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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The os trigonum syndrome refers to symptoms produced by pathology of the lateral tubercle of the posterior talar process. Pain can be caused by disruption of the cartilaginous synchondrosis between the os trigonum and the lateral talar tubercle as a result of repetitive microtrauma and chronic inflammation. Additional etiologies include trigonal process fracture, flexor hallucis longus tenosynovitis, posterior tibiotalar impingement by bone block, and intraarticular loose bodies. This pictorial essay explores the role of imaging modalities in the diagnosis and treatment of the os trigonum syndrome, a symptom complex that may present difficult diagnostic problems.
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PMID:The os trigonum syndrome: imaging features. 857 60

Resection arthroplasties were performed through a carpal tunnel incision in 72 hands of 57 patients with trapeziometacarpal joint arthritis and coexistent pathology of the anterior hand or wrist. Sixty-nine hands were followed for an average of 44 (range, 12-74 months). Pain relief was excellent in 60 hands, good in 7, and fair in 2, and thumb motion was satisfactory in 64 hands. Mean strength increase was 30%. Scaphometacarpal space loss was 0.5 mm each year, and residual space averaged 3.1 mm at 60 months. There were two failures. The study corroborated the frequent coexistence of other pathology of the anterior area of the hand and wrist, specifically, carpal tunnel syndrome and flexor carpi radialis tenosynovitis. Furthermore it demonstrated the possibility of an anterior approach to treat these conditions via the same incision. After 5 years, functional results remained good despite progressive collapse of the scaphometacarpal space.
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PMID:Stabilized resection arthroplasty by an anterior approach in trapeziometacarpal arthritis: results and surgical technique. 868 46

While Magnetic Resonance Imaging (MRI) has become a routine diagnostic method in knee studies, little has been published about ankle injuries. This is probably due to the anatomic complexity of the bone and ligament structures of this joint. Our study was aimed at assessing the yield of MRI of the ankle with a cost-effective, compact, low-field (0.2 T) M(R) system (Artoscan, Esaote). January, 1994, to August, 1995, 148 ankle examinations were carried out in a series of patients whose age ranged 7 to 75 years. In 56.7% of cases the exam was performed because of acute joint strain and in 43.3% for pain and chronic ankle instability. In 16.2% of cases the exam was negative; in 41.2% osteochondral injuries were found (which are not considered in this paper) and in 62.1% of cases ligament and tendon injuries were demonstrated. As for the latter, 46 patients had anterior talofibular rupture, 3 associated anterior talofibular and calcaneofibular ligament injuries, 9 tenosynovitis of extensor or flexor tendons, 2 tendon rupture and 17 Achilles tendon conditions (10 chronic tendinitis, 2 bone metaplasia and 5 tendon rupture cases). Three tarsal tunnel syndromes and 3 accessory soleus muscles were also observed. Surgical correlation was available only in 17 patients; after radiography and MRI, the vast majority of patients was treated nonoperatively. Nevertheless, a good correlation was demonstrated between M(R) and intraoperative findings or clinical and US findings. The authors believe that low-field MRI can be a very useful diagnostic tool in the study of ankle tendon injuries and to assess the severity of ligament injuries, for better treatment planning.
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PMID:[Magnetic resonance imaging in tendon and ligament injuries of the ankle. Our personal experience]. 869 20

Articulated total wrist arthroplasties have been used in the United States since 1974. In the 1980s the CFV wrist was developed in an attempt to reduce the incidence of imbalance, loosening, and bone resorption that has been seen in the early implants, and also to eliminate the use of bone cement. Since 1988, we have implanted 15 of these wrists. To date, nine patients are satisfied because of pain relief and motion; however, there have been 6 failures: 2 for infection, 3 because of a loose distal component, and 1 because of balance. Other problems that have been observed are flexor tenosynovitis, carpal tunnel syndrome, and a balancing problem.
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PMID:Results of CFV total wrist arthroplasty: review and early report. 874 95

Thirteen female ballet dancers had an operative release of the flexor hallucis longus tendon because of isolated stenosing tenosynovitis, and the results were reviewed after a mean duration of follow-up of six years and six months (range, two to ten years). All of the patients danced at the advanced or professional level, and all had failed to respond to non-operative management. The mean age of the patients at the time of the operation was twenty years (range, thirteen to twenty-six years). Symptoms, which included pain and tenderness over the medial aspect of the subtalar joint, had been present for a mean of six months (range, two to twelve months) preoperatively and were exacerbated by jumping and by attempts to perform en pointe work. Crepitus was present in six patients, and triggering was present in three. No patient had evidence of a symptomatic os trigonum. Postoperatively, all patients participated in a formal physical-therapy program for a mean of nine weeks (range, four to thirteen weeks). All patients returned to dancing, within a mean of five months (range, two to nine months), and eleven reached a level of full participation in dancing without restriction. At the time of the most recent follow-up, all patients noted improvement compared with the pre-operative condition. Eight patients were professional ballet dancers, four were students at advanced ballet schools, and one had stopped performing ballet for reasons unrelated to the tenosynovitis of the flexor hallucis longus. In addition, two of the students had decided not to pursue careers in dancing because of persistent, but greatly diminished, symptoms. No complications were noted in this series. We concluded that an operative release of the flexor hallucis longus is effective for the treatment of isolated stenosing tenosynovitis in female ballet dancers who place high demands on the foot and ankle and for whom non-operative treatment has failed.
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PMID:Release of the flexor hallucis longus tendon in ballet dancers. 881 55

