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)

Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty / Associação entre bursite trocantérica, osteoartrose e artroplastia total do quadril

OBJECTIVE: this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty. METHODS: sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically. RESULTS: there were 35 female patients (56.5%) and 27 male patients (43.5%), with a mean age of 65 years (±11). Trochanteric bursitis was conformed histologically in nine patients (14.5%), of whom six were female (66.7%) and three were male (33.3%). CONCLUSIONS: 14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients...

OBJETIVO: fazer um estudo epidemiológico da bursite trocantérica no momento da feitura da artroplastia total do quadril (ATQ). MÉTODOS: foram avaliados 62 pacientes, sequenciais, submetidos à ATQ por osteoartrose, sem história prévia de bursite trocantérica. As bursas foram coletadas e avaliadas histologicamente. RESULTADOS: foram observados 35 pacientes do sexo feminino (56,5%) e 27 do masculino (43,5%), com média de 65 anos (+/-11). A bursite trocantérica foi confirmada histologicamente em nove (14,5%), seis do sexo feminino (66,7%) e três (33,3%) do masculino. CONCLUSÕES: das bursas analisadas, 14,5% apresentaram inflamação no momento da feitura da ATQ primária por osteoartrose. A maioria das bursites foi detectada nas pacientes femininas...

Características clínico-epidemiológicas y su manejo rehabilitador de los pacientes con capsulitis adhesiva atendidos en el Instituto Nacional de Rehabilitación, 2008-2012 / Clinical and epidemiological characteristics and its rehabilitative management of patients with adhesive capsulitis attended at the National Institute of Rehabilitation, 2008-2012

Objetivo: Describir las características clínico-epidemiológicas y su manejo rehabilitador de los pacientes con capsulitis adhesiva atendidos en el Instituto Nacional de Rehabilitación en el periodo comprendido del 2008-2012. Material y método: Se realizó un estudio descriptivo, de corte transversal en 155 pacientes atendidos con el diagnóstico de capsulitis adhesiva, en el Departamento de Investigación, Docencia y Rehabilitación Integral de la Unidad Motora y de Dolor en el Instituto Nacional de Rehabilitación en el periodo comprendido del 2008-2012. Resultados: Hay un predominio por el sexo femenino (71.3 por ciento), una edad promedio 55.61 años, un tiempo de enfermedad 6.01 meses, el tipo de capsulitis mas frecuente es la primaria (89.6 por ciento); la secundaria relacionada con diabetes mellitus; encontramos una intensidad del dolor promedio EVA de 6.28 y los rangos articulares más afectados son la rotación interna y externa; la Kinesioterapia (93 por ciento) es el más indicado, seguido del ultrasonido, el láser, 10 que está en relación con la intensidad del dolor además de existir una diferencia significativa con la U de Mann Whitney, al igual que para el ultrasonido, electroterapia, bloqueo para vertebral e infiltración. Conclusiones: Es más frecuente en el sexo femenino entre los 38 a 70 años y probablemente la elección del tipo de tratamiento Rehabilitador es elegido e influenciado por la intensidad del dolor percibido por los pacientes, además en nuestro estudio la diabetes mellitus está relacionada con la presencia de capsulitis adhesiva y actividades repetitivas.

Objective: To describe clinical and epidemiological characteristics and rehabilitation treatment in patients with adhesive capsulitis treated at National Institute of Rehabilitation between 2008 and 2012. Methods: Descriptive cross-sectional study. 115 patients were included, all suffering from adhesive capsulitis at Research, Teaching and Integral Rehabilitation Department of the Motor and Pain Unit, at the National Institute of Rehabilitation, between 2008 and 2012. Results: Female were predominant (71.3 per cent), average age of 55.61 years old, average time of disease 6.01 months. Primary capsulitis was the most frequent (89.6 per cent). We found average pain intensity of 6.28 and most affected articular ranges are internal and external rotation motion. Kinesiology therapy is the predominant treatment (93 per cent) followed by ultrasound and lasers all of them significantly related with pain intensity. Also significantly were ultrasound, electrotherapy, para-spinal block and infiltration. Conclusions: Female are the predominant sex, between 38 and 70 years old. Probably rehabilitation treatment type is related according to pain intensity suffered by patients. Also in our study diabetes mellitus is related with adhesive capsulitis and repetitive activities.

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.