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Tiburzi V, Ciccullo C, Farinelli L, Di Carlo M, Salaffi F, Bandinelli F, Gigante AP. Unveiling the Hidden Links: Anatomical and Radiological Insights into Primary Hip Osteoarthritis. J Pers Med 2024; 14:1004. [PMID: 39338259 PMCID: PMC11433222 DOI: 10.3390/jpm14091004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Hip osteoarthritis (HOA) is a disease with globally rising incidence that leads to disability and morbidity, overall, in older populations, and might be primary or secondary to numerous risk factors. The most common idiopathic HOA is generally a diagnosis of exclusion, with pathogenetic mechanisms largely still misunderstood. We aimed to investigate the correlation between femoral-acetabular and spinopelvic anatomical and computed tomography (CT) characteristics, and the presence of primary OA. METHODS We retrospectively analyzed CT scans from 2019 to 2021, excluding patients under 45 years or with conditions affecting the pelvis, sacrum, or lower limbs. Femoral, acetabular, and spinopelvic parameters were measured; signs of OA were analyzed in the hip and knee joints. Patients were categorized into two groups: A (isolated hip OA) and B (no OA); patients with hip OA, also presenting knee OA, were excluded from this study. RESULTS In total, 232 cases were examined; statistical analyses compared CT parameters between 129 subjects from Group A and 103 patients of Group B. Group A showed a mean femoral version of 16 ± 4.53 degrees, significantly higher than Group B's 13.16 ± 4.37 degrees (p = 0.0001). Other parameters showed no significant differences. CONCLUSION This study highlights an association between femoral version and primary hip OA.
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Affiliation(s)
- Valerio Tiburzi
- Clinical Ortopaedics, Department of Clinical and Molecular Sciences, Politecnica University of Marche, 60126 Ancona, Italy (L.F.); (A.P.G.)
| | - Carlo Ciccullo
- Clinical Ortopaedics, Department of Clinical and Molecular Sciences, Politecnica University of Marche, 60126 Ancona, Italy (L.F.); (A.P.G.)
| | - Luca Farinelli
- Clinical Ortopaedics, Department of Clinical and Molecular Sciences, Politecnica University of Marche, 60126 Ancona, Italy (L.F.); (A.P.G.)
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Politecnica University of Marche, Ospedale “Carlo Urbani”—AST Ancona, 60035 Jesi, Italy; (M.D.C.); (F.S.)
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Politecnica University of Marche, Ospedale “Carlo Urbani”—AST Ancona, 60035 Jesi, Italy; (M.D.C.); (F.S.)
| | - Francesca Bandinelli
- Department, Santa Maria Nuova Hospital, Usl Tuscany Center, 50122 Florence, Italy;
| | - Antonio Pompilio Gigante
- Clinical Ortopaedics, Department of Clinical and Molecular Sciences, Politecnica University of Marche, 60126 Ancona, Italy (L.F.); (A.P.G.)
- IRCCS INRCA, 60126 Ancona, Italy
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Liu B, Xu HY, Zhang R, Han L, Li Y, Sun XF. An Update on Clinical Utility of Musculoskeletal Ultrasonography in Knee Osteoarthritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1413-1422. [PMID: 36715025 DOI: 10.1002/jum.16176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/27/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
In knee osteoarthritis (KOA), timely and accurate assessment of the severity is essential to help orthopedic surgeons determine the most appropriate therapeutic strategies and evaluate disease outcomes and responses for corresponding treatments. In KOA, musculoskeletal ultrasonography (MSUS) could effectively help detect various abnormalities, including synovitis, osteophytes, and cartilage damage. Further, MSUS could be used to monitor the response to different therapies in KOA, to guide local diagnostic and therapeutic procedures. In the future, applications based on continuously evolving US tools could enhance the clinical utility of MSUS in KOA.
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Affiliation(s)
- Bo Liu
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hui-Ying Xu
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Rui Zhang
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lu Han
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Li
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiao-Feng Sun
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
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Imaging-Guided Musculoskeletal Interventions in the Lower Limb. Radiol Clin North Am 2023; 61:393-404. [PMID: 36739153 DOI: 10.1016/j.rcl.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Imaging guidance is essential for musculoskeletal interventional procedures performed in the lower limb. A strong evidence supports the use of imaging guidance to improve safety, accuracy, and effectiveness of these interventions. Joints, tendons, bursae, and nerves can be effectively approached especially with ultrasound-guided injections. Here, we discuss evidence and technique of the most common image-guided musculoskeletal interventional procedures in the lower limb.
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Nanduri A, Stead TS, Kupsaw GE, DeLeon J, Ganti L. Baker's Cyst. Cureus 2021; 13:e20403. [PMID: 35036229 PMCID: PMC8754354 DOI: 10.7759/cureus.20403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/05/2022] Open
Abstract
The authors present a case of a Baker's cyst in the right leg of an 86-year-old woman, whose presentation was more typical for a deep venous thrombosis. Both conditions have inflammation and acute calf pain. The clinical manifestations, imaging findings, and treatment of this common emergency department presentation are discussed.
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Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part V, knee. Eur Radiol 2021; 32:1438-1447. [PMID: 34523008 PMCID: PMC8831279 DOI: 10.1007/s00330-021-08258-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/26/2021] [Accepted: 08/07/2021] [Indexed: 12/16/2022]
Abstract
Objectives Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. Methods We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. Results A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. Conclusions Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. Key Points • A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. • Strong consensus with 100% agreement was obtained for all statements. • Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08258-1.
