Surgery of the Ankle
Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou in Operative Orthopaedics, 2020
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.
Foot and ankle radiology
Maneesh Bhatia in 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).
The wrist
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
The extensor retinaculum has six compartments which transmit tendons lined with synovium. Tenosynovitis can be caused by unaccustomed overuse but sometimes it occurs spontaneously. The resulting synovial inflammation causes secondary thickening of the sheath and stenosis of the compartment, which further compromises the tendon. Early treatment, including rest, anti-inflammatory medication and injection of corticosteroids, may break this vicious circle.
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).
Investigating the optimal handle diameters and thumb orthoses for individuals with chronic de Quervain's tenosynovitis – a pilot study
Published in Disability and Rehabilitation, 2020
Chien-Hsiou Liu, Kai-Shun Yip, Hsin-Yu Chiang
de Quervain's tenosynovitis is inflammation of the tendons, including the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL), which extend the joints of the thumb [1,2]. Splinting reduced the gliding of APL and EPB tendons through the stenosed fibro-osseous canal, thereby minimizing mechanical impingement of the tendons against the retinaculum [3]. Traditionally, a long thumb orthosis is prescribed to an individual at the acute and chronic stages of de Quervain’s tenosynovitis to immobilize the thumb and wrist such that the affected area is restrained to curb the pain [4]. Reports on the clinical effectiveness of the combination of two approaches (ultrasound/steroid injection and orthosis) have been published. Witt, Pess, and Gelberman, reported that injection of steroids and use of a long thumb orthosis for three weeks had a 62% success rate in patients with de Quervain’s tenosynovitis. Also, the combination of therapeutic ultrasound and a long thumb orthosis has been verified to be more effective than therapeutic ultrasound alone in the conservative management of de Quervain’s tenosynovitis [5].
The findings of musculoskeletal ultrasonography on primary Sjögren’s syndrome patients in childhood with articular manifestations and the impact of anti-cyclic citrullinated peptide antibody
Published in Modern Rheumatology, 2019
Kosuke Shabana, Nami Okamoto, Yuko Sugita, Keisuke Shindo, Takuji Murata, Hiroshi Tamai, Kenta Fujiwara
All of 8patients had either joint swelling or tenderness. The relationship between articular manifestations and arthritis by MSUS is shown in Table 2. With a medical examination of whole body joints, the articular manifestations were found in 58 of 352 joints (16.5%). The detail was 32 joints with swelling and 42 joints with tenderness (There is some overlap). Arthritis by MSUS was detected in 6 of 8 patients (75.0%). Good rating agreement was found between operator and interpreter (κ = 0.80 in arthritis by MSUS). We scanned 284 joints by MSUS and arthritis was detected in 30 joints. That was 12 joints with synovial fluid, 21 joints with synovial hypertrophy and 11 joints with abnormal PD signal. When MSUS is gold-standard, sensitivity and specificity were 42.0% and 83.9% respectively. 25 joints were revealed as subclinical arthritis. Tenosynovitis was detected at 7 sites of 3 patients. Enthesitis was detected at one Achilles tendon insertion of ACPA-positive patient, only. Bone erosion was not detected in any joint. Localization of joint findings is shown in Table 3. In this study, arthritis was frequently detected in metacarpophalangeal and knee joints.
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