DOCSLIB.ORG

Trauma and Reiter's Syndrome: Development of 'Reactive Arthropathy' in Two Patients Following Musculoskeletal Injury

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Trauma and Reiter's Syndrome: Development of 'Reactive Arthropathy' in Two Patients Following Musculoskeletal Injury Ann Rheum Dis: first published as 10.1136/ard.43.6.829 on 1 December 1984. Downloaded from Annals of the Rheumatic Diseases, 1984, 43, 829-832 Trauma and Reiter's syndrome: development of 'reactive arthropathy' in two patients following musculoskeletal injury JEFFREY J. WISNIESKI From the Medical Service, Rheumatology Section, Cleveland Veterans Administration Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. SUMMARY Two patients are reported who developed arthropathies with some features of Reiter's syndrome shortly after physical injury. Both were HLA-B27 positive. No other precipitating factors were identified, and the possibility that trauma may have precipitated a reactive arth- ropathy is discussed. Key words: endogenous antigen (immunogen), genetic predisposition, collagen. copyright. Concepts of Reiter's syndrome (RS) have changed swelling, pain, and heat; internal mechanical dramatically in the past decade. Notable develop- derangement was suspected. Five months after the ments include: (1) recognition that clinical activity trauma arthroscopy revealed hyperaemic and thick- may be acute/self-limited, acute/recurrent, or ened synovium but no structural abnormality. Syno- chronic'-5; (2) recognition that disease mani- vial biopsy showed chronic synovitis with marked festations vary from 'incomplete' RS to multisystem lymphocyte and plasma cell infiltration. involvement'-3; (3) development of concepts of Seven months after the injury the knee continued genetic predisposition and linkage4 5; and (4) charac- to be warm and painful, with thickened synovium and http://ard.bmj.com/ terisation of RS as reactive arthritis developing in a large effusion. No other joints were involved. Con- genetically predisposed individuals.45 In most junctivitis of the left eye was noted. There was no patients the inciting event is genitourinary or enteric history of venereal disease, diarrhoea, rash, infection.3 The following cases suggest that trauma mucocutaneous ulceration, dysuria, or back pain. 50 might also provoke a reactive rheumatic syndrome ml of moderately inflammatory (grade II) fluid was consistent with RS. removed from the right knee. Serum and joint fluid were negative for rheumatoid factor. Lumbar spine Case reports and sacroiliac x-rays were normal; knee x-rays on September 24, 2021 by guest. Protected showed capsular distension and thickening. The CASE 1 blood count was normal and the ESR (Wintrobe) was A 23-year-old white man presented with chronic 22 mm/h. HLA-B27 was positive. pain, swelling, and stiffness in his right knee. Seven The patient was treated with rest, indomethacin, months previously he had struck his knee while rock and one injection of intra-articular corticosteroid. climbing. Moderate pain and swelling occurred but One month later he was much improved; conjunc- there was no ecchymosis, locking, or instability. tivitis had resolved. One year after the trauma the Three days after the injury symptoms and signs had knee was normal, with full range of motion. almost resolved; however, on the seventh day pain, swelling, and stiffness recurred. Initial medical CASE 2 evaluation one month after the injury confirmed A 55-year-old white man was admitted for diagnosis Accepted for publication 5 July 1984. of a recurrent rash, fever, and arthritis. He had been Correspondence to J. J. Wisnieski, MD, Cleveland VA Medical well as an adolescent and young adult. At age 20 he Center, 10701 East Boulevard, Cleveland, Ohio 44106, USA. suffered multiple severe contusions in a motor-car 829 Ann Rheum Dis: first published as 10.1136/ard.43.6.829 on 1 December 1984. Downloaded from 830 Wisnieski Fig. 1 Ligament involvement in Reiter's syndrome. Note increased uptake of 99"technetium MDP in the cervical posterior longitudinal spinous ligament. Uptake is particularly heavy at the ligament insertion on the posterior spine of C2 (arrow). copyright. http://ard.bmj.com/ on September 24, 2021 by guest. Protected Fig. 2 Keratodermia blennorrhagica. Note acanthosis, hyperkeratosis, and parakeratosis. Degeneration of epidermal cells has occurred, causing a spongiform appearance. Coalescence ofthese ghost cells and influx of polymorphonuclear leucocytes results in pustule formation. (Haematoxylin and eosin, x80). Ann Rheum Dis: first published as 10.1136/ard.43.6.829 on 1 December 1984. Downloaded from Trauma and Reiter's syndrome 831 accident. By one month of convalescence his trauma- That trauma initiated a 'Reiter's-like' syndrome in tic injuries had almost