Idiopathic Chondrolysis of the Hip in Two Adolescent Females: A Six-Year Follow-Up.

Idiopathic chondrolysis of the hip (ICH) is a rare condition with only a few cases reported in the literature. The average age at the onset of the disease is 11 years, with females having six times higher incidence than males. We report two cases of ICH in two medically free 10-year-old females who presented with atraumatic insidious hip pain and limping. No significant past medical, surgical, or family history was recorded. Laboratory studies were within normal limits, and the imaging showed the pathogenic changes of hip chondrolysis. Both cases were treated conservatively, and regular follow-ups in the clinic showed progressive limitation of the hip range of motion with arthritic changes on plain radiographs. Altogether, ICH is rare and can be misdiagnosed as inflammatory or infectious hip arthritis. Clinical assessment and image interpretation can lead to early diagnosis. Pain management and physical therapy with a prolonged period of protected weight-bearing are the mainstays of treatment.

Intratendinous Ganglionic Cyst of Semimembranosus: A Rare Cause of Thigh Swelling.

Ganglionic cysts are common swellings of the hands. Various mechanisms are thought to generate these lesions, such as cystic mucoid degeneration and inflammation. Typically, ganglionic cysts are asymptomatic but can cause pain. They usually originate from soft tissues like ligaments, joint capsules, and sheaths of tendons. We present the case of a 37-year-old man with mid-thigh swelling with intermittent mild pain. However, no systemic symptoms like fever or weight loss were present. Workup unmasked the presence of a rare intratendinous ganglionic cyst. Ultrasonography (USG) and magnetic resonance imaging (MRI) can confirm the presence of ganglionic cysts and estimate their sizes and relationships with the surrounding structures. Treatment options range from observation and conservative management to interventions like aspiration and surgical excision.

Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO): A Case Report.

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) is an uncommon adulthood disorder that presents as focal swellings and pain accompanied by abnormal changes in bone and surrounding soft tissues. X-rays of the involved region are usually insignificant; however, CT and MRI show excellent visualization of the affected structures. Typical radiological images show cortical thickening leading to decreased marrow cavity, bony erosion, and ligament ossifications. Other associated findings are synovitis and joint effusions. It is usually diagnosed on the basis of clinical as well as radiological findings. The treatment initially relies on non-steroidal anti-inflammatory drugs (NSAIDs). Patients showing poor response are started on corticosteroids and disease-modifying antirheumatic drugs (DMARDs). We report two patients who presented with joint swellings. Their workup unmasked the underlying SAPHO, which was managed well with NSAIDs.

Chronic Recurrent Multifocal Osteomyelitis and Its Management.

Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory disorder of bones first reported by Giedion et al. in 1972. It is a disease of childhood, comparable to SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) in adults. CRMO presents with pain and swelling overlying the involved bones. Inflammatory markers are usually raised and X-rays usually show sclerotic lesions. MRI demonstrates the extent of the lesions accurately and associated soft tissue changes. Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are the mainstays of the management. We report three patients who presented with bone pains. Extensive workup and radiological modalities along with clinical findings supported the diagnosis of CRMO. This article highlights important clinical presentations, radiological findings, and various management options.