Sincondrose Dolorosa da Patela ­ uma causa incomum de dor no joelho / Patellar painful Synchondrosis ­ An uncommon cause of knee pain

A patela é o maior osso sesamoide do corpo humano, posicionado longitudinalmente na fáscia do músculo quadríceps, entre os tendões quadríceps e patelar. A patela bipartida dolorosa, também conhecida como "sincrondose dolorosa", é uma causa conhecida de dor no joelho anterior, é um diagnóstico de exclusão. Objetivo: Relatar um caso e revisar a literatura acerca desta lesão incomum. Materiais e Métodos: Revisão do prontuário do paciente no Hospital Luxemburgo, registro fotográfico do método diagnóstico e revisão da literatura. Resultados: Homem de 45 anos com dor no joelho direito há 01 ano, principalmente na região anterior, que piora ao agachar. Ao exame físico apresenta edema com dor a palpação da patela. A radiografia demonstra patela bipartida. A ressonância magnética (RM) do joelho direito demonstra patela bipartida com união fibrosa entre o fragmento bipartido superolateral e a patela, associada a lesões condrais e edema subcondrais, compatível com "sincondrose dolorosa" da patela. Conclusão: Este relato demonstra a dificuldade de diagnosticar está lesão, pois seu o exame físico é inespecífico e a radiografia demonstra apenas a variação da normalidade ­ patela bipartida, sem evidenciar as alterações próprias da doença, caracterizada apenas pela RM.

The patella is the largest sesamoid bone in thehuman body, positioned longitudinally in the quadriceps muscle fascia, between the quadriceps and patellar tendons. The painful bipartite patella, also known as "painful synchondrosis", is a known cause of anterior knee pain, is a diagnosis of exclusion.Objective: Report a case and review the literature about this uncommon lesion. Materials and Methods: We carried out a review of medical records at Hospital Luxemburgo, a photographic record of diagnostic methods, and a review from the literature. Results: 45-year-old man with right knee pain for 1 year, mainly in the anterior region, which worsens when crouching. Physical examination shows edema with pain on palpation of the patella. Right knee radiography demonstrates a bipartite patella. Magnetic resonance imaging (MRI) of the right knee demonstrates a bipartite patella with a fibrous union between the superolateral bipartite fragment and the patella, associated with chondral lesions and subchondral edema, compatible with patella "painful synchondrosis". Conclusion: This report demonstrates the difficulty of diagnosing this lesion, since its physical examination is nonspecific and the radiography shows only the normal variation ­ bipartite patella, without evidencing the disease alterations, characterized only by MRI.

Vertebroplastia percutánea guiada por tomografía para el manejo del dolor en pacientes con fractura del cuerpo vertebral / CT-guided Vertebroplasty for Painful Vertebral Fractures

Objetivo Describir la técnica y resultados en cuanto a la mejoría del dolor y complicaciones al realizar este procedimiento mediante guía por tomografía computada. Materiales y Métodos Estudio observacional descriptivo de una serie de 108 pacientes a quienes se les realizó vertebroplastia percutánea guiada por tomografía computada realizadas en dos hospitales universitarios, entre mayo 2007 y mayo 2017. Todos los procedimientos se realizaron de forma ambulatoria con anestesia local y se valoró el dolor mediante la escala visual análoga. Resultados Se realizaron 125 vertebroplastias, en el 87,9% de los pacientes (n = 95) se realizó el procedimiento en un cuerpo vertebral, en el 8,3% (n = 9) y 3,7% (n = 4) de los pacientes se cementaron 2 y 3 vertebras respectivamente. El rango de dolor según la escala visual análoga (EVA) previo al tratamiento varió entre 5 y 10, donde un 94% (n = 102) de los pacientes manifestaban una intensidad 10/10. En el postratamiento el rango de dolor varió entre 0a7dondeel 98% de la población reportó un valor menor o igual a 3. Se presentaron 3 complicaciones: tromboembolismo pulmonar por metil-metacrilato, extravasación al plexo de Batson y extravasación al espacio interdiscal, cada una en tres pacientes diferentes. Conclusión La vertebroplastia percutánea guiada por TC ofrece una indiscutible mejora inmediata del dolor en pacientes con fractura de uno o más cuerpos vertebrales, con una baja tasa de complicaciones.

