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HO JW, Kim JY, Lee YK. Acute blockage of forearm supination due to flap tear of the triangular fibrocartilage disc: A case report. Medicine (Baltimore) 2024; 103:e37915. [PMID: 38640286 PMCID: PMC11029995 DOI: 10.1097/md.0000000000037915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/26/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE Acute blockage of forearm supination has been reported in several studies. It is caused by loose bodies in the wrist joint, extensor carpi ulnaris tendon interposition, and distal radioulnar joint (DRUJ) injuries, including forearm bone fractures. Some studies have reported cases of DRUJ injuries caused by triangular fibrocartilage complex (TFCC) tears.We report a case of acute blockage of forearm supination after minor trauma and suggest a possible TFCC tear when a patient complains of forearm supination blocking. In addition, we present a comparison between our case and other reports on etiology, magnetic resonance imaging (MRI) findings, and arthroscopic findings, and show the specific characteristics of our case. PATIENTS CONCERNS A 22-year-old male presented with left wrist pain as the chief complaint. He was injured 2 months prior to pushing his left hand on the floor during exercise. Physical examination showed a relative limitation of range of motion (ROM) in the left wrist of about 10° in flexion and about 15° in extension compared with the right side. The patient also complained of supination limitation and volar side wrist pain during supination. The patient showed tenderness in the axial compression test. DIAGNOSES Plain radiographs showing no abnormalities. MRI showed a TFCC tear in the central portion. A torn flap of the TFCC was interposed on the volar side of the DRUJ. INTERVENTIONS Arthroscopic surgery of the left wrist joint was performed. Arthroscopic examination revealed a tear in the TFCC on the radial side. A torn flap was interposed on the volar side of the DRUJ. We removed the flap from the DRUJ using an arthroscopic grasper and partially resected it. OUTCOMES Intraoperative tests showed no locking and the forearm was well supinated. Two months after the surgery, the patient had no pain and showed full forearm supination. LESSONS DRUJ blocking due to a TFCC tear should be suspected when acute blockage of forearm supination occurs after minor trauma. MRI is helpful for diagnosis; however, we suggest that the diagnosis should be confirmed through arthroscopy. Symptoms can be resolved by surgical treatment using arthroscopy.
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Affiliation(s)
- Ji Woong HO
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Jee Yune Kim
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Young-Keun Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
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Dai Y, Yuan W, Chen Y, Lan Q, Qin F, Ding H, Zhang H, Lei Y, Long L. Value of Magnetic Resonance T1 Mapping in Evaluating the Early Response to Treatment for Rheumatoid Arthritis. Curr Med Imaging 2024; 20:1-9. [PMID: 38389340 DOI: 10.2174/0115734056252909230925060431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/22/2023] [Accepted: 08/25/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) is usually used for the semi-quantitative evaluation of joint changes in Rheumatoid Arthritis (RA). However, this method cannot evaluate early changes in bone marrow edema (BME). OBJECTIVE To determine whether T1 mapping of wrist BME predicts early treatment response in RA. METHODS This study prospectively enrolled 48 RA patients administered oral anti-rheumatic drugs. MRI of the most severely affected wrist was performed before and after 4 (48 patients) and 8 weeks of treatment (38 patients). Mean T1 values of BME in the lunate, triangular, and capitate bones; RAMRIS for each wrist; Erythrocyte-Sedimentation Rate (ESR); and 28-joint Disease Activity Score (DAS28)-ESR score were analyzed. Patients were divided into responders (4 weeks, 30 patients; 8 weeks, 32 patients) and non-responders (4 weeks, 18 patients; 8 weeks, 6 patients), according to EULAR response criteria. Receiver operating characteristic (ROC) curves were used to evaluate the efficacy of T1 values. RESULTS ESR and DAS28-ESR were not correlated with T1 value and RAMRIS at each examination (P > 0.05). Changes in T1 value and DAS28-ESR relative to the baseline were moderately positively correlated with each other at 4 and 8 weeks (r = 0.555 and 0.527, respectively; P < 0.05). At 4 weeks, the change and rate of change in T1 value significantly differed between responders and non-responders (-85.63 vs. -19.92 ms; -12.89% vs. -2.81%; P < 0.05). The optimal threshold of the rate of change in T1 value at 4 weeks for predicting treatment response was -5.32% (area under the ROC curve, 0.833; sensitivity, 0.900; specificity, 0.667). CONCLUSION T1 mapping provides a new imaging method for monitoring RA lesions; changes in wrist BME T1 values reflect early treatment response.
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Affiliation(s)
- Yi Dai
- Department of Radiology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning, Guangxi - 530007, China
| | - Wenzhao Yuan
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
| | - Yidi Chen
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
- Department of Radiology, West China Hospital, Sichuan University, No.37 Guoxue Road, Chengdu-610041, China
| | - Qiaoqing Lan
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
| | - Fang Qin
- Department of Rheumatology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
| | - Hao Ding
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
| | - Huiting Zhang
- MR Scientific Marketing, Siemens Healthineers Ltd., No.99 Zhongnan Road, Wuhan, Hubei-430071, China
| | - Yiwu Lei
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
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Sekiguchi T, Saito S, Ogura T, Tsuchiya A, Shiratsuchi H. Abnormal Wrist Sagittal Kinematics in Gymnasts With Dorsal Wrist Pain: A New Syndrome. Am J Sports Med 2024; 52:232-241. [PMID: 38164673 DOI: 10.1177/03635465231204361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The pathology of dorsal wrist pain in gymnasts without abnormal radiographic findings remains unclear. PURPOSE/HYPOTHESIS The purpose of this study was to identify abnormal wrist sagittal kinematics in gymnasts with dorsal wrist pain. It was hypothesized that gymnasts with dorsal wrist pain would show abnormal sagittal kinematics with reversible hypermobility of the intercarpal joint. STUDY DESIGN Controlled laboratory study. METHODS Participants included 19 wrists in male gymnasts with dorsal wrist pain, 18 wrist in male gymnasts without wrist pain, and 20 adult men without a history of wrist pain. Magnetic resonance imaging (T2-weighted sagittal images) findings at 0°, 30°, 60°, and 90° of wrist extension were used in kinematic analysis. The angles and translations of the radiolunate, capitolunate, and third carpometacarpal joint were measured and compared between the 3 groups. RESULTS At 90° of wrist extension, gymnasts with dorsal wrist pain had a significantly lower radiolunate joint angle (28.70°± 6.28° vs 36.19°± 7.81°; P = .020) and a significantly higher capitolunate joint angle (57.99°± 6.15° vs 50.50°± 6.98°; P = .004) and distal translation (1.17 ± 0.50 mm vs 0.46 ± 0.62 mm; P = .002) than gymnasts without dorsal wrist pain. CONCLUSION Gymnasts with dorsal wrist pain showed abnormal wrist sagittal kinematics. These novel findings may facilitate understanding of dorsal wrist pain, which can be recognized as a new syndrome termed "gymnast's lunate dyskinesia."
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Affiliation(s)
- Takahiro Sekiguchi
- Department of Rehabilitation, Funabashi Orthopaedic Clinic, Funabashi, Chiba, Japan
| | - Shinobu Saito
- Japan Community Health care Organization (JCHO) Tokyo Joto Hospital, Koto-ku, Tokyo, Japan
| | - Takahiro Ogura
- Sports Medicine Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Akihiro Tsuchiya
- Sports Medicine Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
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Kapoor L, Banjara R, Sahoo B, Kumar VS, Ansari MT, Khan SA. Functional Outcomes of Centralization of the Ulna as a Method of Reconstruction Following Resection of Campanacci Grade 3 Giant Cell Tumor of the Distal Radius. J Hand Surg Am 2024; 49:63.e1-63.e9. [PMID: 35842330 DOI: 10.1016/j.jhsa.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 03/29/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Wrist reconstruction after distal radial tumor resection poses a challenge to the orthopedic oncologist. We evaluated the functional outcomes of centralization of the ulna with ulnocarpal arthrodesis as a method of reconstruction following resection of distal radius tumors, using impairment measures and patient-reported outcomes. METHODS Evaluation of functional outcome was performed using the Musculoskeletal Tumor Society 93 scoring system and Disabilities of the Arm, Shoulder, and Hand questionnaire. We also determined hand grip strength on the affected side, time to radiologic union at the ulnocarpal junction and reduction in wrist circumference. Local complications and oncologic outcomes were recorded. RESULTS The study included 26 patients with Campanacci grade 3 giant cell tumor of the distal radius. Mean follow-up period in the study was 32.8 ± 12 months. Mean resection length was 10.3 ± 2.5 cm. Radiologic union at the ulnocarpal junction was achieved in 38.5%, 77% and 96% of the patients by 4, 5, and 6 months respectively. Mean hand grip strength was 74 ± 3.9% of the contralateral side whereas mean reduction in wrist circumference was 16.9 ± 6.4%. A good functional outcome with a mean the Musculoskeletal Tumor Society 93 score of 26 ± 1.4 and mean Disabilities of the Arm, Shoulder, and Hand score of 10.5 ± 6.3 was observed. Fracture of the ulna, hardware loosening, and reflex sympathetic dystrophy were each noted in 1 patient, with an overall complication rate of 10.7% (3/28). No patient had nonunion, infection, or local recurrence. CONCLUSIONS This is a simple and effective modality of reconstruction after resection of distal radial tumors. It provides good functional outcome and preservation of good hand grip strength, with low complication rates. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Love Kapoor
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Roshan Banjara
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Bismaya Sahoo
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Mohammed Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Strohmaier A, Häfeli M. [Ulnocarpal Wrist Pain - Tips for the Daily Practice]. Praxis (Bern 1994) 2023; 112:571-577. [PMID: 37823814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Ulnar wrist pain is a frequent symptom with many possible traumatic and non-traumatic causes. The complex anatomy and biomechanics of the wrist with the ulnocarpal complex including the triangular fibrocartilaginous complex (TFCC), the distal radio-ulnar joint (DRUJ) and the ulnar carpal bones make the differentiation between the possible causes difficult. A precise clinical investigation and appropriate imaging studies are essential for detecting the most important differential diagnoses, the first therapeutical steps and an early and appropriate referral to the hand surgeon.
