Patellofemoral pain and asymmetrical hip rotation

BACKGROUND AND PURPOSE: Patellofemoral joint problems are the most common overuse injury of the lower extremity, and altered femoral or hip rotation may play a role in patellofemoral pain. The purpose of this case report is to describe the evaluation of and intervention for a patient with asymmetrical hip rotation and patellofemoral pain. CASE DESCRIPTION: The patient was a 15-year-old girl with an 8-month history of anterior right knee pain, without known trauma or injury. Prior to intervention, her score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was 24%. Right hip medial (internal) rotation was less than left hip medial rotation, and manual muscle testing showed weakness of the right hip internal rotator and abductor muscles. The intervention was aimed at increasing right hip medial rotation, improving right hip muscle strength (eg, the muscle force exerted by a muscle or a group of muscles to overcome a resistance), and eliminating anterior right knee pain. OUTCOMES: After 6 visits (14 days), passive left and right hip medial rotations were symmetrical, and her right hip internal rotator and abductor muscle grades were Good plus. Her WOMAC score was 0%. DISCUSSION: The patient had right patellofemoral pain and an uncommon pattern of asymmetrical hip rotation, with diminished hip medial rotation and excessive hip lateral (external) rotation on the right side. The patient's outcomes suggest that femoral or hip joint asymmetry may be related to patellofemoral joint pain.     

关节滑膜骨软骨瘤的诊断和鉴别价值

目的探讨影像学对滑膜软骨瘤的诊断价值。方法对经病理及临床综合确诊的19例滑膜骨软骨瘤病的影像学表现进行回顾性分析。结果病变累及膝关节14例,髋关节4例,肩关节1例,影像学表现为关节均有轻度肿胀,关节周围见大小不等的小结节样钙化或骨化影。结论滑膜软骨瘤病的影像学表现具有一定的特征性,结合临床具有较高的诊断价值     

滑囊软骨瘤病的CT和MRI影像学分析

目的 探讨滑囊软骨瘤病的CT和MRI表现特点.方法 回顾性分析手术病理证实的29例滑囊软骨瘤病的临床影像学资料,29例均有X线平片检查,其中8例行CT检查,9例行MRI检查.结果 病变累及三角肌滑囊2例,肩周多个滑囊3例,髂腰肌囊4例,髌上囊20例;X线平片和CT表现为滑囊内多发大小不等的斑片状、类圆形钙化或骨化结节影,MRI清晰地显示含有不同钙盐成分的软骨瘤结节、滑膜增厚和滑囊积液.结论 X线平片是诊断滑囊软骨瘤病的首选方法,但CT或MRI可直接显示滑囊本身变化.     

The diagnostic and therapeutic challenge of femoral head osteoid osteoma presenting as thigh pain: a case report

Osteoid osteoma, an infrequent but important cause of musculoskeletal pain, is often difficult to diagnose. We present a case of a 31-year-old man who, for 2 years, had left groin pain radiating to the thigh. Symptoms began 1 month after a motorcycle crash in which he sustained only shin abrasions. Initial spine and hip radiographs were negative. Treatment with naproxen provided significant relief, but the symptoms gradually worsened over 6 months. An electromyogram and lumbar magnetic resonance imaging (MRI) of the left lower leg were unremarkable. Hip MRI revealed edema without fracture. Prophylactic femoral pinning for impending stress fracture provided no relief. Rheumatologic evaluation revealed normal serologies and synovial fluid. Cyclobenzaprine and sulfasalazine were started and provided mild relief. At presentation to our institution, he was in significant discomfort, but could ride a bicycle for exercise and was completing a home exercise program. He had antalgic gait and globally restricted hip motion with end-range pain. A neurologic examination showed no abnormalities. Hip and pelvis computed tomography scan revealed increased sclerosis of the femoral head, with a central lucency suggestive of osteoid osteoma. This was confirmed by biopsy. Radiofrequency ablation provided significant symptom relief.     

