingement stadium II and III (atrophy, hypertrophy, effusion), intracapsular ruptures, acute isolated tenosynovitis and bony changes of the sulcus (bony spurs, shallow and dysplastic sulcus with subluxation of the LHB). Each abnormal finding was confirmed by x-ray and arthrography (some via CT) and compared with sonographic report. There seems to be a strikingly high percentage of rotator cuff tears connected with lesions of the LHB and the reduced filling of the sheath of the LHB, if combined lesions were apparent elsewhere in the shoulder. We consider sonography to be the method of choice in the assessment of LHB injuries; in case of verified lesion of the LHB, other pathologic conditions elsewhere in the shoulder are likely.

Adolescent↗

PubMed1999

Soft Tissue Masses: The Underutilization of Sonography.

For the evaluation of soft tissue masses, sonography (US) has proved to be very accurate in confirming the presence or absence of a lesion, with a very high negative predictive value. Many soft tissue masses result from trauma, inflammation, infection, or cystic changes and are not true neoplasms. In the proper clinical context, US can diagnose a muscular tear, hernia, myositis ossificans, or rhabdomyolysis. Retained foreign bodies are readily identified and localized with US. US differentiates between cellulitis and abscess and can diagnose masses resulting from tendinitis, tenosynovitis, or bursitis. It is the modality of choice for diagnosing cysts, including intact or ruptured BakerÕs cysts and ganglion cysts in the distal extremities. Among benign neoplasms, lipomas and hemangiomas display a wide spectrum of echogenicity. US can diagnose nerve sheath tumors by demonstrating the connection between the mass and the normal nerve. Except for some well-differentiated liposarcomas, which may appear echogenic, the vast majority of malignant tumors in the soft tissues are hypoechoic. Real-time US is ideal for guiding large-core needle biopsy of soft tissue sarcomas. US is extremely sensitive in detecting early recurrences after surgical excision, which are readily confirmed by US-guided fine-needle aspiration. Any nonpalpable mass visualized by US can be conveniently localized pre- or intraoperatively with US guidance. Provided the examination is done by a well-trained operator using state-of-the-art equipment, the cost-effectiveness of US justifies its use as a first-line examination technique in many situations involving soft tissues, with magnetic resonance imaging being the problem-solving tool and staging procedure.

Journal Article↗

PubMed1998

Sonography of the Wrist and Hand.

With the advent of new technical improvements and innovations, sonography is gaining ground in use and acceptance as a highly useful modality to diagnose a variety of diseases involving the wrist and the hand. Common ailments such as tendinitis and tenosynovitis can be diagnosed easily, and the diagnosis of small soft tissue masses such as ganglia has become almost routine. Sonography holds great promise in the evaluation of disease involving the median and the ulnar nerves, the ligaments of the wrist, and the triangular fibrocartilage. It is the ideal modality in the diagnosis of intra-articular loose bodies.

Journal Article↗

PubMed1998

Ultrasound of the Foot and Ankle.

For specific indications, ultrasound is an inexpensive and efficient alternative to magnetic resonance (MR) imaging of the ankle and foot. In addition to the tendons, the anterior joint, retrocalcaneal bursa, ligaments, plantar fascia, and soft tissues can be imaged with ultrasound. Tenosynovitis, tendon tears and tendinosis, joint effusions, intra-articular loose bodies, ganglion cysts, plantar fasciitis, and Morton neuromas can be demonstrated with ultrasound. In most cases, a focused ankle or foot ultrasound can be performed more rapidly and efficiently than magnetic resonance imaging. Direct correlation with the site of pain and rapid comparison with the asymptomatic ankle are possible with this modality. As pressure for cost containment continues, demand for ultrasound of the ankle and foot will likely increase.

Journal Article↗

PubMed1998

Ultrasound of Musculoskeletal Infections.

Ultrasound (US) can play an important role in differentiating infectious processes from other musculoskeletal diseases. US is the imaging modality of choice to diagnose superficial abscesses. These abscesses may have variable echogenicity and their detection can be facilitated by ultrasonographic dynamic evaluation and color Doppler imaging. Septic arthritis either in a native or prosthetic joint may have devastating complications on the joint function. Early diagnosis requires joint fluid analysis. US is very sensitive in the detection of joint effusions and is helpful to guide the arthrocentesis. US may help in the early diagnosis of osteomyelitis, although one must always remember that a normal US never excludes bone infection. This article also reviews the role of US in the diagnosis of necrotizing fasciitis, tenosynovitis, bursitis, and pyomyositis. After initial radiographs, along with nuclear medicine studies, US should be considered as the next imaging step in the investigation of musculoskeletal infections.