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Affiliation(s)
- Alina Strohmaier
- Departement Chirurgie, Handchirurgie, Kantonsspital Graubünden, Chur, Schweiz
| | - Mathias Häfeli
- Departement Chirurgie, Handchirurgie, Kantonsspital Graubünden, Chur, Schweiz
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Tamai M, Grundeken V, Arima K, Brinck RT, Mil AHMVDHV, Ohki N, Uetani M, Kawakami A. Predictive Value of Magnetic Resonance Imaging-detected Tenosynovitis of the Metacarpophalangeal and Wrist Joints for the Development of Rheumatoid Arthritis among Patients with Undifferentiated Arthritis. Intern Med 2023; 62:2329-2334. [PMID: 36631087 PMCID: PMC10484776 DOI: 10.2169/internalmedicine.0077-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/24/2022] [Indexed: 01/13/2023] Open
Abstract
Objective The early diagnosis of rheumatoid arthritis (RA) improves disease outcomes. Using bilateral magnetic resonance imaging (MRI), we investigated whether or not tenosynovitis at the level of the metacarpophalangeal (MCP) and wrist joints, as well as non-symmetrical versus symmetrical involvement, predicts RA development in undifferentiated arthritis (UA) patients. Methods We collected the clinical and serological findings as well as bilateral gadolinium-enhanced 1.5-T MRI data of UA patients after 1 year. A multivariate logistic regression analysis was used to determine the association of tenosynovitis in UA with RA development. Ninety-one UA patients from the Nagasaki Early Arthritis Clinic who did not meet the 2010 European League Against Rheumatism/American College of Rheumatology classification criteria for RA were selected. Tenosynovitis at the MCP and wrist joints was scored according to the RA MRI scoring system. Results Of these 91 UA patients, 29 (31.9%) progressed to RA, with a median disease duration of 3 months, despite only 10.9% being positive for anti-cyclic citrullinated peptide antibody (ACPA). A univariate analysis showed higher MCP tenosynovitis scores, MCP flexor tenosynovitis, and symmetrical MCP tenosynovitis in the RA development group than in the non-development group (p<0.05). A multivariate analysis showed that symmetrical MCP tenosynovitis was independently associated with RA development after adjusting for age, gender, swollen joint count, C-reactive protein level, and ACPA positivity (odds ratio: 4.96). The presence of symmetrical MCP tenosynovitis had low sensitivity (35%) but high specificity (87%) for RA development. Conclusion MRI-detected tenosynovitis, especially symmetrical findings at the MCP joint, is predictive of RA development in a UA population with low ACPA positivity.
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Affiliation(s)
- Mami Tamai
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Vincent Grundeken
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - Kazuhiko Arima
- Department of Public Health, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Robin Ten Brinck
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | | | - Nozomi Ohki
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
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7
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Nevalainen MT, Zoga AC, Rivlin M, Morrison WB, Roedl JB. Extensor carpi ulnaris tendon pathology and ulnar styloid bone marrow edema as diagnostic markers of peripheral triangular fibrocartilage complex tears on wrist MRI: a case-control study. Eur Radiol 2023; 33:3172-3177. [PMID: 36809434 PMCID: PMC10121535 DOI: 10.1007/s00330-023-09446-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/30/2022] [Accepted: 01/18/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES To evaluate extensor carpi ulnaris (ECU) tendon pathology and ulnar styloid process bone marrow edema (BME) as diagnostic MRI markers for peripheral triangular fibrocartilage complex (TFCC) tears. METHODS One hundred thirty-three patients (age range 21-75, 68 females) with wrist 1.5-T MRI and arthroscopy were included in this retrospective case-control study. The presence of TFCC tears (no tear, central perforation, or peripheral tear), ECU pathology (tenosynovitis, tendinosis, tear or subluxation), and BME at the ulnar styloid process were determined on MRI and correlated with arthroscopy. Cross-tabulation with chi-square tests, binary logistic regression with odds ratios (OR), and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were used to describe diagnostic efficacy. RESULTS On arthroscopy, 46 cases with no TFCC tear, 34 cases with central perforations, and 53 cases with peripheral TFCC tears were identified. ECU pathology was seen in 19.6% (9/46) of patients with no TFCC tears, in 11.8% (4/34) with central perforations and in 84.9% (45/53) with peripheral TFCC tears (p < 0.001); the respective numbers for BME were 21.7% (10/46), 23.5% (8/34), and 88.7% (47/53) (p < 0.001). Binary regression analysis showed additional value from ECU pathology and BME in predicting peripheral TFCC tears. The combined approach with direct MRI evaluation and both ECU pathology and BME yielded a 100% positive predictive value for peripheral TFCC tear as compared to 89% with direct evaluation alone. CONCLUSIONS ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to diagnose tears. KEY POINTS • ECU pathology and ulnar styloid BME are highly associated with peripheral TFCC tears and can be used as secondary signs to confirm the presence of TFCC tears. • If there is a peripheral TFCC tear on direct MRI evaluation and in addition both ECU pathology and BME on MRI, the positive predictive value is 100% that there will be a tear on arthroscopy compared to 89% with direct evaluation alone. • If there is no peripheral TFCC tear on direct evaluation and neither ECU pathology nor BME on MRI, the negative predictive value is 98% that there will be no tear on arthroscopy compared to 94% with direct evaluation alone.
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Affiliation(s)
- Mika T Nevalainen
- Department of Diagnostic Radiology, Oulu University Hospital, P.O. Box 50, 90029, Oulu, Finland.
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland.
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Thomas Jefferson University Hospitals, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA.
| | - Adam C Zoga
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Thomas Jefferson University Hospitals, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Michael Rivlin
- Department of Hand and Orthopaedic Surgery, Rothman Institute of Orthopaedics, Sidney Kimmel Medical College, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA
| | - William B Morrison
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Thomas Jefferson University Hospitals, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Johannes B Roedl
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Thomas Jefferson University Hospitals, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
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Evans AG, Morgan MD, Aiken BA, Assi PE, Joseph JT, Kesayan T, Mioton LM, Esteve IVM, Hill JB, Thayer WP, Al Kassis S. Can Diffusion Tensor Imaging Apparent Diffusion Coefficient Diagnose Carpal Tunnel Syndrome? A Systematic Review and Meta-Analysis. Hand (N Y) 2023; 18:91S-99S. [PMID: 35695339 PMCID: PMC9896277 DOI: 10.1177/15589447221096706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Magnetic resonance diffusion tensor imaging (DTI) can detect microstructural changes in peripheral nerves. Studies have reported that the median nerve apparent diffusion coefficient (ADC), a quantification of water molecule diffusion direction, is sensitive in diagnosing carpal tunnel syndrome (CTS). Five databases were searched for studies using ADC to investigate CTS. Apparent diffusion coefficient (measured in mm2/s) were pooled in random-effects meta-analyses. Twenty-two studies met criteria yielding 592 patients with CTS and 414 controls. Median nerve ADC were measured at the level of the distal radioulnar joint (CTS ADC: 1.11, 95% CI: 1.07-1.15, I2 = 54%; control ADC: 1.04, 95% CI: 1.01-1.07, I2 = 57%), pisiform (CTS ADC: 1.39, 95% CI: 1.37-1.42, I2 = 0%; control ADC: 1.27, 95% CI: 1.23-1.31, I2 = 59%), hamate (CTS ADC: 1.40, 95% CI: 1.36-1.43, I2 = 58%; control ADC: 1.27, 95% CI: 1.25-1.28, I2 = 47%), and as an combination of several measurements (CTS ADC: 1.40, 95% CI: 1.37-1.47, I2 = 100%; control ADC: 1.39, 95% CI: 1.24-1.53, I2 = 100%). Median nerve ADC is decreased in individuals with CTS compared to controls at the levels of the hamate and pisiform. ADC cut-offs to diagnose CTS should be established according to these anatomic levels and can be improved through additional studies that include use of a wrist coil.
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Affiliation(s)
- Adam G. Evans
- Meharry Medical College,
Nashville, TN, USA
- Vanderbilt University Medical
Center, Nashville, TN, USA
| | | | | | | | | | - Tigran Kesayan
- Vanderbilt University Medical
Center, Nashville, TN, USA
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Zhou J, Al-Ani S, Jester A, Oestreich K, Baldrighi C, Ting JWC. Wrist Ganglion Cysts in Children: An Update and Review of the Literature. Hand (N Y) 2022; 17:1024-1030. [PMID: 33174451 PMCID: PMC9608283 DOI: 10.1177/1558944720966716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ganglion cysts are the most common soft tissue tumor of the hand and wrist, affecting pediatric and adult populations. Despite their frequency, there is no consensus within the literature regarding the best management of pediatric wrist ganglia, and there are few recent publications examining this topic. We provide an up-to-date literature review examining the current issues and controversies in the management of pediatric wrist ganglia.
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Affiliation(s)
- Jieyun Zhou
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Monash Health, Melbourne, VIC, Australia
| | - Sami Al-Ani
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Andrea Jester
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Kerstin Oestreich
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Carla Baldrighi
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Jeannette W. C. Ting
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Monash Health, Melbourne, VIC, Australia
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
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Zelenski NA, Corona J, Bishop AT, Shin AY. Outcomes of Surgical Management of Intraosseous Ganglia of the Carpal Bones: A Case Series. Hand (N Y) 2022; 17:893-898. [PMID: 33084381 PMCID: PMC9465773 DOI: 10.1177/1558944720963873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraosseous ganglia of the carpal bones are uncommon with sparse publications to guide treatment. The purpose of this study was to review a single-institution experience to determine the outcomes of patients with surgically treated intraosseous carpal ganglia. METHODS Skeletally mature patients with intraosseous carpal ganglia between 1995 and 2016 treated operatively were identified. Demographic information, clinical data, and radiographic studies were evaluated. RESULTS Thirty-three ganglia in 31 patients were identified. Intraosseous ganglia were located in the lunate (23), scaphoid (9), and trapezoid (1). Patients who presented with pathologic fracture or collapse had larger intraosseus ganglia than those presenting with pain alone. Surgery significantly improved pain. Patients treated with debridement with autograft bone graft had a higher consolidation rate compared with allograft bone but no difference in pain. CONCLUSIONS Patients with large or symptomatic lesions can be treated successfully with curettage and debridement, which leads to relief of pain. The use of bone grafting remains controversial.
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Lenartowicz KA, Miller AJ, Mauermann ML, Shin AY, Bishop AT. Reconstruction of Triangular Fibrocartilage Complex Avulsions (Palmar 1C) with Associated Lunotriquetral and Dorsal Capsule Injury: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00021. [PMID: 36099448 DOI: 10.2106/jbjs.cc.21.00606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 34-year-old farmer and railroad worker injured his left wrist when working at a railroad. The resulting dorsal-ulnar wrist blow caused disabling pain. Splits and 2 subsequent surgeries failed, including an arthroscopic triangular fibrocartilage complex (TFCC) debridement and thermal ablation. Subsequently, magnetic resonance imaging documented a rare Palmer type 1C distal TFCC avulsion. Function was restored and return to farming permitted by reconstruction of the ulnotriquetral (UT) ligament using an extensor carpi ulnaris (ECU) slip. CONCLUSION Chronic Palmer type 1C TFCC injuries can be successfully treated with ECU reconstruction of the UT ligament.