healed; however, fever, low the two patients described above may be a fortuitous back pain, tender and swollen joints, and a rash observation. None of the current rheumatology developed three weeks after the trauma. The affected texts3 6-8 or reviews of the subject' 5 9 list trauma as a joints were the knees, wrists, and ankles. The rash causative factor. However, psoriatic arthritis, which was scaly and pustular and involved only the may closely resemble RS, has been reported as a extremities. consequence of musculoskeletal injury in some Episodes of fever, arthritis, rash, and/or low back patients with psoriatic skin disease.' " In several pain lasting up to 2 to 10 months recurred at irregular patients with only cutaneous psoriasis, a chronic intervals throughout his adult life. Mild conjunctivitis inflammatory arthritis of the knee developed after and painless mouth ulcers were noted during several the knee was injured." Arthrotomy and synovial recurrences. There was no history of dysuria, gonor- biopsy revealed only synovial proliferation con- rhoea, penile ulcerations, or diarrhoeal illness. sistent with psoriatic arthritis. Similarly, Williams On admission, low grade fever and arthritis of and Scott described a psoriatic patient whose chronic knees, wrists, shoulders and metacarpophalangeal erosive arthritis began shortly after trauma to the joints were noted. Neck motion was limited and pain- right middle finger. Only joints in that finger became ful. The sacroiliac joints were tender to gentle pres- arthritic, with periosteal elevation along the proximal sure. There was warmth, swelling, and tenderness on phalanx.'2 palpation of the posterior ligamentous insertions on How trauma might cause a reactive syndrome with the dorsal spines of C2 and C7. Mild bilateral con- RS features is not clear. Trauma may possibly alter junctivitis was observed. A few scaly skin lesions and/or release antigen(s) from connective tissue. 0 5-1-0 cm in diameter were found on the Like some Klebsiella antigens, 'S'5 these may interact extremities. The haematocrit was 34 and ESR (Win- with B27 or immune response gene products on lym- trobe) was 55 mm/h. Joint fluid was moderately phocyte membranes to influence critically cell viabil- inflammatory (grade II). Both serum and joint fluid ity and function. Through such interaction both bac- copyright. were negative for rheumatoid factor (RF). A bone terial antigens and self-antigens like collagen may scan with technetium methylene diphosphonate trigger cell and antibody mediated responses against showed marked uptake in the sacroiliac, shoulder, host connective tissue, especially synovium and car- knee, ankle, and wrist joints. There was also heavy tilage. In normal persons foreign or self-antigen uptake around the ligament insertion on the spine of would not interact with gene/gene products. How- C2 (Fig. 1). X-rays showed asymmetrical sacroiliitis ever, in predisposed individuals interaction may not and non-marginal syndesmophytes of the lumbar only occur but result in perpetuation of immune spine. Biopsy of a skin lesion was consistent with responses which cause clinical disease. Although keratodermia blennorrhagica (Fig. 2). HLA-B27 antibodies against and lymphocyte hyperreactivity to http://ard.bmj.com/ was positive. collagen, particularly type II, have been found consis- The patient was treated with physiotherapy, tently in rheumatoid arthritis, too few RS patients indomethacin, and low-dose prednisone. The fever have been studied to permit conclusions about the and rash promptly resolved, and the arthritis im- incidence or role of these abnormalities in Reiter's proved sufficiently to allow self care and ambulation syndrome.6` 9 with a walking frame. Recent studies with rat models indicate a possible role for self-antigens in the pathogenesis of rheuma- on September 24, 2021 by guest. Protected Discussion tic disease. Pearson and Chang produced a disease The temporal relationship between physical trauma much like RS in inbred rats using either complete and development of a rheumatic syndrome in these Freund's adjuvant or a non-immunogenic synthetic two patients is striking. In case 1 the time between adjuvant. They postulated that the injection and/or trauma and initial symptoms was seven days, and in adjuvant itself releases potentially immunogenic case 2 it was 20-25 days. The first patient's illness was self-antigen(s). Rheumatic disease may then occur as consistent with incomplete Reiter's syndrome and the result of an abnormal, genetically determined was self limited, lasting approximately one year. The immune response to such antigen(s), facilitated by second patient had arthritis, conj unctivitis, mouth the adjuvant.20) Although the nature ofsuch antigen(s) ulcers, and a rash. The rash never affected his palms remains speculative, type II collagen may be an or soles. The inflammatory lesion of the posterior important source of endogenous antigen. Trentham spinous ligament on bone scan demonstrates
