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Journal of the American Veterinary... May 2024The data presented in this paper are derived from an in vivo study performed to characterize the nature of the synovial integration process of a 2.5% synthetic...
Histologic and cytologic changes in normal equine joints after injection with 2.5% injectable polyacrylamide hydrogel reveal low-level macrophage-driven foreign body response.
OBJECTIVE
The data presented in this paper are derived from an in vivo study performed to characterize the nature of the synovial integration process of a 2.5% synthetic cross-linked injectable polyacrylamide hydrogel (2.5 iPAAG) injected IA in horses.
ANIMALS
10 healthy horses not suffering from OA or signs of joint disease were administered 50 or 100 mg 2.5 iPAAG in a total of 13 metacarpophalangeal or middle carpal joints.
METHODS
Injected joints were examined at 0, 14, 42, and/or 90 days postinjection. Parameters investigated included clinical examination, synoviocentesis, gross pathology, histology, and scanning electron microscopy.
RESULTS
All horses remained clinically normal, with no adverse events recorded throughout the study period. Gross postmortem did not reveal any significant findings. Arthrocentesis cytology parameters remained within clinically normal levels throughout the study. Synovial histology demonstrated that cellular infiltration of macrophages, villus hyperplasia, and vascularization were significantly higher in 2.5 iPAAG-injected joints compared to controls. Scanning electron microscopy confirmed that the 2.5 iPAAG demonstrated an extensive tissue integration as a 3-D scaffolding structure with intact cross-linked strands.
CLINICAL RELEVANCE
Results confirm that an IA injection of 2.5 iPAAG induces a typical foreign body response that is predominately macrophage driven with no evidence of fibrosis or mineralization. Integration of the gel is evident by 14 days, with no free gel remaining in the joint cavity at this time.
PubMed: 38382205
DOI: 10.2460/javma.23.10.0553 -
Journal of Clinical Medicine Jan 2024Over recent years, temporomandibular joint (TMJ) minimally invasive procedures, such as arthrocentesis and arthroscopy, have been appointed as an initial TMJ...
Over recent years, temporomandibular joint (TMJ) minimally invasive procedures, such as arthrocentesis and arthroscopy, have been appointed as an initial TMJ intra-articular treatment. Both procedures present safe and effective clinical results in managing temporomandibular disorders (TMD) by reducing pain and improving mouth opening. The use of these techniques in adults is validated in the literature. However, data on the safety and effectiveness of minimally invasive TMJ interventions in pediatric patients are scarce. This study aims to investigate the effectiveness of TMJ arthrocentesis and arthroscopy in the pediatric population. A prospective study was conducted at Instituto Português da Face (IPF) in Lisbon, Portugal, including patients treated for TMD from 1 June 2019 to 30 June 2023. In the present study, 26 patients (17 female and 9 male) were included, representing a total of 48 joints operated. A statistically significant reduction was observed in the primary outcome, TMJ pain, from 3.93 ± 2.80 preoperatively (mean ± SD) to 0.50 ± 1.53 (mean ± SD) postoperatively ( < 0.05). An improvement in the secondary outcome, maximum mouth opening, from 36.92 ± 8.79 preoperatively to 42.96 ± 5.07 postoperatively, was observed ( < 0.05). The overall success rate was 84.62%. This prospective study showed that TMJ arthrocentesis and arthroscopy appear to benefit pediatric patients with TMD, significantly lowering pain and improving MMO without relevant postoperative complications.
PubMed: 38337365
DOI: 10.3390/jcm13030672 -
Journal of Maxillofacial and Oral... Feb 2024Internal derangement (ID) of temporomandibular joint (TMJ) is a common temporomandibular disorder (TMD) which causes hypomobility of the joint. Minimally invasive...
Use of Sodium Hyaluronate and Triamcinolone Acetonide Following Arthrocentesis in Treatment of Internal Derangement of Temporomandibular Joint: A Prospective Randomized Comparative Study.
