Achilles Tendon Infection Due to Mycobacterium chelonae

Atypical tuberculous tenosynovitis of the foot and ankle is extremely rare. The determination of the Mycobacterium species is essential because resistance of atypical mycobacterial strains to antituberculous drugs is often encountered. We report a case of Mycobacterium chelonae paratendinous and intratendinous infection involving the Achilles tendon. Repeat aggressive irrigation and debridement procedures, coupled with removal of foreign materials and the appropriate use of prolonged antibiotic therapy, can result in a successful long-term outcome.     

Outcome of low level lasers versus ultrasonic therapy in de Quervain's tenosynovitis

Background:

de Quervain''s tenosynovitis is an inflammation of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) muscle tendon sheaths at the level of radial styloid process. Its conservative management includes nonsteroidal anti-inflammatory drugs, wrist and thumb immobilization, ultrasonic therapy (US Th.) and low level laser therapy (LLLT). Literature is scanty on comparative efficacy of US Th. and LLLT for its management. This prospective study evaluates outcome of US Th. versus LLLT in de Quervain''s disease.

Materials and Methods:

Thirty patients clinically diagnosed de Quervains tenosynovitis were included in the study and randomly assigned to two groups. The average age was 36 years (range: 21-45 years). One group was given LLLT and the other US Th. for a total of 7 exposures on alternate days. The clinical criteria used were Finkelstein''s test, tenderness over radial styloid (Ritchie''s tenderness scale), grip strength, pain (visual analog scale [VAS]) and radiological criteria was ultrasonographic assessment of change in thickness of APL and EPB tendon sheath. They were measured before commencement and at the end of seven sessions of therapy, as per standard procedure.

Results:

Significant improvement was seen within both groups in the following outcome measures assessed: Ritchie''s tenderness scale, grip strength and VAS. Finkelstein''s test was not significantly improved in either groups. Ultrasonographic measurement of tendon sheath diameters, the mediolateral (ML), and anteroposterior (AP) diameters was not found to be significantly different in the US Th. group and the laser therapy group after treatment. On comparing both the groups, no statistically significant difference was found. However, looking at the mean values, the grip strength and VAS showed better improvement in the US Th. group as compared to the laser therapy group.     

钩型小针刀治疗屈指肌腱狭窄性腱鞘炎200例临床观察

目的：观察钩型小针刀治疗屈指肌腱狭窄性腱鞘炎的疗效。方法将Ⅲ度及Ⅳ度的屈指肌腱狭窄性腱鞘炎患者200例,随机分为小针刀组和封闭组,进行治疗效果临床对比分析。结果经6~12个月随访,小针刀组优良率99.11%,封闭组优良率82.86%,两组经χ2检验,χ2=17.91,两组优良率比较差异有统计学意义（P〈0.01）。结论钩型小针刀疗法治疗狭窄性腱鞘炎,治疗简单,费用低,一般一次即可治愈,无毒副作用,符合中医的简、便、廉、验的特点,可作为首选方法,值得临床推广。     

超声引导下局部注射治疗类风湿性关节炎手腕部腱鞘炎

目的 探讨超声引导下局部注射治疗类风湿性关节炎（RA）手腕部腱鞘炎的临床效果。方法 对62例RA手腕部腱鞘炎患者分别给予超声引导下（超声引导组,n=37）及触诊引导下（触诊引导组,n=25）手腕部腱鞘注射复方倍他米松注射液和盐酸利多卡因注射液。对比分析2组治疗过程中不良反应发生率;比较2组治疗前及治疗后2、4及12周疼痛视觉模拟量表（VAS）、28关节疾病活动度（DAS28）、灰阶超声（GSUS）、能量多普勒超声（PDUS）评分及治疗有效率。结果 超声引导组治疗过程中不良反应发生率为2.70%（1/37）,触诊引导组为20.00%（5/25）,差异有统计学意义（P=0.03）。超声引导组治疗后4、12周VAS评分及DAS28评分均低于触诊引导组（P均<0.01）;治疗后2、4及12周PDUS评分均低于触诊引导组,治疗后12周GSUS评分低于触诊引导组（P均<0.01）;治疗后4、12周治疗有效率均高于触诊引导组（P均<0.05）。结论 超声引导下局部注射治疗RA手腕部腱鞘炎的疗效及安全性均较好。     

