scholarly journals THUMB TUBERCULOSIS: A CASE REPORT

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0006
Author(s):  
Yunus R. Mohd ◽  
A.A. Ahmad ◽  
A.R. Ahmad
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Range Of Motion ◽  
Active Form ◽  
Plain Radiograph ◽  
Proximal Phalanx ◽  
Diagnostic Delay ◽  
Joint Space ◽  
Rare Presentation ◽  
Wound Debridement ◽  
Limited Range Of Motion

Tuberculosis is caused by Mycobacterium tuberculosis, occurs in about 2 billion people. Approximately 8 million people/year develop the active form.1,2 Tuberculosis in the hand is manifested as osteomyelitis in carpals, metacarpals and phalanges.1 Musculoskeletal tuberculosis occurs, in most cases, through haematogenous dissemination from the primary focus. In immunosuppression circumstances, it is reactivated. Methods: 47 years old lady, who had underlying pulmonary tuberculosis on anti-TB medications since June 2018, presented to us for swelling over right thumb. Associated with tender, erythematous skin and limited range of motion of right thumb. Results: Plain radiograph demonstrated soft tissue swelling, joint space narrowing, mottled lucency of the proximal phalanx and cystic degenerative changes. MRI shows osteomylities proximal phalanx of right thumb. Patient underwent wound debridement of right thumb, culture and sensitivity shows Mycobacterium tuberculosis infections. Post debridement, range of motion of MCP joint of right thumb was improved and anti-TB medications to restart. Discussions: Tuberculosis involvement of the metacarpals and phalanges is a rare presentation of extrapulmonary TB. The radiographic features of osseous tuberculosis are present in conditions such as inflammatory arthritis, pyogenic osteomyelitis, osteopenia, softtissue swelling with minimal periosteal reaction, narrowing of the joint space, cysts in bone adjacent to joints, and subchondral erosions. The gold standard to diagnose is culture of Mycobacterium tuberculosis from bone tissue. Current treatment is a 2 month initial phase of isoniazid, rifampin, pyrazinamide, and ethambutol followed by a 6 to 12 month regimen of isoniazid and rifampin. Conclusion: Finger swelling is a rare presenting sign of disseminated tuberculosis. Early biopsy and appropriate microbiologic testing can avoid diagnostic delay. References: Malaviya AN, et al. Best Pract Res Clin Rheumatol. 2003;17:319–43. Fortún J, et al. Mycobacterium tuberculosis infection? Medicine. 2010;10:3808–19. DOI: 10.1016/S0304-5412(10)70119-0.

scholarly journals Unilateral premature osteoarthritis of the hip with excessive anteversion of the femoral neck developing in the early second decade: two surgical cases

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Takahiro Nishimura ◽  
Hideaki Watanabe ◽  
Naoya Taki ◽  
Saki Onuma ◽  
Ichiro Kikkawa
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Range Of Motion ◽  
Joint Space ◽  
Limited Range ◽  
Leg Length ◽  
Anteversion Angle ◽  
Unaffected Side ◽  
Limited Range Of Motion ◽  
History Of

Abstract Background Osteoarthritis (OA) of the hip rarely develops in the early second decade. As the incidence of this disease is low, no treatment method has been established. We report two patients with unilateral OA in their early teens in whom the anteversion angle of the femoral neck on the affected side was greater than that on the unaffected side. Case presentation Case 1 was an 11-year-old girl with left coxalgia and limited range of motion. There was no history of femoroacetabular impingement (FAI) or developmental dysplasia of the hip (DDH). Plain X-rays revealed the disappearance of the Y cartilage, joint space narrowing of the left hip, and acetabular/femoral head osteosclerosis. In CT images, the anteversion angle of the femoral neck (lt/rt) was 45/35 degrees. As osteoarthritis was severe, proximal femoral flexional derotational varus osteotomy (PFFDVO) and triple pelvic osteotomy (TPO) were performed. Case 2 was a 13-year-old girl with left coxalgia and limited range of motion. There was no history of FAI or DDH. Plain X-ray revealed irregularity of the left anterolateral femoral head, and a subcartilaginous cyst. In CT images, the anteversion angle of the femoral neck (lt/rt) was 30/20 degrees. As osteoarthritis was severe, PFFDVO was performed. In addition, we resected bone spurs on the femoral head because flexion was limited owing to the presence of osteophytes. In both patients, coxalgia and claudication/gait disorder resolved postoperatively, and joint space narrowing and osteosclerosis improved. However, in Case 1, there was a 3-cm difference in the leg length, and in Case 2, range-of-motion limits remained. Conclusions We present the findings in two patients with unilateral OA in their early second decade in whom the femoral anteversion angle on the affected side was greater than that on the unaffected side. PFFDVO + TPO was performed in Case 1, and PFFDVO + bone spur resection on the femoral head was performed in Case 2. Coxalgia resolved, and plain X-ray demonstrated improvements in OA; however, a difference in the leg length and range-of-motion limits remained.

