scholarly journals P12 Focal myositis—A case series of a rare cause of hip immobility and calf pseudotumor in children

2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Fahim Patel ◽  
Arani Sridhar
Keyword(s):  
Case Report ◽  
External Rotation ◽  
Full Range ◽  
Case Series ◽  
Joint Involvement ◽  
Inflammatory Cell Infiltrate ◽  
Eye Drops ◽  
Range Of Movement ◽  
Obturator Internus ◽  
Rare Differential Diagnosis

Abstract Case report - Introduction Focal myositis is a rare immune-mediated pseudotumour of a single skeletal muscle group. Only around 200 cases have been described in the literature, so little is known about incidence, prevalence, patient management and outcomes. This differs and should not be confused with post-viral myalgia which bears neither the histological changes nor chronicity of focal myositis. Treatment options are centred on immunomodulation and in severe cases surgical management of contractures. Case report - Case description Case 1 A systemically well 7-year-old girl presented with 5-weeks of right calf tenderness and swelling following a short episode of pharyngitis and generalised maculopapular rash. There was no gait abnormality, focal neurology or restriction in activity aside from fatigability on walking distances. There were no skin rashes, joint involvement, eye changes or involvement of other muscles. She had a raised creatine kinase, plasma viscosity and lactate dehydrogenase. Her other blood results were normal including an extended autoimmune screen, immunoglobulins, complement levels, ASOT and titres of mycoplasma, EBV and CMV. MRI showed evidence of extensive inflammation of the gastrocnemius and soleus. A muscle biopsy showed heavy interstitial inflammatory cell infiltrate of predominantly lymphocytes, features of fibre necrosis including phagocytosis and hyalinisation with concurrent fibre regeneration. Case 2 A systemically well 14-year-old presented with 6-months of left-sided hip pain, weight loss and inability to weight-bear without crutches. On examination there was painful fixed limitation of the left hip to 45o on abduction and external rotation with bilateral mild swelling of the proximal interphalangeal (PIP) joints on both upper limbs. Otherwise, there was a full range of movement in all joints, with no rashes or other joint swelling or inflammation. Her blood tests were ANA positive 1:6000 and MRI of her hips demonstrated high T2 signal intensity in the left gluteus minimis and medius, obturator internus, obturator externus in keeping with myositis. Case report - Discussion Case 1 She was initially managed with physiotherapy and anti-inflammatory medications but then developed intermittent right calf pain, restriction in activity and tiptoe walking due to gastrocnemius contractures. She was commenced on an 8-week tapering course of oral steroids and is improving with weekly methotrexate. Case 2 She received a pulse of corticosteroids followed by a course of methotrexate. There was immediate improvement in her PIP joint swellings and within a few weeks she was able to walk without crutches for the first time in 6 months; a surveillance MRI confirmed complete radiographical resolution of myositis. Unfortunately, 18 months after her diagnosis, she had developed anterior uveitis of her left eye with posterior synechiae; this responded well to steroid and cyclopentolate eye drops. Case report - Key learning points We emphasise that clinicians should bear this rare differential diagnosis for in mind for consideration of early conservative management, assessment for uveitis, immunomodulation and possibly surgical correction to improve patient outcome.

Acute and Subacute Changes in Hip Strength and Range of Movement After Arthroscopy to Address Chondrolabral Pathology

2019 ◽  
Vol 47 (8) ◽  
pp. 1939-1948 ◽  
Author(s):  
Matthew D. Freke ◽  
Kay Crossley ◽  
Kevin Sims ◽  
Trevor Russell ◽  
Patrick Weinrauch ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Repeated Measures ◽  
External Rotation ◽  
Case Series ◽  
Hip Pain ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Hip Strength ◽  
Hip Flexion ◽  
And Function