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Affiliation(s)
| | - Andrew J Miller
- Philadelphia Hand to Shoulder Center, Philadelphia, Pennsylvania
| | | | - Alexander Y Shin
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Allen T Bishop
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
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Vega-Morales D, Del Carmen Larios-Forte M, Pérez-Barbosa L, Esquivel-Valerio JA, Garza-Elizondo MA, Skinner-Taylor CM, Vázquez-Fuentes BR, Flores-Alvarado DE, Villarreal-Alarcón MÁ, de Jesús Hernández-Galarza I, Lozano-Plata LI, Castañeda-Martínez MM, Castañeda-Martínez DD, Herrera-Sandate P, Cardenas-de la Garza JA, Galarza-Delgado DÁ. Bone erosions by MRI in first-degree relatives of patients with RA: an exploratory study. Clin Rheumatol 2022; 41:1343-1348. [PMID: 35088207 DOI: 10.1007/s10067-021-06028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/OBJECTIVES First-degree relatives (FDR) of patients with rheumatoid arthritis (RA) are at increased risk of RA diagnosis. Magnetic resonance imaging (MRI) has been proposed as a useful tool to detect subclinical synovitis and bone abnormalities as predictors of progression to RA. The presence of grade ≥ 2 bone erosions in RA MRI scoring system (RAMRIS) was reported to be RA-specific. We aim to describe the prevalence and characteristics of MRI findings in RA patients and FDR. METHODS A cross-sectional and exploratory study of 60 individuals was performed in 38 RA patients and 22 FDR with hand arthralgia without clinical arthritis and positive rheumatoid factor or anticitrullinated protein antibodies. All patients underwent an MRI and were evaluated for synovitis, bone erosion, and bone marrow edema. We evaluated second to fifth metacarpophalangeal joints of the dominant hand according to RAMRIS. RESULTS Among the total population, eighteen (30%) subjects had grade ≥ 2 bone erosions, and 42 (70%) had at least one erosion of any grade. In patients with grade ≥ 2 bone erosions, 12 (31.6%) were from RA patients and 6 (27.2%) from FDR (p = 0.72). In patients with erosions of any grade, 26 (68.4%) were from RA patients and 15 (68.2%) were from FDR (p = 0.98). CONCLUSION A high prevalence of bone erosions was found in RA patients' FDR who had symptoms without clinical arthritis and positive serology. MRI might be helpful in this population for an early detection of RA-specific erosions. The prognosis and the treatment decisions in these subjects should be elucidated. KEY POINTS • First-degree relatives (FDR) of rheumatoid arthritis (RA) patients with positive serology and joint symptoms constitute a select subpopulation of individuals with an increased risk of developing RA. • Magnetic resonance imaging (MRI) of FDR shows a high prevalence of bone erosions of any grade, grade ≥ 2 erosions, and synovitis. • MRI might be helpful in FDR of RA patients to screen for the presence of RA-specific erosions or clinically undetectable synovitis.
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Affiliation(s)
- David Vega-Morales
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico.
| | - María Del Carmen Larios-Forte
- Radiology Department, Hospital Regional Monterrey, Instituto de Seguridad Y Servicios Sociales de los Trabajadores del Estado, Monterrey, Nuevo León, Mexico
| | - Lorena Pérez-Barbosa
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Jorge Antonio Esquivel-Valerio
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Mario Alberto Garza-Elizondo
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Cassandra Michelle Skinner-Taylor
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Diana Elsa Flores-Alvarado
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Miguel Ángel Villarreal-Alarcón
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Iván de Jesús Hernández-Galarza
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Luis Iván Lozano-Plata
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Martha Mariana Castañeda-Martínez
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Diana Daniela Castañeda-Martínez
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Pablo Herrera-Sandate
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Dionicio Ángel Galarza-Delgado
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
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Ratneswaran A, Rockel JS, Antflek D, Matelski JJ, Shestopaloff K, Kapoor M, Baltzer H. Investigating Molecular Signatures Underlying Trapeziometacarpal Osteoarthritis Through the Evaluation of Systemic Cytokine Expression. Front Immunol 2022; 12:794792. [PMID: 35126358 PMCID: PMC8814933 DOI: 10.3389/fimmu.2021.794792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeNon-operative management of trapeziometacarpal osteoarthritis (TMOA) demonstrates only short-term symptomatic alleviation, and no approved disease modifying drugs exist to treat this condition. A key issue in these patients is that radiographic disease severity can be discordant with patient reported pain, illustrating the need to identify molecular mediators of disease. This study characterizes the biochemical profile of TMOA patients to elucidate molecular mechanisms driving TMOA progression.MethodsPlasma from patients with symptomatic TMOA undergoing surgical (n=39) or non-surgical management (n=44) with 1-year post-surgical follow-up were compared using a targeted panel of 27 cytokines. Radiographic (Eaton-Littler), anthropometric, longitudinal pain (VAS, TASD, quick DASH) and functional (key pinch, grip strength) data were used to evaluate relationships between structure, pain, and systemic cytokine expression. Principal Component Analysis was used to identify clusters of patients.ResultsPatients undergoing surgery had greater BMI as well as higher baseline quick DASH, TASD scores. Systemically, these patients could only be distinguished by differing levels of Interleukin-7 (IL-7), with an adjusted odds ratio of 0.22 for surgery for those with increased levels of this cytokine. Interestingly, PCA analysis of all patients (regardless of surgical status) identified a subset of patients with an “inflammatory” phenotype, as defined by a unique molecular signature consisting of thirteen cytokines.ConclusionOverall, this study demonstrated that circulating cytokines are capable of distinguishing TMOA disease severity, and identified IL-7 as a target capable of differentiating disease severity with higher levels associated with a decreased likelihood of TMOA needing surgical intervention. It also identified a cluster of patients who segregate based on a molecular signature of select cytokines.
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Affiliation(s)
- Anusha Ratneswaran
- Hand Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Jason S. Rockel
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Daniel Antflek
- Hand Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - John J. Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Konstantin Shestopaloff
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Mohit Kapoor
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Heather Baltzer
- Hand Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
- *Correspondence: Heather Baltzer,
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Affiliation(s)
- Kashif Ahmad
- Liverpool University Hospitals NHS Foundation Trust, UK
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15
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Prado G, Nen DL, Saraux A. Macroscopic diagnosis of joint metallosis. Rheumatology (Oxford) 2021; 59:2650. [PMID: 32011694 DOI: 10.1093/rheumatology/keaa013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/09/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Guillaume Prado
- Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), Rheumatology Unit, CHU Brest
| | | | - Alain Saraux
- Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), Rheumatology Unit, CHU Brest
- UMR1227, Lymphocytes B et Autoimmunité, Inserm, Université de Brest, CHU Brest
- LabEx IGO, Brest, France
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Shiraishi K, Burghardt AJ, Osaki M, Khosla S, Carballido-Gamio J. Global and Spatial Compartmental Interrelationships of Bone Density, Microstructure, Geometry and Biomechanics in the Distal Radius in a Colles' Fracture Study Using HR-pQCT. Front Endocrinol (Lausanne) 2021; 12:568454. [PMID: 34122326 PMCID: PMC8187761 DOI: 10.3389/fendo.2021.568454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bone parameters derived from HR-pQCT have been investigated on a parameter-by-parameter basis for different clinical conditions. However, little is known regarding the interrelationships of bone parameters and the spatial distribution of these interrelationships. In this work: 1) we investigate compartmental interrelationships of bone parameters; 2) assess the spatial distribution of interrelationships of bone parameters; and 3) compare interrelationships of bone parameters between postmenopausal women with and without a recent Colles' fracture. METHODS Images from the unaffected radius in fracture cases (n=84), and from the non-dominant radius of controls (n=98) were obtained using HR-pQCT. Trabecular voxel-based maps of local bone volume fraction (L.Tb.BV/TV), homogenized volumetric bone mineral density (H.Tb.BMD), homogenized μFEA-derived strain energy density (H.Tb.SED), and homogenized inter-trabecular distances (H.Tb.1/N) were generated; as well as surface-based maps of apparent cortical bone thickness (Surf.app.Ct.Th), porosity-weighted cortical bone thickness (Surf.Ct.SIT), mean cortical BMD (Surf.Ct.BMD), and mean cortical SED (Surf.Ct.SED). Anatomical correspondences across the parametric maps in the study were established via spatial normalization to a common template. Mean values of the parametric maps before spatial normalization were used to assess compartmental Spearman's rank partial correlations of bone parameters (e.g., between H.Tb.BMD and L.Tb.BV/TV or between Surf.Ct.BMD and Surf.app.Ct.Th). Spearman's rank partial correlations were also assessed for each voxel and vertex of the spatially normalized parametric maps, thus generating maps of Spearman's rank partial correlation coefficients. Correlations were performed independently within each group, and compared between groups using the Fisher's Z transformation. RESULTS All within-group global trabecular and cortical Spearman's rank partial correlations were significant; and the correlations of H.Tb.BMD-L.Tb.BV/TV, H.Tb.BMD-H.Tb.1/N, L.Tb.BV/TV-H.Tb.1/N, Surf.Ct.BMD-Surf.Ct.SED and Surf.Ct.SIT-Surf.Ct.SED were significantly different between controls and fracture cases. The spatial analyses revealed significant heterogeneous voxel- and surface-based correlation coefficient maps across the distal radius for both groups; and the correlation maps of H.Tb.BMD-L.Tb.BV/TV, H.Tb.BMD-H.Tb.1/N, L.Tb.BV/TV-H.Tb.1/N, H.Tb.1/N-H.Tb.SED and Surf.app.Ct.Th - Surf.Ct.SIT yielded small clusters of significant correlation differences between groups. DISCUSSION The heterogeneous spatial distribution of interrelationships of bone parameters assessing density, microstructure, geometry and biomechanics, along with their global and local differences between controls and fracture cases, may help us further understand different bone mechanisms of bone fracture.
