RESUMEN
PURPOSE: This prospective study assessed the effects of low-dose radiotherapy in patients diagnosed with greater trochanteric pain syndrome (GTPS) with recurrent symptoms or refractory to previous conservative measures. METHODS: We evaluated a total of 155 patients (90.3% women, mean age 69 years). Most patients (n = 136) received 10 Gy (1 Gy/day/3 fractions per week on alternate days), but after recommendations of DEGRO guidelines published in 2015, the remaining 19 patients (12.2%) received 6 Gy (1 Gy/day/3 fractions per week on alternate days). RESULTS: At the pre-treatment visit, the mean (standard deviation, SD) visual analog scale (VAS) score was 8), which decreased to 5 (SD 2.2) after 1 month of the end of treatment and to 4 (SD 2.3) after 4 months. An objective symptom response with increased mobility, better sleep quality, and reduction of analgesic medication was found in 56% of patients at 1 month. In 129 patients (83.2%), there was a decrease of at least 1 point in the VAS score, and in 49 patients (29.0%), the VAS score was lower than 3. The mean length of follow-up was 45 months. The probability of maintaining the analgesic response estimated by the Kaplan-Meier method was 53% at 5 years. CONCLUSION: Low dose radiotherapy effectively improved pain in the trochanteric area in most patients with recurrent or refractory GTPS, allowing a reduction in the need for analgesic medications and, more, importantly, better functioning and mobility. Further randomized studies in selected populations of GTPS are needed to define the treatment position of low-dose radiotherapy in this clinical setting.
Asunto(s)
Bursitis , Anciano , Bursitis/diagnóstico , Bursitis/terapia , Femenino , Fémur , Humanos , Masculino , Dolor/etiología , Dolor/radioterapia , Dimensión del Dolor , Estudios ProspectivosRESUMEN
La capsulitis adhesiva de hombro se caracteriza por la inflamación crónica de la capa subsinovial de la cápsula articular que produce fibrosis, contractura y adherencia de la cápsula a sí misma y al cuello anatómico del húmero. La rehabilitación enfocada en optimizar el rango de movilidad en forma activa y pasiva es la base del tratamiento, independientemente de la etapa. Sobre la base de la historia natural de la enfermedad, la inyección con corticoides en forma precoz tiene utilidad en acortar la duración general de los síntomas, y permite a los pacientes trabajar el rango de movilidad en las etapas de rehabilitación y así volver a sus actividades cotidianas más rápidamente. La mayoría de los pacientes tratados con terapia física logran la resolución completa de síntomas. En casos con rigidez refractaria, puede estar indicada la manipulación bajo anestesia o la liberación capsular artroscópica; debido a varios riesgos potenciales de complicaciones con las manipulaciones, se prefiere esta última. Existen escasos estudios con alto nivel de evidencia que comparen diferentes técnicas para la liberación capsular: tanto la liberación circunferencial como la capsular anteroinferior han demostrado ser efectivas como técnica quirúrgica. La cirugía debe ser seguida de forma temprana por una terapia física diligente y dirigida a prevenir la rigidez recurrente
Adhesive capsulitis is characterized by chronic inflammation of the capsular subsynovial layer, which produces capsular fibrosis, contracture, and adherence of the capsule to itself and to the anatomic neck of the humerus. Physical therapy is the mainstay of treatment, regardless of stage. Based on the natural history of the disease, early corticosteroid injection has a role in shortening the overall duration of symptoms allowing patients to move faster in the stages of rehabilitation and thus return to their daily life activities more rapidly. Most patients will see complete resolution of symptoms with nonsurgical management. In cases with refractory stiffness, manipulation under anesthesia or arthroscopic capsular release may be indicated. Because of various potential risks of complications with manipulations, arthroscopic capsular release is preferred. There is a lack of high-level studies comparing different techniques for capsular release. Both circumferential and anteroinferior release have proven to be effective. Surgery should be followed by early, diligent and directed therapy to prevent recurrent stiffness