Background:Hip pain is associated with reduced muscle strength, range of movement (ROM), and function. Hip arthroscopy is undertaken to address coexistent intra-articular pathologies with the aim of reducing pain and improving function.Purpose:To evaluate changes in strength and ROM in a cohort with chondrolabral pathology before surgery to 3 and 6 months after hip arthroscopy.Study Design:Case series; Level of evidence, 4.Methods:Sixty-seven individuals with hip pain who were scheduled for hip arthroscopy were matched with 67 healthy controls. Hip strength and ROM were collected preoperatively and at 3 and 6 months postoperatively. Repeated measures analysis of variance evaluated whether strength and ROM differed between limbs and among time points. Bonferroni post hoc tests determined differences in hip strength and ROM among testing times and between the hip pain group and matched controls.Results:Hip extension, internal rotation (IR), external rotation (ER), and adduction ( P < .040) strength were greater at 3 months after surgery; all directions, including flexion, abduction, and squeeze, were greater at 6 months ( P < .015). Hip flexion ROM was greater at 3 months after surgery ( P = .013). Flexion, IR, and ER ROM was greater at 6 months ( P < .041). At 6 months, IR ROM ( P = .003) and flexion, IR, and ER strength ( P < .005) remained less than matched controls.Conclusion:With the exception of squeeze and flexion, all directions of hip strength and hip flexion ROM are significantly improved 3 months after arthroscopy to address chondrolabral pathology. By 6 months after arthroscopy, strength in all directions and flexion and rotation ROM are significantly improved in both limbs, but hip flexion, IR, and ER strength and IR ROM remain significantly less than that of healthy matched controls in both limbs.

scholarly journals Surgery for Clavicular and Humeral Fractures in an Osteopetrotic Patient: A Case Report

2007 ◽  
Vol 15 (2) ◽  
pp. 251-254 ◽  
Author(s):  
J Nakayama ◽  
H Fujioka ◽  
M Kurosaka ◽  
H Kitazawa ◽  
N Maesawa ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Rare Disease ◽  
Multiple Trauma ◽  
Full Range ◽  
Humeral Fractures ◽  
Bone Union ◽  
Range Of Movement ◽  
Severe Multiple Trauma

Osteopetrosis is a rare disease characterised by generalised sclerosis of the bone. Surgical treatment for fractures in osteopetrotic bones is difficult due to their hardness. We report successful surgical treatment of humeral and clavicular fractures in a 30-year-old osteopetrotic patient with severe multiple trauma. Two years after surgery, the patient had a full range of movement at the shoulder and elbow, with good bone union and alignment.

scholarly journals O28 A rare sight-threatening complication of a rare disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Mithun Chakravorty ◽  
Archana Pradeep ◽  
Ira Pande
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Retinal Detachment ◽  
Case Series ◽  
Relapsing Polychondritis ◽  
The Body ◽  
Eye Drops ◽  
Exudative Retinal Detachment ◽  
Posterior Scleritis ◽  
Initial Symptoms