超声用于腱鞘滑车系统研究进展

腱鞘滑车系统位置表浅而结构精细,高频超声可用于检查相关病变,如诊断及治疗指屈肌腱狭窄性腱鞘炎、评估系统性疾病和系统性硬化症累及腱鞘滑车系统等。本文对腱鞘滑车系统超声表现及相关研究进展进行综述。     

Low risk of thromboembolic complications after fast-track hip and knee arthroplasty

Background and purpose Pharmacological prophylaxis can reduce the risk of deep venous thrombosis (DVT), pulmonary embolism (PE), and death, and it is recommended 10–35 days after total hip arthroplasty (THA) and at least 10 days after total knee arthroplasty (TKA). However, early mobilization might also reduce the risk of DVT and thereby the need for prolonged prophylaxis, but this has not been considered in the previous literature. Here we report our results with short-duration pharmacological prophylaxis combined with early mobilization and reduced hospitalization.

Patients and methods 1,977 consecutive, unselected patients were operated with primary THA, TKA, or bilateral simultaneous TKA (BSTKA) in a well-described standardized fast-track set-up from 2004–2008. Patients received DVT prophylaxis with low-molecular-weight heparin starting 6–8 h after surgery until discharge. All re-admissions and deaths within 30 and 90 days were analyzed using the national health register, concentrating especially on clinical DVT (confirmed by ultrasound and elevated D-dimer), PE, or sudden death. Numbers were correlated to days of prophylaxis (LOS).

Results The mean LOS decreased from 7.3 days in 2004 to 3.1 days in 2008. 3 deaths (0.15%) were associated with clotting episodes and overall, 11 clinical DVTs (0.56%) and 6 PEs (0.30%) were found. The vast majority of events took place within 30 days; only 1 death and 2 DVTs occurred between 30 and 90 days. During the last 2 years (854 patients), when patients were mobilized within 4 h postoperatively and the duration of DVT prophylaxis was shortest (1–4 days), the mortality was 0% (95% CI: 0–0.5). Incident cases of DVT in TKA was 0.60% (CI: 0.2–2.2), in THA it was 0.51% (CI: 0.1–1.8), and in BSTKA it was 0% (CI: 0–2.9). Incident cases of PE in TKA was 0.30% (CI: 0.1–1.7), in THA it was 0% (CI: 0–1.0), and in BSTKA it was 0% (CI: 0–2.9).

Interpretation The risk of clinical DVT, and of fatal and non-fatal PE after THA and TKA following a fast-track set-up with early mobilization, short hospitalization, and short duration of DVT prophylaxis compares favorably with published regimens with extended prophylaxis (up to 36 days) and hospitalization up to 11 days. This calls for a reconsideration of optimal duration of chemical thromboprophylaxis.     

A Comparison of Physical Examinations with Musculoskeletal Ultrasound in the Diagnosis of Biceps Long Head Tendinitis

Provocative tests are useful in diagnosing biceps tendon tendinitis. This is the first study to establish the reliability of these tests by comparing the resuts with musculoskeletal ultrasound (US) findings. This study examined 125 patients (69 women and 56 men) and 143 shoulders with shoulder pain. Yergason’s test, Speed’s test and a bicipital groove tenderness test were performed and musculoskeletal US findings were used as standard reference. Biceps tendon tendinitis was diagnosed with US in 39.1% of the patients and, of those, 55.3% had coexisting rotator cuff injury. The sensitivity and specificity of Yergason’s test were 32% and 78%, respectively. The sensitivity and specificity of Speed’s test were 63% and 58%, respectively. In conclusion, all three tests are limited by poor sensitivity. US can be an image modality choice in diagnosing biceps pathology.