Tendinitis cálcica atraumática de tendón extensor común del dedo medio: un caso infrecuente de dolor metacarpofalángico / Atraumatic calcium tendonitis of common extensor tendon of the middle finger: a rare case of metacarpophalangeal pain

Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.

Reduction of recurrent tendinitis scar using autologous mesenchymal stem cells derived from adipose tissue from the base of the tail in Holsteiner horses (Equus ferus caballus) / Reducción de la cicatriz de tendinitis recidivante mediante células madre mesenquimales autólogas derivadas de tejido adiposo de la base de la cola en equinos Holsteiner (Equus ferus caballus)

As a result of their intense physical activity, racehorses suffer high tendon stress which may result in various pathologies. One of these is tendonitis in the tendon of the superficial digital flexor muscle (TSDFM). Conventional treatment with rest, has not shown to be very effective, and regenerative medicine through the application mesenchymal stem cells appears to be a promising therapy. The objective of this work was to assess the effect of the application of autologous MSC on reduction of the scar length in recurrent TSDFM tendinitis in Holsteiner horses, using image analysis. This study included two groups of five animals each: A control group that received conventional treatment (CG) and an experimental group which was also treated with intralesional injections of MSC (EG). Scar evolution was assessed by echographic analysis, with measurements taken of the scar length over a four month period; the length at month zero, was taken as the initial value of 100 %. During the first month, the mean scar length diminished to 81.14 % (EG) and 95.85 % (CG); after the second month, lengths were 64.4 % (EG) and 92.3 % (CG); following the third month lengths were 51.92 % (EG) and 87.42 % (CG); finally at the end of the fourth month the lengths recorded were 26.7 % (EG) and 83.92 % (CG). These results show that treatment with autologous MSC helps TSDFM scar length was significantly reduced, as compared to conventional treatment.

Reducción de la cicatriz de tendinitis recidivante mediante células Madre mesenquimales autólogas derivadas de tejido adiposo de la base de la cola en equinos Holsteiner (Equus ferus caballus). En equinos deportistas, la actividad física intensa ocasiona gran estrés en los tendones, pudiendo ocasionar diversas patologías como la tendinitis del tendón del músculo flexor digital superficial (TMFDS). El tratamiento convencional con reposo es poco eficaz, siendo la medicina regenerativa a través de la aplicación de células madres mesenquimáticas (MSC) una promisoria terapia. El objetivo de este trabajo, fue evaluar el efecto de la aplicación de MSC autólogas, sobre la reducción de la longitud de la cicatriz en tendinopatías recidivantes del TMFDS en equinos Holsteiner, a través del análisis de imagen. Este estudio conto con dos grupos de cinco animales cada uno, el grupo control mantuvo el tratamiento convencional (GC) y el grupo experimental fue tratado adicionalmente con inyección interlesional de MSC (GE). El análisis ecográfico permitió evaluar la evolución de la cicatriz, a través de la medición de su longitud durante los cuatros meses, tomando la longitud del mes cero como la medición inicial del 100 %. Durante el primer mes, la longitud de la cicatriz se redujo a un 81,14 % (GE) y 95,85 % (GC), al segundo mes la longitud fue de un 64,4 % (GE) y de 92,3 % (GC), al tercer mes, la longitud fue de 51,92 (GE) y un 87,42 (GC), finalmente al cuarto mes la longitud fue de 26,7 % (GE) y del 83,92 % (GC). Estos resultados muestran que el tratamiento con MSC autólogas favorece a la disminución de la longitud de la cicatriz del TMFDS de forma significativa respecto al tratamiento convencional.

Acute Retropharyngeal Calcific Tendinitis in an Unusual Location: a Case Report in a Patient with Rheumatoid Arthritis and Atlantoaxial Subluxation

Retropharyngeal calcific tendinitis is defined as inflammation of the longus colli muscle and is caused by the deposition of calcium hydroxyapatite crystals, which usually involves the superior oblique fibers of the longus colli muscle from C1-3. Diagnosis is usually made by detecting amorphous calcification and prevertebral soft tissue swelling on radiograph, CT or MRI. In this report, we introduce a case of this disease which was misdiagnosed as a retropharyngeal tuberculous abscess, or a muscle strain of the ongus colli muscle. No calcifications were visible along the vertical fibers of the longus colli muscle. The lesion was located anterior to the C4-5 disc, in a rheumatoid arthritis patient with atlantoaxial subluxation. Calcific tendinitis of the longus colli muscle at this location in a rheumatoid arthritis patient has not been reported in the English literature.