Abstract Case report - Introduction Relapsing polychondritis (RP) is a rare autoimmune disorder characterised by inflammation of cartilaginous structures throughout the body. It usually presents in the fourth and sixth decade, and commonly affected areas include the nasal and respiratory tracts, external ears and joints. Ocular involvement is reported in around 65% of RP patients during their lifetime but is rarely sight-threatening. However, we present an unusual case of recurrent ocular inflammation due to RP that resulted in unilateral posterior scleritis with sub-retinal exudation, and posed a high risk of retinal detachment. Prompt escalation of immunosuppressive treatment was required to prevent this. Case report - Case description A 48-year-old man of south-east Asian descent presented to rheumatology in December 2020 with a typical history of new inflammatory arthritis of 4 weeks duration. He was known to have bilateral episcleritis and ocular hypertension for 3 years and took Brinzolamide and Latanoprost eye drops, as well as metformin for type 2 diabetes mellitus. The only other relevant history was treatment with antibiotics as an inpatient for bilateral pinna cellulitis 2 months prior, which was suspected to be related to his diabetes. Examination revealed mildly reduced hand grips but no definite synovitis. The most remarkable finding was bilateral painless red eyes. Both pinnae appeared inflamed on close inspection without obvious auricular lobe involvement. Blood tests showed raised C-Reactive Protein (38 mg/L), and Erythrocyte Sedimentation Rate (62 mm/hr), with normochromic normocytic anaemia but other blood counts were normal. Renal and liver function was normal. Detailed immunology was negative. Relapsing Polychondritis was suspected and confirmed following multidisciplinary team (MDT) discussions with the Ear Nose and Throat and ophthalmology teams. At the next visit, his disease progressed to florid polyarthritis in a rheumatoid distribution. This responded well to low-dose prednisolone and methotrexate. However, the patient attended eye casualty on multiple occasions over the next 6 weeks with alternating acute eye pain and redness, mildly reduced visual acuity and raised intraocular pressures. He developed sub-retinal fluid pockets suggestive of posterior scleritis in the right eye and retinal tomography demonstrated extensive pigment clumping especially in the macula with outer retinal disruption. Urgent pulses of intravenous methylprednisolone were given, followed by high-dose prednisolone tapering. The case was discussed with the regional uveitis MDT, and treatment was escalated to adalimumab. He is currently 1 month into treatment and has preserved visual acuity and stable intraocular pressures, with no other systemic involvement of his RP. Case report - Discussion The diagnosis of RP requires a high index of clinical suspicion given the lack of diagnostic markers. The clinical features are multisystem and might not occur simultaneously as in this case, where the eye disease preceded the ear and joint manifestations by a couple of years. Perichondritis might be more difficult to appreciate in patients with darker skin and can further delay diagnosis. The average time to diagnosis from the initial symptoms has been reported as 14 months from a case series of 158 patients with RP in China. Ocular complications are usually bilateral and the commonest are episcleritis and scleritis (over 50% of cases have one of these), followed by uveitis and retinopathy. Eyelid oedema, proptosis and optic neuritis can also occur but are rarer, and exudative retinal detachment has only been noted in a small number of case reports. Unfortunately, no current treatment guidelines exist for RP due to a lack of randomised controlled trials but treatment is usually guided by the severity of manifestations in conjunction with trends from case series and expert opinion. The aim is to halt or slow disease progression and glucocorticoids are often used first-line for moderate to severe disease, with or without the addition of steroid-sparing agents such as methotrexate, ciclosporin and azathioprine. A meta-analysis of biologics in RP conducted by Kemta et al. in 2012 has suggested anti-TNF (particularly Infliximab) might be beneficial as second-line treatment for severe or refractory cases of organ involvement due to RP such as central nervous system, nasal or pulmonary involvement. However, due to the extreme rarity of both RP and associated severe retinal disease, the optimum therapeutic choice in this setting is currently not known. Case report - Key learning points

scholarly journals Bilateral patella fracture with unilateral refracture: a case report

2020 ◽  
Vol 7 (1) ◽  
pp. 175
Author(s):  
Santosh Reang ◽  
Pulak Saha ◽  
Tapan K. Das
Keyword(s):  
Case Report ◽  
Full Range ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Patella Fracture ◽  
Range Of Movement ◽  
X Ray ◽  
Pathological Conditions ◽  
Patella Fractures ◽  
Good Range

<p class="abstract">Patella fracture consists of approximately 1% of all skeletal fractures. However bilateral patella fracture is even rarer (2-3% of all patella fractures) and is seen mostly in either dash board injuries or in different pathological conditions. A 21 year old male presented with bilateral patella fracture, where right patella was fractured due to RTA and the left one got fractured due to a fall while he was being helped for an X-ray for the first one. Bilateral tension band wiring was done and patient was being regularly followed up with good range of movement recovery. But again he had a fall in bathroom 3 month post-operative and on right side suffered a re-fracture. Modified tension band wiring was done. Patient gained full range of movement on both sides and returned to his normal activities at 9 months post op of index surgery. A case of bilateral patella fracture where mechanism of fracture for each patella fracture are different is unheard of. A case of bilateral patella fracture with re-fracture has not been reported yet in literature so far we know/ searched. Here we report and discuss the challenges in management of such a case and protocol we followed.</p>