Asunto(s)
Articulación del Hombro , Bursitis/cirugía , Bursitis/diagnóstico , Bursitis/fisiopatología , Bursitis/terapia , Dolor de HombroRESUMEN
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)
Asunto(s)
Humanos , Bursitis/diagnóstico , Bursitis/etiología , Codo/anatomía & histología , Bursitis/terapia , Bursitis/epidemiologíaRESUMEN
OBJECTIVE: The aim of this study is to evaluate the internal validity of a clinical test for the early diagnosis of shoulder adhesive capsulitis, called the Distension Test in Passive External Rotation (DTPER). MATERIAL AND METHOD: The DTPER is performed with the patient standing up, the arm adducted, and the elbow bent at 90°. From this position, a smooth passive external rotation is started, the affected arm being supporting at the wrist with one hand of the examiner and the other maintaining the adducted elbow until the maximum painless point of the rotation is reached. From this point of maximum external rotation with the arm in adduction and with no pain, an abrupt distension movement is made, increasing the external rotation, causing pain in the shoulder if the test is positive. This term was performed on a group of patients with shoulder pain of many origins, in order to analyse the predictive values, sensitivity, specificity, and the likelihood ratio. RESULTS: The DTPER showed a sensitivity of 100% (95% CI; 91.8 to 100%) and a specificity of 90% (95% CI; 82.4 to 94.8%). The positive predictive value was 0.62 and a likelihood ratio of 10.22 (95% CI; 5.5 to 19.01). False positives were only found in patients with subscapular tendinopathies or glenohumeral arthrosis. DISCUSSION: The DTPER has a high sensitivity for the diagnosis of adhesive capsulitis, and is excluded when it is practically negative. False positives can easily be identified if there is external rotation with no limits (subscapular tendinopathy) or with a simple shoulder X-ray (glenohumeral arthrosis).
Asunto(s)
Bursitis/diagnóstico , Rango del Movimiento Articular , Rotación , Articulación del Hombro/fisiopatología , Adulto , Anciano , Bursitis/fisiopatología , Diagnóstico Precoz , Reacciones Falso Positivas , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadAsunto(s)
Humanos , Adulto , Atención Primaria de Salud/normas , Protocolos Clínicos/normas , Reumatología/normas , Artritis Psoriásica/diagnóstico , Artritis Reumatoide/diagnóstico , Atención Secundaria de Salud/normas , Bursitis/diagnóstico , Dolor Facial/diagnóstico , Dolor de la Región Lumbar/diagnóstico , Fibromialgia/diagnóstico , Gota/diagnóstico , Lupus Eritematoso Sistémico/diagnóstico , Osteoartritis/diagnósticoRESUMEN
A patologia descritiva das lesões em animais domésticos de açougue permite enriquecer a literatura médica veterinária especializada em inspeção sanitária de carnes, assim como subsidiar tecnicamente os profissionais inspetores. A oncocercose é uma parasitose causada pelo nematódeo Onchocerca sp,, sendo que a espécie O. gutturosa é a que mais acomete bovinos na América do Sul. Foram avaliados, pelo exame anatomopatológico, dois casos de lesões localizadas no ligamento nucal de bovinos abatidos para o consumo. A macroscopia de um caso revelou bursite crônica, representada por grande quantidade de líquido citrino e viscoso e, ainda, muitos corpúsculos livres, elípticos e achatados desprovidos de raiz (arrizo). A microscopia dessas estruturas evidenciou moldes de fibrinas amorfos e eosinofílicos. O segundo caso foi caracterizado por bursite aguda, e a microscopia das lesões ligamentar e periligamentar revelou granulomas epitelioides com reação gigantocitária, centralizados por formações semelhantes ao Onchocerca sp.(AU)
