DOCSLIB.ORG

Elbow Tendonopathy & Enthesopathy Outline

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Elbow Tendonopathy & Enthesopathy Outline 7/7/2017 Elbow Tendonopathy & Outline Enthesopathy • Medial epicondylitis • Medial elbow “snapping” Patrick H. Smock, MD • Triceps enthesopathy Sports and Orthopedic Specialists 7 July, 2017 • Distal biceps tendinitis • Lateral epicondylitis Tendinopathy vs. Enthesopathy Medial Epicondylitis • “Tendinopathy refers to disease of the tendon and enthesopathy refer “Golfers elbow” to disease of the tendon bone junction (where the tendon joins the • 3‐6x less common than lat. Epicondylitis bone).... In the context of sports medicine, most of these conditions • Repetitive microtrauma (valgus stress are overuse in nature with repetitive loading leading to accumulative and wrist/forearm flexion/pronation) damage to the tendon or its insertion.” • “Angiofibroblastic hyperplasia” • Clinical features: Pain/tenderness over “With age, the circulation to some tendons decrease and this impairs medial epicondyle • Pain with grip and with resisted wrist the attempts of the body to repair the degenerated areas. flexion/pronation Tendinopathy and enthesopathy can also result in calcification within the tendon. In some cases, the progressive degeneration of the tendon • R/O Ulnar nerve pathology and medial or enthesis eventually causes the structure to fail and results in a tear.” elbow instability • Imaging as needed if diagnosis unclear Tendinopathies and enthesopathies: the bugbear of athletes • US vs. MRI https://www.ttsh.com.sg/patient‐guide/medical‐departments/page.aspx?id=1177 ©AllinaHealthSystem 1 7/7/2017 Management Medial elbow snapping • Conservative management is the mainstay • Rest, avoidance of offending activity, • Ulnar nerve vs. Medial triceps stretch, ice, NSAIDs tendon (or both) • Wrist splinting vs. counterforce strap • Painful snapping palpated/visualized with elbow • Shock‐wave therapy? flex/ext • Injections (CSI, autologous blood products)* • Check for subluxation of the Ulnar • Medial antebrachial cutaneous nerve nerve • Surgical debridement/repair (address associated ulnar nerve compression) • Synovial pathology Shoulder Elbow. 2014 Jan;6(1):47‐56. doi: 10.1111/sae.12022. Epub 2013 Jun 10. Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies. Donaldson O1, Vannet N1, Gosens T2, Kulkarni R1. Distal Biceps tendonitis Triceps Enthesoapthy • Incidence unknown • Pain with resisted elbow extension • Tendinosis vs. partial tear poorly • Tender bony prominence at the tip defined of olecranon • Suspect correlation with distal biceps rupture • Overlying olecranon bursitis • Ant. elbow pain with elbow • Plain films, +/‐ MRI flexion/supination • Conservative treatment first (rest, ice, • Conservative management (elbow stretching, modalaties) pad/compressive sleeve, ice, • PRP ? * NSAIDs) • Surgical detachment, debridement, • Steroid injection? repair Shoulder Elbow. 2015 Apr;7(2):110‐4. doi: 10.1177/1758573214567558. Epub 2015 Jan 16. • Surgical debridement, tendon repair Ultrasound‐guided platelet‐rich plasma injection for distal biceps tendinopathy. Barker SL1, Bell SN1, Connell D2, Coghlan JA1. ©AllinaHealthSystem 2 7/7/2017 Management Lateral Epicondylitis • Conservative management is the • “Tennis elbow” mainstay • Very common (1‐3% overall incidence) • Rest, avoidance of offending • Repetitive microtrauma (wrist/forearm activity, stretch, ice, NSAIDs extension) • Wrist splinting vs. counterforce • “Angiofibroblastic hyperplasia” strap* • Clinical features: Pain/tenderness over Lateral epicondyle • Shock‐wave therapy? • Pain with grip and with resisted wrist/elbow • Injections (CSI, autologous blood, extension PRP)* • R/O Radiocapitellar pathology, radial • Surgical debridement/repair tunnel syndrome • Open vs. arthroscopic • Imaging as needed if diagnosis unclear Phys Sportsmed. 