Objetive Describe the technique, results in terms of pain improvement and complications to perform this procedure by computed tomography. Materials and Methods A descriptive observational study of a 108 cases series of percutaneous vertebroplasty guided by computed tomography performed in two university hospitals between May 2007 and May 2017. All procedures were performed with local anesthesia on an outpatient basis, pain was assessed by means of the Visual analogue scale (VAS). Results A total of 125vertebroplasties were performed. In 87.9% (n = 95) of the patients, the procedure was performed in one vertebral body, in 8.3% (n = 9) and 3.7% (n = 4) of the patientshad two or three vertebrae cemented respectively. The range of pain according to VAS prior to treatment varied between 5 and 10, where 94% (n = 102) of the patients manifested a 10/10 intensity; after treatment, the range of pain varied between 0 to 7 where 98% of the population reported a value less than or equal to 3. Three complications were reported, one pulmonary thromboembolism due to methylmethacrylate, one extravasation in to the Batson plexus and one extravasation of cement to the interdiscal space. Conclusion CT-guided percutaneous vertebroplasty offers an undeniable immediate improvement of pain in patients with fracture of one or more vertebral bodies, with a low rate of complications.

Gaucher's disease in a patient presenting with hip and abdominal pain

Summary Gaucher's disease is characterized by glucocerebroside accumulation in the cells of the reticuloendothelial system. There are three subtypes. The most common is type 1, known as the non-neuropathic form. Pancytopenia, hepatosplenomegaly and bone lesions occur as a result of glucocerebroside accumulation in the liver, lung, spleen and bone marrow in these patients. Findings associated with liver, spleen or bone involvement may be seen at radiological analysis. Improvement in extraskeletal system findings is seen with enzyme replacement therapy. Support therapy is added in patients developing infection, anemia or pain. We describe a case of hepatosplenomegaly, splenic infarction, splenic nodules and femur fracture determined at radiological imaging in a patient under monitoring due to Gaucher's disease.

Medidas y cambios morfo-radiológicos en proyecciones de rodilla de pacientes con dolor anterior de rodilla / Morpho-radiological and measure changes in radiographic knee images of patients with anterior knee pain

Introducción: existen diferentes estudios radiológicos de rodilla en los cuales realizamos medidas que pueden orientarnos a la etiología del dolor anterior de rodilla. Nuestro objetivo fue identificar cambios morfo-radiológicos y cambios en medidas útiles en proyecciones radiográficas de rodilla de pacientes con dolor anterior de rodilla. Material y métodos: El presente es un estudio transversal en el cual se incluyó los estudios radiológicos de pacientes con dolor anterior de rodilla registrando medidas en proyecciones anteroposteriores, laterales y axiales de rótula con un posterior análisis de datos. Resultados: Entre los resultados identificamos como diagnóstico clínico más frecuente la Gonartrosis y en segundo lugar el Síndrome femoropatelar. El tipo de patela más frecuentemente encontrado fue la tipo 1. Los ángulos femoro-rotulianos fueron en su mayoría paralelos, siendo convergentes en un menor porcentaje. No existe diferencia significativa entre el tipo de patela y la lateralización rotuliana. Con un valor P de 0.820. Discusión: En base a esto podemos afirmar que el ángulo de desplazamiento de Muñoz es más útil para medir el desplazamiento rotuliano. El ángulo de congruencia de toda la población estudiada oscila entre 120° y 145°. Conclusión: No existe una diferencia significativa de lateralización rotuliana de acuerdo al ángulo de desplazamiento de Muñoz en pacientes con patela Tipo I o II. El ángulo de Muñoz es más útil que el índice de Muñoz para identificar la lateralización rotuliana. El ángulo de congruencia puede encontrarse normal incluso si existe subluxación rotuliana.

