Arnica compositum, Hekla lava and Acidum Nitricum Together are Superior to Arnica compositum Alone in the Local Treatment of Symptomatic Calcific Periarthritis of the Shoulder: A Pilot Study.

BACKGROUND: To evaluate the usefulness of Arnica compositum (AC) + Acidum nitricum (AN) + Hekla lava (HL) ointment in Emergency Medicine Department (EMD) as alternative nonpharmacological local treatment of patients with symptomatic calcific periarthritis of the shoulder (CPS) and to compare the effectiveness of this mixture against AC ointment alone. METHODS: A series of 41 consecutive patients (20 women, 19 men, median age 49 years, range 25-80 years) with non-traumatic painful unilateral CPS were randomly assigned to receive local treatment with AC+AN+HL ointment mixture (Group A, cases, N=21) or AC ointment alone (Group B, controls, N=20). The radiological Gartner classification of the CPS, and the quantification of pre- and post-treatment pain intensity using a Visual Analogue Scale (VAS) were obtained. The orthopedic evaluation of Shoulder Motion (SM) was also performed. The use of painkillers was reported as a number of doses needed. RESULTS: Age, gender distribution, Gartner type, main calcification size, baseline VAS (VAS-0) and degree of SM did not differ (p=NS) between Groups. After 3-day therapy, the reduction of pain in Group A (4.5±2.5) was superior to that observed in Group B (2.7±2.6) (p =0.03). The same result was observed in the improvement of SM in Group A (69.4±24.9) than in Group B (51.1±21.1) (p =0.015). No local or general adverse effects were noted. The number of doses of paracetamol was similar, but Group A patients used less ibuprofen (p =0.007). CONCLUSION: Local administration of the AC+AN+HL ointment mixture, which in our pilot study was superior to AC alone, could be safely suggested as an alternative uneventful treatment of patients with CPS.

Arthroscopic treatment of symptomatic calcific periarthritis on the medial side of the knee after posterior cruciate ligament reconstruction: Case report and literature review.

Calcific periarthritis in the distal femur is a rare condition. Forty two year old Asian male visited to the outpatient clinic of orthopedic department with acute excruciating knee pain. The arthroscopic posterior cruciate ligament (PCL) reconstruction was performed 20 years ago with the bonepatellar tendon-bone (BPTB) autograft combined with Trevira (polyethylene terephthalate) artificial ligament. Severe tenderness was noted incidentally over the medial epicondyle area of the distal femur which the cancellous screw was inserted for PCL reconstruction, without any preceding trauma history or medial joint line tenderness due to degenerative change. The poorly defined calcific deposition was found in plain radiograph. The arthroscopic debridement of the calcification and screw removal from the distal femur was performed due to resist to conservative treatment with analgesics. After operation, the symptoms were resolved completely. The arthroscopic debridement of calcific periarthritis should be considered in specific cases, such as refractory cases with conservative management during 4-6 weeks. We present the arthroscopic treatment of the symptomatic calcific periarthritis on distal femur after PCL reconstruction can be effective.

Evaluation of ankle swelling due to Lofgren's syndrome: a pilot study using B-mode and power Doppler ultrasonography.

OBJECTIVE: Patients with acute sarcoidosis frequently present with bilateral painful swelling of the ankles, establishing ankle arthritis as a hallmark of Lofgren's syndrome. Standardized high-resolution musculoskeletal ultrasound (MSUS), including power Doppler, has been utilized to further characterize the nature of ankle swelling in patients presenting with Lofgren's syndrome. METHODS: The ankle joints of 36 consecutive patients with Lofgren's syndrome were investigated by high-resolution MSUS using B-mode and power Doppler mode. The presence of effusion/synovitis and tenosynovitis was determined, and hyperperfusion was scored in a semiquantitative fashion (grade 0-3). RESULTS: The majority of patients (26 [72.2%] of 36) did not present characteristic arthrosonographic findings of an acute arthritis (distension of the capsule and hyperperfusion). Ankle joint effusion was only observed in 9 (25%) of the 36 patients, with a generally mild character (grade I ankle joint effusion: n = 8 [88.8%], grade II ankle joint effusion: n = 1 [11.2%]). In contrast, an extensive subcutaneous edema indicating periarthritis was detected in 23 (92%) of 25 patients. In addition, tenosynovitis could be visualized in 14 patients (38.8%) using MSUS. CONCLUSION: Utilizing MSUS, including power Doppler, the present results clearly demonstrate that ankle swelling in patients with Lofgren's syndrome is predominantly due to periarticular soft tissue swelling and tenosynovitis. In contrast, distinct articular synovitis is rare and if present, only to a mild degree, without relevant power Doppler activity.

[Extracorporeal shock wave therapy in athletes with degenerative and dystrophic disorders of locomotory system].

Degenerative and dystrophic changes of joints and ligaments are among the most prevalent disorders in professional athletes. Specification of a complex system for these diseases is an important task in sports medicine. Extracorporeal shock wave therapy is a modern and highly effective method of rehabilitation.

Causation and management of calcific tendonitis and periarthritis.

PURPOSE OF REVIEW: The purpose of this review is to update the reader on contemporary theory related to the cause of calcific periarthritis and provide the latest evidence associated with treating recalcitrant cases. RECENT FINDINGS: Contemporary theory suggests calcific periarthritis is the result of a cellular-mediated process in which calcium is deposited and resorbed via a multiple phase process. Resorption is associated with an acute inflammatory response and is often the factor that prompts one to seek medical care. The majority of cases require nothing more than a combination of symptomatic care and benign neglect. A small percentage of cases require intervention to further stimulate deposit resorption. Moderate evidence exists for extracorporeal shock wave therapy in the treatment of chronic cases related to deposits about the shoulder. Numerous case studies support the use of NSAIDs as an effective intervention for retropharyngeal periarthritis. If conservative interventions fail, surgery appears to be a viable option for symptom relief associated with rotator cuff calcific deposits. SUMMARY: Periarthritis is typically a symptom-limiting condition that resolves spontaneously. Numerous conservative treatment modalities each with varying levels of evidence exist for use in refractory cases. Future study is necessary to further refine the efficacy and parameters associated with available interventions.