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Fredericksen K, Kiel J. Bedside ultrasound-guided aspiration and corticosteroid injection of a baker's cyst in a patient with osteoarthritis and recurrent knee pain. J Am Coll Emerg Physicians Open 2021; 2:e12424. [PMID: 33969342 PMCID: PMC8082707 DOI: 10.1002/emp2.12424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/28/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
Baker's cyst accompanying knee osteoarthritis represents a common cause of knee pain presenting to the emergency department. In this case report, a 56-year-old male presented with atraumatic left knee pain and swelling. Radiographically, he had tricompartmental osteoarthritis and was found to have a baker's cyst on duplex ultrasound. Using point-of-care ultrasound, the cyst was aspirated and corticosteroids were injected. The patient tolerated the procedure well and was discharged with a compression wrap and orthopedic follow-up. Baker's cyst aspiration with corticosteroid injection represents a safe alternative treatment option for patients. In some cases, this treatment may be definitive. Orthopedists currently use this procedure to reduce pain and improve function for patients with chronic knee ailments related to baker's cysts. As demonstrated in this case report, implementing this bedside procedure in the emergency department with orthopedic follow-up expands non-surgical, non-narcotic treatment options for patients with chronic knee pain secondary to Baker's cysts with osteoarthritis.
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Affiliation(s)
- Kim Fredericksen
- Department of Emergency MedicineUniversity of Florida‐Jacksonville College of MedicineJacksonvilleFloridaUSA
| | - John Kiel
- Department of Emergency MedicineUniversity of Florida‐Jacksonville College of MedicineJacksonvilleFloridaUSA
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Van Nest DS, Tjoumakaris FP, Smith BJ, Beatty TM, Freedman KB. Popliteal Cysts: A Systematic Review of Nonoperative and Operative Treatment. JBJS Rev 2021; 8:e0139. [PMID: 32149934 DOI: 10.2106/jbjs.rvw.19.00139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Treatment methods for popliteal cysts have varied over the past several decades and have posed challenges to providers as recurrences were frequent. With greater understanding of relevant anatomy, both operative and nonoperative treatment methods have evolved to appropriately target relevant pathology and improve outcomes. The purposes of this review were to outline the evolution of treatment methods and to qualitatively summarize clinical outcomes. METHODS We performed a systematic review on treatments for popliteal cysts to include publications from 1970 to 2019. Other inclusion criteria consisted of studies with ≥10 patients enrolled, studies with a patient age of ≥16 years, studies with an adequate description of the treatment technique, and studies with a Level of Evidence of IV or higher. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and literature quality was assessed using a modified Coleman methodology score. RESULTS Thirty studies met inclusion criteria in this review. Nine studies discussed nonoperative treatment, and 21 studies discussed operative treatment. Eight of the 9 nonoperative treatment studies utilized corticosteroid injections. The most recent studies have advocated for ultrasound-guided intracystic injection with possible cyst fenestration. Most operative studies utilized an arthroscopic approach to enlarge the communication with the joint space. However, alternative treatment techniques are still utilized. CONCLUSIONS The current literature on the treatment of popliteal cysts indicates that intracystic corticosteroid injection with cyst fenestration is an effective nonoperative treatment method. Arthroscopic surgical procedures with enlargement of the communication have been most widely studied, with positive results; however, further studies are needed to confirm superiority over other treatment methods. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Duncan S Van Nest
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fotios P Tjoumakaris
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bradley J Smith
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tricia M Beatty
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kevin B Freedman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Mortada M, Amer YA, Zaghlol RS. Efficacy and Safety of Musculoskeletal Ultrasound Guided Aspiration and Intra-Lesional Corticosteroids Injection of Ruptured Baker's Cyst: A Retrospective Observational Study. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2020; 13:1179544120967383. [PMID: 33223862 PMCID: PMC7658507 DOI: 10.1177/1179544120967383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
Objective: The aim of the work was to demonstrate the effectiveness and safety of ultrasonographic guided aspiration performed with corticosteroid injection intra-lesional for ruptured Baker cysts (BCs). Methods: Single-center retrospective study that included 42 patients with knee joint disorder associated with ruptured BCs were treated by ultrasonographic guided aspiration of fluid from the cyst and different points from the calf then intra-lesional injection of corticosteroids once or twice, 1 week apart. Follow up were done weekly until complete resolution of symptoms. Visual analog scale (VAS) and Rauschning-Lindgren and Lysholm Knee Scoring Scales (RLC) were used for assessment. Results: Clinical parameters (VAS and RLC) improved significantly in all patients at both post injection evaluation visits (1 week and 12 weeks). Ultrasonographic features improved significantly with complete disappearance of free fluid in the calf in 35 (83.3%) cases 1 week after the injection, and in 41 (97.6%) after 12 weeks. As regards BCs only 4 (9.5%) cases showed complete disappearance after 1 week and there was recurrent BCs in 38 (90.5%) cases which required reaspiration. While after 12 weeks, BCs were completely disappeared in 23 (54.8%) cases, most of the relapsed BCs were complex BCs. No side effects were reported in all cases. Conclusion: Ultrasonographic guided aspiration followed by injection of corticosteroids intra-lesional is an efficient and safe method for managing ruptured BCs.