Journal Article↗

PubMed1991

Quantifying exposure in occupational manual tasks with cumulative trauma disorder potential.

A method of describing the musculoskeletal loads in the hand and wrist during manual tasks is presented. A profile of twelve factors is used to quantify the exposure of applicable soft tissues to modes of loading suggested as being related to a number of chronic, work-related musculoskeletal disorders such as chronic muscle strain, tenosynovitis, and carpal tunnel syndrome. These factors include estimates of tendon loads and movement, frictional work done on the tendon sheaths, and muscle activation determined using electromyography. The response of these measures to changes of force, repetition, and posture was studied using eight conditions of a simulated task utilizing a pistol grip tool. Measures of tendon frictional work and dynamic electromyographic activity best paralleled the injury outcomes of an epidemiological study using similar task definitions (Silverstein et al. 1986). This field-usable system is being used currently to investigate the relationship between occupational exposure and musculoskeletal disorders.

Biomechanical Phenomena↗

PubMed1980

Gonococcal arthritis syndromes: an update on diagnosis and management.

The primary care physician can diagnose gonococcal arthritis with virtual certainty in the presence of migratory polyarthralgia, tenosynovitis of the upper extremity, and characteristic skin lesions. The exquisite antibiotic sensitivity of most gonococcal organisms has made outpatient oral therapy reasonable, with rapid resolution of symptoms usually resulting.

Adult↗

PubMed2002

Accidental Mycobacterium bovis infection in a veterinarian.

CASE: A veterinarian developed tenosynovitis and secondary carpal tunnel syndrome following accidental inoculation of Mycobacterium bovis during the necropsy of a tuberculous possum from Westland, New Zealand. CLINICAL RELEVANCE: M. bovis infection is a zoonotic disease, and occupational exposure to tuberculous animals places people at risk of contracting the disease. CONCLUSIONS: Adhering to safe work practices reviewed in this article is important to minimise the risk of infection to people handling tuberculous animals.

Journal Article↗

PubMed2003

Imaging in rheumatoid arthritis--why MRI and ultrasonography can no longer be ignored.

Implementing the modern treatment strategy in rheumatoid arthritis (RA), i.e. early initiation and optimal adjustments of aggressive therapies, requires methods for early diagnosis and sensitive monitoring of the disease process. In rheumatoid arthritis clinical trials and routine management, conventional radiography is the pivotal method for diagnosing and monitoring structural joint damage. However, it is insensitive to bone damage at its earliest stages and totally incapable of capturing the primary feature of rheumatoid disease, the synovitis. In comparison with radiography, magnetic resonance imaging (MRI) offers assessment of bone damage with improved sensitivities to early pathology and to change. In addition, detailed assessment of soft tissue changes, including synovitis and tenosynovitis, is possible and MRI findings are of prognostic value for the long-term radiological outcome. Ultrasonography (US) is less validated than MRI, but available data suggests that US offers comparable information on both inflammatory and destructive changes in RA finger and toe joints. Issues of reliability, standardization and documentation limit its value in clinical trials, This article reviews current knowledge on conventional radiography, computed tomography, MRI and US for assessment of peripheral joints in RA. The rationale is provided for MRI being the new gold standard for assessment of RA joints and US becoming a routine bedside tool for improved joint assessments and injections by rheumatologists. Pursuing the goal of improving patient care and disease outcome, rheumatologists can no longer afford to ignore MRI and US as means to measure disease activity and joint damage in rheumatoid arthritis.

Arthritis, Rheumatoid↗

PubMedDate not supplied

Dactylitis, a term for different digit diseases.

