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Infectious Disease Clinics of North... Jun 2017Septic arthritis is a rheumatologic emergency that may lead to disability or death. Prompt evacuation of the joint, either by arthrocentesis at the bedside, open or... (Review)
Review
Septic arthritis is a rheumatologic emergency that may lead to disability or death. Prompt evacuation of the joint, either by arthrocentesis at the bedside, open or arthroscopic drainage in the operating room, or imaging-guided drainage in the radiology suite, is mandatory. Methicillin-resistant Staphylococcus aureus (MRSA) has become a major cause of septic arthritis in the United States. MRSA joint infection seems to be associated with worse outcomes. Antibiotic courses of 3 to 4 weeks in duration are usually adequate for uncomplicated bacterial arthritis. Treatment duration should be extended to 6 weeks if there is imaging evidence of accompanying osteomyelitis.
Topics: Age Factors; Anti-Bacterial Agents; Arthritis, Infectious; Drainage; Female; Humans; Immunocompromised Host; Joints; Male; Methicillin-Resistant Staphylococcus aureus; Osteomyelitis; Staphylococcal Infections; Synovial Fluid; United States
PubMed: 28366221
DOI: 10.1016/j.idc.2017.01.001 -
International Journal of Oral and... Sep 2022Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be... (Review)
Review
Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be evidence-informed for different TMD types. A knowledge-to-action rapid review of systematic reviews published in the past 5 years and guidelines published in the past 10 years concerning the management of TMD was conducted. The Cochrane, Embase, MEDLINE, PEDro, and PubMed databases were searched. A qualitative data analysis was undertaken, with quality assessment completed using the AMSTAR 2 checklist. In total, 62 systematic reviews and nine guidelines considering a range of treatment modalities were included. In concordance with current guidelines, moderate evidence supports a multi-modal conservative approach towards initial management. Contrary to existing guidelines, occlusal splint therapy is not recommended due to a lack of supporting evidence. The evidence surrounding oral and topical pharmacotherapeutics for chronic TMD is low, whilst the evidence supporting injected pharmacotherapeutics is low to moderate. In concordance with current guidelines, moderate quality evidence supports the use of arthrocentesis or arthroscopy for arthrogenous TMD insufficiently managed by conservative measures, and open joint surgery for severe arthrogenous disease. Based on this, a management pathway showing escalation of treatment from conservative to invasive is proposed.
Topics: Arthrocentesis; Humans; Occlusal Splints; Systematic Reviews as Topic; Temporomandibular Joint Disorders
PubMed: 35339331
DOI: 10.1016/j.ijom.2021.11.009 -
Dental and Medical Problems 2022Ultrasound (US) is a widely available, low-cost, non-invasive, and safe medical imaging method that enables real-time observation. Ultrasound offers several advantages... (Review)
Review
Ultrasound (US) is a widely available, low-cost, non-invasive, and safe medical imaging method that enables real-time observation. Ultrasound offers several advantages for dentomaxillofacial images, such as portability, the possibility of dynamic and repeated examinations, patient comfort, and availability. It is a useful tool for recognizing the temporomandibular joint (TMJ) structures and their involvement during the course of different pathological processes, such as articular disk displacement, joint effusion and cortical erosion. In addition to its diagnostic use, US has been proposed as an auxiliary tool in minimally invasive procedures for arthrogenic temporomandibular disorders (TMD) to achieve an accurate puncture, recognize joint spaces and reduce surgical trauma. While US is widely used for large joints to visualize internal structures and guide the injection, this technique has only recently gained popularity for the TMJ procedures. Hence, the literature on this topic is scarce. The present review describes the potential advantages and the clinical technique of US guidance for TMJ arthrocentesis and intra-articular injection (IAI).