EFEITOS DO DEEP RUNNING SOBRE A AMPLITUDE DE MOVIMENTO E A CAPACIDADE FUNCIONAL DOS MEMBROS SUPERIORES DE MULHERES MASTECTOMIZADAS: RELATO DE CASOS

2019 ◽  
pp. 121-131
Keyword(s):  
Range Of Motion ◽  
Upper Limb ◽  
Functional Capacity ◽  
External Rotation ◽  
Treatment Protocol ◽  
Range Of Movement ◽  
Flexion Extension ◽  
Before And After ◽  
In The Beginning ◽  
And Function

Introduction: Breast cancer is the most common type of cancer among women in Brazil and in the worl. The surgical treatment procedure may cause severe morbidity in the upper limb homolateral to surgery, including the reduction of the range of motion, with consequent impairment of function. A physiotherapeutic approach has an important role in the recover range of motion and the functionality of these women, guaranteeing the occupational, domestestic, familiar and conjugated activities, and, in this way, also improving the quality of life. Objectives: To analyse chances in the shoulder's range of motion and the functional capacity of the upper limbs, promoted by the deep running procedure in women with late postoperative mastectomy. Methods: All the patients were submitted to an evaluation in the beginning and end of the treatment, including: goniometry of flexion, extension, abduction, adduction, internal and external rotation of the shoulder joint; and function capacity analysis in activities that involve the upper members by DASH questionnaire. The treatment protocol includes twelve sessions of deep running, realized twice a week, in deep pool, for 20-minute during six weeks. Results: Were submitted to treatment a total of 4 patients. Despite the improvement in the numerical values, statistically significant differences were not found on the range of movements and in the functional capacity of upper members before and after the deep running sessions in post-mastectomy women. Conclusion: Deep running had effects on the numerical values of range of movement and upper limb functionality in women in the late postoperative period of the mastectomy procedure, but without statistically significant differences.

scholarly journals AB0648 REACTIVE ARTHRITIS IN SYPHILIS MIMICKING RHEUMATOID ARTHRITIS: A CASE REPORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1357.1-1357
Author(s):  
S. M. Lao ◽  
J. Patel
Keyword(s):  
Rheumatoid Arthritis ◽  
Reactive Arthritis ◽  
Joint Pain ◽  
Inflammatory Markers ◽  
Morning Stiffness ◽  
Treponema Pallidum ◽  
Case Series ◽  
Penicillin G ◽  
Joint Involvement ◽  
Igg Antibody