Load more

Recommended publications
  • Juvenile Spondyloarthropathies: Inflammation in Disguise
    PP.qxd:06/15-2 Ped Perspectives 7/25/08 10:49 AM Page 2 APEDIATRIC Volume 17, Number 2 2008 Juvenile Spondyloarthropathieserspective Inflammation in DisguiseP by Evren Akin, M.D. The spondyloarthropathies are a group of inflammatory conditions that involve the spine (sacroiliitis and spondylitis), joints (asymmetric peripheral Case Study arthropathy) and tendons (enthesopathy). The clinical subsets of spondyloarthropathies constitute a wide spectrum, including: • Ankylosing spondylitis What does spondyloarthropathy • Psoriatic arthritis look like in a child? • Reactive arthritis • Inflammatory bowel disease associated with arthritis A 12-year-old boy is actively involved in sports. • Undifferentiated sacroiliitis When his right toe starts to hurt, overuse injury is Depending on the subtype, extra-articular manifestations might involve the eyes, thought to be the cause. The right toe eventually skin, lungs, gastrointestinal tract and heart. The most commonly accepted swells up, and he is referred to a rheumatologist to classification criteria for spondyloarthropathies are from the European evaluate for possible gout. Over the next few Spondyloarthropathy Study Group (ESSG). See Table 1. weeks, his right knee begins hurting as well. At the rheumatologist’s office, arthritis of the right second The juvenile spondyloarthropathies — which are the focus of this article — toe and the right knee is noted. Family history is might be defined as any spondyloarthropathy subtype that is diagnosed before remarkable for back stiffness in the father, which is age 17. It should be noted, however, that adult and juvenile spondyloar- reported as “due to sports participation.” thropathies exist on a continuum. In other words, many children diagnosed with a type of juvenile spondyloarthropathy will eventually fulfill criteria for Antinuclear antibody (ANA) and rheumatoid factor adult spondyloarthropathy.
    [Show full text]
  • Bursae Around the Knee Joints Priyank S Chatra Department of Radiology, Yenepoya Medical College, Mangalore, Karnataka, India
    MUSCULOSKELETAL RADIOLOGY Bursae around the knee joints Priyank S Chatra Department of Radiology, Yenepoya Medical College, Mangalore, Karnataka, India Correspondence: Dr. Priyank S. Chatra, Department of Radiology, Yenepoya Medical College, Deralakatte, Mangalore – 575 018, Karnataka, India. E-mail: [email protected] Abstract A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent moving structures. Bursae around the knee can be classified as those around the patella and those that occur elsewhere. In this pictorial essay we describe the most commonly encountered lesions and their MRI appearance. Key words: Iliotibial bursa; infrapatellar bursa; pes anserine bursa Introduction and the gastrocnemius-semimembranosus bursa. On MRI imaging, bursitis appears as an oblong fluid collection in A bursa is a fluid-filled structure that is present between its expected anatomical location. the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent Prepatellar Bursitis moving structures. Typically, bursae are located around large joints such as the shoulder, knee, hip, and elbow.[1] The prepatellar bursa is located between the patella and the Inflammation of this fluid-filled structure is called bursitis. overlying subcutaneous tissue. Chronic trauma in the form Trauma, infection, overuse, and hemorrhage are some of prolonged or repeated kneeling leads to inflammation of the common
    [Show full text]
  • 'Dialysis Related Arthropathy': a Survey of 95 Patients Receiving Chronic Haemodialysis with Special Reference to 132 Microglobulin Related Amyloidosis
    Ann Rheum Dis: first published as 10.1136/ard.48.5.409 on 1 May 1989. Downloaded from Annals of the Rheumatic Diseases, 1989; 48, 409-420 'Dialysis related arthropathy': a survey of 95 patients receiving chronic haemodialysis with special reference to 132 microglobulin related amyloidosis N P HURST,' R VAN DEN BERG,' A DISNEY,2 M ALCOCK,3 L ALBERTYN,3 M GREEN,' AND V PASCOE4 From the 'Rheumatology Unit, the 2Renal Unit, the 3Department of Radiology, and the 4Department of Pathology, The Queen Elizabeth Hospital, Woodville, South Australia SUMMARY Ninety five patients receiving chronic haemodialysis (CHD) were surveyed to determine the prevalence of rheumatic disease and, where possible, its aetiology. At least three distinct rheumatic syndromes were identified-a group of patients with a syndrome consisting of large and medium joint synovial swelling, restricted hips and shoulders, tenosynovitis, carpal tunnel