The descriptive pathology of lesions in butcher's domestic animals contribute to enrich literature specialized in veterinary sanitary inspection of meat as well as to guide professional meat inspectors. Oncorcecose is a parasitic disease caused by the nematode Onchocerca sp, and the O. gutturosa species affects cattle in South America. Two cases of lesions located in the nuchal ligament of cattle slaughtered for consumption were evaluated by pathological examination. Macroscopic analysis revealed a case of chronic bursitis represented by a large amount of clear and viscous liquid, and also many free, elliptical and flat corpuscles. Microscopy showed arrizoides molds fibrin, amorphous, and eosinophilic structures. The second case was characterized by acute bursitis and microscopic lesions and ligament periligamentous revealed multiple epithelioid granulomas and giant cells centered on formations similar to Onchocerca sp.(AU)
Asunto(s)
Animales , Bovinos , Bovinos/parasitología , Oncocercosis/diagnóstico , Onchocerca/aislamiento & purificación , Bursitis/diagnóstico , Oncocercosis/veterinaria , Bursitis/veterinariaRESUMEN
A patologia descritiva das lesões em animais domésticos de açougue permite enriquecer a literatura médica veterinária especializada em inspeção sanitária de carnes, assim como subsidiar tecnicamente os profissionais inspetores. A oncocercose é uma parasitose causada pelo nematódeo Onchocerca sp,, sendo que a espécie O. gutturosa é a que mais acomete bovinos na América do Sul. Foram avaliados, pelo exame anatomopatológico, dois casos de lesões localizadas no ligamento nucal de bovinos abatidos para o consumo. A macroscopia de um caso revelou bursite crônica, representada por grande quantidade de líquido citrino e viscoso e, ainda, muitos corpúsculos livres, elípticos e achatados desprovidos de raiz (arrizo). A microscopia dessas estruturas evidenciou moldes de fibrinas amorfos e eosinofílicos. O segundo caso foi caracterizado por bursite aguda, e a microscopia das lesões ligamentar e periligamentar revelou granulomas epitelioides com reação gigantocitária, centralizados por formações semelhantes ao Onchocerca sp...
The descriptive pathology of lesions in butcher's domestic animals contribute to enrich literature specialized in veterinary sanitary inspection of meat as well as to guide professional meat inspectors. Oncorcecose is a parasitic disease caused by the nematode Onchocerca sp, and the O. gutturosa species affects cattle in South America. Two cases of lesions located in the nuchal ligament of cattle slaughtered for consumption were evaluated by pathological examination. Macroscopic analysis revealed a case of chronic bursitis represented by a large amount of clear and viscous liquid, and also many free, elliptical and flat corpuscles. Microscopy showed arrizoides molds fibrin, amorphous, and eosinophilic structures. The second case was characterized by acute bursitis and microscopic lesions and ligament periligamentous revealed multiple epithelioid granulomas and giant cells centered on formations similar to Onchocerca sp...
Asunto(s)
Animales , Bovinos , Bovinos/parasitología , Bursitis/diagnóstico , Onchocerca/aislamiento & purificación , Oncocercosis/diagnóstico , Bursitis/veterinaria , Oncocercosis/veterinariaRESUMEN
Bursite cotovelar é uma cavidade preenchida por fluido, circundada por tecido conjuntivo fibroso denso, que surge na face lateral do olécrano. Normalmente, essa condição clínica é causada por traumatismo crônico. Relata-se um caso de bursite cotovelar aguda bilateral em um cão da raça dálmata, macho, de 35 dias de idade. Clinicamente, o animal apresentava aumento de volume flutuante e indolor, na região do olécrano, bilateral, de um dia de evolução. Na punção aspirativa foi observado um líquido de aspecto seroso e vermelho, e no exame citológico apenas leucócitos e hemácias. Devido ao histórico e tempo de evolução, o diagnóstico presuntivo foi de bursite cotovelar traumática aguda. O tratamento preconizado foi à base de anti-inflamatório, tratamento tópico, bandagem ao redor da lesão e repouso. O cão retornou com sete dias totalmente recuperado. Apesar da bursite em pequenos animais ocorrer devido a traumas repetidos, apresentando uma característica de cronicidade, a bursite pode ser aguda e se originar de um único trauma...
