| BACKGROUND: mycobacterium marinum infections have been reported for over 50 years, mostly in association with trauma in the setting of water exposure. OBJECTIVE: The differential diagnosis for nodules in a sporotrichoid distribution with simultaneous bursitis is discussed. mycobacterium marinum treatment regimens for skin and joint involvement are reviewed. methods: mycobacterium marinum was identified by skin tissue culture with Lowenstein-Jensen medium at 32 degrees C. Histopathologic findings support mycobacterial infection. RESULTS: bursitis and nodules resolved in the first 2 months of a 6-month course of minocycline treatment. CONCLUSION: bursitis is an extremely rare but significant complication of M. marinum. ( info) |
2/198. Multiple rheumatoid bursitis with migrating chylous cysts. Report of a case in a European woman and review of the literature. We report a case of recurrent multiple bursitis (19 episodes at nine sites) requiring seven surgical procedures in a European women with a 38-year history of severe, nodular, destructive seropositive rheumatoid arthritis unresponsive to second-line drugs. The episodes of bursitis were not correlated with activity of the joint disease. Some cysts migrated over a considerable distance. At least two cysts contained chylous fluid. The histologic study of one cyst demonstrated a cholesterol crystal granuloma. Potential relationships linking cholesterol crystals, chylous cysts, and migrating multiple bursitis are discussed. The relevant literature is reviewed. ( info) |
3/198. Large bursa formation associated with osteochondroma of the scapula: a case report and review of the literature. bursitis or large bursa formation associated with osteochondroma has rarely been reported. A 33-year-old male presented with upper back pain, a rapidly developing mass beside the lateral border of his right scapula and snapping elicited by movement of the scapula. Plain radiograms and CT revealed osteochondroma on the ventral surface of the scapula without any unmineralized component and a huge cystic lesion around the osteochondroma. Aspiration of the cystic lesion showed the presence of sero-sanguineous fluid. MRI following the aspiration showed a thin cartilaginous cap with distinct outer margin and no soft tissue mass around the cap. Pathological examinations confirmed the diagnosis of osteochondroma with the large bursa formation. Clinical examination 19 months postoperatively showed an uneventful clinical course. ( info) |
4/198. MRI-induced retrocalcaneal bursitis. This case report describes a patient with acute retrocalcaneal bursitis, which developed after MRI examination of the ankle. The sagittal T2*-weighted gradient echo sequence revealed an extensive susceptibility artifact in the area surrounding the achilles tendon near its insertion at the os calcis. This artifact was caused by postsurgical metallic particles. We postulate that these particles were mechanically stimulated by the magnetic field and induced the inflammatory response. ( info) |
5/198. Adhesive capsulitis of the glenohumeral joint with an unusual neuropathic presentation: a case report. A 37-yr-old woman presented with a 7-mo history of unilateral shoulder girdle stiffness, pain, and weakness and had already been diagnosed with frozen shoulder. physical examination revealed scapular winging and suspicious focal paralysis of shoulder girdle muscles. Subsequently, electrodiagnostic studies reported denervation of deltoid, infraspinatus, serratus anterior, and lower cervical paraspinal muscles, in addition to a prolonged long thoracic nerve latency. The history, physical examination, and cervical magnetic resonance imaging scan seemed most consistent with neuralgic amyotrophy, although the electrodiagnostic examination could be interpreted as cervical radiculopathy. Some of the difficulties in identifying neuralgic amyotrophy and distinguishing it from cervical radiculopathy are discussed herein. Historically, frozen shoulder has seemed to develop as a complication of the neuropathic process. Both neuralgic amyotrophy and frozen shoulder have a poorly understood pathogenesis, and their combined presence is presumed to be rare. Because of difficulties inherent in the physical examination of frozen shoulder, a coexistent neuropathic process may go undetected. ( info) |
| Pain over the lateral aspect of the hip commonly is attributed to trochanteric bursitis. Typical findings include local tenderness and weakness of hip abduction. When conservative measures fail to relieve symptoms, surgical release of the iliotibial band over the greater trochanter has been recommended. In the management of seven such patients, an unusual finding was encountered: partial tear of the gluteus medius tendon at its attachment to the greater trochanter. Each patient presented with increasing hip pain of duration of months to years. There were no diagnostic findings on physical examination. magnetic resonance imaging showed an abnormal signal within the tendon of gluteus medius and fluid within the trochanteric bursa. The disrupted tendons were reattached to bone with heavy nonabsorbable suture. At a median followup of 45 months (range, 21-60 months), all patients were free of pain. ( info) |