2017 May;45(2):97‐104. Epub 2017 Mar 3. • US vs. MRI Platelet rich plasma versus steroid on lateral epicondylitis: meta‐analysis of randomized clinical trials. Mi B1, Liu G1, Zhou W1, Lv H2, Liu Y1, Wu Q1, Liu J1. Does anything really work? “Biopsychosocial approach” “Numerous nonoperative modalities have been described for the (1) “Can I tell you how tennis elbow works?” treatment of lateral tennis elbow. Most are lacking in sound (2) “For no known reason, between the ages of 35 and 65 years, tennis elbow scientific rationale. This has led to a therapeutic nihilism with arises in healthy people doing healthy things.” respect to the nonoperative management of this condition. An (3) “Tennis elbow lasts about a year or so, goes away on its own, is unlikely examination of the literature can only lead us to believe that most, to return, and leaves no trace.” if not all, common nonoperative therapeutic modalities used for (4) “We have been working on this problem for years but have not yet the treatment of tennis elbow are unproven at best or costly and time‐consuming at worst.” found a way to shorten the time it takes to get better.” Enthesopathy of the Extensor Carpi Radialis Brevis Origin: Effective Communication Strategies. J Shoulder Elbow Surg. 1999 Sep‐Oct;8(5):481‐91. Drake ML, Ring DC. Lateral tennis elbow: "Is there any science out there?". J Am Acad Orthop Surg. 2016 Jun;24(6):365‐9 Boyer MI1, Hastings H 2nd. ©AllinaHealthSystem 3 7/7/2017 Phys Sportsmed. 2017 May;45(2):97‐104. Epub 2017 Mar 3. Platelet rich plasma versus steroid on lateral epicondylitis: meta‐analysis of randomized clinical trials. Mi B1, Liu G1, Zhou W1, Lv H2, Liu Y1, Wu Q1, Liu J1. Clin Orthop Relat Res. 2015 Mar;473(3):1093‐107. Epub 2014 Oct 29. Does nonsurgical treatment improve longitudinal outcomes of lateral epicondylitis over no treatment? A meta‐ analysis. Sayegh ET1, Strauch RJ. Shoulder Elbow. 2014 Jan;6(1):47‐56. Epub 2013 Jun 10. Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies. Donaldson O1, Vannet N1, Gosens T2, Kulkarni R1. Shoulder Elbow. 2013 Oct;5: 239–250. Epub 2013 Jun 10. Tendinopathies Around the Elbow Part 1: lateral elbow tendinopathy. Donaldson O1, Vannet N1, Gosens T2, Kulkarni R1. J Hand Surg Am. 2009 Mar;34(3):566‐76. doi: 10.1016/j.jhsa.2009.01.022. Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. Rineer CA1, Ruch DS. J Shoulder Elbow Surg. 1999 Sep‐Oct;8(5):481‐91. Lateral tennis elbow: "Is there any science out there?". Boyer MI1, Hastings H 2nd. J Am Acad Orthop Surg. 2016 Jun;24(6):365‐9 Enthesoapthy of the Extensor Carpi Radialis Brevis Origin: Effective Communication Strategies Drake ML, Ring DC. ©AllinaHealthSystem 4.
Load more

Recommended publications
  • Understanding Entheseal Changes: Definition and Life Course Changes Sébastien Villotte, Christopher J
    Understanding Entheseal Changes: Definition and Life Course Changes Sébastien Villotte, Christopher J. Knüsel To cite this version: Sébastien Villotte, Christopher J. Knüsel. Understanding Entheseal Changes: Definition and Life Course Changes. International Journal of Osteoarchaeology, Wiley, 2013, Entheseal Changes and Occupation: Technical and Theoretical Advances and Their Applications, 23 (2), pp.135-146. 10.1002/oa.2289. hal-03147090 HAL Id: hal-03147090 https://hal.archives-ouvertes.fr/hal-03147090 Submitted on 19 Feb 2021 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. International Journal of Osteoarchaeology Understanding Entheseal Changes: Definition and Life Course Changes Journal: International Journal of Osteoarchaeology Manuscript ID: OA-12-0089.R1 Wiley - ManuscriptFor type: Commentary Peer Review Date Submitted by the Author: n/a Complete List of Authors: Villotte, Sébastien; University of Bradford, AGES Knusel, Chris; University of Exeter, Department of Archaeology entheses, enthesopathy, Musculoskeletal Stress Markers (MSM), Keywords: senescence, activity, hormones, animal models, clinical studies http://mc.manuscriptcentral.com/oa Page 1 of 27 International Journal of Osteoarchaeology 1 2 3 Title: 4 5 Understanding Entheseal Changes: Definition and Life Course Changes 6 7 8 Short title: 9 10 Understanding Entheseal Changes 11 12 13 Keywords: entheses; enthesopathy; Musculoskeletal Stress Markers (MSM); senescence; 14 15 activity; hormones; animal models; clinical studies 16 17 18 Authors: For Peer Review 19 20 Villotte S.
