Unveiling a foreign body masquerading as periarticular calcification: a case report.

INTRODUCTION: Evaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often underlie occult pathologies, benign symptoms are frequently miscategorized as idiopathic. CASE PRESENTATION: We present a case of retained glass obscuring as acute calcific periarthritis on imaging. A 48-year-old White male with vague fifth metacarpophalangeal joint pain had unrevealing exams, but radiographs showed periarticular calcification concerning inflammation. Surgical exploration unexpectedly revealed an encapsulated glass fragment eroding bone. Further history uncovered a forgotten glass laceration decade prior. The foreign body was removed, resolving symptoms. DISCUSSION: This case reveals two imperative diagnostic principles for nonspecific extremity pain: (1) advanced imaging lacks specificity to differentiate inflammatory arthropathies from alternate intra-articular processes such as foreign bodies, and (2) obscure patient history questions unearth causal subtleties that direct accurate diagnosis. Though initial scans suggested acute calcific periarthritis, exhaustive revisiting of the patient's subtle decade-old glass cut proved pivotal in illuminating the underlying driver of symptoms. CONCLUSION: Our findings underscore the critical limitations of imaging and the vital role that meticulous history-taking plays in clarifying ambiguous chronic limb presentations. They spotlight the imperative of probing even distant trauma when symptoms seem disconnected from causative events. This case reinforces the comprehensive evaluation of all subtle patient clues as key in illuminating elusive extremity pain etiologies.

Acute calcific periarthritis-a commonly misdiagnosed pathology.

Acute calcific periarthritis (ACP) is a self-limiting, monoarticular, peri-articular process of dystrophic mineral deposition and adjacent inflammation. Patients present with a sudden onset of pain, localised swelling, erythema, tenderness and restricted range of motion. Symptoms reduce in severity within 4-7 days and self resolve in 3-4 weeks. ACP is commonly misdiagnosed, in particular, as infective or inflammatory pathologies such as septic arthritis and gout. This condition has specific imaging findings which allows differentiation from other disorders when combined with the clinical presentation. Prompt diagnosis results in appropriate management and reduces the likelihood of unnecessary diagnostic and therapeutic procedures.

Fingertip Infections.

The fingertip is the most common site of infections in the hand, which frequently are encountered by surgeons, dermatologists, and emergency and primary providers. Their mismanagement may have serious consequences. This review discusses the unique anatomy of the volar fingertip pulp and perionychium and reviews pathophysiology and treatment of acute and chronic paronychia, including the decision for surgical versus medical management, choice of antibiotics, incisional techniques, and postincisional care. Felons and the evidence regarding their management are reviewed. Several infectious, rheumatologic, and oncologic conditions that may mimic common fingertip infections and about which the managing provider must be aware are presented.

Tuina for periarthritis of shoulder: A systematic review protocol.

BACKGROUND: Periarthritis of shoulder (PAS) symptom is one of the leading causes prompting many patients to seek treatment. Tuina is a common treatment for PAS in China. But at present, there is no systematic evaluation report on its therapeutic effectiveness and safety. This protocol aims to reveal the efficacy and safety of Tuina for treating PAS. METHODS: The following databases will be searched by electronic methods: PubMed, EBASE, WHO International Clinical Trials Registry Platform, Embase, the Chinese Biomedical Literature Database (CBM), Wan-fang Data (WANFANG), the China National Knowledge Infrastructure (CNKI), and other sources from inception to December 2019. Bias risk, subgroup analysis, data synthesis, and meta-analyses will be assessed with RevMan V.5.3 software if the data is met inclusion conditions. RESULTS: This study will present a quality evidence of Tuina for the treatment of PAS patients. CONCLUSION: The systematic review will present reliable evidence to judge whether or not Tuina is a safe and effective intervention for PAS patients. PROSPERO REGISTRATION NUMBER: CRD42019147445.

[Slowly progressive joint destruction in an older man as expression of hydroxyapatite disease. Case report and literature review]. / Langsam progrediente Gelenkzerstörung bei einem älteren Mann als Ausdruck einer Hydroxylapatiterkrankung. Fallbericht und Literaturübersicht.

