Capsulitis adhesiva de hombro: conceptos actuales / Adhesive Capsulitis of the shoulder. Current concepts

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

Diagnóstico y tratamiento de la bursitis olecraniana / Diagnostic et traitement de la bursite olécranienne / Diagnosis and treatment of olecranial bursitis

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)

Anatomopatologia de bursite cervical (oncocercose) encontrada em bovinos abatidos sob inspeção estadual no estado do Rio de Janeiro / Anatomopathology of onchocerciases (cervical bursitis) in slaughtered bovine in the north of Rio de Janeiro state

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...

Bursite cotovelar aguda em filhote: Relato De Caso / Elbow acute bursitis in a puppy: Case Report / Bursitis aguda de codo en cachorro de perro: Relato De Caso

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...

First Report of Nocardia farcinica Bursitis in a Patient with Diabetes Mellitus

No abstract available.

Capsulitis adhesiva de hombro: características histológicas y correlación con los hallazgos artroscópicos y el estadío clínico / Adhesive capsulitis of the shoulder: histological characteristics and correlation between clinical diagnosis and arthroscopic findings

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

Bursite iliopectínea: relato de caso / Iliopectineal bursitis: case report

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.

A síndrome anserina: [revisão] / Anserine syndrome: [review]

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.

Avaliação do resultado do tratamento da capsulite adesiva de ombro com bloqueios seriados do nervo supraescapular / Treatment of frozen shoulder by supraescapular nerve block. Outcome evaluation

Objetivo: Avaliar 136 pacientes (144 ombros) com capsulite adesiva tratados no período de junho de 1994 a fevereiro de 2000 pela técnica dos bloqueios seriados do nervo supraescapular. Método: Analisamos os pacientes em relação à faixa etária, sexo, dominância e classificação, sendo os resultados obtidos com o tratamento avaliados de acordo com critérios da UCLA. O seguimento médio foi de 39 meses. Resultados: Obtivemos resultados satisfatórios em 84,0% (121 ombros) e melhora da dor em 91,7% (132 ombros). Avaliamos os pacientes diabéticos com capsulite adesiva, não sendo notada diferença estatisticamente significativa na gravidade de acometimento destes com relação à população geral do nosso trabalho. Conclusão: O tratamento da capsulite adesiva com bloqueios seriados do nervo supraescapular se mostrou eficaz não apenas nos pacientes não diabéticos como também nos diabéticos.

Periarthropathies: clinical spectrum and patterns

The aim of this study is to review the spectrum of primary periarthropathies. Rheumatology clinic, Ibn Sina teaching hospital, Mosul, Iraq. Prospective non-experimental clinical study. Two hundred patients having primary periarthropathy were included in the study. Secondary cases of periarthropathy were excluded. Patients with multiple periarthropathy were recorded. Two hundred patients were studied, 114 were females and 33 were males who had one type of periarthropathy; the remaining had combinations of periarthropathies. The mean age for periarthropathy was more than 40, except for tendinitis [36.8 +/- 10.5]. The most common periarthropathies is the shoulder 93 [46.5%], followed by Carpal tunnel syndrome 57 [28.5%] and planter fasciitis 34 [17%], history was significantly high in these three conditions. Various combinations of periarthropathies were seen in the study group. Shoulder periarthropathies and CTS were the most common, 46.5% and 28.5% respectively. The concept of oligoarthropathy and possibly poly-periarthropathy needs further research. Constitutional factors, for example, gender and pro-inflammatory mechanisms need further studies

Eficacia de la peloidoterapia y cinesioterapia en la capsulitis adhesiva primaria del hombro / Effectiveness of the peloidotherapy and cinesiotherapy in the primary adhesive capsulitis of the shoulder

Se realizó un ensayo clinicoterapéutico controlado para evaluar la eficacia de la peloidoterapia y cinesioterapia en 64 pacientes con capsulitis adhesiva primaria del hombro, atendidos en el Departamento de Fisioterapia y Rehabilitación del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba desde enero del 2006 hasta igual mes del 2007. Se conformaron 2 grupos (de estudio y control) de 32 integrantes en cada caso: los primeros recibieron peloidoterapia y cinesioterapia; los segundos: electroterapia y cinesioterapia. A las 10 sesiones terapéuticas había mejorado un mayor número de pacientes del grupo de estudio, mientras que los del grupo control necesitaron más de 20 sesiones para lograrlo. A los 3 meses continuaba la mejoría en 90,6 por ciento de los pacientes del primer grupo, por lo cual se planteó que la combinación de peloidoterapia y cinesioterapia fue más eficaz para eliminar las manifestaciones clínicas de esa inflamación, validada por un nivel de significación de 0,03.