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Affiliation(s)
- Mohamed Mortada
- Rheumatology and Rehabilitation Department, Zagazig University, Zagazig, Egypt
| | - Yomna A Amer
- Rheumatology and Rehabilitation Department, Zagazig University, Zagazig, Egypt
| | - Rabab S Zaghlol
- Rheumatology and Rehabilitation Department, Zagazig University, Zagazig, Egypt.,Physical Medicine and Rehabilitation Department, Security Forces Hospital, Makkah, Saudi Arabia
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Song B, Yeh PC, Jayaram P. Leukocyte-rich platelet-rich plasma application in post-traumatic osteoarthritis with popliteal cyst: a case report. Regen Med 2020; 15:1695-1702. [PMID: 32772820 DOI: 10.2217/rme-2020-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To describe the successful treatment of a Baker's cyst in the setting of post-traumatic osteoarthritis using ultrasound-guided injection of platelet-rich plasma. Setting: Outpatient sports clinic. Patient: 29-year old male basketball player. Case description: The patient presented with 2-months history of right knee pain, 17 months after undergoing right knee anterior cruciate ligament reconstruction surgery. Exam revealed medial joint line and medial collateral ligament tenderness with posterior knee swelling. After aspiration, a corticosteroid injection was administered with temporary symptom relief. Diagnostic ultrasound examination confirmed the Baker's cyst. The patient then underwent two serial leukocyte-rich platelet-rich plasma injections into his right knee. Results: The patient reported complete resolution of pain and cyst size. Conclusion: Leukocyte-rich platelet-rich plasma may be considered as a treatment option for patients with Baker's cysts in the setting of post-traumatic osteoarthritis.
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Affiliation(s)
- Bo Song
- H Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Peter Chia Yeh
- H Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Prathap Jayaram
- H Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
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Hautmann MG, Jung EM, Beyer LP, Süß C, Steger F, Weber M, Pohl F, Kölbl O, Putz FJ. Is low dose radiotherapy an effective treatment for Baker’s cyst? Strahlenther Onkol 2018; 195:69-76. [DOI: 10.1007/s00066-018-1389-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 10/17/2018] [Indexed: 01/10/2023]
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Hubbard MJ, Hildebrand BA, Battafarano MM, Battafarano DF. Common Soft Tissue Musculoskeletal Pain Disorders. Prim Care 2018; 45:289-303. [DOI: 10.1016/j.pop.2018.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sakellariou G, Conaghan PG, Zhang W, Bijlsma JWJ, Boyesen P, D'Agostino MA, Doherty M, Fodor D, Kloppenburg M, Miese F, Naredo E, Porcheret M, Iagnocco A. EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis 2017; 76:1484-1494. [DOI: 10.1136/annrheumdis-2016-210815] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/25/2017] [Accepted: 03/05/2017] [Indexed: 11/04/2022]
Abstract
The increased information provided by modern imaging has led to its more extensive use. Our aim was to develop evidence-based recommendations for the use of imaging in the clinical management of the most common arthropathy, osteoarthritis (OA). A task force (including rheumatologists, radiologists, methodologists, primary care doctors and patients) from nine countries defined 10 questions on the role of imaging in OA to support a systematic literature review (SLR). Joints of interest were the knee, hip, hand and foot; imaging modalities included conventional radiography (CR), MRI, ultrasonography, CT and nuclear medicine. PubMed and EMBASE were searched. The evidence was presented to the task force who subsequently developed the recommendations. The strength of agreement for each recommendation was assessed. 17 011 references were identified from which 390 studies were included in the SLR. Seven recommendations were produced, covering the lack of need for diagnostic imaging in patients with typical symptoms; the role of imaging in differential diagnosis; the lack of benefit in monitoring when no therapeutic modification is related, though consideration is required when unexpected clinical deterioration occurs; CR as the first-choice imaging modality; consideration of how to correctly acquire images and the role of imaging in guiding local injections. Recommendations for future research were also developed based on gaps in evidence, such as the use of imaging in identifying therapeutic targets, and demonstrating the added value of imaging. These evidence-based recommendations and related research agenda provide the basis for sensible use of imaging in routine clinical assessment of people with OA.
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Hommel H, Perka C, Kopf S. The fate of Baker's cyst after total knee arthroplasty. Bone Joint J 2017; 98-B:1185-8. [PMID: 27587518 DOI: 10.1302/0301-620x.98b9.37748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/18/2016] [Indexed: 11/05/2022]
Abstract
AIMS It is widely held that most Baker's cysts resolve after treatment of the intra-articular knee pathology. The present study aimed to evaluate the fate of Baker's cysts and their associated symptoms after total knee arthroplasty (TKA). PATIENTS AND METHODS In this prospective cohort study, 102 patients with (105 were included, however three were lost to follow-up) an MRI-verified Baker's cyst, primary osteoarthritis and scheduled for TKA were included. Ultrasound was performed to evaluate the existence and the gross size of the cyst before and at one year after TKA. Additionally, associated symptoms of Baker's cyst were recorded pre- and post-operatively. RESULTS After one year, a Baker's cyst was still present in 87 patients (85%). There was a significant reduction in associated symptoms arising from the Baker's cyst before (71%) to after surgery (31%). No patients developed a new Baker's cyst associated symptoms. However, of the 72 patients who had reported Baker's cyst associated symptoms pre-operatively, 32 patients (44%) still complained of such symptoms one year after surgery. CONCLUSION Baker's cysts had resolved in only a small number of patients (15%) one year after TKA and symptoms from the cysts persisted in 31%. Cite this article: Bone Joint J 2016;98-B:1185-8.