    [Show full text]
  • 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]
  • Olecranon Bursitis
    Olecranon bursitis What is Olecranon How is Olecranon bursitis bursitis? diagnosed? A bursa is a fluid filled sac It is often simple to diagnose Olecranon that stops soft tissues such bursitis without any special test although as tendons, ligaments and your doctor may wish to do blood tests if they skin rubbing on the bone feel it is caused by infection, arthritis or gout. next to them. Bursitis is Occasionally your GP may want to take some inflammation of the bursa of the fluid out of the bursa with a needle to which can be caused by test for infection to ensure they can give the direct impact or by soft correct treatment, although this is unlikely. They tissue tightness over the may also wish to perform an x-ray where there bursa causing repeated has been an injury to ensure there is no small irritation. Olecranon bursitis is an irritation of fracture or bone chip in the elbow. the bursa over the point of the elbow. What is the treatment for What causes Olecranon bursitis? Olecranon bursitis? It is usually caused by repeated injury or Olecranon bursitis will often settle with no irritation to the bursa by activities such as simply treatment other that ensuring the bursa is leaning on the elbow i.e. when reading or protected from whatever caused the irritation in working at a desk which is why it is sometimes the first place. The ‘PRICE’ treatment protocol is called ‘student’s elbow’. It can also be caused by recommended: a one off injury such as falling onto hard ground during sport.
    [Show full text]
  • OES Site Color Scheme 1
    Nuisance Problems You will Grow to Love Thomas V Gocke, MS, ATC, PA-C, DFAAPA President & Founder Orthopaedic Educational Services, Inc. Boone, NC [email protected] www.orthoedu.com Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Faculty Disclosures • Orthopaedic Educational Services, Inc. Financial Intellectual Property No off label product discussions American Academy of Physician Assistants Financial PA Course Director, PA’s Guide to the MSK Galaxy Urgent Care Association of America Financial Intellectual Property Faculty, MSK Workshops Ferring Pharmaceuticals Consultant Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. 2 LEARNING GOALS At the end of this sessions you will be able to: • Recognize nuisance conditions in the Upper Extremity • Recognize nuisance conditions in the Lower Extremity • Recognize common Pediatric Musculoskeletal nuisance problems • Recognize Radiographic changes associates with common MSK nuisance problems • Initiate treatment plans for a variety of MSK nuisance conditions Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Inflammatory Response Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Inflammatory Response* When does the Inflammatory response occur: • occurs when injury/infection triggers a non-specific immune response • causes proliferation of leukocytes and increase in blood flow secondary to trauma • increased blood flow brings polymorph-nuclear leukocytes (which facilitate removal of the injured cells/tissues), macrophages, and plasma proteins to injured tissues *Knight KL, Pain and Pain relief during Cryotherapy: Cryotherapy: Theory, Technique and Physiology, 1st edition, Chattanooga Corporation, Chattanooga, TN 1985, p 127-137 Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc.