Background:Reactive arthritis is a form of spondyloarthritis with aseptic joint involvement occurring after a gastrointestinal or urogenital infection. Most commonly associated with Chlamydia trachomatis, Salmonella, Shigella, Campylobacter, and Yersinia. Syphilis is an infection caused by the spirochete Treponema pallidum and is not usually associated with reactive arthritis. Syphilis is a great imitator of other diseases due to its broad presentation including painless chancre, constitutional symptoms, adenopathy, rash, synovitis, neurological and ocular findings.Objectives:To discuss a patient who presented with symptoms of rheumatoid arthritis (RA) but was later diagnosed with syphilis.Methods:31 year old male, former tobacco smoker, referred to Rheumatology for sudden onset joint pains, elevated anti-cyclic citrullinated peptide (anti-CCP), and elevated inflammatory markers. He reported pain in bilateral wrists, fingers, and right elbow for 6 weeks. Associated with 45 minutes of morning stiffness and new onset lower back pain without stiffness. He denied trauma, fever, chills, skin rash, dysuria, or diarrhea. Initiated trial naproxen 500mg twice a day only to have minimal relief. Patient is sexually active with men and was recently diagnosed with oropharyngeal gonorrhea treated with azithromycin 4 months prior. All other STI screening including syphilis, gonorrhea, HIV were negative at that time. Patient is on emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis. He denied family history of immune mediated conditions. Exam was significant for mild synovitis of both wrists and bilateral 2nd metacarpophalangeal joints. Initial labs revealed weakly positive anti-CCP 21 (normal <20), sedimentation rate 64 (normal ESR 0-15 mm/hr), C-reactive protein 24 (normal CRP 0-10 mg/L), and negative RF, ANA, HLA B27. During a short trial of prednisone taper, there was temporary improvement in symptoms, however synovitis recurred upon completion. Hydroxychloroquine (HCQ) 200mg twice a day was started for possible RA and he was referred to Ophthalmology for baseline retinopathy screening. Incidentally, he developed right sided blurry vision 2 weeks after initiation of HCQ. He was diagnosed with panuveitis of the right eye with inflammation of the optic nerve head and prednisone 40mg daily was initiated for presumed ocular manifestation of RA. However, further workup of panuveitis revealed reactive Treponema pallidum antibody and RPR quantity 1:32. Prednisone was immediately discontinued and he was referred to the emergency department for possible neurosyphilis.Results:Lumbar puncture showed cerebral spinal fluid with 260 red blood cells, 1 white blood cell, 27mg/dL protein, 60mg/dL glucose, non reactive VDRL, reactive pallidum IgG antibody, and negative cultures. Meningitis and encephalitis panels were negative. Patient completed a 14 day course of IV penicillin G with complete remission of joint pain, visual symptoms, and normalization of anti-CCP, ESR, and CRP.Conclusion:This case highlights how syphilis may mimic signs and symptoms of RA including symmetrical small joint pain, morning stiffness, elevated inflammatory markers, and positive anti-CCP. Anti-CCP is >96% specific for RA but was a false positive in this patient. There have only been few reported cases noting positive anti-CCP with reactive arthritis. This is a rare case of reactive arthritis secondary to syphilis with resolution of symptoms upon treating the syphilis.References:[1]Carter JD. Treating reactive arthritis: insights for the clinician. Ther Adv Musculoskelet Dis. 2010 Feb;2(1):45-54.[2]Cohen SE, Klausner JD, Engelman J, Philip S. Syphilis in the modern era: an update for physicians. Infect Dis Clin North Am. 2013 Dec;27(4):705-22.[3]Singh Sangha M, Wright ML, Ciurtin C. Strongly positive anti-CCP antibodies in patients with sacroiliitis or reactive arthritis post-E. coli infection: A mini case-series based review. Int J Rheum Dis. 2018 Jan;21(1):315-321.Disclosure of Interests:None declared.

scholarly journals Correlation of Ultrasound Findings With Clinical Stages and Impairment in Adhesive Capsulitis of the Shoulder

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110036
Author(s):  
Jong Geol Do ◽  
Jin Tae Hwang ◽  
Kyung Jae Yoon ◽  
Yong-Taek Lee
Keyword(s):  
Structural Changes ◽  
External Rotation ◽  
Biceps Tendon ◽  
Adhesive Capsulitis ◽  
Case Series ◽  
Tendon Sheath ◽  
Level Of Evidence ◽  
Cutoff Values ◽  
Diagnostic Values ◽  
Ultrasound Parameters