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Affiliation(s)
- H Hommel
- Hospital Märkisch Oderland, Sonnenburger Weg 3, 16269 Wriezen, Germany
| | - C Perka
- Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - S Kopf
- Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Giant Baker's Cyst Associated with Rheumatoid Arthritis. Case Rep Orthop 2017; 2017:4293104. [PMID: 28116197 PMCID: PMC5237725 DOI: 10.1155/2017/4293104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/10/2016] [Accepted: 12/18/2016] [Indexed: 11/17/2022] Open
Abstract
We report a rare case of a "giant Baker's cyst-related rheumatoid arthritis (RA)" with 95 × 26 mm dimensions originating from the semimembranosus tendon. The patient presented with chronic pain and a palpable mass behind his left calf located between the posteriosuperior aspect of the popliteal fossa and the distal third of the calf. In MRI cystic lesion which was located in soft tissue at the posterior of gastrocnemius, extensive synovial pannus inside and degeneration of medial meniscus posterior horn were observed. Arthroscopic joint debridement and partial excision of the cyst via biomechanical valve excision were performed. The patient continued his follow-up visits at Rheumatology Department and there was no recurrence of cyst-related symptoms in 1-year follow-up. Similar cases were reported in the literature previously. However, as far as we know, a giant Baker's cyst-related RA, which was treated as described, has not yet been presented.
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Musculoskeletal interventional procedures: With or without imaging guidance? Best Pract Res Clin Rheumatol 2016; 30:736-750. [PMID: 27931965 DOI: 10.1016/j.berh.2016.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 11/22/2022]
Abstract
Aspiration and injection of joints and soft tissues is an indispensable skill used in everyday practice by the clinical rheumatologist. Most rheumatologists recognise that performing these procedures using anatomical landmarks is not always successful, particularly in the case of small or infrequently injected joints, bursae or tendon sheaths. Musculoskeletal ultrasound confirms the local pathological-anatomical diagnosis and is the most applicable and feasible imaging method that can be applied in clinical practice in guiding musculoskeletal interventional procedures. From 1993, there has been substantial examination of the accuracy of landmark- and imaging-guided procedures. We have searched the literature and ascertained whether imaging techniques improve the accuracy of musculoskeletal procedures and whether the accuracy of needle placement can be translated into improved clinical outcome (efficacy).
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Saylik M, Gökkuş K. Treatment of baker cyst, by using open posterior cystectomy and supine arthroscopy on recalcitrant cases (103 knees). BMC Musculoskelet Disord 2016; 17:435. [PMID: 27756267 PMCID: PMC5069796 DOI: 10.1186/s12891-016-1291-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022] Open
Abstract
Background Associated joint disorders with popliteal cysts were stated approximately between the ranges of 41–83 % in all reported cases. Combined treatment strategies that eliminate intra-articular pathologies and cyst- associated valve mechanisms are thought to be a good option in treatment of the disease. In this study, our main objective is to present clinical results of our combined treatment results, which includes posterior cyst excision with supine arthroscopic intervention, targeting intra-articular pathologies on recalcitrant cases. Methods One hundred three knees of 100 patients treated with posterior open cystectomy with valve and repair of posterior capsule, in addition to arthroscopic treatment of intra-articular lesions, were included in the study. Preoperative magnetic resonance imaging (MRI) studies were performed in order to evaluate location of Baker cysts behind the knee. Rauschning-Lindgren and Lysholm Knee Scoring Scales were used to assess pre/post-operative knee functions. Mann-Whitney U test was used to evaluate the differences between genders in comparison of Lysholm and Lindgren scores. Mean age within gender groups was compared using independent samples t-test. Wilcoxon test was used to compare the change in Lysholm and Lindgren scores. A p-value of less than 0.05 was considered to show a statistically significant result. Over the 1-year follow-up period, US and MR imaging was performed only with symptomatic patients. Results Cyst recurrence was seen only in 2 (1.94 %) patients. Post-operative Lysholm Knee and Lindgren knee scores demonstrated improvement in knee function and general comfort level of the patients. Conclusions Our midterm follow-up (Mean: 39 Months) results showed that open cyst excision with valve and capsule repair with knee arthroscopy that targets associated intra-articular pathologies reduced the pain and improved the knee function in those patients. Level of evidence IV (Retrospective clinical study without comparison group).
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Affiliation(s)
- M Saylik
- Orthopedics and Trauma Department, Attending orthopedic Surgeon, Bursa Medikal Park Hospital, Hasim Iscan Caddesi Fomara Meydanı No: 1 Osmangazi Bursa, Bursa, Turkey
| | - K Gökkuş
- Orthopedics and Trauma Department, Attending orthopedic Surgeon, Memorial Antalya Hospital, Zafer Mah. Yildirim Beyazit Cad. Number: 91 Kepez, Antalya, Turkey.
