Cases reported "Joint Diseases"

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1/65. Synovial actinomycosis of the hip: case report and review.

    A case of hematogenous spread of an actinomycotic granule to the left hip joint is presented. This occurred in a 62-year-old woman under immunosuppressive treatment for Wegener's disease. It was a chance finding on routine synovium biopsy during a total hip replacement. Treatment consisted of 1 g ampicillin I.M. a day for six weeks. The postoperative course was uneventful.
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ranking = 1
keywords = operative
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2/65. Arthroscopic capsular release for contracture of the wrist: a new technique.

    SUMMARY: Stiffness of the wrist can occur following trauma or surgery. In some patients, loss of motion may be refractory to conservative treatment and operative treatment may thus be indicated. The authors report the results and technique of arthroscopic capsular release of the wrist. A cadaveric study was performed to assess the safety of arthroscopic capsular release. Arthroscopic capsular release was performed on 2 patients with limited wrist mobility. The average distance from the radiocarpal joint capsule to the neurovascular structures were 6.9 mm to the median nerve, 6.7 mm to the ulnar nerve and 5.2 mm to the radial artery. At 6 months follow-up, the average range of motion had improved from 17 degrees flexion and 10 degrees extension to 47 degrees flexion and 50 degrees extension. The average grip strength had improved from 13 to 31 kg. pain measured on a visual analogue score (0-10) had improved from 1.5 to 1.0. There were no complications. Arthroscopic capsular release of the wrist is a safe and minimally invasive technique that provides good improvement to range of motion.
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ranking = 1
keywords = operative
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3/65. Arthroscopic treatment of an intra-articular lipoma of the knee joint.

    Intra-articular lipoma is an exceedingly rare diagnosis. There have been less than 15 documented cases of an intra-articular lipoma of the knee joint. This report presents the first description of an intra-articular knee lipoma treated entirely by arthroscopic methods. Preoperative history, examination, and imaging studies are reviewed. Intraoperative findings, treatment, and postoperative evaluation are discussed as well. Symptomatic intra-articular lipoma of the knee joint can be successfully treated by arthroscopic resection. Differentiating intra-articular lipoma from lipoma arborescens, a similar but more common condition, is important with regards to optimal treatment.
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ranking = 3
keywords = operative
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4/65. Chondrolysis and joint destruction secondary to snake envenomation.

    Although snakebite injuries to the hand are common, intra-articular envenomation has rarely been reported. In this article, we describe a patient who was bitten by a rattlesnake and whose left-index-finger distal interphalangeal joint sustained intra-articular envenomation that resulted in aseptic chondrolysis and severe joint destruction 1.5 years later. Multiple cultures and biopsies were negative, and histology was consistent with nonspecific degenerative changes secondary to necrosis of the articular cartilage from retained toxins. The patient chose arthrodesis; 24 months postoperatively, he was pain-free and had returned to work.
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ranking = 1
keywords = operative
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5/65. Arthroscopic diagnosis and management of ochronotic arthropathy of the knee.

    Ochronotic arthropathy is a progressive joint disorder resulting from the deposition of a derivative of homogentisic acid into connective tissues, especially meniscal and articular cartilage. patients may present with symptoms, physical examination results, and radiographic changes consistent with degenerative joint disease. We present a case in which an operative arthroscopy of the knee was highly suggestive of ochronotic arthropathy. The definitive diagnosis of ochronosis was subsequently confirmed by laboratory and pathologic evaluation.
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ranking = 1
keywords = operative
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6/65. Proximal interphalangeal joint surface replacement arthroplasty.

    A consecutive series of 20 joints in 13 patients underwent arthroplasty with the RMS PIP joint surface replacement implant. Twelve joints were treated for painful osteoarthritis (all females). Two joints were implanted for rheumatoid arthritis, two for post-traumatic pain and stiffness, two for post-traumatic stiffness and one each for post-traumatic pain and pain-free post-traumatic instability. Excellent, often total long-term pain relief was obtained in 18 joints. The other two patients with (compensible work-related) post-traumatic pain and stiffness reported "50-70% pain reduction". No patients lost movement and 14 out of 20 joints were pain-free with a 73.1 degrees average arc of motion. Six joints from the first half of the series had poor motion (average arc of 19.6 degrees ), even after open extensor tenolysis or manipulation under anaesthesia. As experience was gained, reliably better results were achieved with a more intensive regimen of hand therapy, particularly within the first post-operative week.
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ranking = 1
keywords = operative
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7/65. Synovial hemangioma in Hoffa's fat pad (case report).

    A 15-year-old girl presented with anterolateral knee pain for 6 months. There were tenderness and pain at the anterolateral triangulation of the knee joint. magnetic resonance imaging revealed a tumor in the anterolateral corner of the knee joint. arthroscopy did not show the tumor because it was located in fat pad. The tumor was found during fat pad shaving and was resected arthroscopically. Synovial hemangioma was demonstrated histologically. The patient is asymptomatic postoperatively.
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ranking = 1
keywords = operative
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8/65. Deep soft-tissue leiomyoma of the popliteal fossa in a 14-year-old girl.

    This is the first case report of a deep soft-tissue leiomyoma with intraarticular localization within the knee joint. A 14-year-old girl presented with a painless mass in the dorsal aspect of her knee which she had noticed some 9 months earlier. While on plain radiographs no bony lesions were visible, magnetic resonance imaging (MRI) revealed an intraarticularly located tumor with well-defined margins. Intraoperatively, the tumor was found adjacent to the posterior cruciate ligament. The final diagnosis was established immunohistologically. Although this is a very rare tumor, it has to be considered in the differential diagnosis for soft-tissue swellings of the popliteal fossa.
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ranking = 1
keywords = operative
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9/65. Coxa saltans externa treated with Z-plasty of the iliotibial tract in a military population.

    Coxa saltans, or snapping hip, can be attributable to a number of causes. Coxa saltans externa typically occurs when the thickened portion of the iliotibial band snaps over the greater trochanter as the hip is flexed. This condition generally resolves with a course of nonoperative treatment. We have treated three patients with Z-plasty of the iliotibial band, which has the highest published success rate in the English language literature. Only one of three patients was able to return to full activities postoperatively. In our small series, this method of surgical treatment in an active duty military population yielded less than optimal results.
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ranking = 2
keywords = operative
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10/65. Synovial hemangioma of the knee in young children.

    Synovial hemangiomas are relatively rare tumors. Clinicians are inclined to delay treatment in most cases. We encountered three cases, in which there was a delay before the patients were operated on. During the relatively long-term postoperative follow up, none of the three cases showed a recurrence of either hemoarthrosis or knee pain. However, limitations in motion or osteoarthritic changes in the affected knee joint remained. We therefore consider that synovial hemangiomas of the knee, even if found in young children, could possibly result in postoperative limitations in motion or osteoarthritic changes.
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ranking = 2
keywords = operative
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