Atypical <Emphasis Type="Italic">Mycobacterium</Emphasis> infections of the upper extremity

Background: We encountered five patients with atypical Mycobacterium infections in the upper extremity, and examined their outcomes. Patients and methods: Two patients were male and three were female. The average patient age was 67 (range, 63–75) years. A wide synovectomy was performed to diagnose all cases followed by a therapeutic regimen of Rifampicin, Isoniazid, and Ethambutol. Results: The causative atypical organism was Mycobacterium marinum in three cases and Mycobacterium intracellulare in two cases. In one patient, inflammation recurred or did not disappear, and, therefore, three debridements were necessary. The average duration of antimicrobial therapy was 12 (range, 5–24) months. The average follow-up period was 26 (range, 5–66) months, and resolution had been achieved in all cases at the time of follow-up evaluation. Conclusion: Surgical debridement and appropriate mycobacterial culture or PCR method are critical to enable diagnosis and appropriate management.     

Intersection syndrome: MR imaging with anatomic comparison of the distal forearm

Objective To correlate the anatomic and MR imaging characteristics of the area of intersection of the first and the second dorsal extensor tendon compartments (DETC) in the distal forearm in an attempt to improve the design of MR imaging protocols used for the evaluation of intersection syndrome.Design and patients Ten forearms of nine cadavers underwent MR imaging in the axial and sagittal-oblique planes before and after tenography with direct injection of a gadolinium-containing contrast agent into the first DETC in four forearms, the second DETC in four forearms, and both compartments in the remaining two forearms. The area of intersection between the first and second DETC was identified in each case as well as its distance from Listers tubercle. Subsequently all forearms were sectioned in the axial (8 forearms) or sagittal-oblique planes (2 remaining forearms) to parallel the imaging planes. Detailed examination of each of the anatomic slices was performed in a search for anatomic variations and for possible anatomic connections of the tendons sheaths. One forearm was dissected to identify the area of intersection.Results The area of intersection between the first and second DETC occurred between 3.5 cm and 4.8 cm (mean 4.18 cm) proximal to Listers tubercle. After tenography, gadolinium solution was noted in the third DETC in two of four specimens in which the second DETC was injected and in one of two specimens in which both the first and second DETC were injected. Extension of the gadolinium solution between the first and second DETC was noted during isolated injections of either compartment, although this finding may have related to iatrogenic injection effects. The axial plane was the most valuable for assessment of the area of intersection of the first and second DETC.Conclusion MR imaging is a noninvasive method that can be used for the evaluation of distal forearm and wrist pain. Standard wrist protocols do not include the area of intersection between the first and second DETC and, in those cases in which intersection syndrome is suspected, the MR examination must be tailored to include the forearm.     

Pulmonary Nodule and Aggressive Tibialis Posterior Tenosynovitis in Early Rheumatoid Arthritis

We report the case of a 34-year-old man with a rheumatoid pulmonary nodule preceding the development of articular symptoms of rheumatoid arthritis. Pulmonary nodules are a well known feature of rheumatoid arthritis and are mostly seen in severe established rheumatoid factor-positive cases. To differentiate between benign and malign pulmonary nodules we discuss the use of positron emission tomography (PET). Despite intensive therapy with steroids and methotrexate in our patient, within months he developed a severe tibialis posterior tendinitis, with partial rupture and evolution to a planovalgus deformity requiring surgery. Both these symptoms are rare but demonstrate the need for close follow-up in early rheumatoid arthritis. Received: 18 October 1999 / Accepted: 22 March 2000     

钩刀松解法治疗屈指肌腱狭窄性腱鞘炎的 病例对照研究

目的:观察钩刀(钩形针刀)松解法治疗屈指肌腱狭窄性腱鞘炎的疗效及安全性。方法:自2007年9月至2008年9月门诊诊断为狭窄性腱鞘炎Ⅱ、Ⅲ期患者60例,其中女44例,男16例;年龄34～69岁,平均56岁;病程1个月～1年,平均3个月。分为治疗组和对照组,各30例,治疗组采用钩刀松解法,对照组采用封闭疗法治疗。6个月后随访,比较治疗后两组患者患指的活动痛、压痛、牵拉痛、屈指抗阻力痛情况,疼痛程度采用11点数字等级评分法(numerical rating scale,NRS)进行量化。结果:两组患者症状均改善,未出现不良反应,治疗组患指活动痛、压痛、牵拉痛、屈指抗阻力痛的改善好于对照组,临床疗效治疗组优于对照组。结论:钩刀松解法治疗屈指肌腱狭窄性腱鞘炎疗效肯定、微创、安全。     

