A survey of anatomical items relevant to the practice of rheumatology: pelvis, lower extremity, and gait.

This study aimed to generate a minimum list of structural and functional anatomical items about the pelvis/hip, knee, ankle/foot, gait, and lower limb innervation, which are most relevant to the practice of rheumatology. To determine their perceived relevance to clinical practice, seven members of the Mexican Clinical Anatomy Task Force compiled an initial list of 470 anatomical items. Ten local and international experts according to a 0-10 Likert scale ranked these items. Of the original list, 101 (21.48%) items were considered relevant (global rate >40). These included 36/137 (26.27%) pelvis and hip items, 25/82 (30.48%) knee items, 22/168 (13.98%) ankle/foot items, 11/68 (16.17%) neurologic items, and 7/15 (46.66%) gait-related items. We propose that these 101 anatomical items of the lower extremity, when added to the 115 anatomic items of the upper extremity and spine we previously reported, may represent an approximation to the minimal anatomical knowledge central to the competent practice of rheumatology. The meager representation of ankle and foot items may reflect a lesser emphasis in these anatomical regions during rheumatologic training. Attention to these and related items during rheumatologic training and beyond may sharpen the rheumatologist's ability in the differential diagnosis of regional pain syndromes as well as strengthen an endangered art: the rheumatologic physical examination.

Nomina anatomica. Anatomic terminology and the old French terminology.

A surprising finding in our seminars in Latin America and Spain was that approximately half of the participants continued to use the old French anatomical nomenclature. The substance of this paper is a table in which we compare the anatomical names for the items reviewed in our seminar, in a Spanish version of the old French nomenclature and in the Spanish, Portuguese, and English versions of the currently employed anatomical terms.

Clinical anatomy of the pelvis and hip.

The contents of this review may appear odd. After a brief description of the coxofemoral joint, the entities discussed include ilioinguinal neuropathy within the context of the nerves that may be damaged during lower abdominal surgery, meralgia paresthetica, piriformis syndrome with the appropriate caveats, trochanteric syndrome, "ischial bursitis" and trochanteric syndrome caused by ischemia. These cases were chosen to stress our belief that rheumatologists are first and foremost internists. We further believe that being current in other pathologies such as peripheral neuropathies and certain vascular syndromes sooner or later benefits our patients.

Clinical anatomy of the knee.

The clinical anatomy of several pain syndromes of the knee is herein discussed. These include the iliotibial tract syndrome, the anserine syndrome, bursitis of the medial collateral ligament, Baker's cyst, popliteus tendon tenosynovitis and bursitis of the deep infrapatellar bursa. These syndromes are reviewed in terms of the structures involved and their role in knee physiology. All of the discussed structures can be identified in their normal state and more so when they are affected by disease. The wealth of information gained by cross examination of the medial, lateral, posterior and anterior aspects of the knee brings to life knowledge acquired at the dissection table, from anatomical drawings and from virtual images.

Clinical anatomy of the hand.

This article reviews the underlying anatomy of trigger finger and thumb (fibrous digital pulleys, sesamoid bones), flexor tenosynovitis, de Quervain's syndrome, Dupuytren's contracture, some hand deformities in rheumatoid arthritis, the carpal tunnel syndrome and the ulnar nerve compression at Guyon's canal. Some important syndromes and structures have not been included but such are the nature of these seminars. Rather than being complete, we aim at creating a system in which clinical cases are used to highlight the pertinent anatomy and, in the most important part of the seminar, these pertinent items are demonstrated by cross examination of participants and teachers. Self learning is critical for generating interest and expanding knowledge of clinical anatomy. Just look at your own hand in various positions, move it, feel it, feel also your forearms while you move the fingers, do this repeatedly and inquisitively and after a few tries you will have developed not only a taste, but also a lifelong interest in clinical anatomy.

Clinical anatomy of the elbow and shoulder.

The elbow patients herein discussed feature common soft tissue conditions such as tennis elbow, golfers' elbow and olecranon bursitis. Relevant anatomical structures for these conditions can easily be identified and demonstrated by cross examination by instructors and participants. Patients usually present rotator cuff tendinopathy, frozen shoulder, axillary neuropathy and suprascapular neuropathy. The structures involved in tendinopathy and frozen shoulder can be easily identified and demonstrated under normal conditions. The axillary and the suprascapular nerves have surface landmarks but cannot be palpated. In neuropathy however, physical findings in both neuropathies are pathognomonic and will be discussed.