Elbow bursitis is a cavity filled with fluid and surrounded by dense fibrous connective tissue, which appears on the lateral side of the olecranon. Typically, this medical condition is caused by chronic trauma. This paper reports a case of bilateral acute bursitis in the elbow in a Dalmatian dog, male, with 35 days of age. Clinically, the animal presented painless swelling of the floating volume in the olecranon region, bilateral, with a one-day evolution. In aspiration, serous red fluid could be observed, and upon cytological examination, only leukocytes and erythrocytes were observed. Due to the history and evolution time, the presumptive diagnosis was that of acute traumatic bursitis in the elbow. The treatment was based on anti-inflammatory medication, topical treatment, bandage around the lesion and rest. The dog returned after 7 days fully recovered. Although bursitis occurs in small animals due to repeated trauma, presenting a chronicity characteristic, it can also be acute and originated from a single trauma...
La bursitis de codo es una cavidad llena de fluido y rodeada por tejido conectivo fibroso denso, que surge en el lado lateral del olécranon. Por lo general, esa condición clínica es causada por un trauma crónico. Se presenta un caso de bursitis aguda bilateral en el codo de un perro de la raza dálmata, macho, de 35 días de edad. Clínicamente, el animal presentaba aumento de volumen flotante y sin dolor, en la región del olécranon, bilateral, un día de evolución. En una aspiración se ha observado un líquido de aspecto seroso y rojo, y en el examen citológico sólo leucocitos y eritrocitos. Debido al histórico y tiempo de evolución, el diagnóstico presuntivo fue bursitis de codo traumática aguda. El tratamiento preconizado fue a base de antiinflamatorio, tratamiento tópico, vendaje alrededor de la lesión y reposo. El perro volvió con siete días totalmente recuperado. Aunque la bursitis se produce en animales pequeños debido a traumas repetidos, presentando una característica de cronicidad, la bursitis puede ser aguda y originarse a partir de un único trauma...
Asunto(s)
Animales , Perros , Bursitis/clasificación , Bursitis/diagnóstico , Bursitis/veterinaria , Linfangioma Quístico/clasificación , Linfangioma Quístico/diagnóstico , Olécranon/anatomía & histologíaRESUMEN
Bursite cotovelar é uma cavidade preenchida por fluido, circundada por tecido conjuntivo fibroso denso, que surge na face lateral do olécrano. Normalmente, essa condição clínica é causada por traumatismo crônico. Relata-se um caso de bursite cotovelar aguda bilateral em um cão da raça dálmata, macho, de 35 dias de idade. Clinicamente, o animal apresentava aumento de volume flutuante e indolor, na região do olécrano, bilateral, de um dia de evolução. Na punção aspirativa foi observado um líquido de aspecto seroso e vermelho, e no exame citológico apenas leucócitos e hemácias. Devido ao histórico e tempo de evolução, o diagnóstico presuntivo foi de bursite cotovelar traumática aguda. O tratamento preconizado foi à base de anti-inflamatório, tratamento tópico, bandagem ao redor da lesão e repouso. O cão retornou com sete dias totalmente recuperado. Apesar da bursite em pequenos animais ocorrer devido a traumas repetidos, apresentando uma característica de cronicidade, a bursite pode ser aguda e se originar de um único trauma.(AU)
Elbow bursitis is a cavity filled with fluid and surrounded by dense fibrous connective tissue, which appears on the lateral side of the olecranon. Typically, this medical condition is caused by chronic trauma. This paper reports a case of bilateral acute bursitis in the elbow in a Dalmatian dog, male, with 35 days of age. Clinically, the animal presented painless swelling of the floating volume in the olecranon region, bilateral, with a one-day evolution. In aspiration, serous red fluid could be observed, and upon cytological examination, only leukocytes and erythrocytes were observed. Due to the history and evolution time, the presumptive diagnosis was that of acute traumatic bursitis in the elbow. The treatment was based on anti-inflammatory medication, topical treatment, bandage around the lesion and rest. The dog returned after 7 days fully recovered. Although bursitis occurs in small animals due to repeated trauma, presenting a chronicity characteristic, it can also be acute and originated from a single trauma.(AU)