Radial extracorporeal pressure pulse therapy for the primary long bicipital tenosynovitis a prospective randomized controlled study

Long bicipital tenosynovitis is regarded as one of the common causes of shoulder pain and dysfunction. The traditional therapeutic approach includes a variety of conservative treatments, but these treatments are not substantiated, owing to the lack of proven clinical efficacy. Radial extracorporeal shock wave therapy (rESWT) uses a pneumatically generated and radially propagating low-energy pressure pulse and has been clinically shown to be a new alternative form of treating refractory soft tissue inflammation. While treating patients suffering from long bicipital tenosynovitis, a randomized, controlled trial was conducted to analyze the effects of radial shock wave therapy on pain and function. Seventy-nine adults with long bicipital tenosynovitis were randomized to receive either active (1500 pulses, 8 Hz, 3 bars) or sham treatment through four sessions that were held once a week. All of these adults were assessed before treatment and at time intervals of 1, 3 and 12 months since the completion of the treatment. The outcomes were measured through the visual analogue scale (VAS) and L'Insalata shoulder questionnaire. Mean VAS in the rESWT group showed significant and sustained reduction from 5.67 ± 1.32 at baseline to 2.58 ± 1.49 at one month, 1.83 ± 1.25 at three months and 1.43 ± 0.94 at 12 months from baseline, whereas the sham group's mean VAS was 6.04 ± 0.97 before treatment and stabilized at 5.57 ± 0.84 at 12 months. Similar trends were found for the function scores. Mean scores were increased after rESWT from 60.57 ± 6.91 at baseline to 79.85 ± 6.59 at 1 month and 83.44 ± 5.21 at 12 months from baseline. Both pain and function scores showed significant differences between the two groups (p < 0.001). The rESWT group consisted of "invalid conservative treatment subgroup" and "none conservative treatment subgroup." Both groups showed good recovery and prognosis. Therefore, we recommend rESWT in treating primary long bicipital tenosynovitis.     

Unusual presentations and pitfalls of secondary syphilis: Periosteitis,tenosynovitis and hepatic abnormalities

We herein describe two cases of secondary syphilis in patients with human immunodeficiency virus (HIV) infection with an unusual presentation, a diffuse polyostotic periosteitis. Patients referred mainly intense bone pain. Other relevant aspects of the clinical pictures were flexor tenosynovitis and hepatic abnormalities. Given the persistence of symptoms, the treatment duration performed was different from most described in literature. However, although more slowly than expected, both obtained a favorable clinical response after treatment with benzathine penicillin G.     

Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases

Abstract

Musculoskeletal sonography (MSUS) has played a growing role in the diagnosis and management of rheumatic diseases, enabling the imaging of synovitis, bone erosion, and cartilage damage in the early phase of arthritis. “Dynamic” evaluation of tendons and help in guiding needle positioning in interventional manoeuvres are some of the other reasons for its success. MSUS, particularly when coupled with power Doppler (PD) examination, has recently been shown to be an efficient tool for monitoring disease activity and progression in rheumatoid arthritis, spondyloarthritis, crystal-related arthropathy, and osteoarthritis, with general consensus on its interesting results. More specifically, the PD signal has proved to be a simple and promising tool for short-term monitoring of synovial vascularity changes induced by steroids or biological agents in RA patients. MSUS has some limits, because of the physical properties of US and the quality of the equipment; it is, moreover, an operator-related imaging technique, with few standardized protocols. Future goals should be standardization of the examining approach in grey scale and Doppler ultrasound (US), including use of new equipment (3D US), extensive use in other fields (i.e. connective tissue diseases and vasculitis), and possible new applications (e.g. thoracic US).