BACKGROUND
Internal derangement (ID) of temporomandibular joint (TMJ) is a common temporomandibular disorder (TMD) which causes hypomobility of the joint. Minimally invasive treatment modality like arthrocentesis is used as first-line of management having low morbidity and high efficacy. This prospective randomized comparative study was carried to compare the efficacy of intra-articular injection with sodium hyaluronate (SH) and triamcinolone acetonide (TA) after arthrocentesis in ID of TMJ.
MATERIALS AND METHODS
A total 40 patients diagnosed with ID (stage 1-4) were included in the study and randomly divided in two groups. Twenty patients (group A) received intra-articular injection of SH while 20 patients (group B) received intra-articular injection of TA, after arthrocentesis. The clinical parameters of pain (VAS), Maximum mouth opening (MMO) (mm) and clicking sound (present/absent) were evaluated pre-operatively and at seventh day, 1 month and 3 months post-operatively.
RESULTS
There was statistically significant improvement in pain scores in both the groups at all time intervals with SH being superior ( value 0.0086). All the patients showed improved mouth opening at all time intervals, TA being superior but statistically insignificant ( value 0.59). There was reduction in the clicking sound in both the groups which was statistically insignificant at all time intervals.
CONCLUSIONS
Arthrocentesis followed by intra-articular injection with SH is superior to TA in terms of pain reduction, while TA showed superiority in terms of improved mouth opening.
PubMed: 38312952
DOI: 10.1007/s12663-022-01804-4 -
International Journal of Oral and... Jun 2024The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint... (Meta-Analysis)
Meta-Analysis Review
Arthroscopy versus arthrocentesis and versus conservative treatments for temporomandibular joint disorders: a systematic review with meta-analysis and trial sequential analysis.
The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint disorders. Thirteen controlled studies on various patient outcomes were included after a systematic search in seven electronic databases. Meta-analyses were conducted separately for arthroscopic surgery (AS) and arthroscopic lysis and lavage (ALL), and short-term (<6 months), intermediate-term (6 months to 5 years), and long-term (≥5 years) follow-up periods were considered. No significant differences in pain reduction and complication rates were found between AS or ALL and arthrocentesis. Regarding improvement in maximum mouth opening (MMO), both AS at intermediate-term and ALL at short-term follow-up were equally efficient when compared to arthrocentesis. However, at intermediate-term follow-up, ALL was superior to arthrocentesis for MMO improvement (mean difference 4.9 mm, 95% confidence interval 2.7-7.1 mm). Trial sequential analysis supported the conclusion of the meta-analysis for MMO improvement for ALL versus arthrocentesis studies at intermediate-term follow-up, but not for the other meta-analyses. Insufficient evidence exists to draw conclusions regarding other patient outcomes or about comparisons between arthroscopy and conservative treatments. Due to the low quality of the primary studies, further research is warranted before final conclusions can be drawn regarding the management of temporomandibular joint disorders.
Topics: Humans; Arthroscopy; Temporomandibular Joint Disorders; Arthrocentesis; Conservative Treatment
PubMed: 38286713
DOI: 10.1016/j.ijom.2024.01.006 -
Journal of Oral and Maxillofacial... Jun 2024The understanding of the causes of temporomandibular joint pain and dysfunction has evolved over 50 years. Historically, the term internal derangement has been used to... (Review)
Review
The understanding of the causes of temporomandibular joint pain and dysfunction has evolved over 50 years. Historically, the term internal derangement has been used to describe the abnormal relationship between the articular disc, condyle, and glenoid fossa, which was thought to correlate with patient symptoms. It is now known that the pathophysiology of intra-articular pain and dysfunction (IPD) involves synovitis, capsular impingement, symptomatic disc displacement, or a combination of these. Symptomatic disc displacement should only be considered to be a potential source of IPD after synovitis and capsular impingement have been treated. This philosophy provides the opportunity for most patients with IPD to be initially treated nonsurgically or with minimally invasive procedures such as arthrocentesis or arthroscopy.