La bursitis de codo es una cavidad llena de fluido y rodeada por tejido conectivo fibroso denso, que surge en el lado lateral del olécranon. Por lo general, esa condición clínica es causada por un trauma crónico. Se presenta un caso de bursitis aguda bilateral en el codo de un perro de la raza dálmata, macho, de 35 días de edad. Clínicamente, el animal presentaba aumento de volumen flotante y sin dolor, en la región del olécranon, bilateral, un día de evolución. En una aspiración se ha observado un líquido de aspecto seroso y rojo, y en el examen citológico sólo leucocitos y eritrocitos. Debido al histórico y tiempo de evolución, el diagnóstico presuntivo fue bursitis de codo traumática aguda. El tratamiento preconizado fue a base de antiinflamatorio, tratamiento tópico, vendaje alrededor de la lesión y reposo. El perro volvió con siete días totalmente recuperado. Aunque la bursitis se produce en animales pequeños debido a traumas repetidos, presentando una característica de cronicidad, la bursitis puede ser aguda y originarse a partir de un único trauma.(AU)
Asunto(s)
Animales , Perros , Bursitis/clasificación , Bursitis/diagnóstico , Bursitis/veterinaria , Olécranon/anatomía & histología , Linfangioma Quístico/clasificación , Linfangioma Quístico/diagnósticoRESUMEN
Introducción: La capsulitis adhesiva se caracteriza por presentar un cuadro clínico de insidiosa y progresiva pérdida de la movilidad activa y pasiva del hombro, que en general se acompaña de dolor e incapacidad funcional para realizar las actividades de la vida diaria. Histológicamente se define como una fibrodisplasia pancapsular, con un posible sitio de origen en el intervalo rotador. La vimentina, es una proteína citocontractil que se encuentra fuertemente expresada por fibroblastos, especialmente en los nódulos fibróticos. Material y Métodos: Entre enero del 2010 y diciembre de 2012, prospectivamente realizamos 10 capsulotomías artroscópicas, en 10 pacientes con diagnóstico de capsulitis adhesiva idiopática. Durante este procedimiento se tomaron biopsias de: 1- Sinovial y Cápsula del Intervalo de los Rotadores (Ligamento Coracohumeral), 2- Sinovial y Cápsula Antero-Inferior (Ligamento Glenohumeral Inferior), 3- Sinovial y Cápsula Posterior. Se evaluó cuantitativamente el infiltrado linfocitario, la proliferación vascular, la proliferación de fibroblastos, la metaplasia condroide y la expresión de la proteína citocontráctil vimentina. Correlacionamos estos hallazgos con el estadio clínico preoperatorio y los hallazgos por visión artroscópica directa. Resultado: Histológicamente las muestras del intervalo rotador eran similares en todos los hombros biopsiados; hiperplasia sinovial, infiltrado linfocitario (intersticial y perivascular), proliferación de fibroblastos y fibrosis. Las biopsias capsulares presentaron menores cambios histológicos. En todos los casos, en el intervalo rotador se observó positividad intensa de vimentina en las células endoteliales de los vasos de neo formación y en el estroma, y moderada en los fibroblastos. No se pudo hallar correlación entre los hallazgos histológicos, la apariencia artroscópica de la cápsula y el estadio clínico de evolución. Conclusión: El estudio de la histología nos demuestra que, la displasia fibrosa en las capsulitis adhesivas idiopáticas es pancapsular, la vimentina solo se expresa en el intervalo rotador y el ligamento coracohumeral, reflejando contractura capsular, por lo que su liberación seria la llave para la recuperación del rango de movilidad y que no hay correlación entre los hallazgos histológicos, la apariencia artroscópica de la cápsula y el estadio clínico de evolución. Tipo de Estudio: Estudio pronóstico. Nivel de evidencia: IV (AU)