Topics: Humans; Arthrocentesis; Temporomandibular Joint; Temporomandibular Joint Disorders; Ultrasonography; Injections, Intra-Articular
PubMed: 36583838
DOI: 10.17219/dmp/146820 -
International Journal of Molecular... Jul 2021Temporomandibular joint osteoarthritis (TMJ OA) is a low-inflammatory disorder with multifactorial etiology. The aim of this review was to present the current state of...
Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis-A Systematic Review.
Temporomandibular joint osteoarthritis (TMJ OA) is a low-inflammatory disorder with multifactorial etiology. The aim of this review was to present the current state of knowledge regarding the mechanisms of action and the efficacy of hyaluronic acid (HA), corticosteroids (CS) and platelet-rich plasma (PRP) in the treatment of TMJ OA.: The PubMed database was analyzed with the keywords: "(temporomandibular joint) AND ((osteoarthritis) OR (dysfunction) OR (disorders) OR (pain)) AND ((treatment) OR (arthrocentesis) OR (arthroscopy) OR (injection)) AND ((hyaluronic acid) OR (corticosteroid) OR (platelet rich plasma))". After screening of 363 results, 16 studies were included in this review. Arthrocentesis alone effectively reduces pain and improves jaw function in patients diagnosed with TMJ OA. Additional injections of HA, either low-molecular-weight (LMW) HA or high-molecular-weight (HMW) HA, or CS at the end of the arthrocentesis do not improve the final clinical outcomes. CS present several negative effects on the articular cartilage. Results related to additional PRP injections are not consistent and are rather questionable. Further studies should be multicenter, based on a larger group of patients and should answer the question of whether other methods of TMJ OA treatment are more beneficial for the patients than simple arthrocentesis.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Humans; Hyaluronic Acid; Injections, Intra-Articular; Osteoarthritis; Platelet-Rich Plasma; Signal Transduction; Temporomandibular Joint Disorders
PubMed: 34299024
DOI: 10.3390/ijms22147405 -
Journal of Cranio-maxillo-facial... Jan 2020Different treatment options for patients with arthrogenous Temporomandibular Disorders (TMDs) have been reported. However, evidence regarding the most effective... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Different treatment options for patients with arthrogenous Temporomandibular Disorders (TMDs) have been reported. However, evidence regarding the most effective intervention using network meta-analysis (NMA) has not been performed. Thus, we conducted a NMA of randomized clinical trials (RCTs) to identify the most effective treatment of arthrogenous TMDs with respect to pain reduction and improved mouth opening, and to generate a ranking according to their effectiveness.
MATERIAL AND METHODS
An electronic search on three major databases was undertaken to identify RCTs published before August 2019, comparing up to fourteen different treatments against control/placebo patients for arthrogenous TMDs with respect to pain reduction and improved mouth opening. The treatment variables were controls/placebo, conservative treatment (muscle exercises and occlusal splint therapy), occlusal splint therapy alone, intraarticular injection (IAI) of hyaluronic acid (HA) or corticosteroid (CS), arthrocentesis with or without HA, CS and platelet-rich plasma (PRP), arthroscopy with or without HA and PRP, open joint surgery, and physiotherapy. Frequentist NMA was performed using STATA software. Studies meeting the inclusion criteria were divided according to the length of follow-up (short-term (≤5 months) and intermediate-term (≥6 months to 4 years) and type of TMJ arthrogenous disorders; internal derangement (ID) and TMJ osteoarthritis (OA). The standardized mean differences (SMD) in post-treatment pain reduction and maximum mouth opening (MMO) were analysed.