This article reports the case of a 75-year-old male patient presenting with arthralgia of the large joints that had existed for 10 years. Clinically, bursitis of the right elbow joint was found. Laboratory tests showed elevated inflammatory markers and imaging revealed erosive joint destruction. A surgical bursectomy was performed. Histologically, hydroxyapatite crystals were detected in alizarin red S staining and a crystal arthropathy was diagnosed. The diagnostics are difficult since crystals can only be detected by electron microscopy or special staining methods.

Acute Calcific Periarthritis of the Hand: A Case Report in an Active Duty Soldier.

Acute calcific periarthritis of the hand is a condition that can easily be misdiagnosed resulting in unnecessary diagnostic studies and treatment. The condition is thought to be benign with a self-resolving course. The author presents a case of an active duty 29-year-old male who presented to a military emergency department with severe atraumatic hand pain developing overnight with initial concern for flexor tenosynovitis. Following orthopedic consultation, he was determined to have acute calcific periarthritis of the small finger (metacarpophalangeal) MCP joint with resolution over approximately 3 weeks without recurrence over a 5-month period. This case report reviews the natural history of acute calcific deposits of the hand and its correct identification through clinical exam and plain radiographs to avoid unnecessary diagnostic testing and invasive surgical interventions.

[Rheumatology emergencies in general practice]. / Rheumatologische Notfälle im Alltag des Hausarztes.

In rheumatology there may occur emergencies especially in the field of inflammable diseases, the sudden occlusion of the central retinal artery in temporal arteritis as an example. Such incidents are rare. The general practitioner is more often confronted with not necessarily threatening, but very painful and function obstructing acute cases. In this paper four typical problems are represented which can be seen in everyday practice, sometimes misleading to wrong actions and therefore needing to be recognized in time and treated correctly: acute low back pain, periarthropathy of the shoulder joint, crystal arthritis and ruptured Baker's cyst.

[Analysis on clinical palpation laws of muscle meridian focus in scapulohumeral periarthritis].

OBJECTIVE: To explore the distribution rules of proximal and distal focus of muscle meridian region in scapulohumeral periarthritis. METHODS: Three hundred and six shoulder joints of affected side were selected in 216 patients of scapulohumeral periarthritis. Under the guidance of muscle meridian theory, with the anatomical characteristics of muscle meridian focuses, the frequency and location where proximal and distal focus appeared were calculated by palpation. RESULTS: The percentages of the frequency that the focus of muscle meridian of Hand-Yangming, Hand-Shaoyang, Hand-Taiyang, and three yin meridians of hand appeared at proximal points of shoulder joint were 25.6% (1 146/5 657), 30.9% (1 749/5 657), 19.0% (1 075/5 657), and 24.5% (1 387/5 657), respectively, the focuses of muscle meridian region were Jianyuci, Juguci, Xiaoshuoci, Naohuici, etc. The percentages of the frequency that the focus of muscle meridian region appeared at distal points of shoulder joint were 31.77% (287/905), 23.2% (210/905), 10.9% (99/905), and 34.1% (304/905), the focuses of muscle meridian were Yangxici, Shousanlici, Yangchici, etc. CONCLUSION: The location and frequency of proximal and distal focus of muscle meridian in scapulohumeral periarthritis are closely related with the anatomical structure and biomechanical characteristics of the shoulder joints, thus new therapy for scapulohumeral periarthritis is implied.

Role of Newman's classification in predicting outcomes in patients with crystal arthritis.