Nomina Anatomica. Anatomic Terminology and the Old French Terminology / Nómina anatómica, Terminología Anatómica y la antigua terminología francesa

A surprising finding in our seminars in Latin America and Spain was that approximately half of the participants continued to use the old French anatomical nomenclature. The substance of this paper is a table in which we compare the anatomical names for the items reviewed in our seminar, in a Spanish version of the old French nomenclature and in the Spanish, Portuguese, and English versions of the currently employed anatomical terms (AU)

Una sorpresa que tuvimos en los seminarios de anatomía clínica que dimos en Latinoamérica y España fue comprobar que aproximadamente la mitad de los participantes utilizaban la antigua nomenclatura anatómica Francesa. Esta mentalización obsoleta nos hace extranjeros en el cauce del progreso. La médula de este artículo es una tabla en la cual comparamos los términos utilizados en nuestro seminario en la antigua nomenclatura francesa traducida al español y en las versiones en español, inglés, portugués y latín de la terminología anatómica hoy en uso (AU)

Clinical Anatomy of the Elbow and Shoulder / Anatomía clínica del hombro y el codo

The elbow patients herein discussed feature common soft tissue conditions such as tennis elbow, golfers’ elbow and olecranon bursitis. Relevant anatomical structures for these conditions can easily be identified and demonstrated by cross examination by instructors and participants. Patients usually present rotator cuff tendinopathy, frozen shoulder, axillary neuropathy and suprascapular neuropathy. The structures involved in tendinopathy and frozen shoulder can be easily identified and demonstrated under normal conditions. The axillary and the suprascapular nerves have surface landmarks but cannot be palpated. In neuropathy however, physical findings in both neuropathies are pathognomonic and will be discussed (AU)

Se consideran ciertas patologías de los tejidos blandos del codo y del hombro. El codo de tenista, el codo de golfista y la bursitis olecraniana afectan estructuras anatómicas fácilmente identificables y demostrables en el examen cruzado de instructores y participantes. Los temas de hombro incluyen la tendinopatía del manguito rotador, el hombro congelado, la neuropatía del nervio axilar y la neuropatía del nervio supraescapular. En las tendinopatías y el hombro congelado la anatomía relevante es fácilmente identificable y demostrable. No así en las neuropatías que carecen de reparos anatómicos aunque son fácilmente demostrables por los déficits que causan en el examen de pacientes afectados. Este conjunto de estructuras se analiza desde un punto de vista anatómico general (AU)

Clinical Anatomy of the Hand / Anatomía clínica de la mano

This article reviews the underlying anatomy of trigger finger and thumb (fibrous digital pulleys, sesamoid bones), flexor tenosynovitis, de Quervain's syndrome, Dupuytren's contracture, some hand deformities in rheumatoid arthritis, the carpal tunnel syndrome and the ulnar nerve compression at Guyon's canal. Some important syndromes and structures have not been included but such are the nature of these seminars. Rather than being complete, we aim at creating a system in which clinical cases are used to highlight the pertinent anatomy and, in the most important part of the seminar, these pertinent items are demonstrated by cross examination of participants and teachers. Self learning is critical for generating interest and expanding knowledge of clinical anatomy. Just look at your own hand in various positions, move it, feel it, feel also your forearms while you move the fingers, do this repeatedly and inquisitively and after a few tries you will have developed not only a taste, but also a lifelong interest in clinical anatomy (AU)

En este artículo revisa la anatomía subyacente en el dedo en gatillo y el pulgar en gatillo (poleas digitales fibrosas, huesos sesamoideos), tenosinovitis flexora, síndrome de De Quervain, contractura de Dupuytren, algunas deformidades de la mano en la artritis reumatoide, el síndrome del túnel carpiano y la compresión del nervio cubital en el canal de Guyon. Debido a la naturaleza de estos seminarios, no se han incluido algunos síndromes importantes y estructuras. Más que ser exhaustivos, nuestro objetivo es crear un sistema en el que los casos clínicos se utilizan para resaltar la anatomía pertinente y, en la parte más importante del seminario, estos elementos se muestran a partir de una examen cruzado entre participantes y profesores. El autoaprendizaje es fundamental para generar interés y ampliar el conocimiento de la anatomía clínica. Basta con mirarse las propias manos en distintas posturas, moverlas, sentirlas; sientan también el antebrazo mientras mueven los dedos, háganlo varias veces, con espiritu de indagación, y tras unos pocos intentos no solo habrán adquirido un gusto, sino un interés por la anatomía clínica (AU)

Clinical Anatomy of the Pelvis and Hip / Anatomía clínica de la pelvis y la cadera

The contents of this review may appear odd. After a brief description of the coxofemoral joint, the entities discussed include ilioinguinal neuropathy within the context of the nerves that may be damaged during lower abdominal surgery, meralgia paresthetica, piriformis syndrome with the appropriate caveats, trochanteric syndrome, "ischial bursitis" and trochanteric syndrome caused by ischemia. These cases were chosen to stress our belief that rheumatologists are first and foremost internists. We further believe that being current in other pathologies such as peripheral neuropathies and certain vascular syndromes sooner or later benefits our patients (AU)