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Affiliation(s)
- Kazuteru Shiraishi
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Andrew J. Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Julio Carballido-Gamio
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- *Correspondence: Julio Carballido-Gamio,
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17
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Stergiou IE, Christoforou P, Sypsa G, Skoufias S, Mitropoulos D, Tzioufas AG, Voulgarelis M. Extraordinary extrahaematological manifestations of chronic myelomonocytic leukaemia. Lancet 2020; 396:853. [PMID: 32950091 DOI: 10.1016/s0140-6736(20)31905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/09/2020] [Accepted: 08/06/2020] [Indexed: 11/20/2022]
MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Aged
- Antineoplastic Agents, Alkylating/therapeutic use
- Biopsy, Needle/methods
- Bone Marrow/pathology
- Cyclophosphamide/therapeutic use
- Facial Paralysis/diagnosis
- Facial Paralysis/etiology
- Female
- Hematoma/etiology
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Kidney/blood supply
- Kidney/diagnostic imaging
- Kidney/pathology
- Knee Joint/pathology
- Leukemia, Myelomonocytic, Chronic/complications
- Leukemia, Myelomonocytic, Chronic/pathology
- Leukemia, Myelomonocytic, Chronic/therapy
- Male
- Nephrectomy/methods
- Polyarteritis Nodosa/drug therapy
- Polyarteritis Nodosa/pathology
- Stomatitis, Aphthous/etiology
- Synovitis/etiology
- Tongue Diseases/pathology
- Wrist Joint/pathology
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Affiliation(s)
- Ioanna E Stergiou
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece.
| | - Panagiotis Christoforou
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Georgia Sypsa
- Radiology Department, Laikon Hospital, Athens, Greece
| | - Spyridon Skoufias
- 1st Department of Urology, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Dionysios Mitropoulos
- 1st Department of Urology, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Athanasios G Tzioufas
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Michael Voulgarelis
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
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Abstract
A 38-year-old man presented with a 2-month history of pain and stiffness in the bilateral wrist. The pain in right wrist was disabling and severe enough to restrict the daily life activities. After the evaluation of clinical and radiological features, the patient was diagnosed with Kienböck's disease Lichtman stage IIIB in the right wrist and stage IIIA in the left wrist. Routine laboratory investigations revealed a serum uric acid 9.27 mg/dL. Lunate excision and scaphocapitate fusion were done in the right wrist after discussing with the patient. The histopathological examinations of tophi in synovial tissue were negatively birefringent under polarised light microscopy. It confirmed the diagnoses of gout. Febuxostat was started postoperatively. The patient returned to work at the end of 5 months. There was no recurrence of symptoms and radiological signs of arthritis at the end of 1 year.
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Affiliation(s)
- Deepak Chouhan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Vivek Shankar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Mohammed Tahir Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Abstract
Background: Cystic lesions of the carpal bones are rare entities that are infrequently reported in the literature. Scaphoid intraosseous cystic lesions represent a rare subset of carpal bone cysts. This review aims to summarize the available evidence on the evaluation and treatment of scaphoid cystic lesions to help guide clinical management. Methods: Systematic electronic searches were performed using PubMed, Ovid, and Embase databases. Studies included were graded for their risk of bias. Pooled descriptive statistics were performed on incidence, etiology, physical exam findings, treatment, and follow-up. Results: A total of 38 patients representing 41 scaphoid cystic lesions were pooled from 27 articles. Patients presented with wrist pain without fracture (n = 27), pathological fracture (n = 9), swelling only (n = 1), or were asymptomatic (n = 4). Cystic lesions of the scaphoid were initially revealed on imaging with radiographs alone (n = 22), radiographs in combination with computed tomography (CT) (n = 10) or magnetic resonance imaging (n = 6), CT alone (n = 1), or using all 3 modalities (n = 2). Intraosseous ganglia were identified most frequently (n = 31), followed by "bone cyst-like pathological change" (n = 3), unicameral bone cysts (n = 2), aneurysmal bone cysts (n = 2), primary hydatid cysts (n = 2), and cystic like changes post fall (n = 1). Treatment modalities included curettage and bone graft (n = 39) or below-elbow cast (n = 2). On follow-up (average of 21.3 months; n = 40), all patients improved clinically after treatment and were found to have full wrist range of motion without pain (n = 31), slightly reduced grip strength (n = 3), limited range of motion (n = 2), or persistent mild discomfort (n = 2). Conclusions: Scaphoid cystic lesions are most commonly intraosseous ganglia, but can include other etiologies as well. The main presenting symptom is radial wrist pain that usually resolves after treatment. The presence of intracarpal cystic lesions should be considered in the differential diagnosis of wrist pain.
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Affiliation(s)
| | | | - Becher Al-Halabi
- Division of Plastic and Reconstructive
Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Hassan Al-Naeem
- Division of Plastic and Reconstructive
Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive
Surgery, McGill University Health Center, Montreal, Quebec, Canada
- Sabrina Cugno, Department of Plastic and
Reconstructive Surgery, McGill University Health Center, 1001 Decarie Boulevard
B05.3029, Montreal, Québec, Canada H4A 3J1.
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Aizenberg E, Shamonin DP, Reijnierse M, van der Helm-van Mil AHM, Stoel BC. Automatic quantification of tenosynovitis on MRI of the wrist in patients with early arthritis: a feasibility study. Eur Radiol 2019; 29:4477-4484. [PMID: 30421014 PMCID: PMC6610273 DOI: 10.1007/s00330-018-5807-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/12/2018] [Accepted: 09/27/2018] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Tenosynovitis (inflammation of the synovial lining of the sheath surrounding tendons) is frequently observed on MRI of early arthritis patients. Since visual assessment of tenosynovitis is a laborious task, we investigated the feasibility of automatic quantification of tenosynovitis on MRI of the wrist in a large cohort of early arthritis patients. METHODS For 563 consecutive early arthritis patients (clinically confirmed arthritis ≥ 1 joint, symptoms < 2 years), MR scans of the wrist were processed in three automatic stages. First, super-resolution reconstruction was applied to fuse coronal and axial scans into a single high-resolution three-dimensional image. Next, 10 extensor/flexor tendon regions were segmented using atlas-based segmentation and marker-based watershed. A measurement region of interest (ROI) was defined around the tendons. Finally, tenosynovitis was quantified by identifying image intensity values associated with tenosynovial inflammation using fuzzy clustering and measuring the fraction of voxels with these characteristic intensities within the measurement ROI. A subset of 60 patients was used for training and the remaining 503 patients for validation. Correlation between quantitative measurements and visual scores was assessed through Pearson correlation coefficient. RESULTS Pearson correlation between quantitative measurements and visual scores across 503 patients was r = 0.90, p < 0.001. False detections due to blood vessels and synovitis present within the measurement ROI contributed to a median offset from zero equivalent to 13.8% of the largest measurement value. CONCLUSION Quantitative measurement of tenosynovitis on MRI of the wrist is feasible and largely consistent with visual scores. Further improvements in segmentation and exclusion of false detections are warranted. KEY POINTS • Automatic measurement of tenosynovitis on MRI of the wrist is feasible and largely consistent with visual scores. • Blood vessels and synovitis in the vicinity of evaluated tendons can contribute to false detections in automatic measurements. • Further improvements in segmentation and exclusion of false detections are important directions of future work on the path to a robust quantification framework.
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Affiliation(s)
- Evgeni Aizenberg
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Denis P Shamonin
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Berend C Stoel
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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Zonnino A, Smith DR, Delgorio PL, Johnson CL, Sergi F. MM-MRE: a new technique to quantify individual muscle forces during isometric tasks of the wrist using MR elastography. IEEE Int Conf Rehabil Robot 2019; 2019:270-275. [PMID: 31374641 PMCID: PMC7901716 DOI: 10.1109/icorr.2019.8779562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Non-invasive in-vivo measurement of individual muscle force is limited by the infeasibility of placing force sensing elements in series with the musculo-tendon structures. While different methods based either on shear wave elastography or electromyography have been recently proposed to non-invasively estimate individual muscle forces, they can only be used to quantity forces in a limited set of superficial muscles. As such, they are not suitable to study the neuromuscular control of movements that require coordinated action of multiple muscles. In this work, we present multi-muscle magnetic resonance elastography (MM-MRE), a new technique capable of quantifying force for each muscle in the forearm, thus enabling the study of the neuromuscular control of wrist movements. To quantity individual muscle force, MM-MRE integrates measurements of joint torque provided by an MRI-compatible instrumented handle with muscle-specific measurements of shear wave speed obtained via MRE into a forward dynamic muscle force estimator based on a realistic musculoskeletal model of the forearm. A single-subject pilot experiment demonstrates the possibility of obtaining measurements from individual muscles and establishes that MM-MRE has sufficient sensitivity to detect changes in the muscle specific measurement of shear-wave speed following the application of isometric flexion and extension torques with self-selected intensity.
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Horvath A, Westin O, Samuelsson K, Zeba N. [Not Available]. Lakartidningen 2019; 116:FH9Z. [PMID: 31192400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Alexandra Horvath
- Goteborgs universitet Institutionen for medicin - Invärtesmedicin och klinisk nutrition Goteborg, Sweden Goteborgs universitet Institutionen for medicin - Invärtesmedicin och klinisk nutrition Goteborg, Sweden
| | - Olof Westin
- Sahlgrenska universitetssjukhuset - Ortopedkliniken Goteborg, Sweden Goteborgs universitet Institutionen for kliniska vetenskaper - Avd för Ortopedi Goteborg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska universitetssjukhuset - Ortopedkliniken Göteborg, Sweden Sahlgrenska universitetssjukhuset - Ortopedkliniken Göteborg, Sweden
| | - Nenad Zeba
- Goteborgs universitet Institutionen for kliniska vetenskaper - Goteborg, Sweden Goteborgs universitet Institutionen for kliniska vetenskaper - Goteborg, Sweden
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23
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Abstract
OBJECTIVES To study the correlation between high-frequency ultrasonography of patients with early rheumatoid arthritis (RA) and anti-cyclic citrullinated peptide (CCP) antibody. METHODS Two wrists, 1st to 5th metacarpal phalangeal (MCP) and 1st to 5th proximal interphalangeal (PIP) joints of 53 early RA patients treated from October 2015 to October 2017 and 30 healthy subjects were examined by high-frequency ultrasonography. The thicknesses of synovial membrane, sheaths of 1st to 5th extensor tendons, flexor tendons and ulnar wrist extensor tendons were measured. Related pathological changes were observed. RESULTS RA and control groups had significantly different thicknesses of synovium, extensor and flexor tendon sheaths (P <.001). In RA group, 14.15% of joints had cavity fluid, 5.23% had cartilage destruction, and 2.32% of bone cortices had tendon sheath effusion. The detection rates of tendon sheath effusion and tendon adhesion were 19.81% and 16.30% respectively. Anti-CCP antibody positive group had significantly different DAS28, Health Assessment Questionnaire score and rheumatoid factor positive rate from those of negative group (P <.05). Synovitis, cartilage destruction, bone erosion, tendon sheath effusion, and joint effusion were significantly positively correlated with these values (P <.05). Besides, 8.92% of joints had blood flow signals of thickening synovium, of which joints with signals in the active phase accounted for 4.37%. The resistance index (RI) of synovial artery was (0.58 ± 0.07). However, 0.94% of joints had synovial blood flow signals in the inactive phase, and RI of synovial artery was (0.67 ± 0.03). Anti-CCP antibody positive group was significantly more prone to bone erosion than negative group (P <.05). CONCLUSIONS For patients with early RA, high-frequency ultrasonography was more likely to detect articular cartilage destruction and bone erosion changes when anti-CCP antibody was positive. Combining anti-CCP antibody with ultrasonography can provide valuable evidence for the development of clinical treatment regimens.
