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Foot and ankle radiology
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Tenosynovitis is inflammation of the tendon sheath, which is a synovial membrane that surrounds a tendon. Tenosynovitis manifests as excessive (>2 mm) fluid surrounding a morphologically normal tendon. US demonstrates hypoechoic fluid accumulation within the tendon sheath with increased vascularity (Figure 22.16). On MR, there is circumferential fluid collection around the tendon, which shows high SI on T2-weighted imaging, low to intermediate SI on T1-weighted imaging (Figure 22.17).
Surgery of the Ankle
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Matthew Welck, Laurence James, Dishan Singh
A history of sprains is common. Other causes include trauma, inflammatory arthritides, fibula anatomy (shallow fibular groove, sharp lateral ridge), hypertrophied peroneal tubercle, lateral ankle instability and peroneus quartus (overcrowding). Developmental varus hindfoot alignment is associated with increased incidence of peroneal disorders: Tenosynovitis (a static mass on examination).Tendinosis (a mass moving with the tendon, through sheath).Tears (present with pain and weakness).Subluxation (palpation along the length of the tendons noting any deviation of their course).Os peroneum syndrome: Ossified in 20% population. Articulates with inferior margin of cuboid. May be degenerative/osteochondritis or fractured, leading to pain in the plantar/lateral aspect of the foot.Eventually pain-related functional weakness will lead to deformity.
The wrist and hand
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
De Quervain’s tenosynovitis affects the abductor pollicis longus and extensor pollicis brevis tendons, which have become inflamed. These tendons fuse as they cross the radial styloid and form a common synovial sheath, which forms the anterior border of the ‘snuffbox’. The tendons are lined with a synovial sheath, and in tenosynovitis, the synovial surfaces become roughened, which causes pain and crepitus on movement of the tendon. In injecting, the aim is to introduce the steroid mixed with local anaesthetic into the space between the tendon and the sheath.
Mast cell presence in tendon sheaths of trigger fingers: implications on pathogenesis and clinical presentation
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Takahiko Nakano, Shigeru Kurimoto, Hisao Ishii, Katsuyuki Iwatsuki, Michiro Yamamoto, Masahiro Tatebe, Hitoshi Hirata
Pathological studies of trigger finger and normal tendon sheaths have reported that the finger tendon sheath consists of three layers [1–3]. The outer layer is rich in blood vessels and in continuity with the synovium, the middle layer is a thick layer containing chondrocyte-like cells and fibroblasts, and the inner layer is a single or two-celled layer that abuts the flexor tendon [3]. The tendon sheath of the finger contains abundant collagen in the extracellular matrix, particularly in the middle layer [1,2]. Previous studies have shown that trigger finger tendon sheaths consist of an increased proportion of type-3 collagen, whereas normal tendon sheaths are composed mainly of type-1 collagen [4,5]. Trigger finger is also called ‘stenosing tenosynovitis’; however, it exhibits poor infiltration of inflammatory cells into the tendon sheath, and the mechanism of its onset and pathology is still unclear [3].
Bilateral sacroiliitis following group C streptococcal sepsis
Published in Baylor University Medical Center Proceedings, 2022
Sanjeev Shrestha, Eva Rottmann, Prakash Kharel, Francis Lim, David Henry Bulbin
An 81-year-old woman presented to the emergency department with new-onset polyarthritis for 2 months. Four months earlier, she was admitted with sepsis due to group C Streptococcus cellulitis with bacteremia. She was treated with ceftriaxone during that admission. On presentation, she described migratory polyarthralgia starting in the left hand/wrist followed by shoulder, knee, and foot pain. Her symptoms started abruptly with morning stiffness lasting 2 to 3 hours and improved with use. She denied fever, chills, and urinary, gastroenterology, and respiratory complaints. Mild synovitis was found in the hand, with flexor tenosynovitis. Inflammatory markers were elevated: the C-reactive protein level was 39 mg/dL; erythrocyte sedimentation rate, 88 mm/h; and uric acid, 11.3 mg/dL. Antinuclear antibody was negative, with negative rheumatoid factor and negative anti-CCP. X-ray of the hand (Figure 1a) showed areas of marginal erosion. The initial differential diagnosis included seronegative rheumatoid arthritis, chondrocalcinosis, reactive arthritis, and crystalline arthropathy. The patient was started on subcutaneous methotrexate, and prednisone was extended. Her symptoms were well controlled on the outpatient regimen.
Rheumatological evaluation of patients with interstitial lung disease
Published in Scandinavian Journal of Rheumatology, 2022
S Ottaviani, S Khaleche, R Borie, M-P Debray, P Dieudé, B Crestani
US assessment of joints was performed by one trained rheumatologist (SO), who used an Esaote MyLab70 echograph (Genoa, Italy), with a linear transducer at 5–18 MHz. The grey-scale (GS) score was used to score synovial hypertrophy and search for bone erosions, and power Doppler (PD) US was assessed with a pulse repetition frequency of 750 Hz with medium wall filter; gain was adjusted for the removal of background signals. Joints were analysed according to Outcome Measures in Rheumatology (OMERACT) recommendations (14). GS and PD scores were defined previously (15) and determined using the 0–3 semiquantitative Szkudlarek score (16). US synovitis was defined as GS score ≥ 2 and/or PD score ≥ 1. Erosion was defined by intra-articular discontinuity of the bone surface visible in two perpendicular planes. Tenosynovitis was defined on US as hypoechoic or anechoic thickened tissue with or without fluid within the tendon sheath, seen in two perpendicular planes (14).