RESUMO
Patients with radial-sided wrist pain can be challenging to diagnose and treat. Various physicians, including emergency physicians, primary care physicians, and orthopedic or plastic surgeons can be involved in the initial and subsequent evaluation. We delve into the differential diagnosis of radial-sided wrist pain including osteoarticular, ligament, tendon, nerve, and other pathologies. We review the physical exam findings, diagnostic studies, and treatment options for each pathology based on recent and updated literature.
Los casos de pacientes que presentan dolor radial de muñeca pueden ser de difícil diagnóstico y tratamiento. Varias especialidades médicas, incluidas emergentólogos, médicos de atención primaria, cirujanos ortopédicos o cirujanos plásticos, pueden estar involucrados desde el inicio de la patología y subsecuente evaluación. Profundizamos aquí en el diagnóstico diferencial del dolor radial de muñeca incluyendo las debidas a patologías osteoarticulares, ligamentosas, tendinopatías y neuropatías, entre otras. Esta revisión incluye examen físico, estudios diagnósticos, y opciones terapéuticas para cada condición con base en la literatura reciente y actualizada.
Assuntos
Articulação do Punho , Punho , Humanos , Punho/diagnóstico por imagem , Estudos Retrospectivos , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia , Artralgia/diagnóstico por imagem , Artralgia/etiologia , Diagnóstico DiferencialRESUMO
BACKGROUND: Joint pain in the absence or with little synovitis is observed in a large percentage of HTLV-1 infected subjects. As the virus infect CD4 + and CD8 + positive, macrophages and B cells an exaggerated production of pro-inflammatory cytokines is detected in these patients. However, the possible association of HTLV-1 infection with autoimmune diseases has not been documented definitively and the clinical characteristics of HTLV-1 associated arthropathy has not been defined. The objective this study is to describe clinic and radiographic features in HTLV-1-infected individuals with complaints of joint pain. METHODS: Cross-sectional study enrolling HTLV-1-infected individuals with chronic joint pain, aged up to 75 years, both genders and seronegative controls with osteoarthritis. All participants underwent conventional radiography of the hips, knees and ankles. RESULTS: Eighty-one HTLV-1 infected patients and 30 subjects with osteoarthritis participated in the study. Polyarticular and symmetrical arthritis prevailed in the HTLV-1 positive group (54%), while oligoarticular and asymmetrical (44%) were more common in controls (p < 0.05). The frequency of enthesophytes (90%) in HTLV-1-infected patients was greater than in the control group (73%) (p < 0.05). Radiographic features were similar in HTLV-1 carriers and in patients with probable or definite HTLV-1 associated myelopathy. The presence of enthesophytes in the absence of joint space reduction or osteophytes was only observed in HTLV-1-infected individuals (p < 0.001). Magnetic resonance imaging of the ankles of five HTLV-1-infected patients and five controls demonstrated a higher frequency of enthesitis, bursitis and osteitis in the HTLV-1 infected group. CONCLUSION: HTLV-1-associated arthropathy is clinically characterized by symmetrical polyarthralgia and the main radiological finding is the presence of enthesophytes in the absence of osteophytes and joint space narrowing.
Assuntos
Vírus Linfotrópico T Tipo 1 Humano , Osteoartrite , Osteófito , Idoso , Artralgia/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Masculino , Osteoartrite/diagnóstico por imagemRESUMO
OBJECTIVES: To evaluate the performance of the European League Against Rheumatism (EULAR) definition of arthralgias suspicious for progression to RA in patients with hand arthralgias and to estimate the added value of both auto-antibodies and ultrasound (US) with power Doppler (PD). METHODS: Consecutive patients admitted for hand arthralgias to "Reuma-check" ® program were included. This program includes the following at baseline: clinical assessment, laboratory tests, US with PD of both hands, and radiography of both hands and feet. All patients were followed-up after baseline evaluation by their treating rheumatologists, and a definitive diagnosis of RA (ACR/EULAR 2010 criteria) was established or not. RESULTS: A total of 465 consecutive patients were included. During follow-up, 44 (9.4%) were diagnosed with RA. Mean of baseline EULAR features describing arthralgia suspicious for progression to RA was 4.1 in patients with final diagnosis of RA vs 2.3 in non-RA patients (p < 0.0001). The AUC for the EULAR defined features describing arthralgia suspicious for progression to RA for the final diagnosis of RA was 0.7827, while adding US with PD, rheumatoid factor (RF), and anti-cyclic citrullinated peptide antibodies (ACPA) data, the AUC was 0.9172 (p < 0.0001). In the multivariate regression logistic analysis, baseline features associated with a final diagnosis of RA were difficulty with making a fist, RF, ACPA, and US with PD. CONCLUSIONS: EULAR definition of arthralgia suspicious for progression to RA had an acceptable performance to predict the future development of RA and improves adding information of both RF, ACPA and US with PD data.Key Points⢠Clinically suspect arthralgia may trigger rheumatologists to monitor patients closely for an early diagnosis.⢠EULAR definition of arthralgia suspicious for progression to RA predicts future development of arthritis.⢠Auto-antibodies and ultrasound improve EULAR definition of arthralgia suspicious for progression to RA.