Background: there are different radiological studies of the knee in which we perform radiological measurements that can guide us to the etiology of knee pain. Our objective was to identify morpho-radiological and measure changes in radiographic knee images of patients with anterior knee pain. Methods: The present study is a cross-sectional study in which the radiological studies of patients with anterior knee pain were recorded, recording measurements on Anteroposterior, lateral and Skyline patella projection with a posterior data analysis. Results: Among the results we identi ed as the most frequent clinical diagnosis Knee osteoarthritis and in second place Patellofemoral Syndrome. The most frequently encountered type of patella was type 1. Patellofemoral angles were mostly parallel, being convergent in a lower percentage. There is no signi cant difference between the type of patella and patellar lateralization. (P value = 0.820). Discussion: Based on this, we can say that the Muñoz displacement angle is more useful for measuring patellar displacement. The congruence angle of the studied population ranges from 120° to 145°. Conclusions: We conclude that there is no signi cant difference in patellar lateralization according to the Muñoz displacement angle in patients with type I or II patella. Muñoz angle is more useful than the Muñoz index to identify patellar lateralization. The angle of congruence may be normal even if there is patellar subluxation.

Clinical and radiological differences between traumatic and idiopathic coccygodynia

Several reports of coccygodynia have been confined to the causes, the methods of treatment, and the methods of radiological examination. As far as we know, there has been no previous study about the objective measurement of the coccyx. The purpose of this study was to find the possible cause of idiopathic coccygodynia by comparing the clinical and radiological differences between traumatic and idiopathic coccygodynia by innovative objective clinical and radiological measurements. Thirty-two patients with coccygodynia were evaluated retrospectively. We divided the patients into two groups. Group 1 consisted of 19 patients with traumatic coccygodynia and group 2 consisted of 13 patients with idiopathic coccygodynia. We reviewed medical records and checked age, sex distribution, symptoms, and treatment outcome in each group. We also reviewed coccyx AP and lateral views of plain radiological film and measured the number of coccyx segments and the intercoccygeal angle in each group. The intercoccygeal angle devised by the authors was defined as the angle between the first and last segment of the coccyx. We also checked the intercoccygeal angle in a normal control group, which consisted of 18 women and 2 men, to observe the reference value of the intercoccygeal angle. The outcome of treatment was assessed by a visual analogue scale based on the pain score. Statistical analysis was done with Mann-Whitney U test and Chi-square test. Group 1 consisted of 1 male and 18 female patients, while group 2 consisted of 2 male and 11 female patients. There were no statistically significant differences between the traumatic and idiopathic coccygodynia groups in terms of age (38.7 years versus 36.5 years), male/female sex ratio (1/18 versus 2/11), and the number of coccyx segments (2.9 versus 2.7). There were significant differences between the traumatic and idiopathic coccygodynia groups in terms of the pain score (pain on sitting: 82 versus 47, pain on defecation: 39 versus 87), the intercoccygeal angle (47.9 degree versus 72.2 degrees), and the satisfactory outcome of conservative treatment (47.4% versus 92.3%). The reference value of the intercoccygeal angle in the normal control group was 52.3 degrees, which was significantly different from that of the idiopathic group. In conclusion, the intercoccygeal angle of the idiopathic coccygodynia group was greater than that of the traumatic group and normal control group. Based on the results of this study, the increased intercoccygeal angle can be considered a possible cause of idiopathic coccygodynia. The intercoccygeal angle was a useful radiological measurement to evaluate the forward angulation deformity of the coccyx.

Ultrasonography of the painful hip in children

Fifty patients [aged 20 months to 12 years] presenting to the Orthopedic and Pediatric Clinics with a painful hip were reviewed. All patients were apyrexial with normal ESR, blood count and normal radiographic appearance of the hips. Effusion in 28 hips was diagnosed by ultrasound when a side difference of 2 mm or more in the distance between the femoral neck and the echogenic anterior capsule was measured on the anterior scan. At the time of the first US examination, the average anterior capsule distance [ACD] of the affected and unaffected hips was 8.5 mm and 4.8 mm, respectively. The management protocol was determined according to the US findings upon presentation. All patients were followed up by ultrasound until disappearance of the hip effusion, the latter persisted for an average of 9.3 days. Ultrasound was recommended as the main imaging technique in the diagnosis and follow up of the painful hip in children as it allows for the first time an objective assessment of the condition assisting greatly in its management. Furthermore, it may help select cases requiring hospital treatment leading to obvious financial savings