RESUMO
Flexor tendon tenosynovitis is an entrapment of the flexor tendons at its entrance to the pulley system. Because there is a high incidence of this pathology, it should be well known by physicians, rheumathologists and orthopaedic surgeons. On this paper we present a literature review, analyzing the anatomic facts, biomechanics, diagnosis, classification, therapeutic options and we propose some general recommendations for physicians.
Assuntos
Humanos , Tenossinovite/etiologia , Tenossinovite/epidemiologia , Dedo em Gatilho/diagnóstico , Dedo em Gatilho/terapia , Tenossinovite/classificação , Fenômenos Biomecânicos , Incidência , Infiltração de Neutrófilos , Dedo em Gatilho/cirurgia , AnatomiaRESUMO
The purpose of this series was to describe the ultrasonographic and radiographic manifestations of changes to the hands and wrists in 50 patients with chronic musculoskeletal symptoms secondary to Chikungunya fever during the 2016 outbreak that occurred in Rio de Janeiro, Brazil. Most of the plain radiographs were normal (62%). The most common ultrasonographic findings were small joint synovitis (84%), wrist synovitis (74%), finger tenosynovitis (70%), and cellulitis (50%). In most cases, power Doppler did not show an increase in synovial vascular flow. The plain radiographs showed no specific findings, whereas the ultrasound images revealed synovial compromise and neural thickening.
Assuntos
Celulite (Flegmão)/diagnóstico por imagem , Febre de Chikungunya/complicações , Febre de Chikungunya/diagnóstico por imagem , Mãos/diagnóstico por imagem , Tenossinovite/diagnóstico por imagem , Brasil , Celulite (Flegmão)/etiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tenossinovite/etiologia , Punho/diagnóstico por imagemRESUMO
CASE REPORT: An 18-month-old Charolais steer was presented with lameness and fluctuant swelling of the right stifle joint, which yielded neutrophils on fine-needle aspiration. A diagnosis of bacterial proliferative tenosynovitis and arthritis was made on postmortem and histological examination. Culture and 16S rRNA sequencing identified a Nocardia sp. with 99% homology with the corresponding DNA fragment of N. mexicana DSM 44952. Antimicrobial susceptibility testing revealed the isolate was susceptible to co-trimoxazole and third-generation cephalosporins. CONCLUSION: We report the first case, both in Australia and internationally, of proliferative tenosynovitis and arthritis caused by Nocardia spp. infection in a bovine and the first report of pathology attributed to N. mexicana in a veterinary patient. Given the limited susceptibility of the bacteria, the poor antimicrobial penetration that would be expected and the morphological changes that had taken place in the joint; the steer would have required protracted antimicrobial treatment in addition to invasive debridement of the lesion. This case emphasises the importance of routinely performing cytology and extended incubation of cultures in cases of arthritis in order to make ethical and economically viable treatment decisions.
Assuntos
Artrite Infecciosa/veterinária , Nocardiose/veterinária , Nocardia/isolamento & purificação , Tenossinovite/veterinária , Animais , Antibacterianos/farmacologia , Artrite Infecciosa/etiologia , Artrite Infecciosa/microbiologia , Austrália/epidemiologia , Bovinos , Cefalosporinas/farmacologia , Masculino , Testes de Sensibilidade Microbiana/veterinária , Nocardia/efeitos dos fármacos , Nocardia/genética , Nocardiose/complicações , Nocardiose/epidemiologia , Nocardiose/microbiologia , RNA Ribossômico 16S/genética , Joelho de Quadrúpedes/microbiologia , Tenossinovite/etiologia , Tenossinovite/microbiologia , Combinação Trimetoprima e Sulfametoxazol/farmacologiaRESUMO
La diabetes mellitus (DBT) es un desorden metabólico producto de una deficiencia absoluta o relativa de insulina. Este trastorno tiene consecuencias de importancia en varios órganos y sistemas del cuerpo. Es bien conocido que la DBT está asociada con una cantidad de manifestaciones cutáneas y osteoarticulares. La más común de estas características afecta al pie (síndrome de pie diabético); sin embargo, similares lesiones se pueden observar en la mano (síndrome de mano diabética), generalmente asociadas a una larga evolución de la enfermedad, malos controles glicémicos y complicaciones microvasculares. En este artículo se realiza una revisión de la literatura para actualizar el diagnóstico y la terapéutica de manifestaciones musculo-esqueléticas en la mano de pacientes con DBT: movilidad articular limitada, contractura de Dupuytren, tenosinovitis del flexor (dedo en gatillo), infección por síndrome de mano diabética tropical, ulceración neuropática periférica, síndrome del túnel carpiano, neuropatía cubital y neuropatía en piel y uñas.