    [Show full text]
  • Sports Medicine Examination Outline
    Sports Medicine Examination Content I. ROLE OF THE TEAM PHYSICIAN 1% A. Ethics B. Medical-Legal 1. Physician responsibility 2. Physician liability 3. Preparticipation clearance 4. Return to play 5. Waiver of liability C. Administrative Responsibilities II. BASIC SCIENCE OF SPORTS 16% A. Exercise Physiology 1. Training Response/Physical Conditioning a.Aerobic b. Anaerobic c. Resistance d. Flexibility 2. Environmental a. Heat b.Cold c. Altitude d.Recreational diving (scuba) 3. Muscle a. Contraction b. Lactate kinetics c. Delayed onset muscle soreness d. Fiber types 4. Neuroendocrine 5. Respiratory 6. Circulatory 7. Special populations a. Children b. Elderly c. Athletes with chronic disease d. Disabled athletes B. Anatomy 1. Head/Neck a.Bone b. Soft tissue c. Innervation d. Vascular 2. Chest/Abdomen a.Bone b. Soft tissue c. Innervation d. Vascular 3. Back a.Bone b. Soft tissue c. Innervation 1 d. Vascular 4. Shoulder/Upper arm a. Bone b. Soft tissue c. Innervation d. Vascular 5. Elbow/Forearm a. Bone b. Soft tissue c. Innervation d. Vascular 6. Hand/Wrist a. Bone b. Soft tissue c. Innervation d. Vascular 7. Hip/Pelvis/Thigh a. Bone b. Soft tissue c. Innervation d. Vascular 8. Knee a. Bone b. Soft tissue c. Innervation d. Vascular 9. Lower Leg/Foot/Ankle a. Bone b. Soft tissue c. Innervation d. Vascular 10. Immature Skeleton a. Physes b. Apophyses C. Biomechanics 1. Throwing/Overhead activities 2. Swimming 3. Gait/Running 4. Cycling 5. Jumping activities 6. Joint kinematics D. Pharmacology 1. Therapeutic Drugs a. Analgesics b. Antibiotics c. Antidiabetic agents d. Antihypertensives e.
    [Show full text]
  • 9 Impingement and Rotator Cuff Disease
    Impingement and Rotator Cuff Disease 121 9 Impingement and Rotator Cuff Disease A. Stäbler CONTENTS Shoulder pain and chronic reduced function are fre- quently heard complaints in an orthopaedic outpa- 9.1 Defi nition of Impingement Syndrome 122 tient department. The symptoms are often related to 9.2 Stages of Impingement 123 the unique anatomic relationships present around the 9.3 Imaging of Impingement Syndrome: Uri Imaging Modalities 123 glenohumeral joint ( 1997). Impingement of the 9.3.1 Radiography 123 rotator cuff and adjacent bursa between the humeral 9.3.2 Ultrasound 126 head and the coracoacromial arch are among the most 9.3.3 Arthrography 126 common causes of shoulder pain. Neer noted that 9.3.4 Magnetic Resonance Imaging 127 elevation of the arm, particularly in internal rotation, 9.3.4.1 Sequences 127 9.3.4.2 Gadolinium 128 causes the critical area of the cuff to pass under the 9.3.4.3 MR Arthrography 128 coracoacromial arch. In cadaver dissections he found 9.4 Imaging Findings in Impingement Syndrome alterations attributable to mechanical impingement and Rotator Cuff Tears 130 including a ridge of proliferative spurs and excres- 9.4.1 Bursal Effusion 130 cences on the undersurface of the anterior margin 9.4.2 Imaging Following Impingement Test Injection 131 Neer Neer 9.4.3 Tendinosis 131 of the acromion ( 1972). Thus it was who 9.4.4 Partial Thickness Tears 133 introduced the concept of an impingement syndrome 9.4.5 Full-Thickness Tears 134 continuum ranging from chronic bursitis and partial 9.4.5.1 Subacromial Distance 136 tears to complete tears of the supraspinatus tendon, 9.4.5.2 Peribursal Fat Plane 137 which may extend to involve other parts of the cuff 9.4.5.3 Intramuscular Cysts 137 Neer Matsen 9.4.6 Massive Tears 137 ( 1972; 1990).
    [Show full text]
  • Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079)
    Local Coverage Article: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Noridian Healthcare Solutions, A and B MAC 01111 - MAC A J - E California - Entire State LLC Noridian Healthcare Solutions, A and B MAC 01112 - MAC B J - E California - Northern LLC Noridian Healthcare Solutions, A and B MAC 01182 - MAC B J - E California - Southern LLC Noridian Healthcare Solutions, A and B MAC 01211 - MAC A J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01212 - MAC B J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01311 - MAC A J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01312 - MAC B J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01911 - MAC A J - E American Samoa LLC California - Entire State Guam Hawaii Nevada Northern Mariana Created on 09/28/2019. Page 1 of 33 CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Islands Article Information General Information Original Effective Date 10/01/2019 Article ID Revision Effective Date A57079 N/A Article Title Revision Ending Date Billing and Coding: Injections - Tendon, Ligament, N/A Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma Retirement Date N/A Article Type Billing and Coding AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT codes, descriptions and other data only are copyright 2018 American Medical Association.