A case of rheumatoid arthritis with unilateral knee synovial hypertrophy in hemiplegia

A 64-year-old woman suffering right hemiplegia came in with pain and swelling on her left knee, general weakness and poor oral intake for 2 months. On physical examination we were able to palpate a mass with irregular margin around the left suprapatellar area. From the results of the magnetic resonance imaging (MRI), synovial proliferative disease, infectious arthritis, or gouty arthritis was suspected. We performed a blood laboratory test to detect rheumatologic diseases, knee joint aspiration, and bone scan for differential diagnosis, and were able to diagnose rheumatoid arthritis (RA) from the results of blood laboratory, physical examination, and bone scan. Consequently, we started medications for controlling RA. Herein, we report a case of rheumatoid arthritis with unilateral knee synovial hypertrophy in hemiplegia. If a right hemiplegic patient has recurrent pain on the left knee and synovial hypertrophy, and fails to respond to treatment for osteoarthritis, early detection by evaluation for rheumatic disease is crucial to prevent severe sequelae influencing rehabilitation of hemiplegia.     

Arthroskopische Diagnostik und Therapie synovialer Erkrankungen

Synovial disorders are amongst the most common indications for hip arthroscopy. Arthroscopic intervention has been reported for symptomatic synovial plicae, synovial chondromatosis, pigmented villonodular synovitis (PVNS) and rheumatoid arthritis. In comparison to radiologic imaging one major advantage is the ability to inspect, biopsy and treat during one procedure. In contrast to an arthrotomy hip arthroscopy avoids the potential risks of an extensive surgical exposure and prolonged rehabilitation. Nevertheless hip arthroscopy cannot be promoted as curative in all synovial disorders. In patients with localized synovitis, impinging synovial folds and, to a certain extent, PVNS a curative therapy and “restitutio ad integrum” can be achieved. The goal of hip arthroscopy in patients with synovial chondromatosis and rheumatoid arthritis is to enable the correct diagnosis and to provide symptomatic relief and improve joint function. Success or failure of arthroscopic treatment depends on proper patient selection and a correct arthroscopic technique.     

Synoviale Erkrankungen der Hüfte

Synovial diseases and loose bodies are one of the most common indications for hip arthroscopy. Arthroscopic intervention has been reported in the literature for loose bodies, irritating synovial plicae, synovial chondromatosis, pigmented villonodular synovitis (PVNS) as well as rheumatoid and septic arthritis. One major advantage of arthroscopy in comparison to radiological imaging is the ability to inspect, biopsy and treat within one procedure. In contrast to arthrotomy hip arthroscopy avoids the potential risks of extensive surgical exploration which is associated with a higher morbidity and prolonged rehabilitation. Nevertheless, hip arthroscopy cannot be promoted as curative for all synovial disorders. In patients with loose bodies, synovial plicae, septic arthritis at an early stage and to some extent synovial chondromatosis and localized PVNS, curative therapy and full recovery can be achieved. In contrast, in patients with highly active synovial chondromatosis, diffuse PVNS and rheumatoid arthritis, the goal of hip arthroscopy is to enable the correct diagnosis, to provide symptomatic relief and maintain or improve joint function and to decide whether adjuvant therapy, systemic medication or secondary open surgery is necessary. Success or failure of arthroscopic treatment depends on correct patient selection and correct arthroscopic technique.     

Poncet's disease: An unusual presentation of tuberculosis in a diabetic lady

Authors describe a 53-year-old woman who presentedto their diabetes clinic with a three week history of multiple painful and swollen joints. She had been diagnosed with type 2 diabetes 5 years back. On examination, both knee joints and left ankle were swollen. A soft tissue swelling appeared over the medial end of the left clavicle few days later. Rheumatoid arthritis, collagen vascular diseases and other common causes of polyarthritis were ruled out by appropriate investigations. Non steroidal anti-inflammatory drugs failed to give satisfactory pain relief and the arthritis persisted. Conventional cultures of synovial fluid samples including cultures for tuberculosis were negative. Computed tomography showed a space occupying lesion involving the left sternoclavicular joint. Fine needle aspiration from the lesion was performed and acidfast bacilli were demonstrated in the smear using ZiehlNeelsen stain. The explanation of her arthritis was therefore tuberculous arthritis in left sternoclavicular joint and reactive arthritis in the rest of the joints. A diagnosis of Poncet's disease was considered in her case. We treated her with standard anti-tuberculosis drugs and the arthritis resolved within a few days. She remained symptom-free at her 2 years' follow-up.     