syndrome, and bone cysts due to deposition of 132 microglobulin related amyloid (AMP2m); a second group with erosive azotaemic osteoarthropathy; and a third group with age related degenerative disease of small, large, and axial joints. The data presented suggest that in patients receiving CHD (a) the prevalence of AM2i2m deposition and the associated syndrome increases with duration of dialysis, but in patients who have been dialysed for more than 10 years the risk of developing AM2n2m is related to age; (b) AM2i2m deposition in subchondral cysts, but not synovium, causes joint destruction; also, AMp2m may be more prone to deposition in synovium of joints already damaged by other processes; (c) in the absence of synovial iron deposition synovial AM2n2m is not associated with an inflammatory infiltrate; (d) hyperparathyroidism and perhaps other factors such as synovial iron deposition are probably more important than AMgi2m as causes http://ard.bmj.com/ of peripheral joint degeneration and destructive spondyloarthropathy in patients receiving CHD.
    [Show full text]
  • Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment
    Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment The glenohumeral joint is the most mobile joint in the human body, but this same characteristic also makes it the least stable joint.1-3 The rotator cuff is a group of muscles that are important in supporting the glenohumeral joint, essential in almost every type of shoulder movement.4 These muscles maintain dynamic joint stability which not only avoids mechanical obstruction but also increases the functional range of motion at the joint.1,2 However, dysfunction of these stabilizers often leads to a complex pattern of degeneration, rotator cuff tear arthropathy that often involves subacromial impingement.2,22 Rotator cuff tear arthropathy is strikingly prevalent and is the most common cause of shoulder pain and dysfunction.3,4 It appears to be age-dependent, affecting 9.7% of patients aged 20 years and younger and increasing to 62% of patients of 80 years and older ( P < .001); odds ratio, 15; 95% CI, 9.6-24; P < .001.4 Etiology for rotator cuff pathology varies but rotator cuff tears and tendinopathy are most common in athletes and the elderly.12 It can be the result of a traumatic event or activity-based deterioration such as from excessive use of arms overhead, but some argue that deterioration of these stabilizers is part of the natural aging process given the trend of increased deterioration even in individuals who do not regularly perform overhead activities.2,4 The factors affecting the rotator cuff and subsequent treatment are wide-ranging. The major objectives of this exposition are to describe rotator cuff anatomy, biomechanics, and subacromial impingement; expound upon diagnosis and assessment; and discuss surgical and conservative interventions.
    [Show full text]
  • De Quervain's Tenosynovitis
    GUIDE TO THE DIAGNOSIS OF WORK-RELATED MUSCULOSKELETAL 2 DISORDERS Work-related musculoskeletal injuries are one of the most common occupational health problems for which physicians are consulted. There is solid scientific evidence that these injuries may be occupational in origin. This guide was designed to help physicians interpret the results of a medical examination. By combining the standard clinical assessment procedure with guidelines concerning the identification of etiological factors, it helps physicians identify the cause of injury. AUTHORS Louis Patry holds a degree in medicine from Laval University and a diploma in ergonomics from the Conservatoire National des Arts De Quervain’s et Metiers de Paris (CNAM). He is a specialist in occupational medi- De Quervain’s cine, an associate member of the Royal College of Physicians and Surgeons of Canada, a professor in McGill University’s Department of Epidemiology and Biostatistics and Occupational Health, and con- sulting physician to the Direction de la santé publique (Public Health Department), first in Québec City and currently at the Montréal- TenosynovitisTenosynovitis Centre board. Michel Rossignol holds degrees in biochemistry and medicine from the University of Sherbrooke, in epidemiology and community Louis PATRY, Occupational Medecine Physician, Ergonomist health from McGill University, and in occupational medicine from Michel ROSSIGNOL, Occupational Medecine Physician, Epidemiologist John Hopkins University. He is a professor in McGill University’s Department of Epidemiology and Biostatistics and Occupational Marie-Jeanne COSTA, Nurse, Ergonomist Health, co-director of the Centre for Clinical Epidemiology of the Jewish General Hospital of Montréal, and physician-epidemiologist Martine BAILLARGEON, Plastic Surgeon at the Montréal-Centre board of the Direction de la santé publique (Public Health Department).