Topics: Humans; Temporomandibular Joint Disorders; Arthroscopy; Facial Pain; Arthralgia; Arthrocentesis
PubMed: 38280727
DOI: 10.1016/j.joms.2024.01.003 -
Journal of the American Veterinary... Apr 2024Synovial extramedullary hematopoiesis is a rarely reported condition in humans and, to date, has never been reported in canines. This case report describes the clinical...
OBJECTIVE
Synovial extramedullary hematopoiesis is a rarely reported condition in humans and, to date, has never been reported in canines. This case report describes the clinical presentation, diagnostic work-up, treatment, and outcome of a canine case confirmed to have hematopoietic tissue within multiple joints.
ANIMAL
A client-owned canine.
CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES
The clinical presentation was most consistent with immune-mediated polyarthritis, and arthrocentesis was performed in multiple joints for cytological evaluation and culture. Cytology revealed evidence of extramedullary hematopoiesis, and shortly thereafter the dog was diagnosed with immune-mediated hemolytic anemia and thrombocytopenia.
TREATMENT AND OUTCOME
Pregabalin, prednisolone, clopidogrel, and cyclosporine were started, and after several recheck appointments and dose adjustments, the dog's clinical signs resolved for all conditions.
CLINICAL RELEVANCE
Unusual sites of extramedullary hematopoietic tissue may result in a clinical presentation for which more traditional etiologies and differentials are not applicable.
Topics: Humans; Dogs; Animals; Hematopoiesis, Extramedullary; Bone Marrow; Anemia; Dog Diseases
PubMed: 38266389
DOI: 10.2460/javma.23.11.0617 -
BMC Medical Education Jan 2024General pediatricians often initially address children's musculoskeletal (MSK) issues and play a crucial role in triaging and managing patients' rheumatologic...
BACKGROUND
General pediatricians often initially address children's musculoskeletal (MSK) issues and play a crucial role in triaging and managing patients' rheumatologic conditions. This study assessed the effectiveness of a structured curriculum in enhancing pediatric residents' knowledge, MSK examination skills, and confidence during a 4-week pediatric rheumatology rotation.
METHODS
Pediatric residents in their either second or third year who participated in the 4-week rheumatology rotation once across three academic years (July 2020-June 2023) were enrolled. Residents' knowledge, MSK examination skills, and confidence were assessed at pre- and post-rotation by using 25 multiple-choice questions, the Thai pediatric Gait Arms Legs Spine examination, and a questionnaire, respectively. The curriculum comprised instruction on MSK examinations, interactive lectures, case-based discussion, topic reviews, MSK radiology conference, clinical experience in rheumatology clinic and consultations, with self-guided learning with educational resources.
RESULTS
Fifty-eight pediatric residents (48 females, 10 males) with a mean age of 28.9 ± 0.8 years participated. Significant improvements were noted postrotation. Knowledge scores rose from 63.0 ± 12.2 to 79.7 ± 9.1 (mean difference 16.7 ± 10.3, p < 0.001). Similarly, MSK examination scores increased from 67.5 ± 14.4 to 93.6 ± 8.7 (mean difference 26.1 ± 14.6, p < 0.001). Residents also reported a marked increase in confidence across all evaluated areas, including history taking, MSK examination, arthrocentesis, and diagnosing and treating rheumatologic conditions (p < 0.001).
CONCLUSIONS
The 4-week structured curriculum in the pediatric rheumatology rotation significantly enhanced pediatric residents' knowledge, MSK examination skills, and confidence. These findings support the integration of pediatric rheumatology rotations into pediatric residency training programs.