Dorland's Illustrated Medical Dictionary gives the following definition of dactylitis (deltaalphachitauupsilonlambdaomicronsigma = digit): 'inflammation of a finger or toe'. Although any inflammatory process involving the fingers or toes may be called dactylitis, the term has entered in current use only in some well-defined entities. These differ in the involved tissue of the digit and in the type of involvement. Tuberculous dactylitis is the variant of tuberculous osteomyelitis affecting the short tubular bone of the hands and feet. Radiographs typically show a central, lytic, cystic, and expansive lesion known as spina ventosa. Syphilitic dactylitis is a manifestation of congenital syphilis. Radiological findings mimic those of tuberculous dactylitis but the involvement is bilateral and symmetric. Sarcoid dactylitis is due to typical non-caseating granulomas invading the phalanges and the adjacent soft tissue. Blistering distal dactylitis is an infection of the anterior fat pad on the volar surface of the distal portion of a single finger or more rarely a toe, mostly caused by group A beta-haemolytic streptococci. Sickle cell dactylitis, also known as 'hand-foot syndrome', is due to localized bone marrow infarction of the carpal and tarsal bones and phalanges. Spondyloarthritis dactylitis, also called 'sausage-like' digit, is a diffuse painful swelling of the fingers and toes. Recent ultrasonography (US) and magnetic resonance imaging (MRI) studies on both finger and toe dactylitis have established that dactylitis is due to flexor tenosynovitis and that the enlargement of the joint capsule is not an indispensable condition for the 'sausage-like' feature. There is no evidence of enthesitis of flexor digitorum tendons and joint capsule.

Fingers↗

PubMed2003

Reovirus identified as cause of disease in young geese.

The pathology, epizootiology and aetiology of a specific disease of young geese, which has been seen in Hungary for more than three decades, were investigated. The disease was characterised by splenitis and hepatitis with miliary necrotic foci during the acute phase, and epicarditis, arthritis and tenosynovitis during the subacute/chronic phase. Clinical signs usually appeared at 2 to 3 weeks of age and persisted for 3 to 6 weeks. From different organs of the affected birds, a reovirus was isolated in embryonated eggs and tissue cultures of Muscovy duck or goose origin, as well as in Vero cells. In experimental infections, the dominant features of the disease were reproduced in day-old and young goslings. The biological and partial molecular characterisation of one of the isolated strains (D15/99) showed that it was related to the reovirus described as the cause of a similar disease of Muscovy ducks. An RT-PCR method suitable for the detection of reoviruses was also elaborated and tested. This is the first report on the involvement of reovirus in arthritis of geese.

Age of Onset↗

PubMed1997

Nutritional disorders in a concentration camp.

OBJECTIVE: Observations on nutritional disorders were made by a physician inmate in a concentration camp before and during the Great Starvation in China. METHODS/RESULTS: Based on therapeutic response, many unique abnormalities should be considered as a part of clinical picture of malnutrition, such as mucocutaneous pigmentation, nail layering phenomena and intranail hemorrhage, palmar/plantar fissures, vegetative system crisis, a avitaminostic fevers, multiple premature beats, and enlargement of cartilage, lymph nodes, and submandibular glands. DISCUSSION: Thiamin deficiency should be also considered as one, if not the only, etiologic factor of several common disorders, including submandibular gland cyst, Baker's cyst, stenosing tenosynovitis, direct inguinal hernia, among others.

Adult↗

PubMed1994

Upper extremity disorders in a pork processing plant: relationships between job risk factors and morbidity.

Thirty-two jobs at a pork processing plant were semi-quantitatively analyzed in terms of their ergonomic characteristics, then classified as "hazardous" or "safe" in terms of potential risk for elbow or hand/wrist disorders. The spectrum, number, and incidence of such disorders occurring during the preceding 20 months were then compared to the job analyses and hazard classifications. There were 104 disorders associated with 15 job categories. The disorders included epicondylitis (24), nonspecific hand/wrist pain (41), carpal tunnel syndrome (CTS) (21), trigger finger (12), trigger thumb (3), and De-Quervain's tenosynovitis (3). The strength demands of the jobs associated with morbidity were significantly greater than those of jobs without morbidity. Differences in wrist posture were less significant. Type of grasp and repetitiveness were not significantly different. Practically all morbidity (96%) was associated with the hazardous job categories and occurred with a characteristic pattern of co-morbidity. The hazard classification scheme correctly predicted risk of upper extremity morbidity for 13 (87%) of the 15 job categories associated with morbidity and correctly predicted a lack of risk of morbidity for 16 (94%) of the 17 job categories not associated with morbidity. Significantly elevated relative risks were observed for any upper extremity disorder (11.4), any disorder excluding CTS (39.4), all specific disorders (6.9), and all specific disorders excluding CTS (19.4). The relative risk for CTS was 2.8 and not statistically significant. The results of this study provide additional epidemiological evidence that upper extremity musculotendinous disorders and some cases of CTS may be causally associated with work. The exertional demands of a task best explained the occurrence of morbidity.

