10/15/2018 1 Arthrology

Total Page:16

File Type:pdf, Size:1020Kb

10/15/2018 1 Arthrology 10/15/2018 http://vanat.cvm.umn.edu/ http://www.cvmbs.colostate.edu/vetneuro/VCA3/vca.html Arthrology 1 10/15/2018 • Where a bone joins … Synchondrosis Range of motion (ROM) 2 basic types of joint structure classification Synarthrosis Amphiarthrosis Diarthroses (synovial) No movement (synostosis) Slightly movable Freely movable Without a cavity (2 types) With a cavity (1 type) Bones joined by solid Masses of connective Bones joined by a CT capsule tissue (CT) surrounding a synovial cavity Fibrous Synovial Cartilaginous 2 10/15/2018 Fibrous joints • Syn • Gomphosis • Suture Gomphosis Horse Radius and Ulna desmo Gomphosis Dog Tibia and fiula 3 10/15/2018 Suture Types of Sutures • According to the form of the united margins: Cartilaginous: Synchondrosis Cartilaginous joints • Synchondrosis (primary) -- hyaline cartilage union • Symphysis (secondary) ostoses 4 10/15/2018 Cartilaginous: (symphysis) Nucleus pulposus Anulus fibrosus Intervertebral Disk The ossification process • These provide for bone growth and then subside once bone has reached mature length • Make junvenile radiographic interpretation challenging • Common fracture sight in young • Must know typical closure dates for radiology 5 10/15/2018 Essential structures 1. Articular capsule: Synovial = Diarthrodial - Fibrous layer - Synovial membrane: joints 6 types Articular cartilage: Articular cartilage: 6 10/15/2018 Articular or joint Capsule Articular (Synovial) cavity and Articular Cavity Synovial Fluid 7 10/15/2018 Joint Taps - Synovial Fluid Analysis Synovial fluid Accessory structures Ligaments • Ligamensts • Extracapsular • Intracapsular • Intra-articular fibrocartilage - Capsular • Marginal cartilage (labra) • Fat pads 8 10/15/2018 Fat Pads Articular Discs • Between fibrous and synovial layers • may protrude into joint cavity (pushing the synovial membrane into folds inside the synovial cavity) • e.g., parapatellar fat pads of the stifle joint Meniscus Labrum 9 10/15/2018 Classification of synovial joints According to # of bones forming the joint • According to # of bones forming the joint • According to shape of articular surface • According to axis of movement According to shape of articular surface 1- Plane Spheroidal (ball and socket) • e.g., carpal, tarsal joints, and vertebrae (dorsal articulation) • Gliding or sliding movement Equine cervical vertebra 10 10/15/2018 Ellipsoidal Saddle Condylar Pivot 11 10/15/2018 Pivot (Trochoid) Ex. Atlantoaxial j. According to axis of movement Uniaxial Biaxial According to axis of movement Multiaxial 12 10/15/2018 Movements of synovial joint General Myology Myo + ology = The study of muscle 13 10/15/2018 Types of muscle tissue (3 types): Muscle Skeletal • Smooth Striated Smooth • Cardiac Skeletal Cardiac Skeletal muscle fibers are enveloped by connective tissue epimysium • Epimysium muscle belly perimysium endomysium • Perimysium muscle fascicles endomysium Nucleus • Endomysium muscle fibers (cells) Tendons Muscle muscle fascicle 14 10/15/2018 Types of attachments • Regions: h • Tendons may be: • Very Very short • Very broad aponeurosis • Sharpey's fibers: Sensory innervation of tendons and Panniculus reflex ligaments reflex inhibition 15 10/15/2018 Types of skeletal muscles (according to orientation of fibers in the muscle) Pennate Muscles • Parallel (Strap) ex. Sartorius M. • Fusiform Unipennate Bipennate Multipennate • Appears as a series of • Fibers attach obliquely • Fibers running obliquely along Flat bipennate muscles set side by • along one side of the both sides of a centrally located side. Circular (sphincter muscles) --- fibers arranged in concentric rings → closes the tendon tendon. • Like a number of feathers Like half a feather Like a whole feather • openings. e.g., orbicularis oris and orbicularis oculi • • placed next to one another Genioglosseus M. Common digital extensor M. Pennate fibers join the tendon obliquely → more fibers → more powerful • Abductor pollicis longus M. Gastrocnemius M. Deltoideus M. Psoas minor M. Rectus femoris M. Flat muscle Bipennate muscle Mulitpennate muscle Unipennate muscle Unipennate Bipennate 16 10/15/2018 Types of skeletal muscles (according to number of joints it crosses) Grouping According to action: • Uniarticular • Biarticular • Polyarticular Muscle Nomenclature According to Flexion shape Extension Size Relative position/direction Pronation Abduction Supination Origin and insertion Adduction Function Structure Depression Combination Elevation 17 10/15/2018 Muscle Nomenclature Accessory structures associated Muscle injuries with skeletal muscles • Superficial fascia • Deep fascia endomyseal sheathing and sarcolemma intact regenerates CT (scarring). 18 10/15/2018 Modification Fascia of the deep fascia: clinical importance Carpal flexor approach retinaculum Digital annular ligaments • Compartmental syndrome Synovial Bursa Navicular bursa • A sac-like structure between 2 different tissues to reduce friction. • Structure ----- as the j. capsule, i.e. its wall consists of a fibrous layer lined by a synovial membrane. • E.g., Bicipital bursa • Navicular bursa 19 10/15/2018 Synovial sheath Mesotendon Vascularization of skeletal Muscles Innervation of skeletal Muscles • Motor nerves • Arteries • Veins • Lymphatic • Sensory nerves 20.