Diabetes mellitus (DBT) is a metabolic disorder caused by absolute or relative deficiency of insulin. This disorder has importance consequences in various organs and systems. It is well known that DBT is associated with cutaneous and osteoarticular manifestations; the most common of these complications affects the foot (diabetic foot syndrome). However, similar lesions can be observed in the hand (diabetic hand syndrome), usually associated with long standing disease, poor glycemic control and microvascular complications. This article makes a review of the literature to update diagnosis and therapy ofmusculoskeletal manifestations in patients with diabetic hand syndrome: limited joint mobility, Dupuytrens contracture, trigger finger, tropical diabetic hand, peripheral neuropathic ulceration, carpal tunnel syndrome, cubital neuropathy, and skin and nail changes.
Assuntos
Humanos , Complicações do Diabetes/complicações , Contratura de Dupuytren/etiologia , Diabetes Mellitus/etiologia , Insulina/deficiência , Limitação da Mobilidade , Neuropatias Ulnares/etiologia , Neuropatias Diabéticas/etiologia , Síndrome do Túnel Carpal/etiologia , Tenossinovite/etiologia , Transtornos do Metabolismo de Glucose/diagnósticoRESUMO
La diabetes mellitus (DBT) es un desorden metabólico producto de una deficiencia absoluta o relativa de insulina. Este trastorno tiene consecuencias de importancia en varios órganos y sistemas del cuerpo. Es bien conocido que la DBT está asociada con una cantidad de manifestaciones cutáneas y osteoarticulares. La más común de estas características afecta al pie (síndrome de pie diabético); sin embargo, similares lesiones se pueden observar en la mano (síndrome de mano diabética), generalmente asociadas a una larga evolución de la enfermedad, malos controles glicémicos y complicaciones microvasculares. En este artículo se realiza una revisión de la literatura para actualizar el diagnóstico y la terapéutica de manifestaciones musculo-esqueléticas en la mano de pacientes con DBT: movilidad articular limitada, contractura de Dupuytren, tenosinovitis del flexor (dedo en gatillo), infección por síndrome de mano diabética tropical, ulceración neuropática periférica, síndrome del túnel carpiano, neuropatía cubital y neuropatía en piel y uñas.(AU)
Diabetes mellitus (DBT) is a metabolic disorder caused by absolute or relative deficiency of insulin. This disorder has importance consequences in various organs and systems. It is well known that DBT is associated with cutaneous and osteoarticular manifestations; the most common of these complications affects the foot (diabetic foot syndrome). However, similar lesions can be observed in the hand (diabetic hand syndrome), usually associated with long standing disease, poor glycemic control and microvascular complications. This article makes a review of the literature to update diagnosis and therapy ofmusculoskeletal manifestations in patients with diabetic hand syndrome: limited joint mobility, DupuytrenÆs contracture, trigger finger, tropical diabetic hand, peripheral neuropathic ulceration, carpal tunnel syndrome, cubital neuropathy, and skin and nail changes.(AU)
Assuntos
Humanos , Insulina/deficiência , Contratura de Dupuytren/etiologia , Tenossinovite/etiologia , Complicações do Diabetes/complicações , Diabetes Mellitus/etiologia , Transtornos do Metabolismo de Glucose/diagnóstico , Limitação da Mobilidade , Neuropatias Diabéticas/etiologia , Síndrome do Túnel Carpal/etiologia , Neuropatias Ulnares/etiologiaRESUMO
OBJECTIVE: To perform a detailed magnetic resonance imaging (MRI) analysis of the hands of patients with Jaccoud's arthropathy (JA) secondary to systemic lupus erythematosus (SLE). METHODS: The hand with more expressive deformities compatible with JA from a group of SLE patients was examined by 1.5-T MRI. The protocol included coronal, sagittal, and axial turbo-spin-echo images before and after the administration of contrast medium. The presence of synovitis, edema, erosion, cysts, and tenosynovitis in the carpometacarpal, metacarpophalangeal, and proximal interphalangeal joints were scored based on a modified Outcome Measures in Rheumatology recommendations. RESULTS: Twenty SLE patients, (19 women and one man) with median age of 44.7 years (range: 20-76 years), median disease duration of 14.7 years (range: 5-26 years), and median arthritis duration of 13.7 years (range: 4-26 years) were studied. Of the 300 joints evaluated, 202 (67.3%) had some degree of synovitis. Sixteen out of 300 examined joints (5.3%) small areas of erosion were seen in 10 out of the 20 patients (50%). Subchondral bone edema was found in eight out of the 20 (40%) patients or a total of 18 joints (6%). A total of 200 compartments tendons were evaluated, and changes were found in 77 (38.5%) of them. In four out of the 20 patients, the MRI revealed bone cysts. CONCLUSIONS: The MRI seems to be a non-invasive diagnostic tool in patients with JA secondary to SLE, and may contribute to understanding the mechanism involved in the development of this deformity.