Asunto(s)
Adulto , Persona de Mediana Edad , Bursitis/diagnóstico , Bursitis/patología , Articulación del Hombro/patología , Artroscopía/métodos , Cápsula Articular/lesiones , Vimentina , Estudios Prospectivos , Estudios de SeguimientoRESUMEN
Introducción: La capsulitis adhesiva se caracteriza por presentar un cuadro clínico de insidiosa y progresiva pérdida de la movilidad activa y pasiva del hombro, que en general se acompaña de dolor e incapacidad funcional para realizar las actividades de la vida diaria. Histológicamente se define como una fibrodisplasia pancapsular, con un posible sitio de origen en el intervalo rotador. La vimentina, es una proteína citocontractil que se encuentra fuertemente expresada por fibroblastos, especialmente en los nódulos fibróticos. Material y Métodos: Entre enero del 2010 y diciembre de 2012, prospectivamente realizamos 10 capsulotomías artroscópicas, en 10 pacientes con diagnóstico de capsulitis adhesiva idiopática. Durante este procedimiento se tomaron biopsias de: 1- Sinovial y Cápsula del Intervalo de los Rotadores (Ligamento Coracohumeral), 2- Sinovial y Cápsula Antero-Inferior (Ligamento Glenohumeral Inferior), 3- Sinovial y Cápsula Posterior. Se evaluó cuantitativamente el infiltrado linfocitario, la proliferación vascular, la proliferación de fibroblastos, la metaplasia condroide y la expresión de la proteína citocontráctil vimentina. Correlacionamos estos hallazgos con el estadio clínico preoperatorio y los hallazgos por visión artroscópica directa. Resultado: Histológicamente las muestras del intervalo rotador eran similares en todos los hombros biopsiados; hiperplasia sinovial, infiltrado linfocitario (intersticial y perivascular), proliferación de fibroblastos y fibrosis. Las biopsias capsulares presentaron menores cambios histológicos. En todos los casos, en el intervalo rotador se observó positividad intensa de vimentina en las células endoteliales de los vasos de neo formación y en el estroma, y moderada en los fibroblastos. No se pudo hallar correlación entre los hallazgos histológicos, la apariencia artroscópica de la cápsula y el estadio clínico de evolución. Conclusión: El estudio de la histología nos demuestra que, la displasia fibrosa en las capsulitis adhesivas idiopáticas es pancapsular, la vimentina solo se expresa en el intervalo rotador y el ligamento coracohumeral, reflejando contractura capsular, por lo que su liberación seria la llave para la recuperación del rango de movilidad y que no hay correlación entre los hallazgos histológicos, la apariencia artroscópica de la cápsula y el estadio clínico de evolución. Tipo de Estudio: Estudio pronóstico. Nivel de evidencia: IV
Asunto(s)
Adulto , Persona de Mediana Edad , Articulación del Hombro/patología , Artroscopía/métodos , Bursitis/diagnóstico , Bursitis/patología , Cápsula Articular/lesiones , Vimentina , Estudios Prospectivos , Estudios de SeguimientoAsunto(s)
Imagen por Resonancia Magnética/métodos , Neurilemoma/patología , Neoplasias de los Tejidos Blandos/patología , Bolsa Sinovial/patología , Bursitis/diagnóstico , Diagnóstico Diferencial , Femenino , Articulación de la Cadera/patología , Histiocitoma Fibroso Maligno/diagnóstico , Humanos , Persona de Mediana Edad , Neoplasias de la Vaina del Nervio/diagnóstico , Sarcoma Sinovial/diagnósticoRESUMEN
Se realizó una investigación con enfoque social con el objetivo de describir el impacto social de la clasificación y conducta a seguir ante las afecciones osteomioarticulares en la comunidad, y proponer un instrumento metodológico que contribuya a elevar la competencia del Especialista en Medicina General Integral, en relación con el diagnóstico y tratamiento de las afecciones osteomioarticulares, según su grado de prioridad, con el cual se logre mayor impacto social en correspondencia con las necesidades de la población atendida (AU)