Recommended publications
  • Tenosynovitis of the Deep Digital Flexor Tendon in Horses R
    TENOSYNOVITIS OF THE DEEP DIGITAL FLEXOR TENDON IN HORSES R. W. Van Pelt, W. F. Riley, Jr. and P. J. Tillotson* INTRODUCTION sheaths, statistical comparisons were made be- tween certain values determined for synovial TENOSYNOVITIS of the deep digital flexor ten- effusions from tarsal synovial sheaths of don (thoroughpin) in horses is manifested by affected horses and synovial fluids from the distention of its tarsal synovial sheath due to tibiotarsal joints of control formation of an excessive synovial effusion. Un- horses. less tenosynovitis is acute, signs of inflamma- Control Horses tion, pain or lameness are absent (1). Tendinitis Five healthy horses ranging in age from can and does occur in conjunction with inflam- four to nine years were used as controls. Four mation of the tarsal synovial sheath. of the horses were Thoroughbreds and one As tendons function they are frequently sub- horse was of Quarter Horse breeding. All jected to considerable strain, peritendinous control horses were geldings. Synovial fluid pressure, and friction between the parietal and samples were obtained from the tibiotarsal joint. visceral layers of the tendon sheath (2). Acute direct trauma or trauma that is multiple and Hematologic Determinations minor can precipitate tenosynovitis. In acute Blood samples for determination of serum tenosynovitis of the deep digital flexor tendon, sugar content (measured as total reducing sub- the ensuing inflammatory reaction affects the stances) were obtained from the jugular vein tarsal synovial sheath, which responds to in- prior to aspiration of the tarsal synovial sheath flammation by formation of an excessive syno- in affected horses and the tibiotarsal joint in vial effusion.
    [Show full text]
  • Anatomy of the Dog the Present Volume of Anatomy of the Dog Is Based on the 8Th Edition of the Highly Successful German Text-Atlas of Canine Anatomy
    Klaus-Dieter Budras · Patrick H. McCarthy · Wolfgang Fricke · Renate Richter Anatomy of the Dog The present volume of Anatomy of the Dog is based on the 8th edition of the highly successful German text-atlas of canine anatomy. Anatomy of the Dog – Fully illustrated with color line diagrams, including unique three-dimensional cross-sectional anatomy, together with radiographs and ultrasound scans – Includes topographic and surface anatomy – Tabular appendices of relational and functional anatomy “A region with which I was very familiar from a surgical standpoint thus became more comprehensible. […] Showing the clinical rele- vance of anatomy in such a way is a powerful tool for stimulating students’ interest. […] In addition to putting anatomical structures into clinical perspective, the text provides a brief but effective guide to dissection.” vet vet The Veterinary Record “The present book-atlas offers the students clear illustrative mate- rial and at the same time an abbreviated textbook for anatomical study and for clinical coordinated study of applied anatomy. Therefore, it provides students with an excellent working know- ledge and understanding of the anatomy of the dog. Beyond this the illustrated text will help in reviewing and in the preparation for examinations. For the practising veterinarians, the book-atlas remains a current quick source of reference for anatomical infor- mation on the dog at the preclinical, diagnostic, clinical and surgical levels.” Acta Veterinaria Hungarica with Aaron Horowitz and Rolf Berg Budras (ed.) Budras ISBN 978-3-89993-018-4 9 783899 9301 84 Fifth, revised edition Klaus-Dieter Budras · Patrick H. McCarthy · Wolfgang Fricke · Renate Richter Anatomy of the Dog The present volume of Anatomy of the Dog is based on the 8th edition of the highly successful German text-atlas of canine anatomy.