Assuntos
Anticorpos Antiproteína Citrulinada/sangue , Artrite Reumatoide/diagnóstico , Fator Reumatoide/sangue , Ultrassonografia Doppler , Adulto , Idoso , Área Sob a Curva , Artralgia/sangue , Artralgia/diagnóstico por imagem , Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico por imagem , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Reumatologia/métodos , Reumatologia/normas , Sinovite/sangue , Sinovite/diagnóstico por imagemRESUMO
Introducción: El dolor de rodilla es una de las consultas más comunes en el consultorio traumatológico. Es comúnencontrarnos con pacientes que llegan a la consulta con una Resonancia Magnetica Nuclear (RMN) diciendo que tienenun menisco roto y buscando un turno en el quirófano. La mayoría de estos pacientes son factibles de tratamientoortopédico y es suficiente realizar maniobras semiologicas correctas para determinarlo. A pesar de ello hay un númerocreciente de solicitud de RMN de rodilla por miembros del equipo de salud. La hipótesis de este trabajo postula quelas RMN solicitadas por los especialistas en ortopedia y traumatología ofrecen resultados positivos tanto para los diagnósticos como para los planes de tratamiento.Objetivos: El objetivo de este trabajo es comparar la utilidad en el diagnóstico y en la definición terapéutica de las RMNde rodillas solicitadas por especialistas médicos...
Introduction: Knee pain is one of the most common complications in the trauma clinic. It is common to find patients whocome to the office with a Nuclear Magnetic Resonance (MRI) who have a broken meniscus and who are looking for a lathe inthe operating room. The majority of these patients are feasible for orthopedic treatment and it is sufficient to perform correct semiological maneuvers to determine it. Although there is a growing demand for knee MRI by members of the health team.The hypothesis of this work postulates that the NMR requested by the specialists in orthopedics and traumatology offerpositive results both for the diagnoses and for the treatment plans.Objectives: The aim of this study is to compare the usefulness in diagnosis and in the therapeutic definition of knee MRIs requested by medical specialists...