颞下颌关节滑膜软骨瘤病的影像诊断

目的对颞下颌关节滑膜软骨瘤病的临床、影像、病理学进行综合分析,提高对该病的认识。方法对8例具有完整病例资料并经手术病理证实的颞下颌关节滑膜软骨瘤病患者的临床资料、影像学征象及病理改变进行总结。结果临床表现:8例患者均有耳前区疼痛、肿胀伴张口受限,术中见关节腔内大量游离体。影像学表现:X线示颞下颌关节间隙增宽、髁突周围多发不透亮区;CT示关节腔内软组织密度影伴周围多发钙化,4例见骨质破坏;MR示关节腔内软组织肿块伴积液,周围多发长T_1WI、短T_2WI信号,增强后呈不均匀强化,动态增强扫描时间-信号强度变化曲线呈平坦型。病理表现:关节腔内游离体由透明软骨构成,伴周围纤维化、钙化。电镜下见大量透明软骨细胞覆盖以成纤维样滑膜细胞。结论颞下颌关节滑膜软骨瘤病具有典型的临床、影像及病理特点。     

Old unreduced obturator dislocation of the hip: A case report

BACKGROUNDObturator dislocation is a rare type of hip dislocation, accounting for about 2%-5% of all hip dislocations. The occurrence of old unreduced obturator dislocation is even more infrequent, with only 17 cases reported in nine studies, most of which were from the 1950s to 1980s in developing countries.CASE SUMMARYA 38-year-old woman from Hunan Province, China presented with stiffness of the left hip in abduction, flexion, and external rotation after falling from a 2-meter-tall tree onto her left knee 1.5 mo prior. Pelvic radiograph and computed tomography revealed obturator dislocation of the left hip accompanied by impaction fracture at the superolateral aspect of the left femoral head without associated acetabulum fracture. Open reduction was performed, resulting in restoration of the concentric alignment of the left hip. After surgery, 6-wk skin traction was applied and the patient was kept in bed for an additional 2 wk. At 3 mo after surgery, the patient reported experiencing some pain, which did not affect the function of the affected limb, and some movement restriction but no abduction deformity or claudication was present. An X-ray showed that the left hip was homocentric, and there was no sign of posttraumatic arthritis or avascular necrosis.CONCLUSIONOpen reduction may be an effective treatment strategy for the rare condition of old unreduced obturator dislocation with short neglect time.     

Outcome in the arthroscopic treatment of synovial chondromatosis of the knee

Background. Synovial osteochondromatosis is a disease in which loose cartilaginous bodies develop around large joints, usually the knee. It is caused by synovial metaplasia of unknown etiology. Symptoms are due either to mechanical problems caused by the loose bodies or to the degenerative arthritis that follows after several years. Surgical or arthroscopic removal of the loose bodies appears to be the only effective treatment. This article reports treatment outcome in synovial chondromatosis of the knee. Material and methods. We treated 13 patients: 11 by arthroscopy and 2 by arthrotomy. The follow-up examination was performed at least two years after after surgery. Results. There were 6 good and very good outcomes, while 2 patients required arthroscopic re-operation. Conclusions. Arthroscopy seems to be the treatment of choice in synovial chondromatosis of the knee.     