    [Show full text]
  • Transition Phase Towards Psoriatic Arthritis: Clinical and Ultrasonographic Characterisation of Psoriatic Arthralgia
    Psoriatic arthritis RMD Open: first published as 10.1136/rmdopen-2019-001067 on 23 October 2019. Downloaded from ORIGINAL ARTICLE Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia Alen Zabotti ,1 Dennis G McGonagle,2 Ivan Giovannini,1 Enzo Errichetti,3 Francesca Zuliani,1 Anna Zanetti,4 Ilaria Tinazzi,5 Orazio De Lucia,6 Alberto Batticciotto ,7 Luca Idolazzi,8 Garifallia Sakellariou,9 Sara Zandonella Callegher,1 Stefania Sacco,1 Luca Quartuccio,1 Annamaria Iagnocco,10 Salvatore De Vita1 To cite: Zabotti A, ABSTRACT McGonagle DG, Giovannini I, Objective Non-specific musculoskeletal pain is common Key messages et al. Transition phase in subjects destined to develop psoriatic arthritis (PsA). towards psoriatic arthritis: We evaluated psoriatic patients with arthralgia (PsOAr) What is already known about this subject? clinical and ultrasonographic compared with psoriasis alone (PsO) and healthy controls ► Patients with psoriasis have a period of non-specific characterisation of psoriatic joint symptoms (ie, arthralgia) before psoriatic ar- arthralgia. RMD Open (HCs) using ultrasonography (US) to investigate the anatomical basis for joint symptoms in PsOAr and the thritis (PsA) development, but the anatomical basis 2019;5:e001067. doi:10.1136/ for such arthralgia remains to be defined. rmdopen-2019-001067 link between these imaging findings and subsequent PsA transition. What does this study add? Methods A cross-sectional prevalence analysis of ► Tenosynovitis could be an important contributor to Received 25 July 2019 clinical and US abnormalities (including inflammatory non-specific musculoskeletal symptoms in psoriatic Revised 3 October 2019 and structural lesions) in PsOAr (n=61), PsO (n=57) and patients with arthralgia (PsOAr).
    [Show full text]
  • A Case of Septic Arthritis of the Shoulder Joint That Developed After Suprascapular Nerve Block
    Open Journal of Orthopedics, 2020, 10, 25-32 https://www.scirp.org/journal/ojo ISSN Online: 2164-3016 ISSN Print: 2164-3008 A Case of Septic Arthritis of the Shoulder Joint That Developed after Suprascapular Nerve Block Taihei Go1, Toshiyuki Tsutsui2*, Yasuaki Iida3, Katsunori Fukutake1, Ryoichi Fukano3, Kosei Ishigaki4, Masayuki Sekiguchi1, Hiroshi Takahashi1 1Department of Orthopedics, Toho University, Tokyo, Japan 2Department of Orthopedics, Sagamihara Chuo Hospital, Kanagawa, Japan 3Department of Orthopedics, Omori Red Cross Hospital, Tokyo, Japan 4Department of Orthopedics, Japan Community Health Care Organization Tokyo Kamata Medical Center, Tokyo, Japan How to cite this paper: Go, T., Tsutsui, T., Abstract Iida, Y., Fukutake, K., Fukano, R., Ishigaki, K., Sekiguchi, M. and Takahashi, H. (2020) Septic arthritis of the shoulder is uncommon in the immunocompetent pa- A Case of Septic Arthritis of the Shoulder tient with no previous risk factors for joint infection. We treated an immu- Joint That Developed after Suprascapular nocompetent patient who developed septic arthritis of the shoulder after su- Nerve Block. Open Journal of Orthopedics, 10, 25-32. prascapular nerve block for pain due to rotator cuff tear. An 80-year-old man https://doi.org/10.4236/ojo.2020.102005 with no underlying disease visited a nearby orthopedics clinic with complaint of left shoulder joint pain. Left suprascapular nerve block was performed, but Received: November 30, 2019 Accepted: January 19, 2020 the pain gradually aggravated. On the day after the block, he had a fever of Published: January 22, 2020 39˚C and came to our department. On examination, enlargement and ten- derness were present at the injection site.