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Visser AW, Mertens B, Reijnierse M, Bloem JL, de Mutsert R, le Cessie S, Rosendaal FR, Kloppenburg M. Bakers' cyst and tibiofemoral abnormalities are more distinctive MRI features of symptomatic osteoarthritis than patellofemoral abnormalities. RMD Open 2016; 2:e000234. [PMID: 27252896 PMCID: PMC4879339 DOI: 10.1136/rmdopen-2015-000234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate which structural MR abnormalities discriminate symptomatic knee osteoarthritis (OA), taking co-occurrence of abnormalities in all compartments into account. METHODS The Netherlands Epidemiology of Obesity (NEO) study is a population-based cohort aged 45-65 years. In 1285 participants (median age 56 years, 55% women, median body mass index (BMI) 30 kg/m(2)), MRI of the right knee were obtained. Structural abnormalities (osteophytes, cartilage loss, bone marrow lesions (BMLs), subchondral cysts, meniscal abnormalities, effusion, Baker's cyst) at 9 patellofemoral and tibiofemoral locations were scored following the knee OA scoring system. Symptomatic OA in the imaged knee was defined following the American College of Rheumatology criteria. Logistic ridge regression analyses were used to investigate which structural abnormalities discriminate best between individuals with and without symptomatic OA, crude and adjusted for age, sex and BMI. RESULTS Symptomatic knee OA was present in 177 individuals. Structural MR abnormalities were highly frequent both in individuals with OA and in those without. Baker's cysts showed the highest adjusted regression coefficient (0.293) for presence of symptomatic OA, followed by osteophytes and BMLs in the medial tibiofemoral compartment (0.185-0.279), osteophytes in the medial trochlear facet (0.262) and effusion (0.197). CONCLUSIONS Baker's cysts discriminate best between individuals with and without symptomatic knee OA. Structural MR abnormalities, especially in the medial side of the tibiofemoral joint and effusion, add further in discriminating symptomatic OA. Baker's cysts may present as a target for treatment.
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Affiliation(s)
- A W Visser
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Mertens
- Department of Medical Statistics and Bio-informatics,Leiden University Medical Center, Leiden, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology,Leiden University Medical Center, Leiden, The Netherlands
| | - S le Cessie
- Department of Medical Statistics and Bio-informatics,Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology,Leiden University Medical Center, Leiden, The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology,Leiden University Medical Center, Leiden, The Netherlands
- Department of Thrombosis and Homeostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology,Leiden University Medical Center, Leiden, The Netherlands
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Yavuz F, Kibar S, Balaban B. Hypertonic Dextrose Injection for The Treatment of a Baker's Cyst. J Clin Diagn Res 2016; 10:YD01-2. [PMID: 27042572 DOI: 10.7860/jcdr/2016/17919.7290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/04/2016] [Indexed: 11/24/2022]
Abstract
We present extremely rare and interesting case of a Baker's cyst treated with hypertonic dextrose injection. A 54-year-old female patient had a Baker's cyst which was diagnosed by an ultrasonography. After the failure of the two-weekly conservative treatment, we injected hypertonic dextrose (25%) into her right knee joint for the treatment of a Baker's cyst. Two weeks after the injection, the patient reported improvement in posterior knee pain, and an US showed a resolution of the posterior knee cyst. Certainly hypertonic dextrose injection for the treatment of a Baker's cyst appears to be a reasonable treatment option. Further studies are needed in order to elucidate the efficacy of hypertonic dextrose injection in the treatment of Baker's cysts.
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Affiliation(s)
- Ferdi Yavuz
- The Clinic of Physical Therapy and Rehabilitation, The Fizyocare Medical Center , Ankara-Turkey
| | - Sibel Kibar
- The Clinic of Physical Therapy and Rehabilitation, The Fizyocare Medical Center , Ankara-Turkey
| | - Birol Balaban
- Professor, Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, European University of Lefke, Lefke-Mersin, Turkey; The Clinic of Physical Therapy and Rehabilitation, The Fizyocare Medical Center , Ankara-Turkey
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Calvisi V, Zoccali C. Arthroscopic patterns of the poster-medial aspect of the knee joint: classification of the gastrocnemius-semimembranosus gateway and its relationship with Baker's cyst. Muscles Ligaments Tendons J 2016; 6:492-498. [PMID: 28217572 DOI: 10.11138/mltj/2016.6.4.492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The gastrocnemius-semimembranosus bursa may communicate with the knee joint. The arthroscopic anatomy of the posteromedial aspect varies depending on the angle of the oblique popliteal ligament, the level at which it crosses the medial gastrocnemius tendon, and its relationship with the capsular joint and synovia. The aim of this paper is to identify possible patterns, and to evaluate their characteristics and their relationship with Baker's cyst. METHODS data archived from 185 consecutive arthroscopies were evaluated; an anatomic description and classification was carried out; the percentages of association with BC and the associated pathologies were reported. RESULTS The different anatomies were classified into six groups based on the relationship above the medial gastrocnemius tendon, the capsular joint and synovia. The prevalence of Baker's cyst was 28.3%. The main associated intra-articular pathological condition was the contemporary presence of a meniscal tear and chondropathy. CONCLUSION Exploration of the posterior aspect of the knee must be performed routinely. Knowing the possible anatomy patterns of the posteromedial arthroscopic aspect of the knee joint could help to identify the cyst and its gateway, thus facilitating its treatment. LEVEL OF THE EVIDENCE III.
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Affiliation(s)
- Vittorio Calvisi
- Department of Orthopaedic and Traumatology School, University of L'Aquila, Italy
| | - Carmine Zoccali
- Regina Elena National Cancer Institute, Oncological Orthopedic Department, Rome, Italy
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McAuliffe MB, Derrington SM, Nazarian LN. Evidence for Accuracy and Effectiveness of Musculoskeletal Ultrasound-Guided Compared with Landmark-Guided Procedures. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0103-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, Smith J. American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. PM R 2015; 7:151-68.e12. [PMID: 25708351 DOI: 10.1016/j.pmrj.2015.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 12/23/2022]
Abstract
The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based upon the evidence, the official AMSSM position relevant to each subject is made.