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Abstract
RATIONALE Preiser disease or avascular necrosis (AVN) of the scaphoid causes intolerable wrist pain and malalignment of the carpal bones. In previously reported cases, patients have had a history of steroid use for systemic illness such as autoimmune hemolytic anemia, systemic lupus erythematosus, or renal transplantation, or have had other risk factors, such as smoking, alcoholism, or infection. In particular, systemic glucocorticoid therapy has been most commonly associated with the disease. Although there are reports of AVN of the scaphoid induced by systemic glucocorticoids, no prior report has associated AVN of the carpal bones with repeated local injections of glucocorticoids. PATIENT CONCERNS We present a case in which it was strongly suspected that AVN of the scaphoid was induced by repeated local glucocorticoid injections. The patient had no history of excessive alcohol use, smoking, or trauma, except for local repeated steroid injections. DIAGNOSES Initially, she had diagnosed with de Quervain's disease and was treated by repeated local glucocorticoid injections followed by surgery for de Quervain's disease. Five years after surgery for de Quervain's disease, the patient presented at our hospital with sudden onset of intolerable pain in her right wrist without a history of trauma. In spite of nonsurgical treatment with rest, immobilization, analgesia, and surgery, her wrist pain was not improved. After further repeated local steroid injections in her wrist, radiographs, and magnetic resonance imaging of her wrist showed the AVN of the scaphoid. INTERVENTIONS Surgery was performed and the fragmented proximal scaphoid and the entire lunate were resected. OUTCOMES The diagnosis was confirmed according to the histopathological examination of the proximal scaphoid bone, which showed the characteristic of AVN of the scaphoid. At follow-up evaluation, radiographs of the right wrist showed no progression of osteoarthritis. The patient had no tenderness or residual pain at the wrist and had no desire to pursue additional surgery. LESSONS We have presented a case with AVN of the scaphoid, which was strongly suspected to be associated with the repeated local steroid injections. Further studies are required to more fully elucidate the association between AVN of the scaphoid and repeated local steroid injections.
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Affiliation(s)
| | - Norio Motoda
- Department of Pathology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa
| | - Ryuji Ohashi
- Department of Pathology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa
| | - Takuya Sawaizumi
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Affiliation(s)
- Philip Beak
- St George's University NHS Foundation Trust, London, UK
| | - Shamim Umarji
- St George's University NHS Foundation Trust, London, UK
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Abstract
This is a rare case of tuberculosis (TB) complicated with pseudogout of the wrist joint in a non-immunocompromised 84-year-old female with a history of pulmonary tuberculosis. She was diagnosed with extrapulmonary tuberculosis of the wrist based on a polymerase chain reaction (PCR) study and synovial fluid aspiration in which the cytology was positive for acid-fast bacilli. Calcium pyrophosphate was also positive. We must be careful not to miss articular tuberculosis as it may mimic common inflammatory arthritis, such as pseudogout of the wrist. Even if the patient is positive for calcium pyrophosphate, this does not exclude the possibility of articular tuberculosis.
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Affiliation(s)
- Kenya Watanabe
- Department of Orthopedics, Nagano Prefectural Suzaka Hospital, Japan
| | - Yoshitaka Yamazaki
- Department of Infectious Diseases, Nagano Prefectural Suzaka Hospital, Japan
| | - Mariko Sugawara
- Department of Infectious Diseases, Nagano Prefectural Suzaka Hospital, Japan
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Abstract
We studied the changes in the shape of the triangular fibrocatilage (TFC: disc proper) which occur during forearm rotation in disarticulated and articulated wrists. The influence of artificial 3 mm ulnar lengthening on distortion of the disc was also examined. In the disarticulated wrists, slight distortion of the central and radial portions of the TFC was observed in the ulnar neutral variance specimens. More distortion was noted in the radial and central portions of the TFC in specimens with positive ulnar variance or with the ulna lengthened. However, in the articulated wrist, the TFC demonstrated little change in shape during pronosupination even in the ulnar positive variance wrists or with the ulna lengthened. There was no significant change in palmar and dorsal peripheral lengths of the TFC in ulnar neutral, ulnar positive or ulna-lengthened specimens at three rotatory positions of the forearm. These findings suggest that changes in ulnar variance which occur during forearm rotation can produce distortion on the TFC, but the carpus helps to maintain the shape of the TFC during pronation–supination, even with positive ulnar variance.
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Affiliation(s)
- A Makita
- Biomechanics Laboratory, Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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Wang B, Wu Q, Liu J, Chen S, Zhang Z, Shao Z. What are the Functional Results, Complications, and Outcomes of Using a Custom Unipolar Wrist Hemiarthroplasty for Treatment of Grade III Giant Cell Tumors of the Distal Radius? Clin Orthop Relat Res 2016; 474:2583-2590. [PMID: 27422390 PMCID: PMC5085931 DOI: 10.1007/s11999-016-4975-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/06/2016] [Indexed: 01/31/2023]
Abstract
PURPOSE A giant cell tumor (GCT) of bone presenting in the distal radius is rare, however, when they occur, Campanacci Grade III tumors can present formidable reconstructive challenges. They are associated with a high local recurrence rate with intralesional treatment, therefore approaches to reconstruct the wrist after en bloc resection warrant study. QUESTIONS We asked: (1) What are the functional outcomes after en bloc resection and reconstruction of the wrist with a unipolar prosthesis in patients with Grade III GCT of the distal radius? (2) What complications occur with use of a unipolar prosthesis in these patients? (3) What are the oncologic outcomes with using en bloc resection and reconstruction with a custom unipolar wrist hemiarthroplasty for Grade III GCTs of the distal radius? METHODS We retrospectively analyzed 10 patients with Campanacci Grade III GCTs of the distal radius treated by a unipolar prosthesis after wide resection of the tumor between January 2008 and October 2013. During that period, all patients at our medical group who presented with a Grade III GCT of the distal radius were treated with wide resection and reconstruction using a custom unipolar implant. Pre- and postoperative pain at rest were assessed according to a 10-cm VAS score. The functional outcomes of the wrist were assessed using the modified Mayo wrist score, and the degenerative changes were evaluated radiographically by a new rating system based on the Knirk and Jupiter scale. We also analyzed tumor recurrence, metastases, and complications associated with the reconstruction procedure. All patients were available for followup at a mean of 52 months (range, 24-90 months). RESULTS Although the complication rate associated with prosthetic arthroplasty was relatively high (six of 10), none of our patients experienced severe complications. Two patients reported having occasional pain of the involved wrist at the time of final followup (VAS, preoperative versus postoperative: 0 versus 3; 5 versus 2, respectively). The mean modified Mayo wrist score was 68 (range, 45-90). Degenerative changes were found in three wrists (Grade 1, two patients; Grade 2, one patient). Aseptic loosening occurred in one patient and wrist subluxation occurred in two patients. Lung metastases or local tumor recurrence were not observed. CONCLUSIONS Because of the proportion of patients who had complications and progressive degeneration with this approach, we recommend first exploring alternatives to reconstruction with custom unipolar wrist hemiarthroplasty after resection of Grade III GCTs of the distal radius, such as fibular autografting. However, this technique provides an alternative for patients with concerns regarding possible morbidity associated with autografting, and for situations when allograft is not available. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Baichuan Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Qiang Wu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Jianxiang Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Songfeng Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Zhicai Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Zengwu Shao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China.
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Sulaiman H, Atiya N, Loi KW, Ng KP. Rice bodies in the wrist joint. Eur J Intern Med 2016; 35:e7-e8. [PMID: 27498273 DOI: 10.1016/j.ejim.2016.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Helmi Sulaiman
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
| | - Nadia Atiya
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Kai Weng Loi
- Department of Orthopaedics, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Kee Peng Ng
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
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30
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Lazarou I, Kelly S, Humby F, Di Cicco M, Zou L, Rocher-Ros V, Hands RE, Ng N, Mahto A, Pitzalis C. Ultrasound-guided synovial biopsy of the wrist does not alter subsequent clinical or ultrasound disease activity assessments: a prospective study for incorporation of imaging in clinical trials. Clin Exp Rheumatol 2016; 34:802-807. [PMID: 27463825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 09/21/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Ultrasound-guided synovial biopsy (UGSB) is a minimally-invasive procedure capable of retrieving good quality tissue from small and large joints. The use of UGSB in prospective clinical trials poses a dilemma as to whether biopsied joints may be later included in core data sets for clinical or imagining response, as the procedure itself may alter disease activity assessment. In this study, we examine the impact of UGSB of the wrist on subsequent clinical and ultrasound (US) assessments in a cohort of rheumatoid arthritis (RA) patients prior to initiation of anti-TNF-alpha therapy. METHODS Patients had active disease (DAS>5.1) involving their wrist. Both wrists were scanned and the most inflamed one underwent an UGSB. Ultrasonographic and clinical assessments were repeated at the patients' subsequent visit, without any changes in disease-modifying treatment between visits. US images were scored semi-quantitatively and quantitatively for synovial thickness (ST) and power Doppler (PD). Mixed-effects model and paired-Wilcoxon signed rank test were used to assess the effect of UGSB on these scores. RESULTS Twenty-nine patients were enrolled. No significant difference in mean ST (p=0.32) or PD (p=0.21) was demonstrated pre- and post-biopsy (mean time 14.7 days). Similar results were obtained using quantitative measures. The DAS-28 and its components did not change significantly post-biopsy. CONCLUSIONS In this population, UGSB of the wrist did not significantly alter subsequent clinical or US assessments, indicating that a wrist joint, which has undergone UGSB, may be incorporated into an US dataset or clinical outcome assessment tools, such as the DAS-28, without prejudice.
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Affiliation(s)
- Ilias Lazarou
- Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK
| | - Stephen Kelly
- Rheumatology Department, Mile End Hospital, Barts Health NHS Trust, London, UK.
| | - Frances Humby
- Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK
| | - Maria Di Cicco
- Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK
| | - Lu Zou
- Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK
| | - Vidalba Rocher-Ros
- Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK
| | - Rebecca Eve Hands
- Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK
| | - Nora Ng
- Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK
| | - Arti Mahto
- Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK
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31
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Abstract
The dorsal capsulo-scapholunate septum (DCSS) is an anatomic structure linking the scapholunate ligament and the dorsal capsule of the wrist. It should be a predynamic scapholunate stabilizer. The authors, using their experience for the extrinsic ligaments testing, suggest an arthroscopic testing of the DCSS. The status could be graded in 4 stages according to the trampoline aspect and to the fiber attachment. They report a preliminary study on a series of 53 arthroscopies made between January 2014 and December 2015 with evaluation of scapholunate ligament instability and DCSS laxity. There is a significant correlation between the lesional stage of the DCSS and the arthroscopic predynamic scapholunate instability stage (P<0.01).