A controlled clinical therapeutical trial was carried out to evaluate the effectiveness of the peloidotherapy and kinesiotherapy in 64 patients with primary adhesive capsulitis of the shoulder, assisted in the Department of Physiotherapy and Rehabilitation of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba from January, 2006 to January, 2007. Two groups were conformed (study and control groups) of 32 members in each: the first group received peloidotherapy and kinesiotherapy; the second group: electrotherapy and kinesiotherapy. At the 10 therapeutic sessions a great number of patients of the study group had improved, while those of the control group needed more than 20 sessions to achieve this. At the 3 months the improvement continued in 90,6 percent of the first group patients, reason why it was stated that the peloidotherapy and kinesiotherapy combination was more effective to eliminate the clinical manifestations of that inflammation, validated by a significance level of 0,03.

Tratamiento con Moxibustión en el Síndrome Bi de hombro / Moxibustion treatment in Bi Syndrome of the shoulder

En este estudio se seleccionaron 30 pacientes con el diagnóstico de bursitis aguda de hombro no traumática compatible con un síndrome Bi por frío en medicina tradicional asiática, que acudieron al cuerpo de guardia del Instituto Superior de Medicina Mlitar (ISMM) Luis Díaz Soto en el período comprendido de julio de 1998 a noviembre de 1999. A los mismos se les realizó un diagnóstico tradicional así como una valoración cualitativa del dolor y la movilidad articular antes y después de recibir el tratamiento con moxibustión. Se realizó un estudio prospectivo observacional analítico y se le aplicó el test de Wilcoxon. Todo se realizó con un nivel de significación µ = 0,05 (con un 95 de compatibilidad). Se hizo una evaluación de la respuesta terapéutica, comprobándose la efectividad de la moxibustión en el hombro doloroso, por lo que hubo modificación del dolor en la mayoría de los casos, aumentando el ángulo de abducción la mayor cantidad de pacientes, terminando con evolución satisfactoria el 83,33 de los casos.

We chose 30 patients diagnosed with non-traumatic acute bursitis of the shoulder, compatible with a Bi Syndrome by cold in Asiatic Traditional Medicine, assisting the High Institute of Military Medicine Luis Díaz Soto from July 1998 to November 1999. They were diagnozed in traditional way, and pain and articular mobility were qualitative evaluated before and after being treated with moxibustion. An analitic, observational, prospective study was carried out and the Wilcoxon´s test was applied. Everithing was made with a signification level ? = 0,05 (95 percent of compatibility). We evaluated the therapeutic answer, proving the efectiveness of moxibustion in painly shoulder. There was a pain modification in most of the cases; in most of the patients the abduction angle was increased. 83.33 percent of the cases showed a satisfactory evolution.

Bursite peritrocantérica: descrição de nova manobra semiológica para auxílio diagnóstico / Peritrochanteric bursits: a description of a new semiologic maneuver for diagnostic assistance

O estudo tem como objetivo testar a validade de nova manobra semiológica no diagnóstico de bursite peritrocantérica. Foram avaliados 30 pacientes, com diagnóstico clínico de bursite do grande trocanter. Todos os pacientes foram submetidos à radiografia de bacia AP e Perfil. Quando necessário, outros exames de imagem foram realizados, com a finalidade de descartar doenças associadas; os pacientes foram submetidos a duas manobras semiológicas no quadril são e afetado. TESTE 1: paciente em decúbito dorsal, o membro examinado é aduzido em extensão cruzando sobre o membro contralateral, com o calcâneo em contato com a maca, faz-se a flexão do quadril até aproximadamente 90º, o quadril ao final da manobra estará em flexão, adução e leve rotação externa, durante a manobra poderá ser referida dor na região do trocanter maior. TESTE 2: a posição final do TESTE 1, é a posição inicial desta, faz-se a adução forçada do quadril, pode haver referencia de dor ou exacerbação. Os resultados das manobras foram submetidos ao estudo estatístico, que demonstrou serem os exames diferentes entre si, porém complementares. O teste 2 mostrou ser positivo em 96,6 por cento. As manobras semiológicas denominadas de TESTE 1 e 2, podem ser utilizadas como auxiliares nos diagnósticos clínicos das bursites peritrocanterianas.