An investigation with social approach was carried out with the aim of describing the social impact of the classification and conduct to follow before the osteomyoarticular affections in the community, and to propose a methodological instrument that contributes to elevate the competition of the Integral General Medicine specialist, in relation to the diagnosis and treatment of the osteomyoarticular affections, according to its priority degree, in which it achieve a greater social impact in correspondence with the necessities of the attended population (AU)
Asunto(s)
Humanos , Masculino , Femenino , Bursitis/diagnóstico , Bursitis/tratamiento farmacológico , Tendinopatía/diagnóstico , Tendinopatía/tratamiento farmacológico , Impactos de la Polución en la Salud/métodos , Investigación sobre Servicios de Salud/éticaRESUMEN
The authors describe the case of a 42-year-old woman presenting with significant knee pain and disability. Her imaging findings using contrast MR imaging and FDG PET/CT suggested adhesive capsulitis, which was confirmed by arthroscopy, histology, and the clinical outcome.
Asunto(s)
Bursitis/diagnóstico , Articulación de la Rodilla , Adulto , Artroscopía , Bursitis/cirugía , Femenino , Humanos , Imagen por Resonancia MagnéticaRESUMEN
Knee pain is a common complaint in clinical practice, and pes anserinus tendino-bursitis syndrome (PATB) has been frequently diagnosed based only on clinical features that may cause equivocal interpretations. Patients complain of characteristic spontaneous medial knee pain with tenderness in the inferomedial aspect of the joint. Studies with different imaging modalities have been undertaken during the last years to identify whether these patients suffer from bursitis, tendinitis, or both. Nevertheless, little is known regarding the structural defect responsible for this disturbance. Due to these problems and some controversies, we suggest the term "anserine syndrome" for this condition. Diabetes Mellitus is a known predisposing factor for this syndrome. Overweight and osteoarthritis seem to represent additional risk factors; however, their role in the pathophysiology of the disease is not yet understood. Treatment includes non-steroidal anti-inflammatory drugs, physiotherapy, and injections of corticosteroid, with highly variable responses, from 10 days to 36 months to achieve recovery. The lack of knowledge about its epidemiological, etiological, and pathophysiological aspects requires future studies for this common and intriguing disorder.
Asunto(s)
Bursitis , Articulación de la Rodilla , Tendinopatía , Bursitis/diagnóstico , Bursitis/tratamiento farmacológico , Bursitis/epidemiología , Diagnóstico Diferencial , Humanos , Síndrome , Tendinopatía/diagnóstico , Tendinopatía/tratamiento farmacológico , Tendinopatía/epidemiologíaRESUMEN
Although there are not many reports in literature, iliopectineal bursitis presents clinically with signs and symptoms frequently found in outpatient services and practice. Its clinical presentation is anterior hip pain that worsens with the extension, abduction and internal rotation of the hip. The diagnosis is confirmed by ultrasound or magnetic nuclear resonance imaging of the hip. The iliopectineal bursitis responds well to conservative treatment with non-hormonal anti-inflammatory drugs and rest. Due to its good evolution, it is not rare to treat iliopectineal bursitis successfully without even knowing what is being treated.
Asunto(s)
Bursitis , Articulación de la Cadera , Bursitis/diagnóstico , Femenino , Humanos , Persona de Mediana EdadRESUMEN
A bursite iliopectínea, embora não tenha muitos relatos na literatura, apresenta-se clinicamente com sinais e sintomas frequentemente encontrados nos ambulatórios e consultórios. Sua clínica é de dor na parte anterior do quadril que piora à extensão, abdução e rotação interna do mesmo. O diagnóstico é confirmado pelo ultrassom ou ressonância nuclear magnética do quadril. A bursite iliopectínea responde bem ao tratamento conservador com anti-inflamatório não hormonal e repouso. Devido a esta boa evolução, não raro, pode-se tratar uma bursite iliopectínea com sucesso sem se saber o que está tratando.