    [Show full text]
  • Section 1 Upper Limb Anatomy 1) with Regard to the Pectoral Girdle
    Section 1 Upper Limb Anatomy 1) With regard to the pectoral girdle: a) contains three joints, the sternoclavicular, the acromioclavicular and the glenohumeral b) serratus anterior, the rhomboids and subclavius attach the scapula to the axial skeleton c) pectoralis major and deltoid are the only muscular attachments between the clavicle and the upper limb d) teres major provides attachment between the axial skeleton and the girdle 2) Choose the odd muscle out as regards insertion/origin: a) supraspinatus b) subscapularis c) biceps d) teres minor e) deltoid 3) Which muscle does not insert in or next to the intertubecular groove of the upper humerus? a) pectoralis major b) pectoralis minor c) latissimus dorsi d) teres major 4) Identify the incorrect pairing for testing muscles: a) latissimus dorsi – abduct to 60° and adduct against resistance b) trapezius – shrug shoulders against resistance c) rhomboids – place hands on hips and draw elbows back and scapulae together d) serratus anterior – push with arms outstretched against a wall 5) Identify the incorrect innervation: a) subclavius – own nerve from the brachial plexus b) serratus anterior – long thoracic nerve c) clavicular head of pectoralis major – medial pectoral nerve d) latissimus dorsi – dorsal scapular nerve e) trapezius – accessory nerve 6) Which muscle does not extend from the posterior surface of the scapula to the greater tubercle of the humerus? a) teres major b) infraspinatus c) supraspinatus d) teres minor 7) With regard to action, which muscle is the odd one out? a) teres
    [Show full text]
  • CVM 6100 Veterinary Gross Anatomy
    2010 CVM 6100 Veterinary Gross Anatomy General Anatomy & Carnivore Anatomy Lecture Notes by Thomas F. Fletcher, DVM, PhD and Christina E. Clarkson, DVM, PhD 1 CONTENTS Connective Tissue Structures ........................................3 Osteology .........................................................................5 Arthrology .......................................................................7 Myology .........................................................................10 Biomechanics and Locomotion....................................12 Serous Membranes and Cavities .................................15 Formation of Serous Cavities ......................................17 Nervous System.............................................................19 Autonomic Nervous System .........................................23 Abdominal Viscera .......................................................27 Pelvis, Perineum and Micturition ...............................32 Female Genitalia ...........................................................35 Male Genitalia...............................................................37 Head Features (Lectures 1 and 2) ...............................40 Cranial Nerves ..............................................................44 Connective Tissue Structures Histologic types of connective tissue (c.t.): 1] Loose areolar c.t. — low fiber density, contains spaces that can be filled with fat or fluid (edema) [found: throughout body, under skin as superficial fascia and in many places as deep fascia]
    [Show full text]
  • Review Vasculature of the Normal and Arthritic Synovial Joint
    Histol Histopathol (2001) 16: 277-284 001: 10.14670/HH-16.277 Histology and http://www.ehu.es/histol-histopathol Histopathology Cellular and Molecular Biology Review Vasculature of the normal and arthritic synovial jOint L. Haywood and D.A. Walsh Academic Rheumatology, Nottingham University Clinical Sciences Building, City Hospital, Nottingham, UK Summary. The vasculature of the normal and arthritic synovium as the major nutrient supply for articular knee is described. The joint contains a number of cartilage (Walsh et aI. , 1997). Arterio-venous shunts different tissues, many of which are heterogeneous and have been identified in the synovium and offer a each with varying degrees of vascularization. In the potential mechanism for the control of synovial blood normal joint the vasculature is highly organised, some flow (Lindstrom and Branemark, 1962). tissues are highly vascular with well defined vascular Joints can be classified into groups, according to organisation, whilst other tissues are avascular. During their location, range and nature of motion or anatomy. arthritis vascular turnover is increased. This vascular Synovial joints are present throughout the skeleton and plasticity leads to redistribution of the vascular bed and vary in size. However, due to accessibility and relatively may compromise its functional ability. The normal joint large size in man and experimental animals the knee is is able to regulate its blood flow, but this ability may be the most extensively studied synovial joint. Knee compromised by the inflammation and increased arthritis is a major source of distress and disability in synovial fluid volume that are associated with joint man. This paper focuses on the vasculature of the knee.