A case of subacute sclerosing panencephalitis presenting as depression

2006 ◽  
Vol 18 (1) ◽  
pp. 55-57 ◽  
Author(s):  
Soumitra Shankar Datta ◽  
Rajesh Jacob ◽  
Sudhir Kumar ◽  
Susan Jeyabalan
Keyword(s):  
Clinical Presentation ◽  
Subacute Sclerosing Panencephalitis ◽  
Diagnostic Delay ◽  
Depressive Syndrome ◽  
Adult Patients ◽  
Rare Presentation ◽  
Affective Symptoms

Summary:Subacute sclerosing panencephalitis (SSPE) is rare in adult patients. Clinical presentation in intial phases of SSPE may be non-specific leading to diagnostic delay. We present a 24-year-old patient with depressive syndrome of five months' duration prior to the onset of typical features of SSPE, which is a rare presentation. This patient had responded partially to Sertraline, for a brief period, before he was diagnosed to have SSPE. This case illustrates affective symptoms can be the presenting features of SSPE in adults.

P080 Acroosteolysis: a rare complication or a co-occurrence with Juvenile Idiopathic Arthritis?

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Makhlouf Yasmine ◽  
Miladi Saoussen ◽  
Fazaa Alia ◽  
Sellami Mariem ◽  
Souabni Leila ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Psoriatic Arthritis ◽  
Rare Complication ◽  
Plain Radiograph ◽  
Limited Range ◽  
Acute Phase Reactants ◽  
Limited Range Of Motion ◽  
Macular Rash ◽  
Oligoarticular Juvenile Idiopathic Arthritis ◽  
Dysmorphic Syndrome

Abstract Background Acroosteolysis refers to a destructive process involving the distal phalanges of the fingers and toes that may extend to metacarpals or metatarsals. Rarely idiopathic, the diagnosis of primary acroosteolysis requires ruling out other causes. Juvenile idiopathic arthritis is an exceptional aetiology of acroosteolysis occurring mainly in psoriatic arthritis. Here by a case of juvenile idiopathic arthritis associated with acroosteolysis of the toes. Methods A 13-year-old girl with no past medical history, presented to our department of rheumatology with oligoarthritis affecting both wrists and knees. She had no familiar history of psoriasis nor rheumatic diseases. She described a dull ache and recurring swelling of knees evolving for >6 years associated with a macular rash of the chest without fever. On examination, the knees were swollen with a limited range of motion of < 90°. Examination of the spine and sacroiliac joints was unremarkable. There was no deformity, no dysmorphic syndrome nor ligamentous hyper laxity. The mucocutaneous examination was normal. Similarly, there was no hepatosplenomegaly or swollen lymph nodes. Laboratory investigations showed high acute phase reactants and normal blood count. Rheumatoid factor, anti-cyclic citrullinated peptide antibodies and antinuclear antibodies were also negative. Besides, she was negative for HLAB-27. Ophthalmic examination did not show any sequelae of uveitis. Results Plain radiograph of the feet revealed bone resorption of the second and fifth distal phalanges without signs of reconstruction. Other secondary causes of acroosteolysis were ruled out. The diagnosis of oligoarticular juvenile idiopathic arthritis was made. In view of the involvement of the distal phalanges, the phenotype of psoriatic arthritis was probable. The patient was initially treated with non-steroidal anti-inflammatory drugs as well as intraarticular injections of corticosteroids in knees. As the flares persisted, she was put on Methotrexate at a dosage of 15 mg per week with marked clinical improvement. Conclusion Our case illustrates a possible occurrence of acroosteolysis of the feet in the field of an active juvenile idiopathic arthritis. It is important to rule out other causes and make a rapid diagnosis in order to ensure appropriate management decisions.

