Ultrasound characteristics of gouty tophi in the olecranon bursa and evaluation of their reproducibility

Objectives

To describe the ultrasound characteristics of gouty tophi in the olecranon bursa and to evaluate their reproducibility.

Methods

A prospective study of the ultrasound features of 35 sites of tophi nodulations in the elbows of 31 men (mean 54.6 years). The findings were evaluated dynamically following pre-established standards. The static images were evaluated by another radiologist and were reviewed by the first examiner.

Results

The most frequent characteristics of tophi are: hyperechogenicity (91.7%), poorly defined contours (88.6%), multiple grouped nodules (85.6%) and heterogeneity (68.6%). Intra-observer agreement is almost perfect for echogenicity (K = 1.0), moderate for the involvement of the olecranon bursa (K = 0.47) and fair for other characteristics. Inter-observer agreement is substantial for the echogenicity (K = 0.65), fair for the echotexture (K = 0.27) and the presence of a perilesional hypoechoic halo (K = 0.34) and slight for other characteristics.

Conclusions

The most frequent characteristic of tophi is hyperechogenicity. The intra-observer and inter-observer concordance for echogenicity are almost perfect and substantial, respectively. Knowledge of characteristics of the tophi in the elbow and their intra and inter-observer reproducibility may assist in establishing parameters for monitoring treatment and setting up criteria for differential diagnosis of processes involving the olecraneon bursa.     

Ultrasonographic assessment of pes anserinus tendon and pes anserinus tendinitis bursitis syndrome in patients with knee osteoarthritis

Abstract

Objective. The aim of this study was to assess the ultrasonographic (US) findings of pes anserinus tendon and bursa in patients with knee osteoarthritis (OA) with or without clinical pes anserinus tendinitis bursitis syndrome (PATBS).

Methods. A total of 157 female patients with the diagnosis of knee OA on both knees (314 knees), and 30 age, and body mass index- matched healthy female controls without knee pain (60 knees), were included in the study. PATBS was clinically diagnosed. US evaluation parameters were the measurement of the thickness of pes anserinus tendon insertion region (PA) and examination of the morphologic intratendinous PA tissue characteristics and pes anserinus bursitis (PAB). Radiographic knee osteoarthritis graded I-IV according to Kellgren and Lawrence (KL) for each knee was recorded. Pain and functional status were assessed by the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results. There were 183 PATBS (58.3%) clinical diagnoses among the 314 knees with OA. The mean thickness of PA in the patients with knee OA graded 1,2,3,4 with/without PATBS was significantly greater than the controls (p = 0.001). The mean thickness of PA in knees with OA KL graded 3 and 4 with/without PATBS, was greater than knees with OA KL graded 1 and 2 with/without PATBS (p < 0,05) (except knee OA KL graded 2 with PATBS versus knee OA KL graded 4 without PATBS).The knee OA KL graded 1,2,3,4 with PATBS had significantly more PAB and less loss of normal fibrillar echotexture of PA compared to controls and knees with OA KL graded 1,2,3,4 without PATBS (p < 0.05). The VAS scores of knees with OA KL graded 3, 4 with PATBS were significantly greater than those of knees with OA KL graded 3,4 without PATBS (p < 0.05). PA thickness was significantly associated with the KL grade (r: 0.336, p:0.001) and PATBS (r: 0.371, p < 0.001).

Conclusion. It is concluded that the mean thickness of PA in knees with OA with/without PATBS was significantly greater than the controls. The mean thickness of PA in knees with OA, KL graded 3 and 4 with/without PATBS, was greater than in knees with OA KL graded 1 and 2 with/without PATBS. The knee OA with PATBS had significantly more PAB, less loss of normal fibrillar echotexture of PA, and higher VAS scores compared to the knees with OA without PATBS. US can serve as a useful diagnostic tool for detection of PATBS in knee OA.     

针刺加手法治疗肩周炎50例心得体会

肩周炎又称肩关节周围炎，是以肩关节疼痛和活动不便为主要症状的常见病症。本病的好发年龄在50岁左右，故有“五十肩”之称。女性略多于男性，体力劳动者和脑力劳动者均可发病。本病如得不到有效治疗，有可能使肩关节发生粘连，妨碍日常生活。笔者采用针刺结合手法治疗的方法，疗效显著，值得推广，现将具体内容介绍如下。     

针刺为主治疗肩周炎临床疗效观察

根据祖国传统医学,肩周炎属中医经筋病,病因是中老年人气血不足、并常因劳损或感受风寒等诱因而发病,疼痛常有固定痛点,疼痛尤甚,遇冷则痛剧,有得温则痛缓解等特点,严重者影响日常工作和生活.而现代医学的有关理论及朱汉章数十年临床观察研究认为：肩周炎的根本病因是泌失调所致.所以治疗中采用疏经脉、行气活血,调节内分泌平衡为原则,临床中采用多向透刺剥离法可松解粘连、解除痉挛、行气活血,沟通经穴和非经穴,并在组织内,机械能转化为热能,此热能使小血管扩张,小血管扩张,加强了局部的肌肉组织平衡,同时起到补气活血的作用.中药外敷起到疏通经脉,活血化瘀,使局部肌肉组织得到充足的营养.治疗中观察到二者结合使用,起到协同和互补作用提高治疗效果,缩短治疗时间.     