    [Show full text]
  • Anatomy and Physiology of the Human Knee Joint
    Curriculum Units by Fellows of the Yale-New Haven Teachers Institute 1985 Volume VII: Skeletal Materials- Biomineralization Anatomy and Physiology of the Human Knee Joint Curriculum Unit 85.07.06 by Mara A. Dunleavy Introduction This unit takes an indepth look at a very complex part of the human anatomy, the knee joint. There are numerous structures that are found in this joint, classified as a diarthrodial or synovial joint. Study of this area must include a review of the skeletal and muscular systems in order to see how they interact under normal use. Some knee injuries and the pathologies will be considered. The objectives of this unit are: 1. to introduce the student to the skeletal system with emphasis on the lower extremity; 2. to explain the chemical make-up of bone and the process of ossification; 3. to differentiate between the types of joints in the human body; 4. to introduce the student to the muscular system, with emphasis on those muscle groups of the leg; 5. to describe other structures that are essential for normal movement of this diarthrodial joint, including ligaments, tendons, cartilage and bursa; 6. to explain, demonstrate, and illustrate the coordination of the different systems and each of their specializations; 7. to describe some knee injuries and the pathologies. The outline of the unit is divided into the following five parts: I. Bone, as a tissue Curriculum Unit 85.07.06 1 of 15 a. Histology of bone b. Other tissues related to bones as organs II. Skeleton, bones as organs or structures a.
    [Show full text]
  • Anatomy First Stage
    ANATOMY FIRST STAGE Myology Myology: Is the science deal with study of the description of muscles in the body including tendon, apenurosis, and accessory structures like fascia, synovial bursa, and synovial sheath of the tendon. Note 1-The muscle tissue consist of elongated cells called fibers 2-The sytoplasm of muscle cells called sarcoplasm 3-The cell membrane of muscle cells called sarcolemma 4-The sarcoplasm contains numerous myofibrils which contain two types of contractil protein filaments termed actin and myosin Function of the muscles 1-Assist the movement of articulated bones 2-Ability of excitation (contraction and relaxation)of viscera ,blood vessels and iris of eye. 3-Accept the body its architecture and shape . 4-Act as energy stories (glycogen within muscles). 5-Act as protection and fixation of viscera. 6-Responsible of heart movement . Types of muscle: There are 3 types of muscle in the body 1-Skeletal muscle:the skeletal muscle characterized by 1- Striated muscle fiber 2-Generally attached to bone 3-Usually under voluntary control 4-Consist of numbers of muscular bundles which surrounded by fibrous sheath 5- The muscle fiber have multinuclei located peripherally 6- The skeletal muscle fiber cylindrical in shape and extend along entire length of muscle. Note :- Skeletal muscles are usually arranged in pairs so that they oppose each other (they are "antagonists"), one flexing the joint (a flexor muscle) and the other extending it (extensor muscle). ANATOMY FIRST STAGE 2-Cardiac muscle The cardiac muscle like skeletal muscle but differ from it as follow 1- The cardiac muscle fiber is shorter than skeletal muscle fiber 2- They are branched muscle 3- The have certain structures termed intercalated discs ,(the cardiac muscle fiber is restricted between each two intercalated discs.
    [Show full text]
  • Chapter 14: the Musculoskeletal System
    The musculoskeletal system 14 Introduction – Challenges of lameness and gait abnormalities 14.1 Lameness examination and diagnostic techniques 14.2 Hoof anatomy and conformation 14.3 Trimming and shoeing 14.4 Conditions affecting the hoof 14.5 Conditions affecting the bones 14.6 Conditions affecting the joints 14.7 Conditions affecting the tendons and ligaments 14.8 Conditions affecting the muscles 14.9 Conditions affecting the synovial bursae 14.10 Case study – Malignant oedema 14.11 References 14.12 351 Introduction – Challenges of lameness and gait 14.1 abnormalities The musculoskeletal system consists of structures which move the body or maintain its form: muscles, tendons, ligaments, bones and joints. Lameness/gait abnormalities are perhaps the most common presenting sign to working equine veterinarians. Data from the welfare assessment of 4,903 working equids (Pritchard et al. 2005) suggest that over 99% of animals surveyed show gait abnormalities. Lameness can be very frustrating to treat, especially as many cases are chronic and may have many contributing factors (Broster et al. 2009). Long-term rest is often the most effective treatment but this is usually impractical for the owners of working equids. Golden Rule 1 Basic knowledge of anatomy is essential for a confident diagnosis. Golden Rule 2 Think holistically: ‘management’ rather than ‘treatment’. Golden Rule 3 The direct cause may be difficult to identify. 1. Think about which structures are under the skin in the affected area. 2. Think about what could be happening to those structures and why: Acute or chronic? Bone, joint, tendon, ligament or muscle? Infected or sterile? Single or multiple limbs? 3.
