Stop Searching under the Streetlight! A Primer and Practical Guide to the Diagnosis of Joint Pain and Inflammation.

It is impossible to achieve a diagnosis without a comprehensive list of possible diagnostic explanations for a certain symptom or syndrome. Joint complaints are very frequent in general practice, paediatrics, emergency medicine and naturally rheumatology and orthopaedics. The differential diagnosis of joint and surrounding tissue pain and inflammation is impressively challenging. Orthopaedic surgeons and rheumatologists deal with different aspects of this subject, while primary care physicians need to have a wider perspective that includes both orthopaedic and rheumatic disorders. The purpose of this paper is to provide a unified, comprehensive, clear and concise guide to this subject that will include both orthopaedic and rheumatic disorders and may serve the practitioner as basic reference for differential diagnosis. Short dictionary-style definitions would be given for each disorder in order to provide a 'bird's-eye view', rather than an in-depth description of many diseases. Medical students, residents and primary care physicians are the primary target audience, but we believe that even the experienced orthopaedic surgeon or rheumatologist may benefit from a systematic and well-organised method.

Hip Arthroscopy for Synovial Chondromatosis: Tips and Tricks.

Hip arthroscopy is an important diagnostic and therapeutic tool in the management of synovial chondromatosis. Removal of osteochondral fragments (OCFs) from the central and peripheral compartments is crucial for the relief of mechanical symptoms and subsequent joint destruction. Direct access to the central compartment is often limited because of the ball-and-socket morphology and limitation of traction. We present our surgical technique for removing OCFs and a new method for the removal of a large loose body using a nitinol stone retrieval basket. The technique facilitates removal of difficult-to-access fragments from the central compartment. Moreover, this technique allows removal of far-medial OCFs from the peripheral compartment.

Arthroscopy of the nondistractable hip: a novel extracapsular approach.

Adequate traction to achieve hip joint distraction is essential for avoiding iatrogenic injury to the joint during hip arthroscopy. An inability to distract the joint is a relative contraindication for hip arthroscopy. This report describes a novel technique involving an extracapsular approach to gain safe access to a hip joint that fails a trial of traction during positioning for hip arthroscopy. The anterolateral portal is established under fluoroscopic guidance. The arthroscope is positioned on the lateral rim of the acetabulum. A shaver, introduced through a modified anterior portal, is used to facilitate capsular exposure. An arthroscopic capsular incision is made proximal to the lateral acetabular rim and extended anteriorly with a radiofrequency probe. Osteoplasty of the anterolateral acetabular rim is carried out with a burr while protecting the labrum. Distraction of the hip is then possible, allowing safe central-compartment access and subsequent chondrolabral procedures.