El ultrasonido en el estudio del síndrome de codo doloroso: [revisión] / Ultrasound in the study of elbow pain syndrome: [review]

La ultrasonografía es una herramienta útil para la evaluación de las anormalidades del codo, especialmente aquellas relacionadas con artropatías inflamatorias, mecánicas y degenerativas, al deporte, con actividades repetitivas o con entesitis. Es una herramienta dinámica que permite evaluar tanto estructuras extraarticulares como los ligamentos, tendones, músculos, bursas, entesis, nervios y vasos, así como las estructuras intraarticulares como los recesos articulares, cartílagos y superficies óseas articuladas. El objetivo de esta revision es brindar una actualizacion del uso de este método de imagen en las patologías más frecuentes que afectan el codo.

Ultrasonography is a useful tool for evaluation of abnormalities of the elbow, especially those related to inflammatory arthritis, mechanical and degenerative diseases, sports with repetitive activities or enthesitis. It is a dynamic tool that provides an evaluation of extra-articular structures such as ligaments, tendons, muscles, bursas, enthesis, nerves and vessels, as well as intra-articular structures such as joint recess, cartilage and bone surfaces articulated. The aim of this review is to provide an update on the use of this method of image in the most common diseases that affect the elbow.

La ultrasonografía en el estudio de síndrome de hombro doloroso / Musculoskeletal ultrasound in the evaluation of the painful shoulder

El síndrome de hombro doloroso es una causa frecuente de consulta en la práctica clínica diaria. Su origen puede ser traumático, inflamatorio, degenerativo, infeccioso o tumoral. El abordaje diagnóstico implica un amplio conocimiento de la anatomía regional y la aplicación de maniobras clínicas y técnicas de imagen que conduzcan a un diagnóstico certero para la aplicación de un tratamiento óptimo en cada paciente. En los años recientes, el ultrasonido musculoesquelético ha demostrado ser una herramienta complementaria de altísima utilidad en el examen complementario de los pacientes con hombro doloroso, especialmente en el contexto de la práctica reumatológica. Revisaremos los principales hallazgos patológicos evaluados por esta técnica.

Painful shoulder syndrome is a frequent cause of daily clinical consultation. Its origin can be traumatic, inflammatory, degenerative, infectious or tumor like. The boarding diagnosis implies an ample knowledge of the regional anatomy and the application of clinical and technical maneuvers of image that leads to an accurate diagnosis for the application of an optimal treatment in each patient. In the recent years, the musculoskeletal ultrasound has demonstrated to be a complementary tool of highest utility in the complementary examination of the patients with painful shoulder, especially in the context of the rheumatological practice. We will review the main pathological findings evaluated by this technique.

Iontoforese no tratamento da tendinite calcárea do ombro: implicações clínicas / Iontophoresis in the treatment of calcifying tendinitis of the shoulder: clinical implications

Tendinite calcárea do ombro é caracterizada por uma calcificação reativa dos tendões e incapacidade funcional da articulação envolvida. Diversos tratamentos são realizados, entretanto, os resultados são insatisfatórios. Uma alternativa promissora, porém pouco difundida na prática fisioterápica é a iontoforese com ácido acético. Seus efeitos relacionados à desmineralização e conseqüente reabsorção dos depósitos de cálcio poderiam auxiliar no combate à causa primária dos sintomas da tendinite calcárea. O objetivo deste estudo foi realizar uma revisão da literatura a fim de determinar a real viabilidade e parâmetros adequados da iontoforese para o tratamento da tendinite calcárea do ombro. Uma pesquisa documental em bases de dados, além de um levantamento bibliográfico em livros relacionados ao tema foi realizada. Dentre os artigos revisados, os parâmetros para utilização da iontoforese no tratamento da tendinite calcárea do ombro mostraram-se similares, com exceção ao número de sessões. Redução do tamanho do depósito de cálcio, melhora da dor e da função foram citados como benefícios decorrentes dessa técnica. Porém, a escassez de estudos associada à baixa qualidade metodológica das pesquisas, dificultou a tomada de decisão quanto ao papel da iontoforese com ácido acético no tratamento da tendinite calcárea do ombro.