关节镜诊治髋关节疾病的临床疗效分析

目的 探讨关节镜诊治髋关节疾病的方法及疗效.方法 2003年10月～2009年4月应用关节镜诊治髋关节疾病59例(64髋),其中股骨头骨骺炎29例,非创伤性股骨头坏死11例,髋关节骨性关节炎4例,髋关节游离体2例,髋关节结核2例,滑膜软骨瘤病2例,剥脱性骨软骨炎2例,髋臼盂唇撕裂症2例,髋臼撞击综合征1例,不明原因的髋关节疼痛4例,随访分析其疗效.结果 随访54例,随访平均18个月(6～66个月),按照Harris评分进行疗效评定,术前Harris评分平均44分(29～54分),术后评分平均89分(59～98分).结论 关节镜诊治髋关节疾病具有创伤小、术后恢复快、并发症少等优点,疗效满意.     

The treatment of the sacroiliac joint component to low back pain: a case report.

This case report describes the treatment of a patient who had symptoms and signs suggestive of a sacroiliac joint component of low back pain. The patient developed right-sided low back pain without provocation. He appeared to have sacroiliac joint dysfunction, excessive right hip lateral rotation, and limited right hip medial rotation. The patient's habit of crossing his right leg over his left leg while sitting was believed to have contributed to the excessive lateral hip rotation. After treating the sacroiliac joint and restoring symmetrical hip rotation, the patient no longer complained of low back pain. This case report suggests that asymmetrical hip rotation may contribute to what is often called a sacroiliac joint component of low back pain.     

Groin and hip pain due to fractures at or near the pubic symphysis

Three patients with fractures at or near the pubic symphysis presented with groin pain simulating hip fracture or arthritis. A 71-year-old osteoarthritic woman was treated with a nonsteroidal antiinflammatory drug (NSAID) and exercises for right-sided sciatic pain after a minor fall, but developed left groin pain and tenderness over the pubic symphysis after two days of exercise. She had an impacted fracture of the left pubic symphysis which responded to use of a cane. The second patient was a 90-year-old woman with rheumatoid arthritis (on steroids) who complained of right hip pain after a series of falls in her home. Initially treated with Buck traction for a presumed hip fracture, she was later treated with heat and exercises after negative hip x-rays were obtained. Retrospective analysis of pelvic films and bone scan revealed a right pubic symphysis fracture. The third patient was an 83-year-old rheumatoid arthritic woman with inability to walk secondary to left groin pain. Pubic tomograms revealed disruption of the superior aspect, and bone scan showed increased uptake of the left pubic bone. She was treated with moist heat, rest, and NSAID. Twenty-four cases of os pubis fractures without major trauma or symphysis disruption have been reported. All patients had osteoporosis, and six had rheumatoid arthritis. Our three cases are presented to increase awareness of pubic symphysis fractures as a cause for groin pain, especially in patients with osteoporosis and rheumatoid arthritis.     

Symmetry of timing of hip and lumbopelvic rotation motion in 2 different subgroups of people with low back pain

OBJECTIVES: To examine whether lumbopelvic motion associated with a clinical test of active hip lateral rotation (HLR) systematically varied between people classified into 1 of 2 low back pain (LBP) subgroups: lumbar rotation (Rot) or lumbar rotation with extension (RotExt); and, specifically, to determine whether the timing of hip and lumbopelvic rotation with HLR would be more symmetric, right versus left, in people in the Rot subgroup compared with the RotExt subgroup. DESIGN: Two-group, cross-sectional. SETTING: A university-based movement science laboratory. PARTICIPANTS: Subjects were 39 people (23 men, 16 women; mean age, 28.1+/-8.0 y) with chronic or recurrent LBP who regularly participated in a rotation-related sport and associated their LBP symptoms with participation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects participated in a standardized clinical examination to classify their LBP problem. A 3-dimensional movement system was used to capture kinematics of hip and lumbopelvic rotation during the test of active HLR. To examine timing of motion between the hip and lumbopelvic region, the difference in time between the start of hip and lumbopelvic rotation was calculated (startdiff). Symmetry of motion was indexed by the correlation (r) between right and left startdiff and the coefficient of determination (r2) for each LBP subgroup. RESULTS: There were no significant differences between the 2 groups with regard to subject, LBP, activity, and range of motion variables (P range, >.05 for all comparisons). People in the Rot subgroup displayed significantly more symmetry of timing of hip and lumbopelvic rotation motion with active HLR than people in the RotExt subgroup (Rot subgroup: r=.94, r2=.88, P=.00; RotExt subgroup: r=.31, r2=.10, P=.12). CONCLUSIONS: People in the Rot and RotExt subgroups displayed systematic differences in how they moved the hip and lumbopelvic region with the clinical test of active HLR. These findings are potentially important because such differences in movement patterns between subgroups of people with LBP suggest different contributing factors and may require different treatments to affect the movement patterns.     