    [Show full text]
  • Download Versus Arthritis
    Elbow pain Elbow pain information booklet Contents How does the elbow work? 4 What causes elbow pain and stiffness? 6 Should I see a healthcare professional? 8 What can I do to help myself? 9 How are elbow problems diagnosed? 12 What treatments are there for elbow pain? 14 Specific elbow conditions 18 Glossary 26 Research and new developments 27 Keeping active with elbow pain 28 Where can I find out more? 32 We’re the 10 million people living with arthritis. We’re the carers, researchers, health professionals, friends and parents all united in Talk to us 33 our ambition to ensure that one day, no one will have to live with the pain, fatigue and isolation that arthritis causes. We understand that every day is different. We know that what works for one person may not help someone else. Our information is a collaboration of experiences, research and facts. We aim to give you everything you need to know about your condition, the treatments available and the many options you can try, so you can make the best and most informed choices for your lifestyle. We’re always happy to hear from you whether it’s with feedback on our information, to share your story, or just to find out more about the work of Versus Arthritis. Contact us at [email protected] Words shown are explained in the glossary on p.26. Registered office: Versus Arthritis, Copeman House, St Mary’s Gate, Chesterfield S41 7TD in bold Registered Charity England and Wales No. 207711, Scotland No. SC041156.
    [Show full text]
  • Malignant Olecranon Bursitis in the Setting of Multiple Myeloma Relapse
    Case Report Malignant olecranon bursitis in the setting of multiple myeloma relapse Maxwell M Krem, MD, PhD,a Samer Z Al-Quran, MD,b Craig L Silverman, MD,c Vallejo Miller, RN,a and William Tse, MD, FACPa aDivision of Blood and Bone Marrow Transplantation, Department of Medicine, and Departments of bPathology and cRadiation Oncology, at the James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, Kentucky ultiple myeloma is the most common Case presentation and summary plasma cell neoplasm, with an esti- A 46-year-old man with a longstanding history mated 24,000 cases occurring annu- of multiple myeloma developed swelling of the Mally. 1 Symptomatic multiple myeloma most com- left elbow that was initially painless in September monly presents with one or more of the cardinal 2016. He had been diagnosed with IgA kappa mul- CRAB phenomena of hypercalcemia, renal dys- tiple myeloma and AL deposition in 2011. Over the function, anemia, or lytic bone lesions.2 Less com- course of his disease, he was treated with the follow- monly, patients may present with plasmacytomas ing sequence of therapies: cyclophosphamide, bort- (focal lesions of malignant plasma cells), which may ezomib, and dexamethasone, followed by melphalan- involve bony or soft tissues.1 conditioned autologous peripheral blood stem cell Plasma cell neoplasms occasionally involve the joints, transplant; lenalidomide and dexamethasone; car lzo- including the elbows, typically as plasmacytomas. e mib and dexamethasone; pomalidomide, bortezomib, elbow is an unusual but reported location of plasma- and dexamethasone; and bortezomib, lenalidomide, cytomas.3,4 A case of multiple myeloma and amyloid dexamethasone, doxorubicin, cyclophosphamide, and light-chain (AL) amyloidosis has been reported, with etoposide, followed by second melphalan-conditioned manifestations including pseudomyopathy, bone mar- autologous peripheral blood stem cell transplant.
    [Show full text]
  • Olecranon Bursitis As Initial Presentation of Gout in Asymptomatic Normouricemic Patients
    CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector The Egyptian Rheumatologist (2014) 36, 47–50 Egyptian Society for Joint Diseases and Arthritis The Egyptian Rheumatologist www.rheumatology.eg.net www.sciencedirect.com CASE REPORT Olecranon bursitis as initial presentation of gout in asymptomatic normouricemic patients Yasser Emad a,b,*, Yasser Ragab c,d, Nashwa El-Shaarawy e, J.J. Rasker f a Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt b Rheumatology and Rehabilitation Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia c Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt d Radiology Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia e Rheumatology and Rehabilitation Department, Suez Canal University, Ismailia, Egypt f Rheumatology Department, University of Twente, The Netherlands Received 25 August 2013; accepted 25 August 2013 Available online 4 October 2013 KEYWORDS Abstract Background: Acute bursitis is a less frequent presentation of gout, especially in Olecranon gouty bursitis; normouricemic subjects compared to the typical pattern of acute gouty arthritis. Olecranon bursitis; Aim of the work: The aim of the current case reports is to describe the clinical and the magnetic Gout; resonance imaging features of acute gouty olecranon bursitis as initial presentation of acute gouty MRI features attack. Case report: In this report we describe the clinical and MRI features of three cases presenting with acute gouty olecranon bursitis, in spite of normal serum uric acid and stable renal function. For all cases diagnostic aspiration was carried out to exclude septic bursitis as initial first step of management.