7/198. Malleolar bursitis in figure skaters. Indications for operative and nonoperative treatment. Figure skaters are unique athletes who must train for extended periods of time performing motions and routines that create excessive compressive and shear forces between their malleoli and boots. As a result, they are susceptible to the development of a painful adventitious malleolar bursitis. Most often these patients will relate a recent increase in their training schedule or the purchase of a new pair of skating boots. This condition usually responds favorably to nonoperative measures including stretching of the boot over the affected area and protective padding placed around the inflamed bursa. If the swelling is marked, then an aspiration, subsequent injection with cortisone, and a compressive wrap may be indicated. This treatment regimen will enable the majority of figure skaters to continue skating. If the symptoms continue or increase despite nonoperative measures, then cessation of skating for a brief period must be considered. If this is not a viable option for the skater, surgical excision of the bursa may be warranted. If septic bursitis occurs, immediate surgical debridement and intravenous antibiotics are indicated. A Staphyloccocus aureus organism is most often responsible and should be treated with appropriate antibiotics. These patients may return to skating when there is no sign of further infection, the soft tissues have fully healed, and there is no sign of residual inflammatory bursa, usually at 4 to 6 weeks after surgery. ( info) |
8/198. Clinical and pharmacological aspects of accidental triamcinolone acetonide overdosage: a case study. Local administration of corticosteroids for rheumatic diseases have had a long history of effective and well-tolerated use. We report here the pharmacodynamics and pharmacokinetics of an accidental triamcinolone acetonide (TCA) overdose. The presented patient was treated with 200 mg TCA and developed Cushing's syndrome 6 weeks later (cortisol and ACTH concentrations were below limits of detection, TCA concentrations were > 3 micrograms/l). Because of her severe symptoms, mifepristone was administered for a period of 19 days. Cortisol concentrations became detectable 2 days after initiation of mifepristone treatment and persisted, being detectable for a period of at least a week after cessation of the drug. Twenty days after cessation, cortisol concentrations were undetectable again. Cushing's syndrome persisted more than 6 months while TCA concentrations remained detectable for at least 80 days. Based on plasma TCA concentrations in our patient, we calculated a terminal half-life of TCA of 33 days as opposed to 5 days observed after intra-articular administration of a therapeutic dose of 40 mg TCA. We conclude that after an accidental overdose in this patient, body TCA disappearance was strongly prolonged due to a very slow (absorption) half-life of the drug in comparison to a therapeutic dose. This finding is explained by a 'flap-flop phenomenon' where drug absorption is the rate-limiting step of overall drug disposition. Caution is, therefore, needed to prevent undesired accumulation of TCA that may lead to protracted Cushing's syndrome. ( info) |
9/198. Fibro-fatty nodules and low back pain. The back mouse masquerade. BACKGROUND: Few useful interventions exist for patients with persistent low back pain. We suggest that a fibro-fatty nodule ("back mouse") may be an identifiable and treatable cause of this and other types of pain. methods: We describe 2 patients with painful nodules in the lower back and lateral iliac crest areas. In both cases, the signs and symptoms were unusual and presented at locations distant from the nodule. One patient complained of severe acute lower abdominal pain, and the other had been treated for chronic recurrent trochanteric bursitis for several years. RESULTS: In both patients, symptoms appeared to be relieved by multiple injection of the nodule. DISCUSSION: There is agreement that back mice exist. Referred pain from the nodules might explain the distant symptoms and signs in these cases. Multiple puncture may be an effective treatment because it lessens the tension of a fibro-fatty nodule. CONCLUSIONS: Randomized trials on this subject are needed. In the meantime, physicians should keep back mice in mind when presented with atypical and unaccountable symptoms in the lower abdomen, inguinal region, or legs. ( info) |
10/198. Adhesive capsulitis of the hip after bilateral adhesive capsulitis of the shoulder. Adhesive capsulitis of the hip is a not a common clinical presentation. We report a case of adhesive capsulitis of the hip in a patient with hypothyroidism and previous adhesive capsulitis of the shoulder who was receiving thyroid-hormone replacement. The adhesive capsulitis of both hip and shoulder were treated successfully with physical therapy. Orthopedic surgeons should be aware of this diagnosis and its association with shoulder adhesive capsulitis and thyroid dysfunction, to allow them to recognize it and intervene early. ( info) |