Hereditary angioedema in a family presenting as transient periarthritis.

Hereditary angioedema (HAE) is a rare condition known to cause episodic, self-limiting, nonpruritic, nonpitting edema that involves skin and visceral organs. It may affect any external body surface including face, extremities, and genitalia. Most commonly involved viscera are gastrointestinal and respiratory systems. Patients may have severe abdominal pain because of edema of the bowel wall. This disease can cause life threatening laryngeal edema if it involves the airway.We describe a patient with HAE who was initially diagnosed with arthritis after she had recurrent edema around her peripheral joints. Diagnosis of HAE in her led to the same diagnosis in her sister and her father. HAE should be considered in the differential diagnosis of recurrent attacks of periarticular swelling.

[Rotator cuff tear of the hip]. / Rupture de la coiffe des rotateurs de la hanche.

We report the observations of two women with a recurrent periarthritis of the hip complicated by a spontaneous rupture of the tendons of the gluteus medius and minimus. These patients usually complain from an acute lateral hip pain and show a Trendelenburg gait. When the rupture is complete, clinical evaluation reveals a drop of the pelvis on the non-stance side and resisted rotation starting from the extreme external rotation position is weak. MRI plays a key role in the diagnosis and the evaluation of a possible surgical repair. Hip rotator-cuff rupture is probably insufficiently diagnosed by ignorance. Nonetheless, optimized handling could relieve the pain of most these patients and improve the disability of some of them.

Pseudopodagra: A presenting manifestation of infective endocarditis.

Podagra is a term used to describe acute monoarthritis of the first metatarsophalangeal (1st MTP) joint. The most common diagnoses of arthritis in this joint are: crystal-induced synovitis, septic arthritis, traumatic conditions and reactive arthritis. When etiologies other than gout are involved this is frequently referred to as pseudopodagra. We report the case of a patient who presented with pain and swelling of the 1st MTP The absence of intraarticular crystals and hyperuricemia encouraged further evaluation of the patient. A cardiac murmur was investigated by echocardiography, which revealed valvular vegetations and the diagnosis of infective endocarditis (IE) was established. This is the first reported case of a podagra-like presentation of IE. As in this case, the diagnosis of gout should rest on findings beyond the presence at 1st MTP arthritis, with evaluation of all extraarticular signs in order to rule out other possible diagnoses.

Acute calcific periarthritis of proximal interphalangeal joint in a professional golfer 's hand.

This report describes a 22-yr-old professional golfer with acute calcific periarthritis of the proximal interphalangeal joint of the 4th finger. We considered that the major cause for this condition may be the repeated minor traumas to the affected site. Also, since this condition is self-limiting, a correct diagnosis is required to avoid unnecessary tests and surgery.

Acute Calcific Periarthritis of Proximal Interphalangeal Joint in a Professional Golfer's Hand

This report describes a 22-yr-old professional golfer with acute calcific periarthritis of the proximal interphalangeal joint of the 4th finger. We considered that the major cause for this condition may be the repeated minor traumas to the affected site. Also, since this condition is self-limiting, a correct diagnosis is required to avoid unnecessary tests and surgery.

Procesos pelvianos periarticulares en instrumentistas de quirófano / Circumaticular pelvic diseases in theatre nurses

En este estudio se describen dos tipos de procesos pelvianos periarticulares en instrumentistas de quirófano: las peritrocanteritis y la osteopatía dinámica de pubis. El número de casos registrados desde la puesta en marcha de estos quirófanos en el Servicio Navarro de Salud-Osasunbidea (aproximadamente 25 años) fue de tres y el número de trabajadores expuestos a lo largo de estos años fue de siete. La sobrecarga postural subjetiva señala que la intervención quirúrgica es muy incómoda, y la valoración objetiva indica que el número de posturas forzadas es muy elevado. Como conclusión puede señalarse que existe una sobrecarga postural con falta de pausas, que aconseja cambiar la posición de la instrumentista durante el acto quirúrgico y establecer un cambio de instrumentistas pasado un tiempo de iniciada la intervención (AU)

[Diagnostic image (70). A man with fever, swollen joints and erythema nodosum. Loefgren's syndrome]. / Diagnose in beeld (70). Een man met koorts, gewrichtszwelling en nodulair erytheem. Syndroom van Löfgren.

A 39-year-old man presented with fever, arthritis of knees and wrists, periarticular ankle inflammation, erythema nodosum, bilateral hilar adenopathy and diffuse pulmonary parenchymal changes, due to Löfgren's syndrome.

[Proximal row carpectomy: a 'salvage' procedure for radio-carpal arthritis of the wrist]. / Proximale-rijcarpectomie als behandeling voor radiocarpale artrose van de pols.

In 4 patients, a woman aged 46 years, and 3 men aged 58, 28 and 60 years, respectively, a proximal row carpectomy was done for pain and loss of function due to scapho-lunate dissociation, scaphoid nonunion, Kienböck's disease and scapho-lunate advanced collapse wrist deformity (bilateral). Pain relief was achieved post-operatively in all patients, allowing patients to return to their previous work and activities. Proximal row carpectomy involves the removal of the os scaphoideum, the os lunatum and the os triquetrum. This improves wrist extension and ulnar deviation. Intensive postoperative treatment is essential to achieve good mobility and strength.