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Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, University of California, Davis School of Medicine, Sacramento, CA; Tahoe Orthopedics and Sports Medicine, 1139 Third St, South Lake Tahoe, CA 96150.(∗); Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, IA(†).
| | - Mederic M Hall
- Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, IA(†)
| | - Erik Adams
- Midwest Sports Medicine Institute, Middleton, WI(‡)
| | - David Berkoff
- Department of Orthopaedics and Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC(§)
| | - Andrew L Concoff
- Outpatient Musculoskeletal Rehabilitation, St Jude Medical Center, Fullerton, CA(¶)
| | - William Dexter
- Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA(#)
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, MN; Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN(∗∗)
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22
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Smith MK, Lesniak B, Baraga MG, Kaplan L, Jose J. Treatment of Popliteal (Baker) Cysts With Ultrasound-Guided Aspiration, Fenestration, and Injection: Long-term Follow-up. Sports Health 2015; 7:409-14. [PMID: 26502415 PMCID: PMC4547114 DOI: 10.1177/1941738115585520] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The purpose of this study was to determine the efficacy of ultrasound-guided aspiration, fenestration, and injection as a treatment in patients with symptomatic popliteal cysts. Hypothesis: Ultrasound-guided aspiration, fenestration, and injection (UGAFI) is an effective and safe treatment option for symptomatic popliteal cysts. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: Patients who received a UGAFI of popliteal cysts from 2008 to 2011 were identified. Preaspiration (PA) and follow-up Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, cyst recurrence, complications, cyst complexity, and size were obtained and compared for statistical significance. UGAFI involved aspiration of fluid through a spinal needle, fenestration of the cyst walls and septations, and injection of 1 mL (40 mg) triamcinolone (Kenalog) and 2 mL 0.5% bupivacaine (Sensorcaine) into the decompressed remnant. Results: The mean PA WOMAC score (48.55) improved significantly at final follow-up (FFU) to 17.15 (P < 0.0001) for 47 patients. Within the WOMAC subcategories, there was also a significant difference in pain (PA, 10.68; FFU, 3.94; P < 0.0001), stiffness (PA, 4.51; FFU, 1.77; P < 0.0001), and physical function (PA, 31.34; FFU, 12.17; P < 0.0001). There were 6 reaspirations for recurrence (12.7%), and 1 patient underwent unicompartmental knee arthroplasty. There were no infections or other complications. Conclusion: Significant clinical improvement in patients with symptomatic popliteal cysts can be achieved via UGAFI as the sole treatment. Clinical Relevance: UGAFI is a safe and effective option as the sole treatment modality for symptomatic popliteal cysts.
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Affiliation(s)
- Marvin K Smith
- UHealth Sports Performance and Wellness Institute, Miami, Florida
| | - Bryson Lesniak
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael G Baraga
- UHealth Sports Performance and Wellness Institute, Miami, Florida
| | - Lee Kaplan
- UHealth Sports Performance and Wellness Institute, Miami, Florida
| | - Jean Jose
- UHealth Sports Performance and Wellness Institute, Miami, Florida
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23
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American Medical Society for Sports Medicine position statement: interventional musculoskeletal ultrasound in sports medicine. Clin J Sport Med 2015; 25:6-22. [PMID: 25536481 DOI: 10.1097/jsm.0000000000000175] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based on the evidence, the official AMSSM position relevant to each subject is made.
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Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, Smith J. American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine. Br J Sports Med 2014; 49:145-50. [PMID: 25330777 DOI: 10.1136/bjsports-2014-094219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilisation is by non-radiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases and hydrodissections. OBJECTIVE Critically review the literature related to the accuracy, efficacy and cost-effectiveness of ultrasound-guided injections (USGIs) in major, intermediate and small joints; and soft tissues. DESIGN Systematic review of the literature. RESULTS USGIs are more accurate than landmark-guided injections (LMGIs; strength of recommendation taxonomy (SORT) Evidence Rating=A). USGIs are more efficacious than LMGIs (SORT Evidence Rating=B). USGIs are more cost-effective than LMGIs (SORT Evidence Rating=B). Ultrasound guidance is required to perform many new procedures (SORT Evidence Rating=C). CONCLUSIONS The findings of this position statement indicate there is strong evidence that USGIs are more accurate than LMGI, moderate evidence that they are more efficacious and preliminary evidence that they are more cost-effective. Furthermore, ultrasound-guided (USG) is required to perform many new, advanced procedures and will likely enable the development of innovative USG surgical techniques in the future.
