[Bursitis intermetacarpophalangea calcarea (case report)]

A case of bursitis intermetacarpophalangea calcarea is presented which, after clinical and X-ray examination, raised problems regarding differential diagnosis. Because of the rarity of the findings, the anatomical localization as well as the surgical procedure is presented. Calcifications which may show in tendons and ligaments are discussed. In cases of acute calcareous infiltration in hands, surgery very rarely is indicated. By contrast, in cases of bursitis intermetacarpophalangea calcarea, surgery should be performed as soon as possible to preserve normal hand function.

Xeroradiography in the diagnosis of the Haglund syndrome

Xeroradiography is the radiographic method of choice for assessment of soft tissues and calcaneal detail in patients suffering from a painful swelling localized in the heel. The radiographic triad of retrocalcaneal bursitis, superficial tendo Achillis bursitis, and Achilles tendon thickening, in the presence of an intact posterior superior calcaneal margin, are readily evaluated with xeroradiography. The Haglund syndrome is a painful inflammation involving the two bursae which surround the Achilles tendon. It is associated with a prominent posterior superior calcaneal margin. Of the two objective measurements devised to assess this prominence, neither the posterior calcaneal angle of Philip and Fowler of greater than 75 degrees nor the parallel pitch line (PPL) has proved to be a reliable index. In the present study, we evaluated four patients with heel pain and swelling as well as 100 control patients. The findings suggest that the prominence of the posterior calcaneal angle should be assessed relative to the known normal range rather than by comparison to a single fixed angulation which is arbitrarily designated as being abnormal.

Use of contrast radiography in the investigation of tenosynovitis and bursitis in horses

Contrast radiography, using a 25 per cent solution of sodium diatrizoate, has been used for the investigation of tenosynovitis and bursitis in horses. The procedure was undertaken on a series of 32 clinical cases and on specimens obtained at autopsy. Lesions affecting the extensor tendon sheaths at the carpus, the digital sheath, the tarsal sheath and the bursae at the elbow, hock and fetlock were examined by this means. The results showed the procedure offered the clinician useful information about the nature of the interior of these structures, particularly as regards the presence of adhesions and anastomoses between adjacent sheaths and joint capsules. Together with other clinical and laboratory findings, contrast radiography can assist in assessing the prognosis and in formulating appropriate treatment.

Rheumatoid iliopsoas bursitis presenting as unilateral leg edema

A 66-year-old woman with rheumatoid arthritis presented with unilateral leg edema attributable to an enlarged iliopsoas bursa with presumed impedance of lymphatic drainage. The adjacent hip joint was not severely involved by arthritis. Ultrasonography and computed tomography were used to delineate the bursal mass and demonstrate communication with the joint space.

Meniscal lesions of the knee joint: CT diagnosis

Computed tomography (CT) resulted in a diagnostic accuracy of 89.2% and 96.1% for medial and lateral meniscal lesions, respectively, in 109 patients who underwent surgery after a direct CT study of the knee joint for a clinically suspected meniscal lesion. The meniscal lesions were the only pathologic condition found in 59 patients, while in 35 patients they were associated with various lesions of the cruciate ligaments (31 cases) and collateral ligaments (15 cases) and with cystic bursitis (6 cases). In the remaining 15 patients, the menisci were normal, but in eight of these cases, lesions of other knee joint structures were present. If meniscal lesions are clinically suspected, direct CT study of the knee joint may be considered the elective radiologic diagnostic method, rather than the more invasive arthrography. It may also be helpful in selecting patients for diagnostic and therapeutic arthroscopy.

Synovial cysts of the hip joint and iliopsoas bursitis: a spectrum of imaging abnormalities

Synovium-related soft tissue disease around the hip constitutes a spectrum ranging from isolated iliopsoas bursitis to pure articular synovial herniations without bursal involvement. The clinical, pathologic, and radiographic features of these entities are discussed as they pertain to the variety of underlying disorders which predispose to their occurrence. Nine case reports are utilized to illustrate the variable clinical and radiographic presentations which may be encountered. Based upon these cases as well as those in the literature, an imaging algorithm has been developed which should eliminate unnecessary studies and allow prompt and accurate diagnosis.

