RESUMO
PURPOSE: The reported incidence of postoperative complications after distal biceps tendon repairs (DBTRs) has been determined largely by retrospective studies. We hypothesized that a large prospective cohort study of DBTRs would demonstrate increased complication rates relative to existing literature values. Secondarily, we hypothesized that most complications would be transient and self-limiting, regardless of the surgical technique employed for the repair. METHODS: Consecutive patients undergoing acute, primary DBTR from July 2016 to December 2017 were enrolled. The repair technique, postoperative protocol, and follow-up intervals were determined by the individual surgeons' protocols. Demographic information, surgical data, and complications were tabulated prospectively. Exclusion criteria included chronic DBTRs, secondary DBTRs requiring allograft, DBTRs of partial tears, and postoperative follow-up of less than 12 weeks. We included 212 repairs performed by 37 orthopedic surgeons in 3 different subspecialties. RESULTS: Sixty-five patients (30.7%) had 73 complications. Fifty patients (44.6%) in the 1-incision group experienced complications compared with 15 (15.0%) in the 2-incision group. Sixty patients (28.3%) developed a minor complication. Fifty-seven patients (26.9%) had sensory neurapraxias, 47 after a 1-incision procedure and 10 after a 2-incision procedure, a statistically significant difference. Of the patients with neurapraxias, 94.7% were resolved or improving at the time of the latest follow-up. Five patients (2.4%) developed a major complication, defined as a return to the operating room in the postoperative period due to deep infection or rerupture. CONCLUSIONS: The complication rate after DBTR appears to be higher than 2 other retrospective studies and is predominantly in the form of transient neurapraxias. This study confirms that there is a higher complication rate in 1-incision techniques as compared with 2-incision techniques. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
Assuntos
Traumatismos do Antebraço/cirurgia , Complicações Pós-Operatórias/etiologia , Traumatismos dos Tendões/cirurgia , Adulto , Idoso , Bursite/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/etiologia , Parestesia/etiologia , Estudos Prospectivos , Reoperação/estatística & dados numéricosRESUMO
La bursitis olecraniana es un problema relativamente frecuente que se presenta en los servicios de emergencia. Un tercio de los casos están vinculados a procesos sépticos. Los otros dos tercios están vinculados a bursitis del olécranon no séptica, que incluye los casos traumáticos e idiopáticos. Otros casos, ocasionalmente, están relacionados con la artritis reumatoide o gota. El diagnóstico clínico puede ser difícil, y frecuentemente no son diagnosticados; el tratamiento de primera elección son los antinflamatorios pero muchas veces estos conducen a un retraso en el diagnóstico. Cuando los casos son de etiología séptica se pueden tratar con incisión, drenaje y uso de antibióticos. Es propósito de este trabajo valorar las opciones diagnósticas y de tratamiento, que permitan un mejor manejo de esta afección en los servicios de emergencia(AU)
Olecranial bursitis is a relatively frequent problem that come to emergency services. One-third of the cases are linked to septic processes. The other two thirds are linked to non-septic olecranon bursitis, which includes traumatic and idiopathic cases. Other cases, occasionally, are related to rheumatoid arthritis or gout. The clinical diagnosis turns difficult, it is not frequently diagnosed; anti-inflammatory drugs is the first choice of treatment, but these often lead to a delay in diagnosis. Cases of septic etiology can be treated with incision, drainage and use of antibiotics. The purpose of this study is to assess the diagnostic and treatment options that allow better management of this condition in the emergency services(AU)
La bursite olécranienne est un problème relativement nouveau aux services d'urgence. Un tiers des cas est associé à des processus infectieux. Les deux tiers restants sont associés à la bursite d'origine non-infectieuse, comprenant les cas traumatiques et idiopathiques. D'autres cas sont parfois associés à l'arthrite rhumatoïde ou goutte. Leur diagnostic clinique peut être difficile, de sorte qu'ils sont fréquemment mal diagnostiqués. Le traitement de choix sont les antiinflammatoires, mais d'habitude ils conduisent au retard du diagnostic. Lorsque les cas sont d'origine infectieuse, ils peuvent être traités par incision, drainage et antibiotiques. Le but de ce travail est d'évaluer les options diagnostiques et thérapeutiques permettant une meilleure prise en charge de cette affection aux services d'urgence(AU)