The objective of the present study was to test the validity of a semiologic maneuver on the diagnosis of peritrochanteric bursitis. Thirty patients with a clinical diagnosis of great trochanter bursitis were assessed. All patients were submitted to X-ray studies at AP and LP. Whenever necessary, other imaging tests were performed, intending to rule out any associated diseases; the patients were submitted to two semiologic maneuvers on both hips, the affected and the normal one. TEST 1: with patient at supine position, the examined limb is adduced in extension and crossing it over the contralateral limb, with the calcaneus touching the bed, a hip flexion is produced at approximately 90º; at the end of this maneuver, the hip will be flexed, adduced and slightly externally rotated; during this maneuver, the patient may report pain at major trochanter region. TEST 2: the final position of TEST 1 is the initial position of TEST 2, with a forced hip adduction where pain or exacerbation may be reported. The maneuver results were submitted to statistical analysis, with both tests showing to be different from each other while supplementary. Test 2 was shown to be positive in 96.6 percent. Semiologic maneuvers referred as TEST 1 and TEST2 may be used to assist on providing a clinical diagnosis of peritrochanteric bursitis.

MR Imaging Features of Obturator Internus Bursa of the Hip

The authors report two cases with distension of the obturator internus bursa identified on MR images, and describe the location and characteristic features of obturator internus bursitis; the "boomerang"-shaped fluid distension between the obturator internus tendon and the posterior grooved surface of the ischium.

Pain & resistance in patients with adhesive capsulitis during contrast material injection phase of MR arthrography.

BACKGROUND & OBJECTIVE: Adhesive capsulitis of the shoulder is a condition of unknown aetiology that results in the development of restricted active and passive glenohumeral motion. It has been reported that magnetic resonance (MR) imaging is useful in diagnosing adhesive capsulitis. We carried out this study to assess how pain and/or resistance during contrast material injection affects the diagnosis of adhesive capsulitis on magnetic resonance (MR) arthrography. METHODS: The study included MR arthrography examinations of 21 patients with a diagnosis of adhesive capsulitis. The control group consisted of 20 patients who presented clinically with rotator cuff tear. The pain (visual analog scale, VAS), resistance to injection and the amount of contrast material that could be injected during injection phase of MR arthrography was assessed and compared between groups. RESULTS: The patients in adhesive capsulitis group (mean VAS score 66.5+/-25.5) experienced more pain when compared with the control group (mean VAS score 34.9+/-27.7, P<0.001). A statistically significant difference (P<0.001) in terms of the amount of the injected fluid (4.3+/-2.6 ml for adhesive capsulitis group, and 10.9+/-4.1 ml for control group) was seen into the joint cavity. Resistance to injection was significantly more (P<0.001) in patients with adhesive capsulitis when compared to control group. INTERPRETATION & CONCLUSION: Experience of pain during injection, a decreased amount of contrast material injected and resistance to injection in patients during injection phase of MR arthrography may suggest adhesive capsulitis.

Adhesive capsulitis among patients seen in Prince Hashem Military Hospital

This study was conducted to explore the etiological factors and some clinical profile of patients with Adhesive Capsulitis [AC]. The study was conducted in Prince Hashim Military Hospital at the Physiotherapy department and Rheumatology clinic. Eighty patients fulfilling the criteria for the diagnosis of adhesive capsulitis were included in this study. They suffered from shoulder pain the range of shoulder movements and the presence of various etiological factors for Adhesive Capsulitis [AC] were examined. Age of the subjects ranged from 20-60 years and the duration of symptoms averaged four months; the left shoulder was more commonly involved [60%], [7.5%] had bilateral involvement and [66%] of the subjects were sedentary workers. Adhesive capsulitis was seen most commonly in patients with diabetes mellitus [39%]. Other risk factors included previous myocardial infarction [7.5%], stroke 4%, COPD [5%] and immobilization [7.5%]. Adhesive Capsulitis [AC] mostly affects people in the forth up to sixth decade. The majority of the affected individuals have sedentary life style at the time of the sickness and patients with diabetes mellitus may be at a particular risk. Further, detailed studies are needed in this regard for a complete understanding of this painful, disabling and protracted clinical syndrome