    [Show full text]
  • 10 Soft Tissue Injections
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Repositório Institucional dos Hospitais da Universidade de... Best Practice & Research Clinical Rheumatology Vol. 19, No. 3, pp. 503–527, 2005 doi:10.1016/j.berh.2005.01.003 available online at http://www.sciencedirect.com 10 Soft tissue injections Luı´s P.B.S. Ineˆs MD Rheumatologist Jose´ Anto´nio P. da Silva* MD, PhD Consultant Rheumatologist and Professor of Rheumatology Hospitais da Universidade de Coimbra, 3000-075 Coimbra, Portugal Soft tissue rheumatism includes a wide spectrum of common lesions of the tendons, enthesis, tendon sheaths, bursae, ligaments and fasciae as well as nerve compression syndromes. Studies on the pathogenesis of these lesions do not support a major role for inflammation, thus questioning the rationale for glucocorticoid injections. This chapter reviews current indications for local glucocorticoid injections and available evidence on its efficacy, as well as contra- indications and potential risks. Randomised controlled studies of good methodological quality are rare and there is limited scientific evidence to support the superiority of glucocorticoid injections over alternative treatments. The basic principles of the glucocorticoid injection method are outlined, together with a description of the practical procedure for the more common conditions. Key words: soft tissue rheumatism; treatment; glucocorticoid injection. Periarticular soft tissue rheumatic disorders include a wide spectrum of localised lesions of the tendons, enthesis, tendon sheaths, bursae, ligaments and fasciae as well as nerve compression syndromes. They are extremely common in daily practice and result in significant morbidity and socioeconomic impact. These aspects, together with their tendency to chronicity and recurrence, make the treatment of these conditions an important health care issue.
    [Show full text]
  • Enthesitis of the Hands in Psoriatic Arthritis: an Ultrasonographic Perspective
    Pictorial essay Med Ultrason 2017, Vol. 19, no. 4, 438-443 DOI: 10.11152/mu-1172 Enthesitis of the hands in psoriatic arthritis: an ultrasonographic perspective Alen Zabotti1, Luca Idolazzi2, Alberto Batticciotto3, Orazio De Lucia4, Carlo Alberto Scirè5, Ilaria Tinazzi6, Annamaria Iagnocco7 1Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital Santa Maria della Misericordia, Udine, 2Rheumatology Unit, University of Verona, Ospedale Civile Maggiore, Verona, 3Rheumatology Unit, L. Sacco University Hospital, Milan, 4Department of Rheumatology, ASST Centro traumatologico ortopedico G. Pini – CTO, Milan, 5Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Ferrara, 6Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, 7Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy Abstract Psoriatic arthritis is a systemic inflammatory disease in which enthesitis and dactylitis are two of the main hallmarks of the disease. In the last years, ultrasonography is increasingly playing a key role in the diagnosis of psoriatic arthritis and ultrasonography of the entheses, particularly of the lower limbs, is commonly used to assess patients with that disease. New advancements in ultrasound equipment using high frequencies probes allowed us also to identify and characterize the involve- ment of the entheses of the hand in psoriatic arthritis, confirming the results of the experimental models of the disease and the theory of the sinovial-entheseal complex, even in small joints. Keywords: ultrasonography; psoriatic arthritis; enthesitis; seronegative arthritis; synovio-entheseal complex Introduction fulness to differentiate PsA from Rheumatoid Arthritis (RA) [4,5]. The European League Against Rheumatism Psoriatic Arthritis (PsA), usually included in the (EULAR) recommends the use of imaging in diagnosis Spondyloarthritis (SpA) group, can affect different ar- and management of SpA and, in the last years, ultrasound ticular structures, from bone to soft tissues (e.g.
    [Show full text]