Assuntos
Artrite/patologia , Lúpus Eritematoso Sistêmico/patologia , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Artrite/etiologia , Cistos Ósseos/etiologia , Cistos Ósseos/patologia , Articulações do Carpo/patologia , Edema/etiologia , Edema/patologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Masculino , Articulação Metacarpofalângica/patologia , Pessoa de Meia-Idade , Tenossinovite/etiologia , Tenossinovite/patologia , Adulto JovemRESUMO
OBJECTIVES: The objectives of this study were to evaluate the frequency and characteristics of the peripheral musculoskeletal manifestations in polymyalgia rheumatica (PMR), evaluate if PMR with peripheral synovitis represents a subset with a more severe disease, and examine for clinical and laboratory characteristics at onset of PMR that might later predict rheumatoid arthritis (RA). PATIENTS AND METHODS: Patients were diagnosed with PMR according to the 1982 Chuang criteria. Patients were followed up between 1990 and 2002. The following musculoskeletal manifestations at onset and during the follow up were considered: peripheral synovitis, distal extremity swelling with pitting edema, carpal tunnel syndrome, and distal tenosynovitis. RESULTS: Thirty-eight of the 74 patients (51%) showed distal musculoskeletal symptoms: 29 (39%) had peripheral synovitis, 4 (5%) presented pitting edema, 4 (5%) experienced carpal tunnel syndrome, and one (1.3%) had distal tenosynovitis. These manifestations resolved completely after corticosteroid therapy was initiated. Peripheral synovitis was oligoarticular and often transient. The joints most frequently involved were the wrist, metacarpophalangeal, and knee. Erythrocyte sedimentation rate (ESR) was normal in 7 patients. When comparing patients with PMR with and without peripheral synovitis, no statistically significant differences were found in the studied variables. Through the first year of follow up, 7 patients fulfilled the American College of Rheumatology 1987 criteria for RA, 2 patients developed giant cell arteritis, and 3 had associated malignancy. Patients who developed RA had statistically significantly increased presence of persistent synovitis and a smaller decrease in mean ESR after treatment with corticosteroids. CONCLUSION: Fifty-one percent of the patients with PMR presented distal musculoskeletal manifestations, with peripheral synovitis being the most frequent one. Patients with PMR with peripheral synovitis did not represent a high-risk subgroup with more severe disease. Seven patients who developed criteria for seronegative RA within the first year of follow up had presented statistically significant persistent synovitis compared with those who continued as PMR and also showed a smaller initial decrease in mean ESR after steroid treatment was initiated. The absence of persistent arthritis and the benign course of the arthritis permit the distinction of PMR from other inflammatory arthropathies.
Assuntos
Síndrome do Túnel Carpal/etiologia , Polimialgia Reumática/complicações , Sinovite/etiologia , Tenossinovite/etiologia , Idoso , Síndrome do Túnel Carpal/tratamento farmacológico , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Polimialgia Reumática/tratamento farmacológico , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Sinovite/tratamento farmacológico , Tenossinovite/tratamento farmacológicoRESUMO
Se ha observado un patrón de lesiones que característicamente aparece en aquellos cirujanos que practican cirugía laparoscópica. Se aplicó una encuesta entre la población quirúrgicamente activa del Hospital ABC, en México, D.F., para conocer la frecuencia de estas lesiones. Se repartieron 100 encuestas, obteniendo respuesta en 64 de ellas. Se analizan los resultados, discutiendo la fisiopatología de cada lesión y proponiendo medidas para reducir la frecuencia de estas lesiones