A ultra-sonografia na avaliação da síndrome do ombro doloroso: análise de uma série de casos / The ultrasonography in the assessment of painful shoulder syndrome: analysis of cases serie

Com objetivo de estudar os possíveis achados ultra-sonográficos na Síndrome do Ombro Doloroso (SOD), foram avaliados 77 pacientes com diagnóstico clínico de ombro doloroso encaminhados para investigação através da ultra-sonografia (USG). Além dos achados de exame, procurou-se identificar variáveis clínicas e epidemiológicas, as quais, pudessem estar associadas à presença de alterações patológicas. Dos 77 pacientes incluídos no estudo foram encontradas alterações no exame de USG de 47(61%), destes 38 (80%) apresentaram algum tipô de lesão no manguito rotador (MR), classificadas de tendinose ou tendinopatia, ruptura parcial e ruptura completa. Dentre os outros nove (20%) pacientes, cinco (11%) apresentaram bursite e quatro (9%) derrame articular como diagnósticos isolados. Dentre as variáveis clínicas e epidemiológicas avaliadas, a idade acima de 51 anos e limitação funcional articular estiveram associadas a presença de alterações no exame ultra-sonográfico destes pacientes. A lesão do MR além de ter sido a alteração mais freqüente, esteve associada ao diagnóstico ultra-sonográfico de derrame articular e a necessidade de uso de drogas antiinflamatórias. Concluiu-se que a USG é um importante método de avaliação de pacientes com SOD e que fatores como idade, limitação funcional articular apresentam associação com a presença de lesão do manguito rotador.

Etiological factors and clinical profile of adhesive capsulitis in patients seen at the rheumatology clinic of a tertiary care hospital in India

This study was conducted to examine the clinical profile of patients with adhesive capsulitis [AC] and evaluate various possible etiological factors. The study was conducted in the Department of Physical Medicine and Rehabilitation, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India. One hundred patients fulfilling the criteria for the diagnosis of AC were studied for the severity of shoulder pain and the range of shoulder movements. The patients were also examined for the presence of various etiological factors for AC. Age of the subjects ranged from 25-70 years and duration of symptoms averaged 3.66 +/- 2.36 months; left shoulder was more commonly involved [54%], 2% had bilateral involvement and 63% of the subjects were sedentary workers. Disease was seen most commonly in patients with diabetes mellitus [27%]. Other identifiable risk factors included previous myocardial infarction [5%], immobilization [5%], stroke and chronic bronchitis [4% each]. Fifty-six% of patients with AC had radiological evidence of cervical spondylosis. We conclude that AC mostly affects people in the fifth to seventh decade. The majority of the affected individuals are sedentary at the time of the sickness and subjects with diabetes mellitus are at particular risk

Non-Infectious Ischiogluteal Bursitis: MRI Findings

OBJECTIVE: We wished to report on the MRI findings of non-infectious ischiogluteal bursitis. MATER AND METHODS: The MRI findings of 17 confirmed cases of non-infectious ischiogluteal bursitis were analyzed: four out of the 17 cases were confirmed with surgery, and the remaining 13 cases were confirmed with MRI plus the clinical data. RESULTS: The enlarged bursae were located deep to the gluteus muscles and postero-inferior to the ischial tuberosity. The superior ends of the bursal sacs abutted to the infero-medial aspect of the ischial tuberosity. The signal intensity within the enlarged bursa on T1-weighted image (WI) was hypo-intense in three cases (3/17, 17.6%), iso-intense in 10 cases (10/17, 58.9%), and hyper-intense in four cases (4/17, 23.5%) in comparison to that of surrounding muscles. The bursal sac appeared homogeneous in 13 patients (13/17, 76.5%) and heterogeneous in the remaining four patients (4/17, 23.5%) on T1-WI. On T2-WI, the bursa was hyper-intense in all cases (17/17, 100%) ; it was heterogeneous in 10 cases and homogeneous in seven cases. The heterogeneity was variable depending on the degree of the blood-fluid levels and the septae within the bursae. With contrast enhancement, the inner wall of the bursae was smooth (5/17 cases), and irregular (12/17 cases) because of the synovial proliferation and septation. CONCLUSION: Ischiogluteal bursitis can be diagnosed with MRI by its characteristic location and cystic appearance.