Amyloidosis and silicone synovitis: updated classification, updated pathophysiology, and synovial articular abnormalities.

Amyloidosis is a heterogeneous group of disorders characterized by the extracellular deposition of protein fibrils in organs or tissues. Silicone synovitis, like amyloid arthropathy, is characterized radiographically by multiple subchondral cysts in the absence of cartilage space narrowing. This article examines and compares the classification, pathophysiology, and synovial articular abnormalities associated with amyloidosis and silicone synovitis.

Case report 774. Coincidental parosteal lipoma with osseous excresence and intramuscular lipoma.

The parosteal lipoma is a rare but recognizable lesion. The combination of (a) a well-defined, radiolucent, soft-tissue mass that on CT is confirmed to be entirely composed of homogenous mature adipose tissue and (b) an osseous excresence and/or saucerization at the attachment of the soft-tissue mass to the subjacent cortex should be diagnostic. We were unable to find any other case report of a parosteal lipoma coexisting with another lipoma in the same individual.

Soft tissue chondromas: diagnosis and differential diagnosis.

The authors evaluated three cases of soft tissue chondromas in patients aged 55, 57, and 78 years. Two of the lesions occurred in the foot and one in the hand. All three patients had long histories (over 1 year) of a palpable mass and all three had roentgenograms showing well-demarcated lobulated soft tissue lesions with both central and peripheral calcifications. Recognition of this rare benign chondroid lesion on imaging studies is significant since it may be misinterpreted as an aggressive lesion or a primary synovial abnormality.

Osteoid osteomas of the femoral neck: report of four cases evaluated with isotopic bone scanning, CT, and MR imaging.

Four patients, ranging in age from 6 to 32 years, with surgically proved parosteal lesions of the femoral neck are presented. In one case, magnetic resonance (MR) imaging was the initial study ordered prior to plain radiography, and in three cases MR imaging was performed after plain radiography. Findings in the MR images were abnormal in all four cases; however, the nidus was not identified prospectively. Incorrect diagnoses based on findings at MR imaging of secondary marrow edema and/or synovitis included Ewing tumor, osteonecrosis, stress fracture, Lyme arthritis, and juvenile inflammatory arthritis. In all four cases, the correct diagnosis of intracapsular osteoid osteoma was made following (a) review of plain radiographs leading to a high index of suspicion and (b) performance of thin-section computed tomographic (CT) studies (in one case a screening CT study with 1-cm-thick sections failed to depict the lesion). In three cases, isotopic bone scans provided useful guidance for planning the CT examination.

Case report 706: Silicone-induced reactive synovitis.

In a patient with a disrupted silicone prosthesis, the presence of a swollen articulation should suggest the presence of silicone-induced reactive synovitis. Diagnosis of the entity rests on the identification of particulate matter by polarized microscopy and/or scanning electron microscopy--studies that will not be performed routinely unless the diagnosis is suggested preoperatively. The case presented is that of a 68-year-old woman in whom a silicone elastomer trapeziometacarpal prosthesis had been implanted 5 years previously. Painful swelling had ensued, and biopsy confirmed the diagnosis.

Arthrography for rheumatic disease. When, why, and for whom.

The primary rheumatologic indication for an aspiration/arthrogram is the diagnosis of a septic joint. A second indication is the evaluation of a patient who has monoarticular complaints and normal plain radiographs. A third indication in patients who have known arthritis is that the contrast study can be used to evaluate the extent of cartilage destruction, identify complications that exacerbate pain, and determine if a soft tissue mass near the joint is related to the arthritis.

Posterior limbus vertebrae: a cause of radiating back pain in adolescents and young adults.

Four cases of posterior limbus vertebrae are presented, three in the lumbar spine and one in the lower thoracic spine. All four patients have myelographic documentation of herniated disc material affecting the spinal canal. One patient underwent an additional discogram that confirms the pathophysiology of the limbus vertebra by demonstrating that contrast material injected into the nucleus pulposus tracks between the body and the detached fragment.

Calcific tendinitis of the long head of the biceps brachii distal to the glenohumeral joint: plain film radiographic findings.

Calcific tendinitis is a painful condition related to deposition of hydroxyapatite crystals; it favors large joints. The shoulder, specifically the tendons of the rotator cuff and the insertion of the long head of the biceps on the superior glenoid rim, is a well-recognized location for this abnormality. The purpose of this article is to describe a second site of calcific tendinitis of the biceps, distal to the joint and corresponding to the junction of the tendon and muscle. Radiographs in 119 cases of calcific tendinitis of the shoulder, obtained between 1980 and 1988, were reviewed. Twenty had calcific tendinitis in the region of the tendon of the long head of the biceps (nine at the glenoid insertion and 11 adjacent to the humeral shaft). All 11 patients with calcific tendinitis at the more distal site had a small, homogeneous deposit adjacent to the proximal humeral shaft. The densities in these 11 cases followed the normal course of the tendon of the long head of the biceps and were therefore medial to the proximal humeral shaft on the internal rotation view, lateral to the proximal humeral shaft on the external rotation view, and anterior to the proximal humeral shaft on the axillary projection. The major differential diagnosis of calcific tendinitis of the tendon of the long head of the biceps is loose bodies trapped in the biceps tendon sheath. Although the position of the soft-tissue densities in these two entities is similar, loose bodies have an appearance of bone, and their source (degenerative arthritis or recurrent dislocations) is usually apparent. A site of calcific tendinitis distal to the glenohumeral joint that is detectable on plain films is reviewed. Accurate diagnosis depends on understanding the anatomy of the tendon of the long head of the biceps brachii. The clinical charts of the 11 patients also are summarized, with emphasis on the association between the roentgen finding and bicipital tendinitis and impingement syndrome.