    [Show full text]
  • Rotator Cuff Tear Arthropathy: Pathophysiology, Diagnosis And
    yst ar S em ul : C c u s r u r e M n t & R Orthopedic & Muscular System: c e Aydin, et al., Orthopedic Muscul Syst 2014, 3:2 i s d e e a p ISSN: 2161-0533r o c DOI: 10.4172/2161-0533-3-1000159 h h t r O Current Research Review Article Open Access Rotator Cuff Tear Arthropathy: Pathophysiology, Diagnosis and Treatment Nuri Aydin*, Okan Tok and Bariş Görgün Istanbul University Cerrahpaşa, School of Medicine, Istanbul, Turkey *Corresponding author: Nuri Aydin, Istanbul University Cerrahpaşa, School of Medicine, Orthopaedics and Traumatology, Istanbul, Turkey, Tel: +905325986232; E- mail: [email protected] Rec Date: Jan 25, 2014, Acc Date: Mar 22, 2014, Pub Date: Mar 28, 2014 Copyright: © 2014 Aydin N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract The term rotator cuff tear arthropathy is a broad spectrum pathology but it involves common characteristic features as rotator cuff tear, leading to glenohumeral joint arthritis and superior migration of the humeral head. Although there are several factors described causing rotator cuff tear arthropathy, the exact mechanism is still unknown because the rotator cuff tear arthropathy develops in only a group of patients with chronic rotator cuff tear. The aim of this article is to review pathophysiology of rotator cuff tear arthropathy, to explain the diagnostic features and to discuss the management of the disease. Keywords: Arthropathy; Glenohumeral joint; Articular fluid Rotator cuff tear not only plays a role at the beginning of the disease, but also a developed rotator cuff tear is a result of the inflammatory Introduction process.
    [Show full text]
  • CPT® Procedural Coding 110 L with Areportoftheprocedure
    20610-20611 2017 Illustrated Coding and Billing Expert for Orthopedics Lower 20610-20611 ICD-9-CM Diagnostic Codes M16.7 Other unilateral secondary 711.05 Pyogenic arthritis involving pelvic osteoarthritis of hip 20610 Arthrocentesis, aspiration and/or region and thigh M17.0 Bilateral primary osteoarthritis of injection, major joint or bursa (eg, 711.06 Pyogenic arthritis involving lower leg knee shoulder, hip, knee, subacromial 713.5 Arthropathy associated with ⇄ M17.11 Unilateral primary osteoarthritis, right bursa); without ultrasound guidance neurological disorders knee 20611 Arthrocentesis, aspiration and/or 714.0 Rheumatoid arthritis ⇄ M17.12 Unilateral primary osteoarthritis, left knee injection, major joint or bursa (eg, 715.15 Osteoarthrosis, localized, primary, pelvic region and thigh M17.2 Bilateral post-traumatic osteoarthritis shoulder, hip, knee, subacromial 715.16 Osteoarthrosis, localized, primary, of knee bursa); with ultrasound guidance, with lower leg M17.5 Other unilateral secondary permanent recording and reporting 715.25 Osteoarthrosis, localized, secondary, osteoarthritis of knee (Do not report 20610, 20611 in pelvic region and thigh ⇄ M1A.051 Idiopathic chronic gout, right hip conjunction with 27370, 76942) 715.26 Osteoarthrosis, localized, secondary, ⇄ M1A.062 Idiopathic chronic gout, left knee (If fluoroscopic, CT, or MRI guidance is lower leg ⇄ M25.052 Hemarthrosis, left hip ⇄ M25.061 Hemarthrosis, right knee performed, see 77002, 77012, 77021) 715.35 Osteoarthrosis, localized, not specified whether primary
    [Show full text]
  • Current Trends in Tendinopathy Management