Simulated Compensatory Motion of Transradial Prostheses

2008 ◽  
Author(s):  
Derek Lura ◽  
Rajiv Dubey ◽  
Stephanie L. Carey ◽  
M. Jason Highsmith
Keyword(s):  
Range Of Motion ◽  
Shoulder Joint ◽  
Degrees Of Freedom ◽  
Biomechanical Model ◽  
Elbow Flexion ◽  
Limited Range ◽  
Joint Movement ◽  
Range Of Movement ◽  
Limited Range Of Motion ◽  
Compensatory Motion

The prostheses used by the majority of persons with hand/arm amputations today have a very limited range of motion. Transradial (below the elbow) amputees lose the three degrees of freedom provided by the wrist and forearm. Some myoeletric prostheses currently allow for forearm pronation and supination (rotation about an axis parallel to the forearm) and the operation of a powered prosthetic hand. Older body-powered prostheses, incorporating hooks and other cable driven terminal devices, have even fewer degrees of freedom. In order to perform activities of daily living (ADL), a person with amputation(s) must use a greater than normal range of movement from other body joints to compensate for the loss of movement caused by the amputation. By studying the compensatory motion of prosthetic users we can understand the mechanics of how they adapt to the loss of range of motion in a given limb for select tasks. The purpose of this study is to create a biomechanical model that can predict the compensatory motion using given subject data. The simulation can then be used to select the best prosthesis for a given user, or to design prostheses that are more effective at selected tasks, once enough data has been analyzed. Joint locations necessary to accomplish the task with a given configuration are calculated by the simulation for a set of prostheses and tasks. The simulation contains a set of prosthetic configurations that are represented by parameters that consist of the degrees of freedom provided by the selected prosthesis. The simulation also contains a set of task information that includes joint constraints, and trajectories which the hand or prosthesis follows to perform the task. The simulation allows for movement in the wrist and forearm, which is dependent on the prosthetic configuration, elbow flexion, three degrees of rotation at the shoulder joint, movement of the shoulder joint about the sternoclavicular joint, and translation and rotation of the torso. All joints have definable restrictions determined by the prosthesis, and task.

scholarly journals Clinico-Epidemiological Study of Intraarticular Phalangeal Fractures in Eastern Nepal

2015 ◽  
Vol 12 (1) ◽  
pp. 29-32
Author(s):  
Guru Prasad Khanal ◽  
R Rijal ◽  
B P Shrestha ◽  
P Chaudhary ◽  
R Maharjan ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Open Fracture ◽  
Kirschner Wire ◽  
Proximal Phalanx ◽  
Wound Debridement ◽  
Young Males ◽  
Intraarticular Fractures ◽  
Kirschner Wire Fixation ◽  
Set Up ◽  
Phalangeal Fractures

Background: Fractures and dislocations of the hand are the most common injuries seen in emergency departments. Intraarticular fractures have worst functional outcomes if not managed properly. Objective: To find out the incidence and pattern of intra articular phalangeal fractures in the eastern part of Nepal Methods: Patients presenting at Emergency department of B.P.Koirala institute of Health Sciences between 1st January 2009 and 31st December 2009 and who were diagnosed as phalangeal fractures of hand were included in the study. These patients were reviewed for age at time of injury, gender, location of the incident, mechanism of injury, site of injury, side, hand dominance and mode of treatment. Results: One hundred and one patients were included in the study after excluding twenty patients with other associated injuries like head injury (6), poly trauma (10) or those not giving consent (4). The age ranged from 3 to 76 years. Among them male were 79.2%. Farm related injuries were the most common cause in both the sexes. Left side was the most involved side. Most of the patients attended hospital more than 4 hours after injury. Among them 74% had open fracture. Proximal phalanx was involved in 54.4% of cases. Pattern of involvement was mostly oblique and transverse. Most of the patients were undergone wound debridement and Kirschner wire fixation. Conclusion: Farm related and household events are commonest causes of hand injuries with intraarticular phalangeal fractures in our set up. Young males belonging to economically productive age group are mostly affected by these fractures.DOI: http://dx.doi.org/10.3126/hren.v12i1.11982Health Renaissance 2014;12(1):29-32

Extension-Block Pinning for Unstable Dorsal Proximal Interphalangeal Joint Fracture-Dislocations: A Simple, Percutaneous Technique With Reproducible Outcomes

Hand ◽  
2022 ◽  
pp. 155894472110663
Author(s):  
Christopher A. Worgul ◽  
Andrew B. Stein
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Proximal Phalanx ◽  
Treatment Delay ◽  
Joint Fracture ◽  
Fracture Dislocations ◽  
Pip Joint