    [Show full text]
  • Clinical Manifestations of Synovial Cysts
    THE VESTERN Jourx.4 of Medicine Refer to: Burt TB, MacCarter DK, Gelman MI, et al: Clinical manifestations of synovial cysts. West J Med 133:99-104, Aug 1980 Clinical Manifestations of Synovial Cysts TODD B. BURT, MD; DARYL K. MacCARTER, MD; MARTIN 1. GELMAN, MD, and CECIL 0. SAMUELSON, MD, Salt Lake City Although synovial cysts are most commonly associated with rhaumatoid arthritis and osteoarthritis, they may occur in many other conditions. The clinical manifestations of these cysts are numerous and may result from pressure, dissection or acute rupture. Vascular phenomena occur when pop- liteal cysts compress vessels, and result in venous stasis with subsequent lower extremity edema or thrombophlebitis. Rarely, popliteal cysts may cause arterial compromise with intermittent claudication. Neurological sequelae in- clude pain, paresthesia, sensory loss, and muscle weakness or atrophy. When synovial cysts occur as mass lesions they may mimic popliteal aneurysms or hematomas, adenopathy, tumors or even inguinal hernias. Cutaneous joint fistulas, septic arthritis or osteomyelitis, and spinal cord and bladder compres- sion are examples of other infrequent complications. Awareness of the heter- ogeneous manifestations of synovial cysts may enable clinicians to avoid unnecessary diagnostic studies and delay in appropriate management. Ar- thrography remains the definitive diagnostic procedure of choice, although ultrasound testing may be useful. SYNOVIAL CYSTS are fluid-filled spaces lined by in 1877, resulting in the common eponym Baker synovial membrane and arise from diarthrodial cysts, for popliteal cysts.2 Subsequently, synovial joints, bursae and tendon sheaths. The first pub- cysts have been described in numerous locations lished report of a synovial cyst was made by although the knees, shoulders and wrists remain Adams, an Irish surgeon, in 1840.1 He described the most frequently involved areas.
    [Show full text]
  • Localized Pigmented Villonodular Synovitis of the Shoulder, Acta Med Port 2013 Jul-Aug;26(4):459-462
    Madruga Dias J, et al. Localized pigmented villonodular synovitis of the shoulder, Acta Med Port 2013 Jul-Aug;26(4):459-462 Joint Bone Spine. 2013;80:146–54. Emerg Med. 2012 (in press). 12. Citak M, Backhaus M, Tilkorn DJ, Meindl R, Muhr G, Fehmer T. Necrotiz- 14. Young MH, Aronoff DM, Engleberg NC. Necrotizing fasciitis: pathogen- ing fasciitis in patients with spinal cord injury: An analysis of 25 patients. esis and treatment. Expert Rev Anti Infect Ther. 2005;3:279–94. Spine. 2011;36:E1225-9. 15. Lancerotto L, Tocco I, Salmaso R, Vindigni V, Bassetto F. Necrotizing 13. Wilson MP, Schneir AB. A Case of Necrotizing Fasciitis with a LRINEC fasciitis: classification, diagnosis, and management. J Trauma Acute Score of Zero: Clinical Suspicion Should Trump Scoring Systems. J Care Surg. 2012;72:560–6. CASO CLÍNICO Localized Pigmented Villonodular Synovitis of the Shoulder: a Rare Presentation of an Uncommon Pathology Sinovite Vilonodular Pigmentada Circunscrita do Ombro: uma Apresentação Rara de uma Patologia Incomum João MADRUGA DIAS1, Maria Manuela COSTA1, Artur DUARTE2, José A. PEREIRA da SILVA1 Acta Med Port 2013 Jul-Aug;26(4):459-462 ABSTRACT Pigmented Vilonodular Synovitis is a rare clinical entity characterized as a synovial membrane benign tumour, despite possible aggres- sive presentation with articular destruction. The localized variant is four times less frequent and the shoulder involvement is uncommon. We present the case of a Caucasian 59 year-old patient, who presented with left shoulder pain, of uncharacteristic quality, with local swelling and marked functional limitation of 1 month duration. Shoulder ultrasonography showed subacromial bursitis.
    [Show full text]