RESULTS
Thirty-six RCTs were identified that performed comparative outcome assessments for pain and 33 RCTs for MMO. At the short term (≤5 months), IAI-HA (SMD = -2.8, CI: -3.7 to -1.8) and IAI-CS (SMD = -2.11, CI: -2.9 to -1.2) (all very low quality evidence) achieved a substantially greater pain reduction than control/placebo. At intermediate term (≥6 months), a statistically significant decrease in posttreatment pain intensity was observed following Arthroscopy-PRP (SMD = -3.5, CI: -6.2 to -0.82), Arthrocentesis-PRP (SMD = -3.08, CI: -5.44 to -0.71), Arthroscopy-HA (SMD = -3.01, CI: -5.8 to -0.12), TMJ surgery (SMD = -3, CI: -5.7 to -0.28), IAI-HA (SMD = -2.9, CI: -4.9 to -1.09) (all very low quality evidence), Arthroscopy-alone (SMD = -2.6, CI: -5.1 to -0.07, low quality evidence) and Arthrocentesis-HA (SMD = -2.3, CI: -4.5 to -018, moderate-quality evidence) when compared to the control/placebo groups. Relative to MMO, the most effective treatments for short- and intermediate-term improvement were the arthroscopy procedures (PRP > HA > alone, all very low-quality evidence) followed by Arthrocentesis-PRP (very low-quality evidence) and Arthrocentesis-HA (moderate-quality evidence). The non-invasive procedures of occlusal splint therapy, physical therapy, conservative therapy, placebo/control provided significantly lower quality outcomes relative to pain and MMO.
CONCLUSION
The results of the present meta-analysis support a paradigm shift in arthrogenous TMJ disorder treatment. There is a new evidence (though on a very low to moderate quality level) that minimally invasive procedures, particularly in combination with IAI of adjuvant pharmacological agents (PRP, HA or CS), are significantly more effective than conservative treatments for both pain reduction and improvement of MMO in both short (≤5 months) and intermediate term (6 months-4 years) periods. In contrast to traditional concepts mandating exhaustion of conservative treatment options, minimally invasive procedures, therefore, deserve to be implemented as efficient first-line treatments (e.g. IAIs and/or arthrocentesis) or should be considered rather early, i.e. as soon as patients do not show a clear benefit from an initial conservative treatment.
Topics: Arthrocentesis; Humans; Injections, Intra-Articular; Network Meta-Analysis; Randomized Controlled Trials as Topic; Temporomandibular Joint Disorders
PubMed: 31870713
DOI: 10.1016/j.jcms.2019.10.004 -
The Journal of Emergency Medicine May 2021Joint arthrocentesis is a commonly performed procedure by the emergency physician (EP). Point of care ultrasound (POCUS) has demonstrated promise in identifying joint...
BACKGROUND
Joint arthrocentesis is a commonly performed procedure by the emergency physician (EP). Point of care ultrasound (POCUS) has demonstrated promise in identifying joint effusions and guiding arthrocentesis procedures. EP-performed talonavicular joint arthrocentesis has not been previously described in the literature. We present a case in which an isolated talonavicular joint effusion was identified and then subsequently aspirated using POCUS.
CASE REPORT
A 65-year-old man presented with atraumatic right ankle pain. On arrival, he was noted to have diffuse warmth and edema around the ankle and midfoot. POCUS was performed to evaluate for an ankle joint effusion, which was not present. The ultrasound was then moved distally, where a talonavicular joint effusion was noted. Inflammatory markers were found to be elevated. A magnetic resonance imaging scan revealed an isolated talonavicular joint effusion without additional acute findings. POCUS was then used to perform an arthrocentesis, which revealed monosodium urate crystals consistent with an initial episode of gouty arthritis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS provides the EP with an efficient tool to diagnose joint effusions and guide arthrocentesis procedures. The foot is composed of several small joints where ultrasound can be particularly helpful. Similar to the ankle joint, these joints can be afflicted with pyogenic infections and crystalline arthropathies. To our knowledge, we present the first report of EP-performed talonavicular arthrocentesis guided by POCUS. The approach to this joint and technique for arthrocentesis are presented.
Topics: Aged; Ankle Joint; Arthrocentesis; Humans; Male; Point-of-Care Testing; Ultrasonography; Ultrasonography, Interventional
PubMed: 33516576
DOI: 10.1016/j.jemermed.2020.12.019