Assuntos
Adulto , Artralgia/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética , Ortopedia/estatística & dados numéricos , Estudos RetrospectivosAssuntos
Artralgia/etiologia , Infecções por HIV/complicações , Inibidores da Protease de HIV/efeitos adversos , Articulação do Joelho/patologia , Oligopeptídeos/efeitos adversos , Osteonecrose/etiologia , Piridinas/efeitos adversos , Ritonavir/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Artralgia/induzido quimicamente , Artralgia/diagnóstico por imagem , Sulfato de Atazanavir , Causalidade , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Combinação de Medicamentos , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila , Feminino , Inibidores da Protease de HIV/uso terapêutico , Humanos , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Oligopeptídeos/uso terapêutico , Compostos Organofosforados/uso terapêutico , Osteonecrose/induzido quimicamente , Osteonecrose/diagnóstico por imagem , Piridinas/uso terapêutico , Radiografia , Ritonavir/uso terapêuticoAssuntos
Artralgia/diagnóstico por imagem , Bursite/diagnóstico por imagem , Bursite/patologia , Articulação do Quadril , Tendinopatia/diagnóstico por imagem , Tendinopatia/patologia , Idoso , Artralgia/etiologia , Artralgia/patologia , Bursite/complicações , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Síndrome , Tendinopatia/complicações , UltrassonografiaAssuntos
Tálus/anormalidades , Luta Romana , Articulação do Tornozelo/diagnóstico por imagem , Artralgia/diagnóstico por imagem , Artralgia/etiologia , Feminino , Humanos , Osteocondrite Dissecante/diagnóstico por imagem , Tálus/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Adulto JovemRESUMO
OBJECTIVE: To compare the existence of radiographic abnormalities in two groups of patients, those with and without hip pain. METHODS: A total 222 patients were evaluated between March 2007 and April 2009; 122 complained of groin pain, and 100 had no symptoms. The individuals in both groups underwent radiographic examinations of the hip using the following views: anteroposterior, Lequesne false profile, Dunn, Dunn 45º, and Ducroquet. RESULTS: A total of 1110 radiographs were evaluated. Female patients were prevalent in both groups (52% symptomatic, 58% asymptomatic). There were statistically significant differences between the groups in age (p<0.0001), weight (p = 0.002) and BMI (p = 0.006). The positive findings in the group with groin pain consisted of the presence of a bump on the femoral head in the anteroposterior view (p<0.0001) or in the Dunn 45º view (p = 0.008). The difference in the a angle in the anteroposterior, Dunn, Dunn 45º, and Ducroquet views for all of the cases studied was p,0.0001. The joint space measurement differed significantly between groups in the Lequesne view (p = 0.007). The Lequesne anteversion angle (ρ) and the femoral offset measurement also differed significantly (p = 0.005 and p = 0.0001, respectively). CONCLUSIONS: We conclude that the best views for diagnosing a femoroacetabular impingement are the anteroposterior pelvic orthostatic, the Dunn 45º, and the Ducroquet views. The following findings correlated with hip pain: a decrease in the femoral offset, an increase in the α angle, an increase in the Lequesne ρ angle, a decrease in the CE angle of Wiberg, a thinner articular space and the presence of a bump on the femoral head-neck transition.
Assuntos
Artralgia/diagnóstico por imagem , Impacto Femoroacetabular/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Feminino , Colo do Fêmur/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/etiologia , Radiografia , Estatísticas não Paramétricas , Adulto JovemRESUMO
In chronic dialysis patients, ectopic, extraosseous calcifications can cause significant morbidity. Uremic tumoral calcinosis is an uncommon and severe complication of dialysis therapy. It is defined as deposition of dense nodular calcium-containing masses surrounding the large joints of the body, generally associated with the presence of high serum calcium-and-phosphorus product. We describe a 69-year-old woman submitted to long-term chronic hemodialysis that developed painful, bilateral hip tumors. Radiographic investigation showed extensive periarticular calcifications, and a bone biopsy was suggestive of adynamic bone disease and contained substantial amounts of aluminum. The lesions were surgically excised, and the histological analysis demonstrated amorphous, calcified material associated with densely collagenized connective tissue.
Assuntos
Artralgia/cirurgia , Calcinose/cirurgia , Falência Renal Crônica/terapia , Neoplasias de Tecido Conjuntivo/cirurgia , Diálise Renal , Idoso , Artralgia/sangue , Artralgia/diagnóstico por imagem , Artralgia/etiologia , Calcinose/sangue , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Cálcio/sangue , Feminino , Humanos , Falência Renal Crônica/sangue , Neoplasias de Tecido Conjuntivo/sangue , Neoplasias de Tecido Conjuntivo/diagnóstico por imagem , Fósforo/sangue , RadiografiaRESUMO
Acne fulminans is a rare manifestation that may occur during the evolution of acne vulgaris primarily in male adolescents. Use of isotretinoin, testosterone, and exacerbated immune responses in the body are related triggers. Signs, symptoms and laboratory findings such as fever, hepatomegaly, polyarthralgia, leukocytosis, plaquetose, increased inflammatory markers and transaminases, are characteristic. A bone scan can detect osteolytic lesions in multiple skeletal sites. The treatment is performed with prednisolone, isotretinoin and antibiotics if secondary infection is present. This case describes a male patient with a diagnosis of grade III acne, who developed acne fulminans and bilateral sacroiliitis with inability to ambulate, after initiation of therapy with isotretinoin.