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Affiliation(s)
- Luc Van Overstraeten
- *Hand and Foot Surgery Unit, Tournai, Belgique †Hand Surgery Unit, Polyclinique du Val de Sambre, Maubeuge, France
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Borisch N, Lerch K, Grifka J, Haussmann P. A Comparison of Two Indices for Ulnar Translation and Carpal Height in the Rheumatoid Wrist. ACTA ACUST UNITED AC 2016; 29:144-7. [PMID: 15010160 DOI: 10.1016/j.jhsb.2003.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Accepted: 10/20/2003] [Indexed: 11/30/2022]
Abstract
The indices for ulnar translation described by Chamay et al. (1983 , Annales de Chirurgie de la Main, Vol. 2, pp. 5–17), and Bouman et al. (1994 , Journal of Hand Surgery Vol. 19B, pp. 325–329), and for carpal height described by Youm et al. (1978 , Journal of Bone and Joint Surgery, Vol. 40A, pp. 423–431) and Bouman et al. (1994) were compared in pre- and postoperative wrist X-rays of 91 patients with rheumatoid arthritis undergoing radiolunate arthrodesis. Both indices described by Bouman had a higher applicability and sensitivity than the Chamay and Youm indices and are recommended for use with the rheumatoid wrist. However false-negative values may result when the Bouman index for ulnar translation is used to follow up radiolunate arthrodesis.
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Affiliation(s)
- N Borisch
- Department of Hand Surgery, Plastic and Reconstructive Surgery, DRK - Hospital, Baden - Baden and the Orthopaedic Department of Regensburg University, Germany.
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Terng SCA, Kuypers KC, Koch AR. Inter-Carpal Soft Tissue Entrapment. A Possible Explanation for Chronic Dorsal Wrist Pain. ACTA ACUST UNITED AC 2016; 31:41-6. [PMID: 16221514 DOI: 10.1016/j.jhsb.2005.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 08/25/2005] [Indexed: 10/25/2022]
Abstract
This retrospective study evaluates the surgical treatment of a group of patients with unknown chronic dorsal wrist pain. The cause of their symptoms was interpreted as a painful entrapment of fibrous tissue in the radio-carpal and inter-carpal joints during specific movements. Between 1997 and 2001, 30 patients were treated by surgical excision of this tissue and 26 patients were traced for follow-up. Twenty-three patients were symptom free, or experienced major benefit from surgery. Wrist function measurements using the VAS scale showed improvement in 24 patients. Microscopic examination of the removed specimen shows fibrous tissue with non-specific changes. Inter-carpal soft tissue entrapment can explain the typical clinical findings in some patients with unknown chronic dorsal wrist pain. After careful selection, surgical excision of all entrapped tissue in the radio-carpal and mid-carpal joint may give relief of pain and improvement of wrist function.
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Affiliation(s)
- S C A Terng
- Department of Plastic, Reconstructive and Hand Surgery, Haga Hospital, Leyenburg, Leyweg 275, 2545 CH The Hague, The Netherlands.
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Pickering SAW, Stevens A, Davis TRC. Work Practices and Histopathological Changes in the Tenosynovium in Carpal Tunnel Syndrome in Men. ACTA ACUST UNITED AC 2016; 29:325-8. [PMID: 15234494 DOI: 10.1016/j.jhsb.2003.10.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Accepted: 10/20/2003] [Indexed: 11/29/2022]
Abstract
The aim of this prospective study was to assess whether the fibrous thickening of the carpal tunnel tenosynovium is influenced by working practices. We did this by investigating 50 men (58 hands) with idiopathic carpal tunnel syndrome, who were undergoing carpal tunnel decompression. Occupational history, including vibration tool exposure, and presence of callosities and/or ingrained dirt on hands was recorded at the time of surgery. The flexor tenosynovium was biopsied, and assessed histologically by an observer blinded to occupational history. Occupational group, age, weight and smoking showed no significant association with fibrous tenosynovial thickening. There was also no significant association between fibrous tenosynovial thickening and the presence of hand callosities/in-grained dirt or regular use of vibration tools. Thus no association was found between heavy occupational hand usage and the development of fibrous tenosynovial thickening around tendons within the carpal tunnel.
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Affiliation(s)
- S A W Pickering
- Department of Orthopaedics, University Hospital, Queen's Medical Centre, Nottingham, UK.
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35
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Lowden CM, Attiah M, Garvin G, Macdermid JC, Osman S, Faber KJ. The Prevalence of Wrist Ganglia in an Asymptomatic Population: Magnetic Resonance Evaluation. ACTA ACUST UNITED AC 2016; 30:302-6. [PMID: 15862373 DOI: 10.1016/j.jhsb.2005.02.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Accepted: 02/28/2005] [Indexed: 11/17/2022]
Abstract
Magnetic resonance imaging (MRI) was performed on the wrists of 103 asymptomatic volunteers. The images were evaluated independently by two musculoskeletal radiologists and one orthopaedic surgeon. Wrist ganglia were identified in 53 out of the 103 wrists. The average long and short axes measurements were 8 mm (range 3–22) and 3 mm (range 2–10), respectively. Seventy per cent of the ganglia originated from the palmar capsule in the region of the interval between the radioscaphocapitate ligament and the long radiolunate ligament. Fourteen per cent of the ganglia were dorsal and originated from the dorsal, distal fibres of the scapholunate ligament. Two ganglia had surrounding soft tissue oedema and one had an associated intraosseous component. Unlike previous surgical and pathological series, our study showed that palmar wrist ganglia are more common than dorsal wrist ganglia. The vast majority of these asymptomatic ganglia occur without associated ligamentous disruption, soft tissue oedema or intraosseous communication.
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Affiliation(s)
- C M Lowden
- Hand and Upper Limb Centre, St. Joseph's Health Care, London, UK
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36
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Marx C, Tamborrini G. [Rheumatology 9: calcium pyrophosphate dihydrate disease in Down syndrome]. Praxis (Bern 1994) 2016; 105:595-597. [PMID: 27167486 DOI: 10.1024/1661-8157/a002334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Christian Marx
- 1 UltrasoundCenter, Rheumatologie, Bethesda-Spital Basel
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37
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Gologan R, Ginter VM, Haeffner A, Obertacke U, Schreiner U. 1-Year outcome of concomitant intracarpal lesions in patients with dislocated distal radial fractures: a systematic assessment of 78 distal radial fractures. Arch Orthop Trauma Surg 2016; 136:425-32. [PMID: 26620044 DOI: 10.1007/s00402-015-2357-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ligamentous lesions are concomitant to dislocated distal radius fractures in a high percentage. The purpose of this study was to evaluate the relevance of intracarpal lesions. METHODS Seventy eight of an original cohort of 104 distal radius fractures (74%) were studied over a follow-up period of one year after surgery with complete data (X-rays, CT, MRI, follow-up X-rays and questionnaire). RESULTS Most of our radius fractures (AO 23 type: A 39, B 9, C 30) present additional lesions: 97%. One-year evaluation showed an average Castaing score of 4.5 ± 2.5 points, means a "good" result of a scale of 0-27. Fifty five of seventy eight had an "excellent" or "good" result (<6 points). No patient had more than 12 points ("fair"). CONCLUSIONS The dislocated distal radial fracture implies severe and complex injury to the whole wrist, mostly concerning intracarpal concomitant lesions (MRI). Surgical therapy of dislocated radius fractures followed by 6 weeks relief through thermoplastic splint seems to be sufficient to achieve good 1-year results. MRI-detectable carpal lesions at the time of the radial fracture are common, but only a few of them seem to decompensate later, give symptoms and became of therapeutic relevance.
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Affiliation(s)
- Renata Gologan
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - V M Ginter
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - A Haeffner
- Alameda County Medical Center, Oakland, CA, USA
| | - U Obertacke
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - U Schreiner
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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38
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Saigal R, Chaudhary A, Pathak P, Singh A, Gupta D, Tank ML. Pachydermoperiostosis. J Assoc Physicians India 2016; 64:88-89. [PMID: 27731569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A case of Pachydermoperiostosis (PDP) presented to us in rheumatology clinic with complaints of enlargement and broadening of bilateral hands and feet, grade IV digital clubbing, coarsening of facial features, excessive sweating of the palms, soles during summers.
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Affiliation(s)
| | | | | | | | | | - M L Tank
- Associate Professor, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan
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39
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Joshi AA, Leahy RM, Badawi RD, Chaudhari AJ. Registration-Based Morphometry for Shape Analysis of the Bones of the Human Wrist. IEEE Trans Med Imaging 2016; 35:416-426. [PMID: 26353369 PMCID: PMC4779077 DOI: 10.1109/tmi.2015.2476817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a method that quantifies point-wise changes in surface morphology of the bones of the human wrist. The proposed method, referred to as Registration-based Bone Morphometry (RBM), consists of two steps: an atlas selection step and an atlas warping step. The atlas for individual wrist bones was selected based on the shortest ℓ2 distance to the ensemble of wrist bones from a database of a healthy population of subjects. The selected atlas was then warped to the corresponding bones of individuals in the population using a non-linear registration method based on regularized ℓ2 distance minimization. The displacement field thus calculated showed local differences in bone shape that then were used for the analysis of group differences. Our results indicate that RBM has potential to provide a standardized approach to shape analysis of bones of the human wrist. We demonstrate the performance of RBM for examining group differences in wrist bone shapes based on sex and between those of the right and left wrists in healthy individuals. We also present data to show the application of RBM for tracking bone erosion status in rheumatoid arthritis.
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40
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Barbieri F, Zampogna G, Camellino D, Paparo F, Cutolo M, Garlaschi G, Cimmino MA. Ankylosis of the wrist bones in patients with rheumatoid arthritis: a study with extremity-dedicated MRI. Clin Exp Rheumatol 2016; 34:49-52. [PMID: 26575013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/23/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Ankylosis, or spontaneous bone fusion, of the small joints of the hand is a rare event in patients with rheumatoid arthritis (RA), being observed in 0.8% of them on conventional radiographs. It is associated with long-lasting and severe disease. In other settings, such as fracture healing, bone fusion is a reparative process. The aim of this paper is the study of the frequency of wrist ankylosis in patients with RA in comparison with other arthritides; to correlate ankylosis with disease activity. METHODS A total of 94 patients affected by RA, 71 patients with different rheumatic conditions and 42 controls with no joint disease or with slight hand osteoarthritis were studied. DAS-28 CRP was calculated in patients with RA and psoriatic arthritis. MRI of the clinically most involved wrist was performed with a 0.2 T, extremity-dedicated MRI system. RESULTS Of RA patients, 10/94 (10.6%) showed ankylosis in comparison with 2/113 (1.8%) controls (p=0.015). RA patients with ankylosis had longer disease duration (p=0.019) but similar disease activity. CONCLUSIONS MRI-defined bone ankylosis is frequent in RA. It is not limited to seronegative spondyloarthritides and may be part of the bone damage observed in RA.
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Affiliation(s)
- Francesca Barbieri
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy
| | - Giuseppe Zampogna
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy
| | - Dario Camellino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy
| | | | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy
| | | | - Marco A Cimmino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy.