Calcifying tendinitis of the shoulder is characterized by a reactive calcification of tendons and functional disability of the involved joint. Several treatments were applied; however, the results are unsatisfactory. A promising alternative, but not well-known in physical therapy practice, is the iontophoresis with acetic acid. Its effects related to demineralization and resorption of calcium deposits could help to fight the primary cause of calcifying tendinitis. The aim of this study was a literature review to determine the real viability and adequate parameters of iontophoresis in calcifying tendinitis of the shoulder. It was made a search of articles in databases, and in books related to the subject. According to the reviewed studies, the parameters for iontophoresis use for the treatment of calcifying tendinitis of the shoulder were similar except for the number of sessions. Size reduction of the calcium deposits, improvement in pain and function were considered benefits of this technique. However, the studies are scarce and their poor methodological quality hinders the decision-making on the role of iontophoresis with acetic acid for the treatment of calcifying tendinitis of the shoulder.

The Role of Tendinitis in Fibromyalgia Syndrome

Fibromyalgia Syndrome (FS) is a common disease characterized by diffuse, widespread pain and multiple tender points. The syndrome has been subclassified as primary (PFS) and secondary (SFS) fibromyalgia. The aim of this study was to evaluate the role of common tendinitis (rotator cuff tendinitis, bicipital tendinitis, lateral epicondylitis, De-Quervain's tendinitis and pes anserinus tendinitis) in FS. Twenty female patients with PFS, 20 with SFS and 20 female controls, matched by age and body mass index, participated in the study. Existence of common tendinitis was evaluated with specific examination methods. Right and left rotator cuff tendinitis, pes anserinus tendinitis and left lateral epicondylitis were significantly more common in patients with PFS and SFS than in control subjects. As a result, considering the central hyperexcitability present in the fibromyalgia patients, concomitant pathologies such as tendinitis which lead to shoulder, arm, and leg pain must be evaluated. Follow up and therapy for the disease must be planned according to these factors which are not only probable symptoms of FS, but also leading causes for the occurence and continuity of the pain in this disease.

Resultados de 23 plásticas de ligamento cruzado anterior con la técnica de Pintos - Togni con autoinjerto del palmar menor / Results of 23 plastics of the anterior cruciate ligament with the Pintos - Togni technique with palmar brevis tendon autograft

Este trabajo esta fundamentado sobre el estudio retrospectivo de 23 rodillas operadas por lesión del ligamento cruzado anterior entre abril de 1997 y abril de 1999 según nuestro procedimiento, técnica Pintos - Togni, utilizando el autoinjerto del palmar menor como plástica ligamentaria. Todas las rodillas fueron operadas por nuestro equipo de trabajo constituído siempre por los mismos profesionales. Ello se trata de 23 rodillas, todos hombres con edad promedio de 24 años con edad de mínima 19 y de máxima 26, los cuales son deportistas de alta competición, es decir futbolistas profesionales afiliados a nuestra agremiación. El tiempo medio transcurrido entre el accidente deportivo y la intervención quirúrgica fue de 10 meses con episodios de 1 mes de mínima y de 20 meses de máxima tomando en cuenta los reoperados. La tolerancia de la plástica utilizada fue excelente y no tuvimos en esta serie ningún caso con sinovitis residual ni procesos infecciosos y fundamentalmente ninguna tendinitis rotuliana con hipotrofia cuadricipital, pertinaz secuela que ofrecían las hueso- tendón-hueso del rotuliano. La intención de evitar dicha secuela nos decide por la técnica que presentamos. Los resultados anatómicos evaluados a partir del test de Lachman mostraron una laxitud diferencial con el miembro sano, nula en 19 casos, entre 0 y 2 mm en 2 casos y entre 2 y 4 mm en los dos restantes. Los resultados radiográficos no mostraron en la posición de perfil, imagen de cajón anterior distinto a lo experimentado con la maniobra de Lachman.

Artrite de Takayasu: relato de um caso com manifestaçöes reumáticas incomuns / Takayasu's arteritis: report of a case with uncommon rheumatic manifestations

É apresentado um caso de arterite de Takayasu em uma paciente do sexo feminino de 34 anos. O quadro inicialmente manifestou-se com dor em queimaçäo e ausência de pulso radial no membro superior esquerdo. Posteriormente surgiu sintomatologia reumática pouco comum, tais como: artrite bilateral de tornozelos, calcaneoldínia bilateral e tendinite bilateral do Aquiles. Este fato sugeriu uma associaçäo, näo confirmada pelos exames, de angite com espondiloartropatia seronegativa