Zygapophysial arthropathy. Intervertebral apophyseal joint arthropathy

Normal saline injections into appropriate zygapophysial joints were carried out on low back pain suffers to reproduce the pain. Patients were selected on certain defined clinical criteria for inclusion to this pilot study. Only five out of ten patients reported accurate pain reproduction and these were thought to suffer from zygaphophysial arthropathy. It is argued that recognition of this condition will influence its management.     

Appendicular arthropathy

The radiographic examination plays an extremely important role in the diagnosis of appendicular arthropathies. Accurate diagnosis can be made by observing the radiographic abnormalities in the bones surrounding the joint involved and the distribution of the abnormalities within the joint or the body.     

Cuff-tear arthropathy

In this report we describe the clinical and pathological findings of cuff-tear arthropathy in twenty-six patients and discuss the differential diagnosis and a hypothesis on the pathomechanics that lead to its development. This lesion is thought to be peculiar to the glenohumeral joint because of the unique anatomy of the rotator cuff. Following a massive tear of the rotator cuff there is inactivity and disuse of the shoulder, leaking of the synovial fluid, and instability of the humeral head. These events in turn result in both nutritional and mechanical factors that cause atrophy of the glenohumeral articular cartilage and osteoporosis of the subchondral bone of the humeral head. A massive tear also allows the humeral head to be displaced upward, causing subacromial impingement that in time erodes the anterior portion of the acromion and the acromioclavicular joint. Eventually the soft, atrophic head collapses, producing the complete syndrome of cuff-tear arthropathy. The incongruous head may eventually erode the glenoid so deeply that the coracoid becomes eroded as well. Although treatment of cuff-tear arthropathy is extremely difficult, the preferred method appears to be a resurfacing total shoulder replacement with rotator-cuff reconstruction and special rehabilitation. We think that it is important to recognize cuff-tear arthropathy as a distinct pathological entity, as such recognition enhances our understanding of the more common impingement lesions. Cuff-tear arthropathy is especially difficult to treat, and although many tears of the rotator cuff do not enlarge sufficiently to allow this condition to develop, it is a factor to consider when deciding whether or not a documented tear of the rotator cuff should be surgically repaired.     

Jaccoud's arthropathy

Jaccoud's arthropathy, which was first described in 1869, is a rare syndrome that is characterized by a painless or relatively painless deformity of the digits II, II, IV and V with a dislocation of the extensor tendons in the metacarpal fossae. When the thumb is affected, a Z-deformity is observed. The present analysis was based on 21 patients (30 hands, 24 of which were operated on over the period 1989 to 1996). A distinction should be made between Jaccoud's disease following a known inflammatory arthropathy (15 hands; average patient age 55 years) and the idiopathic form of the disease (9 hands; average patient age 70 years). From a clinical point of view, a classification of the deformities is needed so that appropriate surgical treatment can be determined. In the present study, four groups were therefore proposed: in groups I and II, the realignment to centre of the extensor tendons over the metacarpophalangeal joint and joint stabilization yielded 87% positive results. In groups III and IV, the results were not as satisfactory either for the Swanson implant or for metacarpal shortening osteotomy. The pathogenesis of Jaccoud's disease has not yet been determined, but now that more information has become available and a better analysis can be made of its various clinical and anatomopathological characteristics, these should assist in defining precise surgical indications.     

Hemophilic arthropathy

The most common clinical manifestation of hemophilia is arthropathy secondary to recurrent hemarthroses and chronic synovitis. Joint-surface erosions secondary to chronic synovitis often occur in early childhood and progress to advanced arthropathy by late adolescence. The knee, elbow, ankle, hip, and shoulder are the most commonly involved joints. Management of hemophilic arthropathy has advanced with the development of purified clotting factor concentrates and procedures to prevent chronic synovitis. Radiosynovectomy using beta particle-emitting radiocolloids has been effective in dramatically reducing the frequency of hemarthroses and resolving chronic synovitis. The most common surgical procedures used to manage hemophilic arthropathy are synovectomy, joint debridement, fusion, and joint arthroplasty. Late infection and arthrofibrosis complicate joint arthroplasty more often in these patients than in patients with other forms of arthritis. The high incidence of late infection may relate to frequent intravenous self-infusion of clotting factor combined with immune suppression. Despite the medical and surgical complexities of hemophilic arthropathy, orthopaedic procedures have a high incidence of patient satisfaction.     

Spinal Charcot arthropathy

Charcot joints of the spine are well-documented clinical entities most commonly associated with tabes dorsalis. Spinal neuropathic joints, however, may be produced by other disease processes including syringomyelia. In this review, the authors discuss the cause and treatment of spinal Charcot arthropathy with emphasis on surgical therapy and results.     

Acute sarcoid arthropathy

A case of middle aged female with acute arthritis, mediastinal lymphadenopathy and diabetes mellitus is described. The patient underwent mediastinal lymph node biopsy and was diagnosed as having acute sarcoidosis (Lofgrens syndrome). She was treated with systemic steroids and responded well.     

Idiopathic neurogenic arthropathy

This is a report of an unusual case of idiopathic neurogenic arthropathy in the lower extremities of a 7-year-old girl. A brief review of the known causes of neurogenic arthropathy is presented.     

Idiopathic Charcot's arthropathy

Summary The authors describe a case of idiopathic Charcot's joint in a 67-year-old lady. The diagnosis was made after a careful screening that ruled out all the common causes, known so far, of Charcot's joint.