Assuntos
Humanos , Bursite/diagnóstico , Bursite/etiologia , Cotovelo/anatomia & histologia , Bursite/terapia , Bursite/epidemiologiaRESUMO
OBJECTIVE: To describe chronic chikungunya manifestations seen during the outbreak in the Caribbean from December 2013 to January 2015. METHODS: Patients were seen at our center, the only rheumatology department in Martinique Island, and were examined by a senior rheumatologist using a standard care report form. Chikungunya was diagnosed collectively based on consensus among all clinicians. The median time from onset of acute chikungunya to the first rheumatology consultation was calculated, severity was evaluated based on clinical scales and the degree of joint destruction, and each patient's treatment was recorded. RESULTS: For the 147 patients analyzed, the median time between onset of acute chikungunya and the first rheumatology consultation was 8 months. After review of each patient's medical record, 19 (12.9%) were diagnosed as having epidemic-influenced chikungunya. Four distinct rheumatologic patterns were observed in the remaining patients (those with compatible history and positive serologic findings): 47 patients (32%) had reactivation of painful chronic mechanical manifestations, 9 patients (6.1%) had fibromyalgia, 45 patients (30.6%) met criteria for spondyloarthritis (as evaluated before the chikungunya virus infection in all patients) and experienced a flare, and 27 patients (18.4%), with no history of joint disease, developed de novo bilateral symmetric chronic inflammatory joint disease in response to chikungunya virus infection. For inflammatory arthritis, most patients were treated with methotrexate (up to 25 mg/week), with good response and tolerance. Thirteen patients were treated with conventional doses of anti-tumor necrosis factor agents, with good tolerance and efficacy as expected. CONCLUSION: The term "chronic chikungunya syndrome" covers multiple etiologies. Compliance with the French Society of Rheumatology recommendations, careful recording of patient histories, and serologic verification help prevent errors inherent to the epidemic context and ensure early therapeutic intervention for these patients. To avoid late initiation of treatment, patients should receive rheumatologic consultation as early as possible.
Assuntos
Febre de Chikungunya/fisiopatologia , Doenças Reumáticas/fisiopatologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/uso terapêutico , Artrite/tratamento farmacológico , Artrite/etiologia , Artrite/fisiopatologia , Bursite/etiologia , Bursite/fisiopatologia , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/fisiopatologia , Febre de Chikungunya/complicações , Febre de Chikungunya/tratamento farmacológico , Febre de Chikungunya/epidemiologia , Doença Crônica , Epidemias , Feminino , Fibromialgia/etiologia , Fibromialgia/fisiopatologia , Humanos , Dor Lombar/etiologia , Dor Lombar/fisiopatologia , Masculino , Martinica/epidemiologia , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Osteoartrite/etiologia , Osteoartrite/fisiopatologia , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/etiologia , Espondilartrite/tratamento farmacológico , Espondilartrite/etiologia , Espondilartrite/fisiopatologia , Tendinopatia/etiologia , Tendinopatia/fisiopatologia , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
Protothecosis is a rare infection caused by achlorophyllic algae that are members of the genus Prototheca. They are ubiquitous in nature in organic material. The clinical manifestations can be acute or chronic and local or disseminated. The disease is classified as cutaneous, causing bursitis or disseminated/systemic, affecting both immunocompetent and immunosuppressed patients, with more severe and disseminated infections occurring in immunocompromised individuals. Prototheca wickerhamii and Prototheca zopfii are the most frequent organisms reported in humans. Diagnosis is made by observing asexual sporangia (thecas) on histopathological examination of tissue. Medical and surgical treatment should be considered. Ketoconazole, itraconazole, fluconazole, voriconazole, posaconazole, and amphotericin B are the most commonly used antifungals. Voriconazole and amphotericin B are highly effective against Prototheca spp. Treatment failure is not uncommon because of the comorbidities that limit the therapeutic outcome.