    Best Practice & Research Clinical Rheumatology 33 (2019) 122e140 Contents lists available at ScienceDirect Best Practice & Research Clinical Rheumatology journal homepage: www.elsevierhealth.com/berh 8 Current trends in tendinopathy management * Tanusha B. Cardoso a, , Tania Pizzari b, Rita Kinsella b, Danielle Hope c, Jill L. Cook b a The Alphington Sports Medicine Clinic, 339 Heidelberg Road, Northcote, Victoria, 3070, Australia b La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Victoria, 3083, Australia c MP Sports Physicians, Frankston Clinic, Suite 1, 20 Clarendon Street, Frankston, Victoria, 3199, Australia abstract Keywords: Tendinopathy Tendinopathy (pain and dysfunction in a tendon) is a prevalent Management clinical musculoskeletal presentation across the age spectrum, Rehabilitation mostly in active and sporting people. Excess load above the ten- Achilles tendinopathy don's usual capacity is the primary cause of clinical presentation. Rotator cuff tendinopathy The propensity towards chronicity and the extended times for recovery and optimal function and the challenge of managing tendinopathy in a sporting competition season make this a difficult condition to treat. Tendinopathy is a heterogeneous condition in terms of its pathology and clinical presentation. Despite ongoing research, there is no consensus on tendon pathoetiology and the complex relationship between tendon pathology, pain and func- tion is incompletely understood. The diagnosis of tendinopathy is primarily clinical, with imaging only useful in special circum- stances. There has been a surge of tendinopathy treatments, most of which are poorly supported and warrant further exploration. The evidence supports a slowly progressive loading program, rather than complete rest, with other treatment modalities used as adjuncts mainly targeted at achieving pain relief.
    [Show full text]
  • Pigmented Villonodular Synovitis in Pediatric Population: Review of Literature and a Case Report Mohsen Karami*, Mehryar Soleimani and Reza Shiari
    Karami et al. Pediatric Rheumatology (2018) 16:6 DOI 10.1186/s12969-018-0222-4 CASEREPORT Open Access Pigmented villonodular synovitis in pediatric population: review of literature and a case report Mohsen Karami*, Mehryar Soleimani and Reza Shiari Abstract Background: Pigmented villonodular synovitis (PVNS) is a rare proliferative process in children that mostly affects the knee joint. Case Presentation: The study follows the case of a 3-year-old boy presenting recurrent patellar dislocation and PVNS. Due to symptoms such as chronic arthritis, he had been taking prednisolone and methotrexate for 6 months before receiving a definitive diagnosis. After a period of showing no improvements from his treatment, he was referred to our center and was diagnosed with local PVNS using magnetic resonance imaging (MRI). The patient was treated for his patellar dislocation by way of open synovectomy, lateral retinacular release, and a proximal realignment procedure, with no recurrence after a 24-month follow-up. Conclusion: PVNS may appear with symptoms resembling juvenile idiopathic arthritis, thus the disease should be considered in differential diagnosis of any inflammatory arthritis in children. PVNS may also cause mechanical symptoms such as patellar dislocation. In addition to synovectomy, a realignment procedure can be a useful method of treatment. Keywords: Juvenile idiopathic arthritis, Patellar dislocation, Pigmented villonodular synovitis Background aberrations that cause hemorrhagic tendencies, as well as Pigmented villonodular synovitis (PVNS) is a rare prolif- genetic factors, have been proposed as potential causes erative process that affects the synovial joint, tendon [2, 3]. Trauma and rheumatoid arthritis association have sheaths, and bursa membranes [1]. The estimated inci- also been considered [14, 15, 33].