Este texto sobre pelvis y cadera pudiera causar sorpresa. Después de algunas consideraciones acerca de la articulación coxofemoral, se discuten, en sus aspectos anatómicos, la neuropatía ilioinguinal en el contexto de los nervios expuestos a daño iatrogénico, la meralgia parestésica, el síndrome del músculo piriforme con las reservas del caso, el síndrome trocantérico, la "bursitis isquiática", y un caso de pseudosíndrome trocantérico por oclusión arterial. Elegimos estos casos para enfatizar que antes de ser reumatólogos fuimos internistas y que no debemos perder una visión integral de nuestros pacientes. Estamos convencidos de que los reumatólogos, además de poseer conocimientos de medicina interna y del sistema musculoesquelético, deben estar informados acerca de otras patologías que entran en el diagnóstico diferencial del dolor regional (AU)

Clinical Anatomy of the Knee / Anatomía clínica de la rodilla

The clinical anatomy of several pain syndromes of the knee is herein discussed. These include the iliotibial tract syndrome, the anserine syndrome, bursitis of the medial collateral ligament, Baker's cyst, popliteus tendon tenosynovitis and bursitis of the deep infrapatellar bursa. These syndromes are reviewed in terms of the structures involved and their role in knee physiology. All of the discussed structures can be identified in their normal state and more so when they are affected by disease. The wealth of information gained by cross examination of the medial, lateral, posterior and anterior aspects of the knee brings to life knowledge acquired at the dissection table, from anatomical drawings and from virtual images (AU)

En este artículo se revisa la anatomía clínica de varios síndromes dolorosos de la rodilla. Estos incluyen el síndrome de la bandeleta iliotibial, el síndrome de la pata de ganso, la bursitis del ligamento colateral medial, el quiste de Baker, la tenosinovitis poplítea y la bursitis infrapatelar profunda. El análisis anatómico de estos síndromes revela una multiplicidad de estructuras identificables en su estado normal y más aún en las tendinosis o cuando hay un derrame sinovial. El examen cruzado de las estructuras mediales, laterales, posteriores y anteriores de la rodilla provee aspectos dinámicos que complementan su estudio por disección, láminas anatómicas e imágenes virtuales (AU)

La ecografía en las espondiloartropatías seronegativas: rol y avances / Ultrasound in seronegative spondyloarthropathies: role and perspectives

La ecografía del aparato locomotor tiene una posición cada vez más importante en la evaluación de pacientes con espondiloartropatías seronegativas (EASN), ayudando en la detección y cuantificación del compromiso inflamatorio a nivel articular y tendinoso y permitiendo una precisa valoración del compromiso inflamatorio de las entesis, como una de las características clínicas distintivas en las EASN. Como es bien sabido, la mayoría de las entesitis en pacientes con EASN pueden no ser fácilmente reconocidas clínicamente, siendo la ecografía una técnica de imagen de bajo costo, no invasiva y ampliamente disponible que permite la detección de entesitis subclínica. La dactilitis, otro rasgo característico en las EASN, puede ser valorada por ecografía, permitiendo delinear con precisión las estructuras anatómicas realmente afectadas porel compromiso inflamatorio. La ecografía, además, puede ayudar al reumatólogo para guiar el correcto posicionamiento de la aguja dentro de la estructura anatómica inflamada, como entesis, articulaciones y vaina tendinosa, con el objetivo de llevar a cabo una punción diagnóstica y/o terapéutica. La capacidad de detectar mínimos cambios, principalmente a nivel de la microvascularización mediante la técnica Doppler de poder, a nivel de las diferentes estructuras anatómicas involucradas, brinda la posibilidad de valorar el efecto de la terapia local y/o sistémica, ayudando al reumatólogo para el seguimiento y monitoreo terapéutico de pacientes con EASN. El principal objetivo de esta revisión es proporcionar una actualización de los datos disponibles acerca de la utilidad de la ecografía en la evaluación de pacientes con EASN.

Ultrasound (US) has a progressively more important position in the assessment of patients with spondyloarthritis (SpA), helping to detect synovial and tendon inflammatory involvement and permitting an accurate evaluation of enthesitis, the clinical distinctive feature of SpA. Certainly, the majority of enthesitis are subclinical in SpA being US a low cost, Available and non-invasive imaging technique with an adequate ability to detect them. Dactylitis, another characteristic feature of SpA, can precisely delineate by US showing the real anatomical structures affected by the inflammatory process. US allows rheumatologists to guide needle positioning within involved anatomical structures, as entheses, joints and tendon sheats, in order to perform a diagnostic and/or local therapeutic puncture. The ability to detect minimal inflammatory changes by US, mainly with the power Doppler assessment, permits to evaluate the effects of local or systemic therapies, helping the rheumatologists for the therapeutic monitoring in SpA. The main aim of the present review is to provide an update of the available data about the utilityof US in the evaluation of SpA patients.