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Ali S, Cunningham R, Amin M, Popoff SN, Mohamed F, Barbe MF. The extensor carpi ulnaris pseudolesion: evaluation with microCT, histology, and MRI. Skeletal Radiol 2015; 44:1735-43. [PMID: 26245773 PMCID: PMC4609633 DOI: 10.1007/s00256-015-2224-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 07/08/2015] [Accepted: 07/22/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if magic angle plays a role in apparent central increased signal intensity of the distal extensor carpi ulnaris tendon (ECU) on MRI, to see if histologic findings of tendon degeneration are associated with increased T1 or T2 tendon signal on MR imaging, and to determine the prevalence of the ECU "pseudolesion". MATERIALS AND METHODS A standard 3 Tesla protocol was utilized to scan ten cadaveric wrists. A 40 mm length of 10 ECU and four extensor carpi radialis brevis (ECRB) tendons were immersion fixed before microCT scanning. Staining with Alcian blue, Masson's trichrome and Safranin O was performed before light microscopy. Fifty clinical wrist MRIs were also reviewed for the presence of increased T1 and/or T2 signal. RESULTS Central increased T1 and/or T2 signal was observed in 9 of 10 cadaveric ECU tendons, but not in ECRB tendons. MicroCT and histology showed inter-tendinous matrix between the two distal heads of the ECU. Increased mucoid degeneration correlated with increased MRI signal intensity. The tendon fibers were at a maximum of 8.39° to the longitudinal axis on microCT. Clinical MRIs showed increased T1 signal in 6%, increased T2 signal in 8%, increased T1 and T2 signal in 80%, and 6% showing no increased signal. CONCLUSION Central increased T1 and/or T2 signal in the ECU tendon indicates the presence of normal inter-tendinous ground substance, with increased proteoglycan content (mucoid degeneration) responsible for increased signal intensity. None of the fibers were shown on microCT to approach the magic angle.
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Affiliation(s)
- Sayed Ali
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19140, USA.
| | - Ryan Cunningham
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Mamta Amin
- Department of Anatomy, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Steven N Popoff
- Department of Anatomy, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Feroze Mohamed
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Mary F Barbe
- Department of Anatomy, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA, 19140, USA
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Ali S, Kaplan S, Kaufman T, Fenerty S, Kozin S, Zlotolow DA. Madelung deformity and Madelung-type deformities: a review of the clinical and radiological characteristics. Pediatr Radiol 2015; 45:1856-63. [PMID: 26135644 DOI: 10.1007/s00247-015-3390-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/28/2015] [Accepted: 05/08/2015] [Indexed: 11/28/2022]
Abstract
Madelung deformity of the distal radius results from premature closure of the medial volar aspect of the distal radial physis, leading to increased volar tilt and increased inclination of the radial articular surface, triangulation of the carpus with proximal migration of the lunate and dorsal displacement of the distal ulna. The deformity is particularly common in Leri-Weill dyschondrosteosis, but it may also occur in isolation. True Madelung deformity can be differentiated from Madelung-type deformities by the presence of an anomalous radiolunate ligament (Vickers ligament). In this article, we will review the imaging characteristics of true Madelung deformity, including the common "distal radius" variant, the less common "entire radius" variant and "reverse" Madelung deformity. We will discuss the role of the Vickers ligament in disease pathogenesis and its use in differentiating true Madelung deformity from Madelung-type deformities arising from trauma or multiple hereditary exostoses. Surgical management of these patients will also be addressed.
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Affiliation(s)
- Sayed Ali
- Department of Radiology, Temple University Hospital, 3401 North Broad St., Philadelphia, PA, 19140, USA.
| | - Summer Kaplan
- Department of Radiology, Temple University Hospital, 3401 North Broad St., Philadelphia, PA, 19140, USA
| | - Theresa Kaufman
- Department of Radiology, Temple University Hospital, 3401 North Broad St., Philadelphia, PA, 19140, USA
| | - Sarah Fenerty
- Department of Radiology, Temple University Hospital, 3401 North Broad St., Philadelphia, PA, 19140, USA
| | - Scott Kozin
- Shriners Hospitals for Children, Philadelphia, PA, USA
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Czaplicka K, Wojciechowski W, Włodarczyk J, Urbanik A, Tabor Z. Automated assessment of synovitis in 0.2T magnetic resonance images of the wrist. Comput Biol Med 2015; 67:116-25. [PMID: 26513469 DOI: 10.1016/j.compbiomed.2015.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/01/2015] [Accepted: 10/10/2015] [Indexed: 01/09/2023]
Abstract
According to the current recommendations in diagnosis of rheumatoid arthritis (RA), Magnetic Resonance (MR) images of wrist joints are used to evaluate three main types of lesions: synovitis, bone edema and bone erosions. In the clinical practice, the RA-related lesions seen in MR images are assessed manually with the semi-quantitative RAMRIS scoring system. In this paper we present an automated method for inflamed synovial membrane volume determination, based on the analysis of pre- and post-contrast MR images and segmentation of wrist bones seen in MR images. We found that the correlation between the automatically quantified volume of synovitis and RAMRIS scores was in the range from 0.76 to 0.87 for the total RAMRIS synovitis score. This can be compared with the correlation between the manually quantified volume of synovitis and RAMRIS scores which was in the range from 0.75 to 0.81 for the total synovitis score. The results of the study demonstrate that computer assisted methods for assessment of synovitis have great potential for clinical applications.
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Affiliation(s)
- Kamila Czaplicka
- Jagiellonian University, Prof. Stanisława Łojasiewicza, 30-059 Krakow, Poland
| | - Wadim Wojciechowski
- Jagiellonian University Medical College, Kopernika 19, 31-501 Krakow, Poland; Medical Center iMed24, Zyczkowskiego 29, 31-864 Krakow, Poland
| | - Justyna Włodarczyk
- Jagiellonian University, Prof. Stanisława Łojasiewicza, 30-059 Krakow, Poland
| | - Andrzej Urbanik
- Jagiellonian University Medical College, Kopernika 19, 31-501 Krakow, Poland
| | - Zbisław Tabor
- Cracow University of Technology, Warszawska 24, 31-155 Krakow, Poland.
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Wang Y, Geng Y, Deng XR, Zhang ZL. [Relationship between wrist bone mineral density and synovitis, erosion by ultrasonography in female rheumatoid arthritis patients]. Beijing Da Xue Xue Bao Yi Xue Ban 2015; 47:774-780. [PMID: 26474614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To find the correlation of wrist bone mineral density (BMD) to wrist synovitis and erosion, by comparing wrist BMD and ultrasonography. METHODS A number of 80 female RA patients were examined by BMD measurement of the femoral neck, spine and non-dominant wrist using dual-energy X-ray absorptiometry (DXA). Synovitis of the wrist was examined by ultrasonography. The wrist joint (radiocarpal joint, dorsal midline, and carpoulnar joint) was assessed in the same side of DXA, with transverse and longitudinal scans for USGS synovial hypertrophy and proliferation, tenosynovitis,tendinitis and bone erosion. Colour and power doppler ultrasonography (PDUS) were used to sum the synovitis score. RESULTS We found: (1) In the study, 80 female RA patients were enrolled, the mean age was 54.6±13.3 (27.0-80.0) years, the disease duration was 48 (12-116) months, and the body Mass Index was 23.0±4.0 (14.8-31.2) kg/m2. The Wrist BMD (g/cm2) in RA significantly reduced, compared with normal controls(0.297±0.121 vs. 0.420±0.180,P<0.01). (2) The Wrist BMD (g/cm2) exceeded in early RA compared with the established RA (0.326±0.103 vs. 0.285±0.132,P<0.01); the positive rate of severe osteoporosis in wrist was lower in early RA compared with the established RA (47.8% vs. 64.9%, P<0.05); the positive rate of bone erosion in wrist by ultrasound was lower in early RA compared with the established RA (39.1% vs. 56.1%, P<0.01). (3) The wrist BMD (g/cm2) in RA with high disease activity reduced compared with moderate and low disease activity (0.267±0.140 vs. 0.280±0.126) and (0.267±0.140 vs. 0.320±0.103) respectively, P<0.05). The percentages of positive ACPA in the high and moderate disease activity groups were significantly higher than those in the remission group (85% vs. 81.8% and 92.6% vs. 81.8%, respectively). DAS28ESR was correlated with wrist BMD (r=-0.288, P<0.01). (4) A significant positive correlation was found between wrist and spine/femur BMD (r=0.634, P<0.01, r=0.795, P<0.01), and a negative correlation between wrist and disease duration and DAS28ESR (r=-0.286, r=-0.301, P<0.01). There was a highly significant positive correlation between wrist BMD and femur BMD (r=0.95, P<0.05). (5) RA patients in wrist osteoporosis group had higher RF positive rate and ACPA rate than wrist osteopenia group (75.5% vs. 55.6%, P<0.05,100% vs. 83.3%, P<0.05). The patients of BMD osteoporosis group had higher DAS28ESR compared with osteopenia group (5.3±1.8 vs. 3.7±1.5, P<0.01). The percentages of synovitis (61.5% vs. 51.7%, P<0.05), tendenitis (14.3% vs. 10.0%, P<0.05) and bone erosion (54.2% vs. 46.2%, P<0.05) in wrist by ultrasonography in osteoporosis group were higher than those of osteopenia group. (6) The wrist BMD in negative bone erosion group by ultrasonography was lower than that in positive bone erosion group [(0.333±0.107) g/cm2 vs. (0.264±0.125) g/cm2, P<0.01], also the PDUS score was higher than positive bone erosion group (4.53±1.40 vs. 2.55±2.66, P<0.01). Compared with negative bone erosion group, the patients in positive bone erosion group had longer disease duration (96.0±104.7) months vs. (66.2±78.0) months, P<0.05), higher percentage of RF (81.0% vs. 53.8%, P<0.01), ACPA (92.7% vs. 79.5%, P<0.05). and higher DAS28ESR (5.4±1.8 vs. 4.2±2.0, P<0.05). The percentage of wrist synovitis in positive bone erosion group was higher (75.6% vs. 30.8%, P<0.01) than that of negative bone erosion group, and moreover, the percentage of severe osteoporosis in the wrist was significantly higher (75.0% vs. 46.4%, P<0.01). (7) A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low wrist BMD. Statistically significant variables were age (P=0.001), disease duration (P=0.017), DAS28ESR (P=0.021), and ACPA (P=0.05). CONCLUSION This study shows a highly significant correlation between hand BMD with disease duration and disease activity, and female RA patients with high titer of ACPA have lower wrist BMD.