    [Show full text]
  • Immediate and Short-Term Effects of Kinesiotaping on Muscular Activity
    Reynard et al. BMC Musculoskeletal Disorders (2018) 19:305 https://doi.org/10.1186/s12891-018-2169-5 RESEARCH ARTICLE Open Access Immediate and short-term effects of kinesiotaping on muscular activity, mobility, strength and pain after rotator cuff surgery: a crossover clinical trial Fabienne Reynard1* , Philippe Vuistiner2, Bertrand Léger2 and Michel Konzelmann3 Abstract Background: Kinesiotape (KT) is widely used in musculoskeletal rehabilitation as an adjuvant to treatment, but minimal evidence supports its use. The aim of this study is to determine the immediate and short-term effects of shoulder KT on muscular activity, mobility, strength and pain after rotator cuff surgery. Methods: Thirty-nine subjects who underwent shoulder rotator cuff surgery were tested 6 and 12 weeks post-surgery, without tape, with KT and with a sham tape (ST). KT and ST were applied in a randomized order. For each condition, the muscular activity of the upper trapezius, three parts of the deltoid and the infraspinatus were measured during shoulder flexion, and range of motion (ROM) and pain intensity were assessed. At 12 weeks, the isometric strength at 90° of shoulder flexion, related muscular activity and pain intensity were also measured. Subjects maintained the last tape that was applied for three days and recorded the pain intensity at waking up and during the day. Results: Modifications in muscle activity were observed with KT and with ST. Major changes in terms of decreased recruitment of the upper trapezius were observed with KT (P < 0.001). KT and ST also increased flexion ROM at 6 weeks (P = 0.004), but the differences with the no tape condition were insufficient to be clinically important.
    [Show full text]
  • Calcified Tendinitis: a Review
    Ann Rheum Dis: first published as 10.1136/ard.42.Suppl_1.49 on 1 January 1983. Downloaded from Ann Rheum Dis (1983), 42, Supplement p 49 Calcified tendinitis: a review G. FAURE,' G. DACULSI2 From the 'Clinique Rhumatologique et Laboratoire d'immunologie, Faculte A de Medecin, Universite de Nancy I, 54500 Vandoeuvre les Nancy, France and 2U225 INSERM, Faculte de Chirurgie Dentaire, Place Alexis Ricordeau, 44042 Nantes, France Introduction Calcified tendinitis in clinical practice Calcified tendinitis is a common CLINICAL FEATURES disorder. Many names have been used According to Welfling calcific to describe it: some of them, such as periarthritis is responsible for 7% of 'calcific periarthritis', emphasise the painful shoulder syndromes,' which extra-articular site of the deposit; have various presentations. others, such as 'periarticular apatite (1) Chronic symptoms-more or deposition', mention the nature of the less severe pain; tenderness leading to compound found in the calcification; various degrees of incapacitation. and more recent ones, such as These symptoms induce the demand 'calcifying tendinitis',-'3 emphasise the. for radiographs, which reveal the Fig. 1 Calcific periarthritis ofthe active process that might explain the presence of deposits. shoulder. Calcification is obvious; it deposition. Differentiated from (2) Acute inflammatory crisis with has already migrated from copyright. arthritis at the end of the nineteenth severe pain, tenderness, and local supraspinatus region to bursa area. century, this syndrome has only oedematous inflammation sometimes recently been related to the presence leading to restricted active an*d passive of apatite in tendon sheaths.4'5 It can motion. Fever and malaise may be affect almost any tendon at its observed.
    [Show full text]
  • Musicians and MSI: Symptoms and Types of Injuries
    Musicians and MSI: Symptoms and types of injuries Musculoskeletal injury (MSI) is any injury or disorder of There is also a predominant medical perspective that the muscles, bones, joints, tendons, ligaments, nerves, MSI is neither life-threatening nor medically serious. blood vessels, or related soft tissues. This includes a However, an MSI can be artistically and professionally strain, sprain, or inflammation that is caused or limiting, or even career-ending, with devastating effects aggravated by activity. on your physical, emotional, and financial well-being. If you experience pain that may indicate MSI, take steps to Musicians (including vocalists) are prone to MSI that is deal with the problem. caused or aggravated by practice, rehearsal, or performance. Playing a musical instrument may be Table 1 describes five levels of MSI signs and symptoms in second only to computer use in terms of population performers. If you are at Level I or II, modify your exposure to an MSI risk factor. Some studies have shown activities to prevent further progression of symptoms. If that approximately half of professional musicians and you are at Level III or higher, seek professional assistance. music students experience significant MSI symptoms. Table 1 Progression of MSI signs and symptoms To find out more about MSI, see the information sheet Level I “Musicians and MSI — Prevention and Treatment.” Pain occurs after class, practice, rehearsal, or performance, but you are able to perform normally. MSI symptoms Level II Pain occurs during class, practice, If you develop an MSI, you may experience symptoms rehearsal, or performance, but you are not restricted in performing.
    [Show full text]