小针刀配合臭氧治疗肩周炎58例

目的：探讨小针刀配合臭氧技术治疗肩周炎的有效方法.方法：对58例肩周炎患者应用小针刀配合臭氧综合 方法进行治疗.结果：治疗58例,痊愈52例,占89%,显效4例,占6%,有效2例,占3%,无效 0例.总有效率100%.结论：小 针刀配合臭氧技术治疗肩周炎效果显著.     

A multi-center,double-blind,randomized, placebo-controlled trial protocol to assess Traumeel injection vs dexamethasone injection in rotator cuff syndrome: the TRAumeel in ROtator cuff syndrome (TRARO) study protocol

Background

Shoulder pain is a common musculoskeletal symptom with a wide range of potential causes; however, the majority of conditions can be managed with conservative treatment. The aim of this study is to assess the efficacy and safety of Traumeel injections versus corticosteroid injections and placebo in the treatment of rotator cuff syndrome and bursitis and expand the current evidence base for the conservative treatment of rotator cuff syndrome.

Methods/Design

This is a multi-center, randomized, double-blind, 16-week, three-arm, parallel-group, active- and placebo-controlled trial to assess the efficacy and safety of Traumeel 2 ml injection versus dexamethasone 8 mg injection versus placebo (saline solution). Patients will be randomly allocated to Traumeel, dexamethasone or placebo in a 2:2:1 randomization. After 1 week screening, patients will receive 3 injections at weekly intervals (days 1, 8 and 15) with additional follow-up assessments on day 22, a telephone consultation in week 9 and a final visit at week 15. Male and female patients aged 40 to 65 years, inclusive, will be recruited if they have acute episodes of chronic rotator cuff syndrome and/or bursitis. Patients with calcifications in the shoulder joint or a complete rotator cuff tear will be excluded. At least 160 patients will be recruited. All subacromial injections will be performed under ultrasound guidance utilizing a common technique. The only rescue medication permitted will be paracetamol (acetaminophen), with usage recorded. The primary endpoint is change from baseline in abduction-rotation pain visual analog scale (0–100 mm scale, 0 corresponds to no pain and 100 to extreme pain) at day 22 (Traumeel injections versus dexamethasone injections) for active external rotation. Secondary efficacy parameters include range of motion, disability of arm, shoulder, hand score and patient’s/investigator’s global assessment. Clinical efficacy will be assessed as non-inferiority of Traumeel with respect to dexamethasone regarding the primary efficacy parameter.

Discussion

It is hoped that the results of this trial will expand the treatment options and evidence base available for the management of rotator cuff disease.

Trial registration

ClinicalTrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01702233","term_id":"NCT01702233"}}NCT01702233. EudraCT number: 2012-003393-12.     

Contemporary imaging of rheumatoid arthritis: Clinical role of ultrasound and MRI

Magnetic resonance imaging (MRI) and musculoskeletal ultrasound (MSUS) are sensitive imaging modalities used by clinicians to assist in decision-making in the management of rheumatoid arthritis (RA). This review will examine the utility of MRI and MSUS in diagnosing RA, predicting RA flares, tapering therapy, assessing remission, and examining difficult periarticular features. We will also outline the strengths and weaknesses of utilizing MRI and MSUS as outcome measures in the management of RA.     

Pre-patellar bursitis as a first presentation of gout

We describe the case of a patient who presented with an acute pre-patellar bursitis, which did not improve with antibiotics. Aspiration of the bursa when it became fluctuant revealed urate crystals. Diagnosis was a rare first manifestation of gout, the occurrence of which had not been reported previously in orthopaedic literature. We highlight the importance of aspiration in the management of bursitis and its importance when gout is suspected, especially in one in whom non-steroidal anti-inflammatory drugs (NSAIDs) has recently been stopped. It is important to appreciate that the presence of crystals does not exclude the presence of infection. Bursitis can be caused by gouty crystals, but an infective cause of bursitis can result in secondary gout. Uric acid levels are not useful for the management of the first presentation of gout. We propose a simple algorithm for the management of acute bursitis.No grants were received in the production of this report     

Whole-body fluorodeoxyglucose positron emission tomography/computed tomography in patients with active polymyalgia rheumatica: evidence for distinctive bursitis and large-vessel vasculitis

Abstract

Objectives To investigate fluorodeoxyglucose (FDG) accumulation in large joints, bursas, and large vessels in patients with polymyalgia rheumatica (PMR) using 18-FDG positron emission tomography/computed tomography (PET/CT) and to differentiate PMR from similar diseases.

Methods Fourteen untreated patients with active PMR and 17 control patients with rheumatoid arthritis (n = 11) or other active rheumatic diseases (n = 6) underwent 18-FDG PET/CT. FDG uptake in large joints, bursas and vertebral spinous processes was evaluated by calculating maximum standardised uptake values and by visual scoring (scale 0–4). PET scan images were scored in seven vascular regions, and total vascular scores (range 0–21) were calculated.

Results Polymyalgia rheumatica patients showed increased FDG uptake in ischial tuberosities, greater trochanters, and lumbar spinous processes. Positive results at two or more of these sites showed high sensitivity (85.7%) and specificity (88.2%) for the diagnosis of PMR, and shoulder or hip-joint involvement showed low disease specificity. High FDG accumulations were found in the aortas and subclavian arteries of two PMR patients who were asymptomatic for temporal arteritis and scanty synovium and perisynovium, based on FDG uptake. PET/CT images of the 12 PMR patients without apparent vascular involvement showed synovitis and/or perisynovitis.

Conclusions Fluorodeoxyglucose-PET/CT may be useful for the detection of PMR lesions, which are difficult to identify using other methods.     

The Snapping Scapula: Diagnosis and Treatment

As a largely under-recognized problem, snapping scapula stems from the disruption of normal mechanics in scapulothoracic articulation. It is especially common in the young, active patient population, and symptoms are frequently seen with overhead and throwing motions. Understanding the anatomy of the scapula and surrounding neurovascular structures is crucial in making a differential diagnosis and providing both nonoperative and surgical treatments. Common causes of snapping scapula include bursitis, muscle abnormality, and bony or soft-tissue abnormalities. Anatomic variations, such as excessive forward curvature of the superomedial border of the scapula, may also be a cause for snapping. Benign tumor conditions of the scapula can also predispose one to snapping scapula syndrome and should be thoroughly investigated during the course of treatment. Patients with snapping scapula syndrome typically present with a history of pain with overhead activities. Snapping scapula is associated with audible and palpable crepitus near the superomedial border of the scapula. Various imaging studies may be used to rule out soft-tissue and bony masses, which may cause impingement at the scapulothoracic articulation. In most cases nonoperative treatment is curative and includes physical therapy for scapular muscle strengthening and nonsteroidal anti-inflammatory medications. Corticosteroid injections may also be used for therapeutic and diagnostic purposes. In most cases overuse injuries and repetitive strains respond well to nonoperative treatments. When nonoperative measures fail, surgery is a proven modality, especially if a soft-tissue or bony mass is implicated. Both open and arthroscopic techniques have been described with predictable results.