The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage.

The Segond fracture is a small vertical avulsion injury of the lateral aspect of the proximal tibia just distal to the plateau. It results from excessive internal rotation and varus stress. The plain film and arthrographic findings were studied in nine patients with the fracture. Although previous publications have relied primarily on the anteroposterior projection for diagnosis, the injury was apparent only on the tunnel view in two of our cases. The arthrogram was particularly important in identifying abnormalities of the anterior cruciate ligament (nine of nine cases) and/or meniscal tears (six of nine cases). The arthrographic findings related to the lateral ligamentous damage depended on the severity of the injury and on the interval between the injury and the arthrogram. In our series, the Segond fracture was uniformly associated with detachment of the capsular portion of the lateral collateral ligament and tears of the anterior cruciate ligament. In the majority of cases, there were associated injuries of the menisci and other supporting ligaments.

[Orthopedic problems in children caused by neuromuscular diseases]. / Problèmes orthopédiques posés chez l'enfant par les maladies neuromusculaires.

In the child, neuromuscular diseases have an affect not only on the soft tissues but also on the skeleton, with consequences regarding statics and locomotion. Problems essentially involve the joints of the lower limb. Certain are due to muscular imbalance, eg. an unstable hip, coxa valga, hyperanteversion or miscellaneous abnormalities of the knee. Others are due to sensory denervation, resulting in "neurological joints". Vertebro-pelvic abnormalities also occur with manifestations, according to the individual case, including tilting of the pelvis, paralytic scoliosis or vertebral dysmorphism. It is easy to understand the importance of awareness of such abnormalities, which can be detected early radiologically, and then subjected to expert evaluation in order to be able to select in good time the most appropriate orthopedic management.

Pigmented villonodular synovitis. Diagnosis and differential diagnosis.

PVNS is a proliferative disorder that can affect joints, tendons and bursae. Its etiology is unknown. The most widely accepted theories attribute this disorder to a chronic inflammatory response or a benign neoplasm of fibrohistiocytic origin. On gross specimens, the synovial changes are characterized by villous and/or nodular hyperplasia. This disorder occurs most frequently in the third or fourth decades of life and has no sex predilection. As a joint problem, it favors the knee and hip. As a tendon abnormality, it favors the digits. Plain film findings include 1) soft tissue swelling, 2) increased density of the synovium secondary to hemosiderin deposition, 3) multiple subchondral cysts, and 4) extrinsic cortical pressure erosions. Cartilage space narrowing, if present, is gradual and occurs later than the other plain film findings. Arthrography can demonstrate the nodular synovial changes and determine if the process is diffuse or focal. MRI can, in some cases, reveal areas of decreased signal within the hyperplastic synovium reflecting the deposition of hemosiderin. The major roentgen differential diagnoses of articular PVNS include uncalcified synovial chondromatosis, tuberculous arthritis, and hemophilic arthropathy.

Bursae and abscess cavities communicating with the hip. Diagnosis using arthrography and CT.

Bursae or abscess cavities communicating with the hip joint were demonstrated by hip arthrography or by computed tomography (CT) in 40 cases. The bursae or abscess cavities were associated with underlying abnormalities in the hip, including painful hip prostheses, infection, and inflammatory or degenerative arthritis. Structures communicating with the joint capsule included iliopsoas bursae (13 cases), bursae associated with the greater trochanter (21 cases), ischiotrochanteric bursae created by abnormal articulation between the ischium and lesser trochanter (two cases), and abscess cavities not associated with a bursa (four cases). Symptoms may be produced directly as a result of infection or indirectly as a result of inflammation or pressure on adjacent structures. In cases of suspected infection, direct puncture and aspiration of the bursa or abscess cavity, in addition to joint aspiration, may be necessary to obtain organisms for culture as joint aspiration may not yield fluid. Hip arthrography can confirm a diagnosis of bursae and abscess cavities communicating with the hip joint in patients with hip pain or soft-tissue masses around the groin. Differentiation of enlarged bursae from other abnormalities is important to avoid unnecessary or incorrect surgery.

Femoral neck fractures complicating Gaucher disease in children.

In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton [16, 17]. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceded by multiple bone "crises" localized to the proximal femora.

The bicipital groove: radiographic, anatomic, and pathologic study.

By using patient radiographs and pathologic specimens, the bicipital groove of the humerus was studied to determine the normal configuration and common abnormalities of this region. Factors analyzed in evaluating the bicipital groove included the medial wall angle, depth and width of the intertubercular sulcus, and presence or absence of bony spurs arising from the floor or medial wall of the groove. The supratubercular ridge was observed as an osseous protuberance in about one-half of the population; it does not seem to be of pathologic significance. A specific radiographic projection is described, which allows evaluation of the bicipital groove.