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Affiliation(s)
- Yu Wang
- Department of Rheumatology, Peking University First Hospital, Beijing 100034, China
| | - Yan Geng
- Department of Rheumatology, Peking University First Hospital, Beijing 100034, China
| | - Xue-rong Deng
- Department of Rheumatology, Peking University First Hospital, Beijing 100034, China
| | - Zhuo-li Zhang
- Department of Rheumatology, Peking University First Hospital, Beijing 100034, China
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Tămaş MM, Bondor CI, Rednic N, Ghib LJ, Rednic S. The evolution of time-intensity curves of contrast enhanced ultrasonography in early arthritis patients with wrist involvement. Med Ultrason 2015; 17:345-351. [PMID: 26343084 DOI: 10.11152/mu.2013.2066.173.mmt] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIMS The aim of the study was to assess the evolution of time-intensity curves parameters of contrast-enhanced ultrasonography (CEUS) after 6 months of conventional treatment in early arthritis patients with wrist involvement. MATERIAL AND METHODS Patients diagnosed with early rheumatoid arthritis or undifferentiated arthritis on the basis of 2010 ACR/EULAR classification criteria, with bilateral wrist arthritis and both radiocarpal (RC) and intercarpal (IC) synovial hypertrophy identified by grey-scale ultrasonography, were enrolled. Synovial hypertrophy was semi-quantitatively scored (grade 0-3) by grey-scale and by Power Doppler at wrist level. CEUS was performed using Sonovue. The region of interest was selected as the area corresponding to the synovial hypertrophy of the RC and IC joints. Time-intensity curves parameters were calculated with Contrast Dynamic Software. The minimum and the maximum values of Peak, area under the curve (AUC), and slope were selected for each patient at baseline and after 6 months of conventional treatment. The difference between the visits was noted as "Δ". RESULTS Eleven patients fulfilled the inclusion criteria. Maximum time-intensity curves parameters' difference significantly decreased at 6 months: Peak (30.00+/-5.90% vs 23.22+/-5.22%, p=0.008), AUC (1206.08+/-216.91%s vs 949.13+/-280.12%s, p=0.04) and slope (1.6 (1.4;2.3) %/s vs 1(0.7;1.2) %/s, p=0.03). Moderate correlations were found between maximum ΔPeak, maximum ΔAUC and maximum ΔPower Doppler grade (r=0.44, p=0.17; r=0.46, p=0.16, respectively). CONCLUSIONS Peak and AUC for joints that had high baseline values significantly decreased following treatment with conventional synthetic drugs in EA patients with wrist arthritis. This decrease in Peak and AUC was moderately correlated with a decrease in US parameters. The joint with the highest values of these parameters may be used for evaluation of EA patients at follow-up.
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Affiliation(s)
- Maria-Magdalena Tămaş
- Rheumatology Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Cosmina Ioana Bondor
- Department of Informatics and Biostatistics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Rednic
- 4th Medical Department, Railway Hospital, Cluj-Napoca, Romania
| | - Linda Jessica Ghib
- Rheumatology Department, Clinical Emergency County Hospital, Cluj-Napoca, Romania
| | - Simona Rednic
- Rheumatology Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Koh JH, Jung SM, Lee JJ, Kang KY, Kwok SK, Park SH, Ju JH. Radiographic Structural Damage Is Worse in the Dominant than the Non-Dominant Hand in Individuals with Early Rheumatoid Arthritis. PLoS One 2015; 10:e0135409. [PMID: 26247204 PMCID: PMC4527732 DOI: 10.1371/journal.pone.0135409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 07/21/2015] [Indexed: 01/01/2023] Open
Abstract
Objective The relationship between mechanical stress and radiographic progression in rheumatoid arthritis (RA) is unclear. The assumption is that mechanical stress is greater in the dominant hand. Therefore, the aim of the present study was to compare the presence and progression of erosions and joint space narrowing (JSN) in the dominant and non-dominant hand. Methods Data from 194 patients recently diagnosed with seropositive RA, and with hand radiographs taken at the time of diagnosis and at 2-year follow-up, were analyzed retrospectively. Radiographs were scored using the van der Heijde-modified Sharp Score (HSS) method. Each joint group within each hand was rated separately by two independent examiners in a double-blinded manner. Results One hundred and ninety-four patients were enrolled (80% female, 88% positive rheumatoid factor, 92% positive anti-citrullinated protein antibody, and 95.4% right-handed). The baseline, follow-up erosion and JSN HSS were significantly higher in the dominant hand than in the non-dominant hand. The annual rate of radiographic progression was also higher in the dominant hand. The erosive progression in the wrist joints varied significantly according to handedness, but the erosion in the proximal interphalangeal joints and metacarpophalangeal joints was similar in both hands. The radiographic progression was associated with the dominant hand, an abnormal baseline C-reactive protein level, and joint damage at baseline. There was no significant difference in bone mineral density between the right and left hands. Conclusion Radiological damage was worse and progressed faster in the dominant hand, suggesting that mechanical stress is associated with radiographic joint damage in early and active RA.
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Affiliation(s)
- Jung Hee Koh
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jennifer Jooha Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- * E-mail:
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LaPlante M, Usatine R. Acute onset of polyarthralgia and skin plaques. Am Fam Physician 2015; 91:723-724. [PMID: 25978204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Maria LaPlante
- University of Texas Health Science Center, San Antonio, TX, USA
| | - Richard Usatine
- University of Texas Health Science Center, San Antonio, TX, USA
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Tekin F, Sürmeli M, Şimşek H, Ceran C, Tezcan S, Taner ÖF, Şimşek G. Comparison of the histopathological findings of patients with diabetic and idiopathic carpal tunnel syndrome. Int Orthop 2015; 39:2395-401. [PMID: 25920601 DOI: 10.1007/s00264-015-2790-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/03/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE This study is aimed to investigate whether there are any histopathological differences between diabetic and idiopathic carpal tunnel syndromes. METHODS The biopsy specimens were taken from transverse carpal ligament (TCL), tenosynovium adjacent to median nerve and epineurium of median nerve and evaluated in 47 patients (21 diabetic and 26 idiopathic) who were diagnosed with carpal tunnel syndrome (CTS) and treated surgically with open carpal tunnel release. Fibroblast proliferation, fibrosis, perivascular inflammation, oedema, vascular proliferation and vascular wall thickness were determined and scored in all specimens. RESULTS There weren't any histopathological abnormalities in TCL specimens of both groups. Synovial hyperplasia, fibrosis and perivascular inflammation were not observed in tenosynovial analysis of both groups. Diabetic CTS patients, when compared with idiopathic CTS patients, had higher rates of synovial edema (idiopathic CTS 57 %, diabetic CTS 87 %), vascular proliferation (idiopathic CTS 30.8 %, diabetic CTS 90.5 %) and increased vascular wall thickness (idiopathic CTS 11.5 %, diabetic CTS 90.5 %). There was no oedema, fibrosis and perivascular inflammation of the epineurium in specimens of either group. But increases in vascular proliferation (idiopathic CTS 7.7 %, diabetic CTS 71.4 %) and vascular wall thickness (idiopathic CTS 3.8 %, diabetic CTS 71.4 %) was seen in the epineurium of diabetic patients and these differences were statistically significant (p < 0.05). CONCLUSION Because of the severe synovial and epineurial histopathological abnormalities and inadequate neural regeneration capacity, surgical open carpal tunnel decompression should be planned earlier in diabetic CTS patients. Further studies should be considered to evaluate the histopathological features of diabetic CTS patients early in the course of the disease.
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Affiliation(s)
- Fatih Tekin
- Department of Plastic and Reconstructive Surgery, Keçiören Training and Research Hospital, Pınarbaşı Mah. Sanatoryum Cad. Ardahan Sok. No:25, 06380, Keçiören, Ankara, Turkey.
| | - Mehmet Sürmeli
- Department of Plastic and Reconstructive Surgery, Keçiören Training and Research Hospital, Pınarbaşı Mah. Sanatoryum Cad. Ardahan Sok. No:25, 06380, Keçiören, Ankara, Turkey
| | - Hülya Şimşek
- Department of Pathology, Artvin State Hospital, Artvin, Turkey
| | - Candemir Ceran
- Department of Plastic and Reconstructive Surgery, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Soner Tezcan
- Department of Plastic and Reconstructive Surgery, Keçiören Training and Research Hospital, Pınarbaşı Mah. Sanatoryum Cad. Ardahan Sok. No:25, 06380, Keçiören, Ankara, Turkey
| | - Ömer Faruk Taner
- Department of Plastic and Reconstructive Surgery, Keçiören Training and Research Hospital, Pınarbaşı Mah. Sanatoryum Cad. Ardahan Sok. No:25, 06380, Keçiören, Ankara, Turkey
| | - Gülçin Şimşek
- Department of Pathology, Keçiören Training and Research Hospital, Ankara, Turkey
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Isidro A, Díez-Santacoloma I, Méndez-López J. Approach to the diagnosis of unusual carpal ankylosis from ancient Egypt. Clin Exp Rheumatol 2015; 33:50-55. [PMID: 25437122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/29/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Carpal fusion is not an uncommon finding in archaeological bones. The majority of cases are due to inflammatory or infectious diseases and those are usually associated with other major alterations in the skeleton. METHODS Two distinct individual cases, both adult females recovered from the Necropolis of Sharuna in the Middle Egypt from the Ptolemaic Period (IV to I BC) are presented in this study. Specimen 4323/1 shows a fusion of the scaphoid, lunate and triquetral bones in the right wrist. Specimen 4323/2 is a very rare fusion of a dysplastic lunate bone with the radius in the left wrist. In the proximal end of that left wrist, two possible remains of the flattened scaphoid and triquetral bones are also present. RESULTS A differential diagnosis of both abnormalities as well as broad research into similar paleopathological cases were carried out: the most probable diagnosis for the specimen 4323/1 is an uncommon carpal coalition of three bones from the same row; the diagnosis of the specimen 4323/2 is more dubious with both rheumatoid arthritis and septic arthritis being strong candidates. CONCLUSIONS In archaeological remains, carpal fusion should be thoroughly studied in order to ensure an accurate differential diagnosis.
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Affiliation(s)
- Albert Isidro
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona; and Museu Egipci de Barcelona, Spain
| | - Ivan Díez-Santacoloma
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Jose Méndez-López
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona; and Hand Unit, M.C. Mutual, Barcelona, Spain
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Pomeranz SJ, Salazar P. Scapholunate advanced collapse. J Surg Orthop Adv 2015; 24:140-143. [PMID: 25988698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This case study reviews the pathophysiology of scapholunate advanced collapse (SLAC), which is the most common etiology of degenerative arthritis in the wrist. The scapholunate ligament serves a critical role in stability of the carpus. Disruption of the scapholunate ligament, its sequela, and the magnetic resonance imaging evaluation are discussed, with review of the defining features of this disease and its progression.
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Affiliation(s)
- Stephen J Pomeranz
- ProScan Imaging, LLC, Cincinnati, Ohio; Department of Radiology, University of Louisville, Louisville, Kentucky; Department of Radiology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio; Saint George Children's Hospital, Puerto Rico; and World Care Clinical Research, Boston, Massachusetts.
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