Although there are not many reports in literature, iliopectineal bursitis presents clinically with signs and symptoms frequently found in outpatient services and practice. Its clinical presentation is anterior hip pain that worsens with the extension, abduction and internal rotation of the hip. The diagnosis is confirmed by ultrasound or magnetic nuclear resonance imaging of the hip. The iliopectineal bursitis responds well to conservative treatment with non-hormonal anti-inflammatory drugs and rest. Due to its good evolution, it is not rare to treat iliopectineal bursitis successfully without even knowing what is being treated.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Bursitis , Articulación de la Cadera , Bursitis/diagnósticoRESUMEN
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.
Asunto(s)
Complicaciones de la Diabetes/complicaciones , Dolor de Hombro/diagnóstico , Dolor de Hombro/etiología , Bursitis/diagnóstico , Bursitis/etiología , Bursitis/terapia , Calcinosis/complicaciones , Calcinosis/diagnóstico , Calcinosis/etiología , Calcinosis/terapia , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/terapia , Neuropatías Diabéticas/complicaciones , Neuropatías Diabéticas/diagnóstico , Neuropatías Diabéticas/terapia , Humanos , Modelos Biológicos , Osteoartritis/complicaciones , Osteoartritis/diagnóstico , Osteoartritis/etiología , Osteoartritis/terapia , Distrofia Simpática Refleja/diagnóstico , Distrofia Simpática Refleja/etiología , Distrofia Simpática Refleja/terapia , Dolor de Hombro/terapiaRESUMEN
Dor no joelho é uma condição comum na clínica diária e a patologia anserina, também conhecida como pata de ganso, tem sido considerada uma das principais causas. O diagnóstico tem sido realizado de maneira eminentemente clínica, o que tem gerado equívocos. Os pacientes queixam-se tipicamente de dor na parte medial do joelho, com sensibilidade na porção ínferomedial. Estudos de imagem têm sido realizados para esclarecer se tais pacientes possuem bursite, tendinite ou ambos os distúrbios na região conhecida como pata de ganso. Entretanto, o defeito estrutural responsável pelos sintomas permanece desconhecido, motivo pelo qual preferimos intitular como "Síndrome Anserina". O diabetes mellitus é um fator predisponente bem reconhecido. O sobrepeso e a osteoartrite de joelho parecem ser fatores adicionais de risco, contudo, seus papéis na gênese da moléstia ainda não são bem entendidos. O tratamento atual inclui anti-inflamatório, fisioterapia e infiltração de corticoide, com evolução muito variável, que oscila entre 10 dias e 36 meses. A falta de conhecimento sobre a etiofisiopatologia e dados epidemiológicos exige futuros estudos para esse frequente e intrigante distúrbio.
Knee pain is a common complaint in clinical practice, and pes anserinus tendino-bursitis syndrome (PATB) has been frequently diagnosed based only on clinical features that may cause equivocal interpretations. Patients complain of characteristic spontaneous medial knee pain with tenderness in the inferomedial aspect of the joint. Studies with different imaging modalities have been undertaken during the last years to identify whether these patients suffer from bursitis, tendinitis, or both. Nevertheless, little is known regarding the structural defect responsible for this disturbance. Due to these problems and some controversies, we suggest the term "anserine syndrome" for this condition. Diabetes Mellitus is a known predisposing factor for this syndrome. Overweight and osteoarthritis seem to represent additional risk factors; however, their role in the pathophysiology of the disease is not yet understood. Treatment includes non-steroidal anti-inflammatory drugs, physiotherapy, and injections of corticosteroid, with highly variable responses, from 10 days to 36 months to achieve recovery. The lack of knowledge about its epidemiological, etiological, and pathophysiological aspects requires future studies for this common and intriguing disorder.