按摩治疗肩周炎临床机理解析及手法操作

肩周炎是临床中的常见病与多发病,也是按摩疗法的适应症之一。本病多见于中老年患者,临床中凡因肩部急、慢性损伤,或因其它原因所致的肩关节周围软组织广泛性的炎性改变,出现肩部疼痛、活动受限的一类病症,称为肩周炎。本病又称“老年肩”“五十肩”“漏肩风”等,属祖国医学“痹症”的范畴。然而临床中如何根据其特点、性质,遵循正确的治疗原则,采用适宜的手法,则是获得良好疗效的关键,在此笔者就多年来时本病治疗的一些体会,与同道们做一探究。     

小针刀联合电针治疗肩周炎150例临床体会

目的：研究探讨采用小针刀和电针联合治疗肩周炎的临床体会。方法：对近几年来采用小针刀联合电针治疗肩周炎的临床资料进行分析和讨论。结果：150例中治愈120例、显效19例、好转10例、无效1例。结论：采用小针刀联合电针治疗肩周炎,操作简单、痛苦小、见效快、疗效短等优点,值得基层医院推广。     

小针刀、手法配合超短波治疗肩周炎

肩周炎又称肩关节周围炎,又名＂冻结肩＂、＂五十肩＂.本病好发于50岁左右人群,女性高于男性,多见于体力劳动者.是以肩周活动时疼痛、功能受限为其主要临床表现.此病中西医治疗方法很多,如推拿、针灸、封闭、拔火罐等疗效不佳.本人采用小针刀结合手法、超短波治疗肩周炎取得满意疗效.     

Magnetic resonance imaging of the elbow in athletes

Acute and chronic elbow pain is common, particularly in athletes. Although plain radiographs, ultrasound, and computed tomography all have a role to play in the investigation of elbow pain, magnetic resonance imaging (MRI) has emerged as the imaging modality of choice for diagnosis of soft tissue disease and osteochondral injury around the elbow. The high spatial resolution, excellent soft-tissue contrast, and multiplanar imaging capabilities of MRI make it ideal for evaluating the complex joint anatomy of the elbow. This article reviews imaging of common disease conditions occurring around the elbow in athletes, with an emphasis on MRI.     

Erkrankungen der Sehnenscheiden oder des Sehnengleitgewebes sowie der Sehnen- oder Muskelansätze (2101) und der Schleimbeutel (2105)

This overview characterizes the mechanically caused occupational diseases of tendon sheaths, paratenon, and tendon and muscle insertions and bursitis. The clinical picture in each, the causative damage and the guidelines for expert medical assessment are discussed.      

Sodium Tetradecyl Sulphate Sclerotherapy for Lateral Malleolar Bursitis of the Ankle

BackgroundThe aim of this study was to evaluate clinical outcomes of sodium tetradecyl sulphate (STS) sclerotherapy for conservative treatment of lateral malleolar bursitis of the ankle.MethodsWe reviewed data from 20 consecutive patients (20 ankles) who underwent STS sclerotherapy between August 2018 and June 2019. After aspiration of fluid from the lateral malleolar bursal sac, 2 mL (20 mg) STS was injected into the sac. Clinical outcomes and side effects and complications were evaluated at 2 weeks, 3 months, 1 year, and 2 years after sclerotherapy. Responses to treatment were assessed according to degree of fluctuation, shrinkage of the bursal sac, and soft-tissue swelling. The 36-item short form survey (SF-36) was completed for each patient before and after therapy.ResultsComplete response was observed in 17 patients (85%), and partial response was observed in 3 patients (15%) after STS sclerotherapy. SF-36 physical component scores improved from 62.2 (interquartile range, 5.2) before therapy to 70.0 (interquartile range, 7.9) at last follow-up (p < 0.05). One patient (5%) experienced transient hyperpigmentation at the injection site. No major complications occurred.ConclusionsSTS sclerotherapy was an effective and safe treatment for patients with lateral malleolar bursitis of the ankle.