Background: Proximal interphalangeal (PIP) joint fracture-dislocations can be technically challenging injuries to treat, and no technique has proven to be superior nor lead to predictably good outcomes. We describe our experience of treating unstable dorsal fracture-dislocations of the PIP joint with extension-block pinning (EBP) at our institution over a 22-year period. Methods: In all, 23 patients with 24 unstable dorsal fracture-dislocations of the PIP joint treated with EBP between January 1998 and October 2020 were identified. All patients underwent closed reduction of the PIP joint and insertion of a Kirschner wire into the proximal phalanx, creating a mechanical block. Range of motion and joint congruity were assessed at final clinic follow-up. Long-term function was assessed via completion of a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Spearman’s correlation coefficient was utilized to assess if any association existed between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Results: Mean range of motion at final follow-up was 83.3° and 22 of 24 PIP joints demonstrated a congruent reduction. In all, 15 of the 23 patients completed the QuickDASH questionnaire at a median long-term follow-up of 57.5 months (range: 3-157 months). Average QuickDASH score was 18.8, indicating minimal long-term disability. No statistically significant associations were found between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Conclusions: EBP offers a simple and innovative method to treat a complex injury of the PIP joint. It is technically straightforward and cheap, and produces excellent functional outcomes with minimal long-term disability.

scholarly journals Automated Knee Osteoarthritis Assessment Increases Physicians’ Agreement Rate and Accuracy: Data from the Osteoarthritis Initiative

Cartilage ◽  
2019 ◽  
pp. 194760351988879 ◽  
Author(s):  
Stefan Nehrer ◽  
Richard Ljuhar ◽  
Peter Steindl ◽  
Rene Simon ◽  
Dietmar Maurer ◽  
...  
Keyword(s):  
Joint Space Narrowing ◽  
Detection System ◽  
Intraclass Correlation ◽  
Plain Radiograph ◽  
Joint Space ◽  
Research Society ◽  
Computer Assisted ◽  
Agreement Rate ◽  
Osteoarthritis Initiative ◽  
The Impact

Objective. To assess the impact of a computerized system on physicians’ accuracy and agreement rate, as compared with unaided diagnosis. Methods. A set of 124 unilateral knee radiographs from the Osteoarthritis Initiative (OAI) study were analyzed by a computerized method with regard to Kellgren-Lawrence (KL) grade, as well as joint space narrowing, osteophytes, and sclerosis Osteoarthritis Research Society International (OARSI) grades. Physicians scored all images, with regard to osteophytes, sclerosis, joint space narrowing OARSI grades and KL grade, in 2 modalities: through a plain radiograph ( unaided) and a radiograph presented together with the report from the computer assisted detection system ( aided). Intraclass correlation between the physicians was calculated for both modalities. Furthermore, physicians’ performance was compared with the grading of the OAI study, and accuracy, sensitivity, and specificity were calculated in both modalities for each of the scored features. Results. Agreement rates for KL grade, sclerosis, and osteophyte OARSI grades, were statistically increased in the aided versus the unaided modality. Readings for joint space narrowing OARSI grade did not show a statistically difference between the 2 modalities. Readers’ accuracy and specificity for KL grade >0, KL >1, sclerosis OARSI grade >0, and osteophyte OARSI grade >0 was significantly increased in the aided modality. Reader sensitivity was high in both modalities. Conclusions. These results show that the use of an automated knee OA software increases consistency between physicians when grading radiographic features of OA. The use of the software also increased accuracy measures as compared with the OAI study, mostly through increases in specificity.

Traumatic bilateral posterior dislocation of the shoulder: a case report

Open Medicine ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. 810-813
Author(s):  
C. Garving ◽  
T. Dienstknecht ◽  
K. Horst ◽  
M. Pishnamaz ◽  
P. Kobbe ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Dislocation ◽  
Limited Range ◽  
Clinical Suspicion ◽  
Posterior Dislocation ◽  
X Rays ◽  
Posterior Shoulder Dislocation ◽  
Limited Range Of Motion ◽  
Posterior Shoulder ◽  
Bilateral Posterior Shoulder Dislocation

AbstractIntroduction. Bilateral posterior dislocation of the shoulder is a rare injury, accounted for about 2–5% of all shoulder dislocations. Main courses are electrical shock, epilepsy or extreme trauma with uncontrolled muscle forces. We report about a case of bilateral posterior shoulder dislocation without additional fractures but with a concomitant acromioclavicular joint dislocation. Case presentation. A 46-year-old Caucasian motorcyclist presented to our facility after a fall on slippery ground. He claimed pain in both shoulders with limited range of motion. The initial X-rays were inconclusive, clinical examination showed typical findings of a Rockwood injury with an additional limited external rotation so that a posterior shoulder dislocation was suspected. The CT scan confirmed the clinical suspicion. A closed reduction was performed followed by immobilization in a shoulder abduction pillow for 4 weeks and continuous physiotherapy. Upon follow up normal function with full range of motion was observed. Conclusion. A bilateral posterior shoulder dislocation can be caused by trauma and results in a limited range of motion with often additional injuries. Due to the unusually presentation the risk of missing the injury is increased. Therefore it is most important to consider this rare diagnosis and in case of clinical suspicion perform a careful algorithm of diagnostic.

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