Rheumatoid bursitis extending into the clavicle and to the skin surface

A woman with rheumatoid arthritis developed persistent sterile drainage from a cutaneous fistula after biopsy of an inflamed supraclavicular mass. Radiographs showed several cavities in the underlying clavicle. Inability to culture a pathogen and failure of the fistula to heal despite empirical courses of antibiotic therapy led to surgical intervention. The final diagnosis, based on careful histological analysis by special staining techniques, was rheumatoid bursitis extending into the clavicle and to the skin surface.

Heel pain due to retrocalcaneal bursitis-radiographic diagnosis (with an historical footnote on Sever's disease)

Retrocalcaneal bursitis is a distinct condition causing posterior heel pain in active, healthy children. It appears to result from post-traumatic inflammation of the soft tissues of the posterior heel, and is unrelated to avascular necrosis of the calcaneal apophysis. The diagnosis may be confirmed radiographically by the loss of the lucent retrocalcaneal recess, with a normal Achilles tendon and superficial soft tissue contour, and intact cortex of the underlying os calcis.

Calcifying supracoracoid bursitis as a cause of chronic shoulder pain

A case of chronic shoulder pain is reported with marked limitation of both active and passive elevations and a normal range of motion of the glenohumeral joint. X-ray examination demonstrated cloudy calcification in the coracoclavicular region, presumably indicating calcifying supracoracoid bursitis.

The Haglund painful heel syndrome. Experimental investigation of cause and therapeutic implications

Haglund syndrome, a common cause of pain in the posterior heel, consists of a painful swelling of the local soft tissues (the so-called pump bump) and prominence of the calcaneal bursal projection. The condition is caused by compression of the distal Achilles tendon and surrounding soft tissue between the os calcis and the posterior shoe counter. Osseous plantar projections appear to be a critical etiologic factor in Haglund syndrome. With an experimental model, it has been demonstrated that osseous projections on the plantar surface of the calcaneus adversely influence the bone-soft tissue relation of the posterior heel. Shoe heel elevation has been shown to be clinically effective in alleviating symptoms. It is demonstrated with an experimental model that elevation of the shoe heel decreases the pitch angle. This diminishes the prominence of the bursal projection and allows the foot to slip forward, displacing the posterior calcaneus away from the shoe counter.

Ileopectineal bursitis following total hip replacement

Two cases of ileopectineal bursitis following total hip replacement are presented. Inflammation, infection and trauma are discussed as pathogenic factors. The results of fine needle biopsy, radiologic examination including CT and ultrasonography, as well as bacteriological cultures are described. The therapy was surgical in both cases.

Computed tomography of the knee joint: clinical results

Computed tomography (CT) was used to examine the knee joint in 175 patients with various pathological conditions. In 118 of these patients a unique technique of study was employed. This technique is based on thin slices, a high resolution reconstruction program, and routine multiplanar reconstructions, without intraarticular contrast medium administration. In 36 patients studied with this technique, surgery was performed, thus permitting verification of the CT patterns. We concluded that CT may identify lesions of menisci, cruciate and collateral ligaments, and other pathologic conditions with at least 90% accuracy.

Enthesopathic erosive lesions of patella and tibial tuberosity in juvenile ankylosing spondylitis. Anatomico-radiological study of a case with tibial bursitis

The authors report the case of a 20-year-old joiner suffering from ankylosing spondylitis, with recurrent knee effusions from the age of 11 and radiological evidence of sacro-iliac involvement. The patient presented with pain and bone erosions localized to the sites of tendinous attachments in the upper pole of the left patella and in tibial tuberosities. On both sides an inflammation of deep infrapatellar bursa was observed on anatomical examination. These destructive lesions are considered as rare forms of the erosive enthesopathy which has been described in ankylosing spondylitis, particularly on spine and calcaneum. They could be considered as highly localized forms of algodystrophy.