Arm↗

PubMed1996

Low level laser therapy with trigger points technique: a clinical study on 243 patients.

Among the various methods of application techniques in low level laser therapy (LLLT) (HeNe 632.8 nm visible red or infrared 820-830 nm continuous wave and 904 nm pulsed emission) there are very promising "trigger points" (TPs), i.e., myofascial zones of particular sensibility and of highest projection of focal pain points, due to ischemic conditions. The effect of LLLT and the results obtained after clinical treatment of more than 200 patients (headaches and facial pain, skeletomuscular ailments, myogenic neck pain, shoulder and arm pain, epicondylitis humery, tenosynovitis, low back and radicular pain, Achilles tendinitis) to whom the "trigger points" were applied were better than we had ever expected. According to clinical parameters, it has been observed that the rigidity decreases, the mobility is restored (functional recovery), and the spontaneous or induced pain decreases or even disappears, by movement, too. LLLT improves local microcirculation and it can also improve oxygen supply to hypoxic cells in the TP areas and at the same time it can remove the collected waste products. The normalization of the microcirculation, obtained due to laser applications, interrupts the "circulus vitiosus" of the origin of the pain and its development (Melzak: muscular tension > pain > increased tension > increased pain, etc.). Results measured according to VAS/VRS/PTM: in acute pain, diminished more than 70%; in chronic pain more than 60%. Clinical effectiveness (success or failure) depends on the correctly applied energy dose--over/underdosage produces opposite, negative effects on cellular metabolism. We did not observe any negative effects on the human body and the use of analgesic drugs could be reduced or completely excluded. LLLT suggests that the laser beam can be used as monotherapy or as a supplementary treatment to other therapeutic procedures for pain treatment.

Acute Disease↗

PubMed1993

Age-related differences in measures of upper extremity impairment.

BACKGROUND: Upper extremity cumulative trauma disorders (CTDs) are among the most prevalent and costly occupational injuries. These disorders include nerve compression syndromes, tenosynovitis, epicondylitis, tendinitis, and arthritis. These have been related in the past to repetitive use of the upper extremity. The expected increase in the age of the American work force and the assumption that older workers are more susceptible to the disorders prompted this investigation of the relationship of age to signs and symptoms of upper extremity impairment. METHODS: A battery measuring seven objective signs and four reported symptoms of upper extremity cumulative trauma disorders was administered to two stratified random samples of workers. One group (n = 157) processed cooked poultry and the second group (n = 118) performed data entry at VDT terminals. Workers were separated into three age groups (younger: 20-35 years, middle-aged: 36-50 years, and older: 51-71 years). RESULTS: A series of analyses of variance were computed to determine whether the older workers were more impaired. No significant age differences were found for sign, symptom, or total scores in either sample, and no significant Age x Gender interaction was present. Older workers were more impaired for vibratory sensation, cutaneous pressure, and motor latency. CONCLUSIONS: The results support the hiring of older workers for general tasks in the workplace without significant worry of increased susceptibility to CTDs.

Adolescent↗

PubMed2006

Conservative treatment of work-related upper limb disorders: a review.

AIM: The literature review was carried out to identify and summarize the evidence-base for conservative clinical management of upper limb disorders (ULDs) including specific disorders and non-specific ULDs. METHOD: Keywords were identified through a scoping study and guidance from the project sponsor. A number of databases were searched including Web of Knowledge, Pub Med, Medline, Ergonomics Online, the Cochrane Library and BMJ Clinical Evidence for the years 1993-2004. Abstracts were obtained for papers identified in the search and full papers were obtained for literature, which included diagnostic methods, conservative treatments, new data or results or systematic reviews. RESULTS: The review identified that there is evidence for the efficacy of conservative treatments for the management of carpal tunnel syndrome, epicondylitis, rotator cuff tendonitis and bicipital tendonitis and tension neck syndrome. There was no evidence found to support or refute conservative treatment of tenosynovitis, tendonitis, de Quervain's disease or diffuse non-specific ULDs. CONCLUSION: The evidence reviewed was not always of good quality and data gaps including methodological design issues need to be addressed by future research.

Carpal Tunnel Syndrome↗