Breast and osteoarticular tuberculosis in a male patient

Breast tuberculosis is an uncommon illness. It is predominant in young women. To our knowledge, only 7 cases of tuberculous mastitis in men have been reported in the English literature since 1945. Furthermore, there are no male patients who have breast and osteoarticular tuberculosis in the literature. We presented a 41-year-old man who was admitted with a fixed tender mass in the right retromammary region and pain in the right hip. Mycobacterium tuberculosis colonies were isolated from the semisolid mass of breast. Histopathologic examination revealed caseous granulomatous infection in the right hip synovial tissue. He was treated successfully with only antituberculous drugs.     

Point-of-Care Ultrasound for the Detection of Hip Effusion and Septic Arthritis in Adult Patients With Hip Pain and Negative Initial Imaging

BackgroundAcute or recurrent hip pain in adults can be a challenging presentation in the emergency department. While ultrasound is routinely used in the evaluation of pediatric patients with hip pain and a new limp, it is not commonly used for this purpose in adult emergency medicine. This case series demonstrates the clinical utility of point-of-care ultrasound (POCUS) in adult patients with acute or recurrent hip pain because performance of POCUS was the critical action that led to the identification of pathologic hip effusions in this series of adults.Case SeriesThis case series includes 5 patients in whom clinical suspicion existed for the presence of a hip effusion and possible septic arthritis, despite nondiagnostic radiographic findings. Ultrasound was used to detect the effusion and guide subsequent arthrocentesis, imaging, or surgical intervention. In all patients, computed tomography scans or magnetic resonance imaging scans were later used to confirm the presence of effusion. In all 5 patients (2 women and 3 men, with a mean age of 47.4 years), POCUS accurately detected the presence of hip effusion. Two of 5 synovial collections were caused by septic arthritis as confirmed by synovial fluid microbiologic examination.Why Should an Emergency Physician Be Aware of This?This case series emphasizes the clinical utility of POCUS in adult patients with acute and recurrent hip pain to detect a hip effusion, particularly in patients with significant risk factors for septic arthritis. POCUS can also be used to guide further imaging, arthrocentesis, surgical consultation, and intervention.     

关节镜下治疗膝关节滑膜软骨瘤病

目的 探讨关节镜治疗膝关节滑膜软骨瘤病的疗效.方法 2005年1月-2009年10月,对23例(28膝)滑膜软骨瘤病患者入院行X线片、关节活动度检查、视觉模拟评分以及Lysholm膝关节功能评分.根据镜下所见分为表浅型6例,游离体型17例.结合病理学检查行Milgram分期,Ⅱ期16例,Ⅲ期7例.所有患者均行关节镜下病...     

Anterior superior iliac spine avulsion in a young soccer player

Avulsion fractures of the anterior superior iliac spine are rare. They usually occur in teenagers during sport activities. Cases concerning adults are very uncommon. We report here the case of a 23-year-old man who was admitted for recent pain of the left hip that worsened while kicking a ball in a soccer match eight days earlier. The examination found pain when moving the left hip in extension. Radiographs showed an avulsion fracture of the left anterior superior iliac spine, which was confirmed by computer tomography. The treatment was conservative consisting in rest and non-weight bearing with releasing of pain a few weeks later.