Adhesive capsulitis of the shoulder: arthrographic diagnosis and treatment

Thirty-one patients (33 shoulders) had clinical adhesive capsulitis confirmed by arthrography and simultaneously treated by intra-articular injection of lidocaine and long-acting corticosteroid introduced with the contrast material during the examination. The routine arthrographic procedure was modified to include gentle passive manipulation of the joint while under the effect of the local anesthetic agent. The patients were instructed to continue exercises at home. The clinical follow-up has averaged eight months. In 31 of the 33 shoulders (94%) excellent relief of symptoms and restoration of function were obtained. There are several advantages to this approach: (1) an accurate diagnosis is made, (2) accurate intra-articular injection of steroid is assured as opposed to blind clinical injections, which often deposit medication in the periarticular soft tissues, (3) the morbidity is much lower than with operative techniques involving general anesthesia, and (4) the therapeutic result has been far better than with the usual program of analgesics and physical therapy.

Arthrography of the shoulder

Arthrography of the shoulder is a simple, safe, and relatively painless diagnostic procedure that is used to demonstrate the integrity, shape, and capacity of the glenohumeral joint space.

Navicular disease in the horse. A microangiographic investigation

Microangiographical investigations of the navicular bone in horses with navicular disease show, compared to similar investigations of normal navicular bones, that, in general, the vascular pattern is preserved but the vessels are dilated with "pooling" of the contrast medium subchondrally under facies flexoria. Similar changes may be observed in cases of human arthrosis. The present investigation therefore supports the view that navicular disease is a disease which resembles arthrosis.

Olecranon bursitis related to calcium pyrophosphate dihydrate crystal deposition disease

A case of olecranon bursitis in an 81-year-old patient is presented. Analysis of the bursal fluid revealed positive birefringent crystals; radiographs showed calcifications in the distal triceps tendon. A bursectomy was performed. X-ray diffraction analyses demonstrated calcium pyrophosphate dihydrate patterns in a subcutaneous "tophus" and in a specimen of the tendon. On histologic examination, there was a bursitis with positive birefringent crystals on the bursa's inner surface; histologic images of "chondrocalcinosis" were observed in and around the tendon. It is concluded that bursitis may be part of the extraarticular manifestations of calcium pyrophosphate dihydrate crystal deposition disease.

The Haglund syndrome: initial and differential diagnosis

Haglund syndrome is a common cause of posterior heel pain, characterized clinically by a painful soft-tissue swelling at the level of the achilles tendon insertion. On the lateral heel radiograph the syndrome is characterized by a prominent calcaneal bursal projection, retrocalcaneal bursitis, thickening of the Achilles tendon, and a convexity of the superficial soft tissues at the level of the Achilles tendon insertion, a "pump-bump." An objective method for evaluating prominence of the bursal projection is measurement using the parallel pitch lines. This measurement helps to identify patients with Haglund syndrome and patients predisposed to develop this condition, and also to differentiate local causes of posterior heel pain from systemic causes. The parallel pitch line measurement was determined in 10 symptomatic feet and 78 control feet and the results were analyzed statistically.

Traumatic olecranon bursitis. Radiologic observations

The affected elbow of 28 patients with traumatic olecranon bursitis was radiographically compared with the homologous elbow of 28 matched controls. Olecranon spurs, amorphous calcium deposits, or both, were present in 16 patients and 4 controls (p less than 0.01). Air was injected in the bursa in 12 additional patients. Nodules in the bursal floor were noted in 10, and the bursa was partially septated in 8. Olecranon spurs, present in 6 patients, corresponded to the insertion of the triceps tendon. With elbow flexion the bursa flattened and lengthened while the olecranon process glided distally beneath the bursal floor.