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Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, Sacramento, California, USA Department of Physical Medicine and Rehabilitation, Mayo Clinic college of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA
| | - Mederic M Hall
- Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, Iowa, USA
| | - Erik Adams
- Midwest Sports Medicine Institute, Middleton, Wisconsin, USA
| | - David Berkoff
- Department of Orthopaedics and Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew L Concoff
- Outpatient Musculoskeletal Rehabilitation, St. Jude Medical Center, Fullerton, California, USA Department of Family Medicine, Division of Sports Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - William Dexter
- Maine Medical Center, Portland, Maine, USA Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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25
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The course of ultrasonographic abnormalities in knee osteoarthritis: 1 year follow up. Osteoarthritis Cartilage 2014; 22:1651-6. [PMID: 25278074 DOI: 10.1016/j.joca.2014.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 06/03/2014] [Accepted: 06/12/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Imaging of (peri)articular structures and inflammation with Ultrasonography (US) during the course of osteoarthritis (OA) might contribute to knowledge about early diagnosis of OA, prognosis and possibly the effect of disease modifying drugs. Our goal was to identify the prevalence of distinct patterns (stable vs fluctuating) in a set of US features in a cohort of patients receiving standard multimodal treatment for knee OA at T = 0, T = 3 months and T = 12 months. DESIGN This was a prospective, explorative study including 55 patients fulfilling the American College of Rheumatology clinical criteria for knee OA. Six US features were investigated including: effusion, synovial proliferation, infrapatellar bursitis, meniscal protrusion, Baker's cyst and cartilage thickness at three time points during 1 year. A composite inflammatory score was composed. Overall prevalence was assessed as well as individual patterns which were appointed as stable or unstable. RESULTS Inflammation like effusion and synovial hypertrophy does occur in over 40% of patients at some time in the year of follow up and shows a fluctuating pattern. Meniscal protrusion and Baker's cyst however are more stable features. CONCLUSIONS Our study gives insight in the prevalence and course of US abnormalities in patients with knee OA and contributes to the knowledge on the possible role of this imaging modality in research.
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26
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Abstract
Baker's cyst, or popliteal cyst, is a fluid-filled mass that is a distention of a preexisting bursa in the popliteal fossa, most commonly the gastrocnemio-semimembranosus bursa. This bursa is unique in that it communicates with the knee joint, unlike other periarticular bursae, via an opening in the joint capsule posterior to the medial femoral condyle. Many have theorized that this opening creates a valve-like mechanism in the presence of effusion that contributes to the formation of these cysts in adults. Popliteal cysts rarely manifest alone and are most often found in conjunction with other intra-articular pathologies and inflammatory conditions, such as osteoarthritis, meniscus tears, and rheumatoid arthritis. In children, popliteal cysts are only occasionally associated with these conditions and are more often an incidental finding discovered during a routine physical examination. Popliteal cysts may present as either a chronically persistent or relapsing condition or as an acute and dramatic condition that can occur in the case of cyst rupture presenting as pseudothrombophlebitis. Ultrasound and magnetic resonance imaging have proven to be consistent and accurate in the confirmation of popliteal cysts, with magnetic resonance imaging becoming the modern imaging modality of choice. This review discusses the anatomy and etiology of popliteal cysts, describes the common clinical presentations, reviews the differential diagnoses, and provides guidance for proper diagnostic imaging. It also provides a comparison of current conservative, minimally invasive, and invasive treatment options, along with a discussion of results. Postoperative rehabilitation depends largely on the condition associated with the popliteal cyst.
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Lesniak BP, Loveland D, Jose J, Selley R, Jacobson JA, Bedi A. Use of ultrasonography as a diagnostic and therapeutic tool in sports medicine. Arthroscopy 2014; 30:260-70. [PMID: 24485118 DOI: 10.1016/j.arthro.2013.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/23/2013] [Accepted: 10/29/2013] [Indexed: 02/02/2023]
Abstract
Ultrasonography has many important advantages over other imaging modalities and many important applications in sports medicine. This article presents an evidence-based discussion of the use of ultrasound technology to diagnose and treat common musculoskeletal disorders, with emphasis on the shoulder, elbow, hip, knee, and foot and ankle. Topics include basic principles, scan artifacts, the appearance of musculoskeletal structure characteristics and pathologies, and various diagnostic and therapeutic applications in sports medicine.
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Affiliation(s)
- Bryson P Lesniak
- UHealth Sports Medicine, the Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Dustin Loveland
- UHealth Sports Medicine, the Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Jean Jose
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Ryan Selley
- Section of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Asheesh Bedi
- Section of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.
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28
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Wang Y, Peng R, Ma R. Epidemiological investigation of osteoarthritis in middle-aged mongolian and senior residents of the inner mongolia autonomous region. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e8303. [PMID: 24693375 PMCID: PMC3950787 DOI: 10.5812/ircmj.8303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 04/15/2013] [Accepted: 07/15/2013] [Indexed: 11/17/2022]
Abstract
Background To investigate the prevalence and characteristics of osteoarthritis (OA) in Mongolian middle-aged and senior residents of the Inner Mongolia autonomous region, compared with the prevalence of OA in different regions, to understand the OA-associated factors and provide theoretical evidences for intervention and prevention. Objectives Thereby the prevalence, distribution characteristics and correlative factors of OA in Mongolian middle-aged and senior residents in the Inner Mongolia autonomous region were investigated in this study. Materials and Methods Rural and urban residents in Hohhot, Baotou and Erdos were selected using stratified, multi-stage and cluster random sampling. 2000 residents aging over 45 filled out questionnaires, underwent specialized physical and X-ray examinations. The factors affecting OA were analyzed by the multivariate unconditional logistic regression. Results Obtained total of 1877 questionnaires were completed. 93% of the residents were unaware of OA-related issues. The prevalence of radiological OA and clinical OA (neck OA: 36.72%; waist OA: 44.02%; knee OA: 12.43%; hand OA: 6.83%) were 62.17% and 56.15%, respectively. Urban residents were more subjected to cervical spine (χ2 = 8.92, P = 0.005) and less to lumbar spine disease (χ2 = 10.32, P = 0.004) compared to rural ones. The prevalence of OA in knees and hands of females (χ2 = 8.65, P = 0.003) was significantly higher than males (χ2=4.37, P=0.042). The prevalence of OA in postmenopausal females was slightly higher than males (χ2 = 3.86, P = 0.052), with no statically significant difference. The risks of OA obviously increased with age. The residents with hypertension, diabetes and atherosclerosis were more subjected to OA. Conclusions The prevalence of OA in Mongolian middle-aged and senior residents in part of the Inner Mongolia autonomous region was similar to the other ethnic groups. The prevalence of OA was affected by age, gender, location, hypertension, diabetes, atherosclerosis and osteoporosis. The residents need further educations about OA prevention and treatment.
