1/22. synovitis of small joints: sonographic guided diagnostic and therapeutic approach.OBJECTIVE: The aim of this pictorial essay is to describe the sonographic guided approach to investigation and local injection therapy of a small joint in a patient with psoriatic arthritis (PA). methods: Sonographic pictures are obtained using a high frequency ultrasonography apparatus equipped with a 13-MHz transducer. RESULTS: ultrasonography allows a careful morphostructural assessment of soft tissue involvement in PA patients. Sonographic findings include joint cavity widening, capsular thickening, synovial proliferation, synovial fluid changes, tendon sheath widening. Ultrasound guided placement of the needle within the joint and injection of corticosteroid under sonographic control can be easily performed. CONCLUSIONS: High frequency ultrasonography is a quick and safe procedure that allows a useful diagnostic and therapeutic approach in patients with arthritis of small joints.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/22. diagnostic imaging of pigmented villonodular synovitis of the temporomandibular joint associated with condylar expansion.Pigmented villonodular synovitis (PVNS) is a rare lesion of the temporomandibular joint. We report a case which was initially misdiagnosed as a parotid tumor. CT revealed a well-defined mass demonstrating higher attenuation than the adjacent soft tissue with marked expansion of the mandibular condyle. MRI clearly delineated the extent of the lesion which had very low signal intensity on both T1W and T2W sequences due to the effect of hemosiderin. The usefulness of these imaging procedures in diagnosis of PVNS is discussed.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
3/22. Sea urchin puncture resulting in PIP joint synovial arthritis: case report and MRI study.Of the 600 species of sea urchins, approximately 80 may be venomous to humans. The long spined or black sea urchin, Diadema setosum may cause damage by the breaking off of its brittle spines after they penetrate the skin. synovitis followed by arthritis may be an unusual but apparently not a rare sequel to such injury, when implantation occurs near a joint. In this case report, osseous changes were not seen by plain x-rays. magnetic resonance imaging (MRI) was used to expose the more salient features of both soft tissue and bone changes of black sea urchin puncture injury 30 months after penetration. In all likelihood, this type of injury may be more common than the existing literature at present suggests. It is believed to be the first reported case in this part of the world as well as the first MRI study describing this type of joint pathology. Local and systemic reactions to puncture injuries from sea urchin spines have been described previously. These may range from mild, local irritation lasting a few days to granuloma formation, infection and on occasions systemic illness. The sea urchin spines are composed of calcium carbonate with proteinaceous covering. The covering tends to cause immune reactions of variable presentation. There are only a handful of reported cases with sea urchin stings on record, none of them from the Red Sea. However, this condition is probably more common than is thought and can present difficulty in diagnosis. In this case report, the inflammation responded well to heat treatment, mobilization and manipulation of the joint in its post acute and chronic stages. As some subtle changes in soft tissues and the changes in bone were not seen either on plain x-rays or ultrasound scan, gadolinium-enhanced MRI was used to unveil the marked changes in the joint.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
4/22. Snapping knee caused by intra-articular tumors.Locking of the knee can present with no history of antecedent injury. We identified impingement of intra-articular tumors in 2 cases. Intra-articular tumors are relatively rare. Mechanical symptoms were present in both cases. On physical examination, there was a palpable mass at the medial region of the patellofemoral joint. The interior had been replaced mainly by amorphous necrotic tissue. The definite diagnosis of a soft-tissue mass of the knee could not be made on histologic examination.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
5/22. Posterior approach for arthroscopic treatment of posterolateral impingement syndrome of the ankle in a top-level field hockey player.A case history of a 25-year-old field hockey player, a member of the German National Field hockey Team, is presented. The patient could not remember any specific ankle injury, but since the World Indoor Championship in February 2003, he experienced significant but diffuse pain around the posterior ankle, especially while loading the forefoot in hockey training and competition. For 2 months, the patient was unable to run. Conservative treatment failed, and surgery was performed. Posterior ankle arthroscopy revealed a frayed posterior intermalleolar ligament and meniscoid-like scar tissue at the posterolateral ankle, indicating a posterolateral soft tissue ankle impingement syndrome. A concomitant inflammation of the posterolateral ankle and subtalar synovium was present. After arthroscopic resection and early functional aftertreatment, the patient returned to full high-level sports ability within 2 months.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
