| We describe a patient whose prepatellar bursa was infected with sporothrix schenckii. The infection persisted despite itraconazole therapy and cure was achieved only after surgical excision of the bursa. A review of treatments for bursal sporotrichosis is presented. ( info) |
12/198. Variation among giant rice bodies: report of four cases and their clinicopathological features. OBJECTIVE: To report four cases of rice bodies (RBs) showing remarkable size variations and discuss their pathogenesis. DESIGN AND patients: Based on analysis of the clinical data, we speculate on the pathogenesis of RBs using immunohistochemical and ultrastructural methods. The patients comprised three men and one woman, three with RBs in the subacromial bursae and one in the wrist synovial sheath, aged 28 (woman), 44, 50 and 81 (wrist) years, respectively. RESULTS: There were no particular differences in clinical data among the patients. T2-weighted MR imaging was very useful for diagnosis of the RBs, allowing their clear delineation from the bursal fluid. The RBs consisted of a layered protein- aceous substance with vague targetoid cut surfaces. Much fibrin and a lesser amount of collagen fibers were recognized together with various mononuclear cells, which were few in number and predominantly T cells. The bursae and synovial sheath had multiple fibrinoid spheroids at the luminal surface. CONCLUSION: Fibrinoid nodular deposits probably became detached, forming the nuclei of RBs and growing to a giant RB 65 mm in diameter. ( info) |
13/198. Scapular osteochondroma with reactive bursitis presenting as a chest wall tumour. A 32-year-old male presented with a painful, rapidly enlarging chest wall mass. A malignant chest wall neoplasm was suspected. A CT scan was performed which showed a mass extending from under the scapular and an exostosis arising from the anterior surface of the scapular. The mass and exostosis were resected resulting in complete resolution of symptoms. Histological examination showed the mass to be a reactive bursa, with no evidence of neoplasia. ( info) |
14/198. End-range mobilization techniques in adhesive capsulitis of the shoulder joint: A multiple-subject case report. BACKGROUND AND PURPOSE: The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis. CASE DESCRIPTION: Four men and 3 women (mean age=50.2 years, SD=6.0, range=41-65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range=3-12) were treated with end-range mobilization techniques, twice a week for 3 months. indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment. OUTCOMES: After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=70-120) to 151 degrees (SD=22, range=110-170), mean flexion in the sagittal plane increased from 113 degrees (SD=17, range=90-145) to 147 degrees (SD=18, range=115-175), and mean lateral rotation increased from 13 degrees (SD=13, range=0-40) to 31 degrees (SD=11, range=15-50). There were also increases in passive range of motion: Mean abduction increased from 96 degrees (SD=18, range=70-125) to 159 degrees (SD=24, range 110-180), mean flexion in the sagittal plane increased from 120 degrees (SD=16, range=95-145) to 154 degrees (SD=19, range=120-180), and mean lateral rotation increased from 21 degrees (SD=11, range=10-45) to 41 degrees (SD=8, range=35-55). The mean capacity of the glenohumeral joint capsule (its ability to contain fluid) increased from 10 cc (SD=3, range=6-15) to 15 cc (SD=3, range=10-20). Four patients rated their improvement in shoulder function as excellent, 2 patients rated it as good, and 1 patient rated it as moderate. All patients maintained their gain in joint mobility at the 9-month follow-up. DISCUSSION: There seems to be a role for intensive mobilization techniques in the treatment of adhesive capsulitis. Controlled studies regarding the effectiveness of end-range mobilization techniques in the treatment of adhesive capsulitis are warranted. ( info) |
15/198. Inflamed retrocalcaneal bursa and Achilles tendonitis in psoriatic arthritis demonstrated by ultrasonography. OBJECTIVE: To demonstrate the use of high resolution ultrasound measurements and power Doppler mode in the diagnosis and follow up of a patient with psoriatic arthritic with retrocalcaneal bursitis and Achilles tendonitis. methods: An outpatient based ATL HDI 3000 ultrasound equipment was used with a CL10-5 MHZ 26 mm probe and musculoskeletal software. Real time B mode and power Doppler mode were used to detect changes in structure and blood flow. RESULTS: Unilateral retrocalcaneal bursitis and Achilles tendonitis were demonstrated by sonography. Power Doppler mode was useful to demonstrate an increased blood flow around an abnormal retrocalcaneal bursa. A follow up examination showed marginal thickening of the achilles tendon without any bursitis. CONCLUSIONS: ultrasonography is an objective method in the confirmation of clinical diagnosis after physical examination. During the examination it is possible to gain not only qualitative but also quantitative data. A comparative study with quantitative data is possible in longitudinal studies. ( info) |