Assuntos
Antifúngicos/uso terapêutico , Bursite/tratamento farmacológico , Infecções Oportunistas/tratamento farmacológico , Prototheca/isolamento & purificação , Dermatopatias Infecciosas/tratamento farmacológico , Bursite/etiologia , Bursite/patologia , Humanos , Infecções Oportunistas/complicações , Infecções Oportunistas/patologia , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/patologiaAssuntos
Bursite/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Olécrano/diagnóstico por imagem , Patela/diagnóstico por imagem , Radiografia/métodos , Esclerodermia Limitada/complicações , Idoso , Bursite/etiologia , Bursite/fisiopatologia , Calcinose/etiologia , Calcinose/fisiopatologia , Feminino , Humanos , Olécrano/fisiopatologia , Patela/fisiopatologia , Amplitude de Movimento Articular , Esclerodermia Limitada/fisiopatologia , Tela Subcutânea/patologiaRESUMO
Male, 76 year-old patient with a history of total hip arthroplasty who presents with a mass in the iliac fossa with swelling of the thigh and hip pain upon flexion and extension. Complementary ultrasound and computed tomography scan studies show a giant lobulated cystic mass in the left iliac fossa, 7 cm in diameter, near the prosthesis. Cyst formation caused by polyethylene disease after total hip arthroplasty is infrequent. We present a case of large psoas bursitis secondary to the release of polyethylene particles which caused superficial femoral vein compression and thrombosis.
Assuntos
Bursite/complicações , Veia Femoral , Polietileno/efeitos adversos , Falha de Prótese , Músculos Psoas , Trombose/etiologia , Idoso , Artroplastia de Quadril , Bursite/etiologia , Humanos , MasculinoRESUMO
The musculoskeletal system can be affected by diabetes in a number of ways. The shoulder is one of the frequently affected sites. One of the rheumatic conditions caused by diabetes is frozen shoulder (adhesive capsulitis), which is characterized by pain and severe limited active and passive range of motion of the glenohumeral joint, particularly external rotation. This disorder has a clinical diagnosis and the treatment is based on physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections and, in refractory cases, surgical resolution. As with adhesive capsulitis, calcific periarthritis of the shoulder causes pain and limited joint mobility, although usually it has a better prognosis than frozen shoulder. Reflex sympathetic dystrophy, also known as shoulder-hand syndrome, is a painful syndrome associated with vasomotor and sudomotor changes in the affected member. Diabetic amyotrophy usually affects the peripheral nerves of lower limbs. However, when symptoms involve the shoulder girdle, it must be considered in the differential diagnosis of shoulder painful conditions. Osteoarthritis is the most common rheumatic condition. There are many risk factors for shoulder osteoarthritis including age, genetics, sex, weight, joint infection, history of shoulder dislocation, and previous injury, in older age patients, diabetes is a risk factor for shoulder OA. Treatment options include acetaminophen, NSAIDs, short term opiate, glucosamine and chondroitin. Corticosteroid injections and/or injections of hyaluronans could also be considered. Patients with continued disabling pain that is not responsive to conservative measures may require surgical referral. The present review will focus on practice points of view about shoulder manifestations in patients with diabetes.
Assuntos
Complicações do Diabetes/complicações , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Bursite/diagnóstico , Bursite/etiologia , Bursite/terapia , Calcinose/complicações , Calcinose/diagnóstico , Calcinose/etiologia , Calcinose/terapia , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/terapia , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/terapia , Humanos , Modelos Biológicos , Osteoartrite/complicações , Osteoartrite/diagnóstico , Osteoartrite/etiologia , Osteoartrite/terapia , Distrofia Simpática Reflexa/diagnóstico , Distrofia Simpática Reflexa/etiologia , Distrofia Simpática Reflexa/terapia , Dor de Ombro/terapiaRESUMO
Coxa saltans or snapping hip, in its internal and external varieties, is a well-known syndrome in the coxofemoral orthopedic pathology. The internal variety is less frequent and is rather unusual after a total hip arthroplasty (THA). This disorder is often times mistaken with chronic groin pain after a THA. This paper describes a typical case of snapping hip in the setting of THA and helps recognize the clinical differences between both entities, with a description of the signs and symptoms that characterize them. In order to support the etiology and pathogenesis, the diagnosis and treatment, we include anatomical considerations concerning the variants of the iliopsoas musculo-tendinous complex attachment, its relations with the articular capsule and the iliopectineal bursa. The role of implant malpositioning in this entity is reviewed and the usefulness of various diagnostic and treatment methods is discussed.