6/22. Mycobacterial synovitis caused by slow-growing nonchromogenic species: eighteen cases and a review of the literature.CONTEXT: Slow-growing nonchromogenic mycobacterial species are an infrequent cause of soft tissue infection. Because these organisms are rare, they are not often initially considered in the differential diagnosis of synovitis. OBJECTIVE: To evaluate the clinical and pathologic characteristics of patients with synovitis resulting from slow-growing nonchromogenic mycobacterial species. DESIGN: A 20-year retrospective review of records from The Methodist Hospital microbiology Laboratory identified 18 culture-positive cases of synovitis that resulted from slow-growing nonchromogenic mycobacteria, including 14 caused by mycobacterium avium complex, 1 caused by Mycobacterium malmoense, 1 caused by mycobacterium haemophilum, and 2 caused by Mycobacterium nonchromogenicum isolates. In addition, a comprehensive literature search revealed an additional 48 cases of synovitis caused by slow-growing nonchromogenic mycobacteria. RESULTS: The historic literature described the majority of the 48 patients as previously healthy, elderly individuals with a several-month history of monoarticular pain and swelling in the small joints of the upper extremity. In contrast, the current series demonstrated the probable role of multiple chronic coexisting medical conditions in promoting disease susceptibility. These patients were also unique in their significantly younger age distribution and diversity of infection sites. Histologic examination and direct acid-fast bacteria stains generally did not aid the diagnosis. amputation was performed in 2 patients because of delayed identification of disease. CONCLUSIONS: The current series demonstrates that difficult identification and infrequent occurrence cause these organisms to be overlooked by physicians and laboratory personnel. A heightened clinical suspicion for slow-growing nonchromogenic mycobacterial species is necessary when routine culture and histopathologic findings do not readily isolate an organism, or when the patient does not respond to antibiotic and anti-inflammatory treatment.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
7/22. Staphylococcal septic synovitis of the sternoclavicular joint with retrosternal extension.Bacterial arthritis of the sternoclavicular joint is an uncommon disorder caused by a variety of microorganisms. Both Gram-positive and gram-negative bacteria have been identified as etiologies of an acute suppurative arthritis, whereas a few other bacteria such as mycobacteria and treponemes have been incriminated in chronic disease of the sternoclavicular joint. We recently treated a patient with staphylococcal synovitis of the sternoclavicular joint, which is the 24th recorded in the literature. His illness was complicated by a retrosternal abscess, soft tissue abscess of the chest, septic bursitis, and lumbosacral discitis. He recovered after 6 weeks of nafcillin therapy without any residual infection. Six previous patients with extension into the substernal space and mediastinum have been described. Staphylococcal infection of the sternoclavicular joint, although usually confined to the joint, can be associated with sepsis and metastatic abscess formation as well as substernal extension even in immunocompetent individuals.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
8/22. Case report 590: Diffuse pigmented villonodular synovitis with a cartilaginous component.The authors present the case of a patient 54 years of age who developed well-defined osteolysis in the distal end of the humerus, with a slight radiodensity in the soft tissue. The radionuclide scintigram and above all the CT, were useful in defining the characteristics and expansion of the mass more precisely. Surgical intervention and histological examination demonstrated a seemingly unique case of PVNS of the elbow with diffuse cartilaginous components and erosion of the distal end of the humerus. The pathological findings in this unusual case, actually suggested the possibility of an intermediate form of PVNS associated with synovial chondromatosis.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
9/22. synovitis in angioimmunoblastic lymphadenopathy with dysproteinemia simulating rheumatoid arthritis.We describe a patient with angioimmunoblastic lymphadenopathy with dysproteinemia who developed a symmetric, rheumatoid-like, peripheral polyarthritis. Radiographs of the involved joints revealed soft tissue swelling without erosions or cartilage loss. rheumatoid factor and fluorescent antinuclear antibodies were negative, and c-reactive protein and erythrocyte sedimentation rate were normal. synovial fluid analysis showed an inflammatory effusion (white blood cell count of 3,500/mm3, with 76% polymorphonuclear leukocytes). A closed synovial biopsy of the wrist revealed a mononuclear infiltrate consistent with angioimmunoblastic lymphadenopathy with dysproteinemia. Monthly parenteral chemotherapy treatment with high-dose methyl-prednisolone and cyclophosphamide resulted in remission of all manifestations of disease, including arthritis.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
10/22. Pigmented villonodular synovitis of the talus in a child.An unusual case of localized pigmented villonodular synovitis of the ankle joint in a 3-year-old boy is described. The child was brought to the hospital because of abrupt onset of pain and joint effusion. A soft tissue mass eroding the talar dome was seen in roentgenograms. Exact diagnosis was established by excisional biopsy. curettage of the lesion resulted in healing without recurrence at 10-year follow-up examination.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
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