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Affiliation(s)
- Yuewen Wang
- Department of Orthopaedics, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Rui Peng
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Ruilian Ma
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Corresponding Author: Ruilian Ma, Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China. Tel/Fax: +86-4716636812, E-mail:
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Nam SH, Kim J, Lee JH, Ahn J, Kim YJ, Park Y. Palpation versus ultrasound-guided corticosteroid injections and short-term effect in the distal radioulnar joint disorder: a randomized, prospective single-blinded study. Clin Rheumatol 2013; 33:1807-14. [PMID: 23934387 DOI: 10.1007/s10067-013-2355-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/24/2013] [Accepted: 07/30/2013] [Indexed: 11/30/2022]
Abstract
The aim of this study was to conduct a randomized, prospective single-blinded clinical study on the mid-term benefits and accuracy rate of the ultrasound (US)-guided versus palpation-guided intra-articular (IA) injections for the treatment of distal radioulnar joint (DRUJ) disorder. Subjects with DRUJ disorder (n = 60) were randomly assigned to undergo US-guided or palpation-guided IA injection. Primary outcomes were measured with Disability of the Arm, Shoulder, and Hand questionnaire (DASH) and secondary outcomes included Verbal Numeric Pain Scale (VNS), Modified Mayo Wrist Score (MMWS), range of motion (ROM), and accuracy rate between two groups; 1.25 mL of mixed material (0.5 ml Omnipaque + 1 % lidocaine 0.25 ml + triamcinolone 20 mg 0.5 ml) was injected into the intra-articular space of the DRUJ. Treatment effects were assessed by using VNS, DASH, MMWS, and passive ROM of the DRUJ (supination, pronation from neutral) before the injections and at 1, 3, and 6 months after the injections. After the US-guided and palpation-guided IA injection into DRUJ, a radiographic image was taken to determine whether the injected material had reached the IA space or infiltrated into the soft tissue. US-guided IA injections showed significantly higher accuracy (100 %) than palpation-guided IA injections (75.8 %) in DRUJ. VNS, DASH, MMWS, and ROM were improved at 1, 3, and 6 months in both groups. There was no significant difference in clinical outcomes between the group receiving US-guided injections and the group receiving palpation-guided injections. US-guided IA injection showed significantly higher accuracy than palpation-guided IA injection in the DRUJ, and corticosteroid IA injections were effective in improving of the pain of patients with DRUJ disorder during 6 months of follow-up.
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Affiliation(s)
- Sang Hyun Nam
- Plastic and Reconstructive Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
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Courtney P, Doherty M. Joint aspiration and injection and synovial fluid analysis. Best Pract Res Clin Rheumatol 2013; 27:137-69. [PMID: 23731929 DOI: 10.1016/j.berh.2013.02.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Joint aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of joint disease. This chapter addresses (1) the indications, technical principles, expected benefits and risks of aspiration and injection of intra-articular corticosteroid and (2) practical aspects relating to SF analysis, especially in relation to crystal identification. Intra-articular injection of long-acting insoluble corticosteroids is a well-established procedure that produces rapid pain relief and resolution of inflammation in most injected joints. The knee is the most common site to require aspiration although any non-axial joint is accessible for obtaining SF. The technique involves only knowledge of basic anatomy and should not be unduly painful for the patient. Provided sterile equipment and a sensible, aseptic approach are used, it is very safe. Analysis of aspirated SF is helpful in the differential diagnosis of arthritis and is the definitive method for diagnosis of septic arthritis and crystal arthritis. The gross appearance of SF can provide useful diagnostic information in terms of the degree of joint inflammation and presence of haemarthrosis. Microbiological studies of SF are the key to the confirmation of infectious conditions. Increasing joint inflammation associates with increased SF volume, reduced viscosity, increasing turbidity and cell count and increasing ratio of polymorphonuclear:mononuclear cells, but such changes are non-specific and must be interpreted in the clinical setting. However, detection of SF monosodium urate and calcium pyrophosphate dihydrate crystals, even from un-inflamed joints during intercritical periods, allows a precise diagnosis of gout and calcium pyrophosphate crystal-related arthritis.
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Affiliation(s)
- Philip Courtney
- Department of Rheumatology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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Akgul O, Guldeste Z, Ozgocmen S. The reliability of the clinical examination for detecting Baker's cyst in asymptomatic fossa. Int J Rheum Dis 2013; 17:204-9. [DOI: 10.1111/1756-185x.12095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ozgur Akgul
- Department of PMR, Division of Rheumatology, Faculty of Medicine; Erciyes University; Kayseri Turkey
| | - Zuhal Guldeste
- Department of PMR, Division of Rheumatology, Faculty of Medicine; Erciyes University; Kayseri Turkey
| | - Salih Ozgocmen
- Department of PMR, Division of Rheumatology, Faculty of Medicine; Erciyes University; Kayseri Turkey
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