16/198. Adhesive capsulitis of shoulder and treatment with protease inhibitors in patients with human immunodeficiency virus infection: report of 8 cases. OBJECTIVE: To describe our experience with human immunodeficiency virus (HIV) infected patients receiving protease inhibitor therapy who presented with adhesive capsulitis of the shoulder. methods: Between July 1996 and December 1999, 8 HIV-infected patients (7 male) treated with protease inhibitors who presented with adhesive capsulitis of the shoulder were retrospectively identified. diagnosis of adhesive capsulitis relied on clinical features including shoulder pain and both active and passive restricted range of motion (ROM). All available clinical and radiographic data were reviewed. RESULTS: Onset of symptoms was insidious, and at presentation, patients complained of shoulder pain, which was bilateral in 4 of the 8 cases. physical examination showed global restriction of active and passive ROM of the glenohumeral joint. The mean delay between initiation of hiv protease inhibitors and onset of shoulder pain was 14 months (range 2 to 36). The protease inhibitor therapy always included indinavir. No underlying condition associated with secondary adhesive capsulitis of the shoulder, including shoulder trauma, diabetes mellitus, thyroid disease, pulmonary or cardiac diseases could be identified. In all 8 patients, despite continuation of therapy with indinavir, both shoulder pain and restricted ROM completely resolved, after a mean disease course of 7.4 months. CONCLUSION: Adhesive capsulitis of shoulder seems to be a new adverse event of HIV protease inhibitor therapy. In all reported cases, patients were treated with indinavir. Further observations will be necessary to confirm adhesive capsulitis as a side effect. ( info) |
17/198. bursitis due to Mycobacterium goodii, a recently described, rapidly growing mycobacterium. We report a case of olecranon bursitis due to Mycobacterium goodii in a 60-year-old man. Prior to recognition of his infection, he received intrabursal steroids and underwent olecranon bursectomy. His infection was cured with antimicrobial therapy consisting of doxycycline and ciprofloxacin. This case illustrates that previously unrecognized members of the mycobacterium smegmatis group of mycobacteria have pathogenic potential. ( info) |
18/198. Pediatric septic bursitis: case report of retrocalcaneal infection and review of the literature. Septic bursitis in children is rarely discussed in the medical literature. This review summarizes the clinical manifestations and management of 10 cases of septic bursitis involving patients aged <16 years. In every case in this series, acute trauma was the predisposing condition. Group A streptococci were frequently isolated from the infected bursa. Septic bursitis, an underappreciated infection in children, should be considered in the differential diagnosis of common childhood conditions. ( info) |
19/198. Physical therapy for spinal accessory nerve injury complicated by adhesive capsulitis. BACKGROUND AND PURPOSE: The authors found no literature describing adhesive capsulitis as a consequence of spinal accessory nerve injury and no exercise program or protocol for patients with spinal accessory nerve injury. The purpose of this case report is to describe the management of a patient with adhesive capsulitis and spinal accessory nerve injury following a carotid endarterectomy. CASE DESCRIPTION: The patient was a 67-year-old woman referred for physical therapy following manipulation of the left shoulder and a diagnosis of adhesive capsulitis by her orthopedist. Spinal accessory nerve injury was identified during the initial physical therapy examination, and a program of neuromuscular electrical stimulation was initiated. OUTCOMES: The patient had almost full restoration of the involved muscle function after 5 months of physical therapy. DISCUSSION: This case report illustrates the importance of accurate diagnosis and suggests physical therapy intervention to manage adhesive capsulitis as a consequence of spinal accessory nerve injury. ( info) |
20/198. Intermetatarsophalangeal bursitis induced by a plantar epidermal cyst. A 44-year-old woman was admitted to the authors' institution for evaluation of two masses in the right forefoot. Standard radiographs showed foci of calcification within the mass. magnetic resonance imaging and macroscopic findings during surgery revealed the lesion was composed mainly of two different portions: dorsal cystic masses and a solid mass in the plantar side of the fifth metatarsal head. Histologic and immunohistochemical examinations showed that the former was an intermetatarsophalangeal bursitis induced by keratinous material, whereas the latter was a ruptured epidermal cyst. To the best of the authors' knowledge, the current case is the first report of intermetatarsophalangeal bursitis caused by an untreated epidermal cyst. ( info) |