Background: Ultrasound is an essential tool for diagnosing shoulder disorders. However, the role of ultrasound in assessing and diagnosing adhesive capsulitis has not been fully studied. Purpose: To evaluate the ultrasound features of adhesive capsulitis and estimate the correlations between clinical impairment and ultrasound parameters. Study Design: Case series; Level of evidence, 4. Methods: A total of 61 patients with clinically diagnosed unilateral adhesive capsulitis were retrospectively reviewed using high-resolution ultrasound. To compare ultrasound parameters, we performed ultrasound examinations on both affected and unaffected shoulders. Ultrasound parameters, including thickness of the coracohumeral ligament (CHL), rotator interval (RI), axillary recess (AR), hypervascularity of the RI, and effusion of the long head of the biceps tendon sheath, were measured. Passive range of motion (PROM), visual analog scale for pain, and the Shoulder Pain and Disability Index were used for clinical assessment. Results: The CHL, the RI, and the AR in affected shoulders were significantly thicker than in unaffected shoulders ( P < .05). CHL thickness in affected shoulders was significantly correlated with PROM limitation, which included forward elevation, abduction, external rotation (ER), and internal rotation (IR) ( P < .05). AR thickness correlated with passive forward elevation limitation and passive IR limitation ( P < .05). The CHL was significantly thicker in stage 2 compared with stage 1, and the RI was thicker in stage 2 compared with stage 3. The diagnostic cutoff values for adhesive capsulitis were 2.2 mm for CHL thickness (77% sensitivity, 91.8% specificity) and 4 mm for AR thickness (68.9% sensitivity, 90.2% specificity). Conclusion: The ultrasound parameters associated with structural changes were correlated with clinical characteristics of adhesive capsulitis. Thickened CHL, RI, and AR were observed in affected shoulders. The cutoff values of 2.2 mm for CHL thickness and 4 mm for AR thickness can be used as cutoff diagnostic values for adhesive capsulitis.

scholarly journals Desmoplastic small round cell tumor: A case report of a rare differential diagnosis of solid tumors of the pleura

2015 ◽  
Vol 10 (5) ◽  
pp. 2991-2995 ◽  
Author(s):  
YUAN CAO ◽  
YING CHEN ◽  
LI YANG ◽  
ZI-HUA QIAN ◽  
SHU-GAO HAN ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Solid Tumors ◽  
Cell Tumor ◽  
Round Cell ◽  
Round Cell Tumor ◽  
Small Round Cell Tumor ◽  
Small Round Cell ◽  
Rare Differential Diagnosis

Abstract WP314: Frequency and Characteristics of Hemiplegic Shoulder Pain - A Population-Based Assessment

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Zoe A Allen ◽  
Keyword(s):  
Visual Analogue Scale ◽  
Shoulder Pain ◽  
Analogue Scale ◽  
External Rotation ◽  
South Australia ◽  
Population Based ◽  
Active Movement ◽  
Range Of Movement ◽  
Stroke Incidence ◽  
Post Stroke

Background: Shoulder pain is common complication of stroke with multiple aetiological mechanisms but there are few population-based studies of the clinical profile, frequency and impact of the disorder. Objectives: To determine the frequency and characteristics of hemiplegic shoulder pain in the first year after stroke. Methods: Data on any shoulder pain were obtained in patients registered in a population-based stroke incidence study undertaken in a defined area of the western suburbs of Adelaide, South Australia, over a 12-month period to July 2010. Subjective (any, onset, severity [visual analogue scale] and aggravating factors) and three objective (modified Neer test, passive hand-behind-neck, and passive external rotation) measures of pain were undertaken at baseline, and 4 and 12 months post-stroke. Results: Among 301 stroke patients, shoulder pain data were available for 198 (66%), as 62 had died prior to the 4 month assessment and 41 either refused or were unavailable for assessment. Information on shoulder pain was available from 198 stroke survivors at baseline, 156 at 4 months and 148 at 12 months. Overall, 10% reported shoulder pain at baseline, whilst 21% reported pain at both follow-up assessments, so that overall approximately one third (27%) of patients reported some shoulder pain during 12 months post-stroke. The median pain score (visual analogue scale = 40) was highest at 4 months, and the characteristics varied from mild and prominent at rest (including night) in the early weeks, to being more associated with limited range of movement and aggravated by active movement towards 12 months, suggesting increasing musculoskeletal contributions to pain over time. Objective passive range of motion tests were associated with higher frequencies of pain than were elicited by self-reports. Conclusions: The frequency of post-stroke shoulder pain was similar to other population-based studies, suggesting limited progress in prevention and management of this complication. As the disorder is most common and severe after hospital-discharge, targeted protocols may facilitate identification and management.

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