Topics: Female; Male; Humans; Child; Adult; Rheumatology; Curriculum; Learning; Pediatricians; Arthritis, Rheumatoid
PubMed: 38263148
DOI: 10.1186/s12909-024-05043-8 -
Journal of Cranio-maxillo-facial... Mar 2024This study aims to compare the effectiveness of two different techniques of double puncture arthrocentesis with and without the addition of catheters and a vacuum pump... (Randomized Controlled Trial)
Randomized Controlled Trial
This study aims to compare the effectiveness of two different techniques of double puncture arthrocentesis with and without the addition of catheters and a vacuum pump for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR). A total of 48 patients with DDWOR were randomly and blindly allocated into two treatment groups (N = 24): Group 1, TMJ arthrocentesis with the addition of catheters and a vacuum pump to the second needle; Group 2, TMJ arthrocentesis without any addition device. The following variables were registered and compared between groups: patient's pain perception (visual analogue scale [VAS; 0-10]); maximal interincisal distance [MID; mm]; joint effusion (JE, presence or absence); facial edema (FE; presence or absence); and the operation duration (OP; minutes). Patients in Group 1 presented with significantly lower VAS scores (p < 0.001) and presence of FE (p = 0.03) in the post-operative period, also an increase in MID values (p = 0.026), and a reduction in JE (p = 0.022) after 3 months. Besides that, in this group, the procedure was performed significantly faster (p < 0.001). Performing arthrocentesis with the addition of a vacuum pump makes the procedure faster and yields better results in terms of pain, facial swelling, mouth opening and joint effusion.
Topics: Humans; Arthrocentesis; Vacuum; Treatment Outcome; Punctures; Temporomandibular Joint Disorders; Catheters; Range of Motion, Articular; Temporomandibular Joint
PubMed: 38253472
DOI: 10.1016/j.jcms.2024.01.020 -
Skeletal Radiology Jan 2024Evaluate the microbial yield and factors predicting culture positivity for image-guided arthrocentesis of suspected septic sternoclavicular (SC) arthritis.
OBJECTIVE
Evaluate the microbial yield and factors predicting culture positivity for image-guided arthrocentesis of suspected septic sternoclavicular (SC) arthritis.
MATERIALS AND METHODS
An electronic health record search identified image-guided SC joint aspirations for suspected septic arthritis. Data was extracted by retrospective chart review including patient demographics, procedure characteristics, pre-procedure lab testing, joint culture results, final SC joint diagnoses and any effect of positive synovial cultures on subsequent antibiotic therapy. Factors associated with positive joint fluid cultures were assessed using a Chi-squared test for categorical predictors and logistic regression for continuous predictors.
RESULTS
A total of 31 SC arthrocenteses met inclusion criteria with most (81%) performed using ultrasound guidance. Synovial fluid was successfully aspirated in 19/31 (61%) of cases, and in all other cases lavage fluid was successfully obtained. Synovial cultures were positive in 9/31 (29%) of cases. A final diagnosis of septic arthritis was assigned to 20/31 cases (65%) in which 9/20 (45%) had positive synovial cultures. There was no statistically significant association between synovial culture positivity and risk factors for septic arthritis, positive blood cultures, pre-aspiration antibiotics and whether synovial fluid or lavage fluid was cultured. Serum white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) demonstrated statistically significant positive correlation with positive synovial cultures.
CONCLUSION
Arthrocentesis is effective for microbial speciation in SC septic arthritis, and diagnostic yield may be increased with lavage when encountering a dry tap. Normal serum WBC and ESR values indicate an extremely low likelihood of positive synovial cultures.
PubMed: 38238456
DOI: 10.1007/s00256-024-04596-5 -
Pediatric Emergency Care Jan 2024Septic arthritis is one potential cause of pediatric joint effusion and pain that may lead to significant morbidity. We present a case where point-of-care ultrasound was... (Review)
Review
Septic arthritis is one potential cause of pediatric joint effusion and pain that may lead to significant morbidity. We present a case where point-of-care ultrasound was used to identify and aspirate a joint effusion in a pediatric patient with septic arthritis of the ankle, facilitating timely diagnosis and care. We review the technique for arthrocentesis of the ankle and literature on point-of-care ultrasound in the diagnosis of pediatric septic arthritis.
Topics: Humans; Child; Arthrocentesis; Ankle; Point-of-Care Systems; Arthritis, Infectious; Ultrasonography, Interventional
PubMed: 38157397
DOI: 10.1097/PEC.0000000000003105