The flexor hallucis longus (FHL) tendon is susceptible to injury along its entire course from the posterior aspect of the ankle to its insertion into the base of the distal phalanx of the great toe. Various lacerations, ruptures, longitudinal splits, and stenosing tenosynovitis have been noted. This report documents three cases of longitudinal split of the FHL at the knot of Henry. The diagnosis of this entity is based solely on history and physical examination. Patients with this problem have experienced either an acute or chronic repetitive hyperextension of the hallux metatarsophalangeal joint. They complain of pain with prolonged walking and running and have tenderness with palpation of the knot of Henry (the anatomical crossover between the FHL and the flexor digitorum longus) about one thumb-breadth lateral to the tuberosity of the navicular. Noninvasive imaging studies, including ultrasound and magnetic resonance imaging, are not helpful in establishing this diagnosis. Surgical treatment includes release of the knot of Henry, debridement and repair of the longitudinal split in the FHL, and excision of the interconnecting tendon between the FHL and the flexor digitorum longus. All three patients presented in this report have obtained long-term satisfactory relief of their symptoms with surgical treatment.
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PMID:Partial tear of the flexor hallucis longus at the knot of Henry: presentation of three cases. 912 16

A 6-year-old Quarter Horse gelding with acute onset of a grade-4/5 lameness of the left forelimb 21 days after an encounter with a porcupine was examined. Quills had been removed by the referring veterinarian, and the horse had been treated with antibiotics and hydrotherapy for 14 days. The horse was pyretic and had effusion in the digital synovial sheath. Signs of pain were elicited on palpation of the area. A tentative diagnosis of septic tenosynovitis caused by a porcupine quill was made. Exploratory tenoscopy revealed large amounts of fibrin in the sheath and a 1.2-cm quill. Bacteriologic culture of synovial fluid yielded a pure growth of Staphylococcus aureus. The horse improved dramatically after tenoscopic removal of the quill, debridement of fibrin, and lavage to dilute inflammatory mediators and bacteria, debridement of fibrin, discovery and removal of a quill, and complete evaluation of the sheath for prognostic purposes. Tenoscopy can provide a means for direct observation and enhance the ability of clinicians to debride a septic synovial sheath in a minimally invasive manner.
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PMID:Use of tenoscopy for management of septic tenosynovitis caused by a penetrating porcupine quill in the synovial sheath surrounding the digital flexor tendons of a horse. 918 27

In sports medicine, a chronic overuse injury is defined as a long-standing or recurring orthopedic problem and pain in the musculoskeletal system, which started during exertion due to repetitive tissue microtrauma (1). Repetitive microtrauma, which is basically repeated exposure of the musculoskeletal tissue to low-magnitude forces, results in injury at the microscopic level, and no single acute trauma is normally involved in the pathogenesis of an overuse injury. In chronic tendon disorders, 'overuse' implies that the tendon has been strained repeatedly to 4-8% strain until unable to endure further tension, whereupon injury occurs (2). The structure of the tendon is disrupted micro- or macroscopically by this repetitive strain, i.e. collagen fibrers begin to slide past one another, causing break-age of their cross-linked structure, and denaturate; inflammation, edema and pain result. Thus, tendinitis, peritendinitis, tenosynovitis, insertion tendinitis, tendinous bursitis or apophysitis is the earliest clinically recognizable manifestation of overuse tendon injury (3).
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PMID:Etiology and pathophysiology of chronic tendon disorders in sports. 921 8

Degenerative and overuse diseases as well as impingement syndromes of the hand are illustrated and discussed in this review article. Osteoarthritis of the interphalangeal joints as described by Heberden and Bouchard is a ubiquitous articular disease often associated with synovitis and erosive joint destruction. Osteoarthritis of the trapeziometacarpal joint is classified into four stages for proper indication of operation. Overuse can result in stenosing tenosynovitis around the wrist and in synovitis with or without impingement of the flexor or extensor tendons of the digitis or ruptures of the annular and cruciform pulleys. Although diagnosis of these entities is usually made by history and clinical investigation, ultrasound and MRI can be helpful tools in imaging of these diseases. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are the characteristic degeneration pattern of the wrist and represent the degeneration mechanisms in scapholunate insufficiency and nonunion of the scaphoid. SLAC wrist is a gradual degeneration classified in three stages and found in posttraumatic scapholunate rupture, calcium pyrophosphate dehydrate deposition disease (CPPD), rheumatoid arthritis, neuropathic diseases, trauma, and beta 2-microglobulin associated amyloid deposition. Ulna impaction syndrome is increasingly recognized as a cause of ulnar sided pain and exhibits a characteristic MRI appearance.
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PMID:Imaging of the hand: degeneration, impingement and overuse. 928 40

De Quervain disease is a job-related tenosynovitis that affects the synovial sheath of the tendons of the abductor pollicis longus and extensor pollicis brevis muscles; it is associated with pain and functional impairment and progresses to cause local fibrosis with blockage or triggering of the thumb. High-resolution ultrasonography of the wrist was performed in eight patients with de Quervain disease; the examination was performed in axial and coronal scans with a 13 MHz linear transducer. The evaluation of normal wrists helped to define the normal sonographic anatomy of the first extensor compartment; obvious changes of the tendon sheath were noted in all cases of de Quervain disease (thickening and edema of the synovial sheath and fluid within the sheath). We conclude that ultrasonography is able to confirm the clinical diagnosis of de Quervain disease and may have a role in the follow-up of this disorder.
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PMID:Ultrasonographic evaluation of de Quervain disease. 932 74


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