PURPOSE: The aim of the study was to evaluate the utility of Newman's classification in predicting outcomes in patients presenting with crystal arthritis. METHODS: Between January and December 2009, all patients who presented to our institution with acute crystal arthritis and were investigated with microbiological assessment of their synovial fluid were included in the study. Patients were divided into two groups depending on the fulfilment of Newman's criteria for culture-negative septic arthritis. Group 1 included patients that fulfilled Newman's B criteria. Group 2 included patients that fulfilled Newman's C criteria. A database looking at the demographics, mode of presentation, investigations, treatment and outcomes was then established and the results compared between the two groups. RESULTS: A total of 58 patients were identified (group 1: n = 13; group 2: n = 45). The average age was 71 years (range 33-96). The joint most commonly involved was the knee followed by the wrist. Clinical findings at presentation were comparable in both groups; however, WBC and C-reactive protein (CRP) were more likely to be raised in group 1. Although most patients in group 1 were treated with antibiotics (62%) there was still a higher rate of morbidity, greater use of supportive therapy and a longer hospital stay (22.3 days, SD 17.4) in comparison with group 2, where most patients were treated by observation only (76%, mean hospital stay 3.5 days, SD ± 4.4). The difference in length of hospital stay was statistically significant (p < 0.0001). CONCLUSIONS: Newman's criteria are a good indicator for prognosis in patients with crystal arthritis. However, the presence of crystals in an acutely inflamed joint does not exclude the need for supportive therapy and long hospital stay even in the absence of positive synovial fluid culture.

[Diagnosis of crystal-induced arthritis]. / Diagnostic d'une arthropathie microcristalline.

Crystal-induced arthritis (CIA) is easy to diagnose as soon as the physician might suspect the diagnosis. Indeed, CIA can be readily ascertained since one single gold standard is available: identification of microcrystals in synovial fluid or in other materials (tophus, synovial tissue biopsy, periarticular tissues). It is therefore mandatory to perform joint aspiration and to get synovial fluid sample for microscopic examination. Monosodium urate crystals are the key feature of gout, and calcium pyrophosphate (CPP) crystals are associated with CPP disease, also called "chondrocalcinosis" in France. Diagnosis of gout can be readily suspected when considering typical clinical presentations such as podagra, presence of tophi, cardiovascular comorbidities, and diuretics use. Plain radiographs, as long as technical quality is present, are an easy way to suspect and eventually to diagnose CPP disease or apatite deposits in any articular or periarticular site. Joint ultrasonography when performed by skilled physicians can easily help in displaying crystal deposits at the cartilage surface (gout) or within the cartilage (CPP), along with peri-tophaceous inflammatory reaction as evidenced by power Doppler.

[Basic calcium phosphate crystal deposition disease]. / Rhumatismes apatitiques.

Hydroxyapatite crystals are a common cause of periarticular disease. Virtually, any joint can be involved, but the shoulder is by far most commonly involved. These calcifications, often asymptomatic, can lead to an acute microcrystalline tendinitis or bursitis, which may simulate infection. The diagnosis of periarticular calcifications relies on imaging techniques using X-rays or ultrasounds. Treatment of acute tendinitis or bursitis includes icing, rest, analgesics or non steroidal anti-inflammatory drug and oral steroids or local steroids injection. Removal of the deposit can be considered in patients with chronic pain, particularly at the shoulder.

Arthroscopic treatment of anterior ankle impingement.

Anterior ankle impingement is a common cause of chronic ankle pain in the athletic population. Its cause can be either soft tissue or osseous in nature. Arthroscopic debridement results in favorable and reproducible outcomes. However, in the population in which ankle instability or narrowing of the ankle joint occur, outcomes may be less favorable.

Long-term treatment of Langerhans cell histiocytosis of the mandibular condyle with indomethacin.

Langerhans cell histiocytosis (LCH) most commonly occurs as a localized solitary bone lesion and appears predominantly in pediatric patients. LCH is characterized by the proliferation and accumulation of Langerhans cells which may cause pain and adjacent soft-tissue swelling. This disease is of clinical importance to dental professionals because LCH commonly involves the oral and maxillofacial region and early symptoms can be manifested in the jaw and, when overlooked, may result in extensive destruction of the involved structures. Considering the fact that this is a relatively rare entity, close investigation of the cases that are encountered are warranted. Herein we report a case of LCH occurring in the left condyle of an 11-year-old boy that initially showed clinical symptoms mimicking an abscess of the temporomandibular joint. The clinical and radiographic features, differential diagnosis, treatment, and long-term follow-up of this patient with indomethacin are presented.