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BMJ Case Reports Mar 2022A male in his 60s with a history of previously treated locally advanced head and neck cancer presented to the emergency department with atraumatic left knee pain and...
A male in his 60s with a history of previously treated locally advanced head and neck cancer presented to the emergency department with atraumatic left knee pain and upper and lower extremity ecchymoses that had been present for 3 weeks. His initial laboratory results showed a normocytic anaemia, normal platelet count, slightly abnormal coagulation studies and normal inflammatory markers. Arthrocentesis of the left knee revealed haemarthrosis, and additional laboratory workup found an undetectable serum vitamin C (ascorbic acid) level consistent with scurvy. It was determined that scurvy had predisposed the patient to injury, leading to haemarthrosis. Following vitamin C supplementation, dietary and activity modifications, and acetaminophen as needed, the patient's serum vitamin C level normalised and his left knee pain and swelling improved. Scurvy is a rare cause of haemarthrosis, but it should be recognised in at-risk patients since treatment is effective.
Topics: Ascorbic Acid; Diet; Hemarthrosis; Humans; Lower Extremity; Male; Scurvy
PubMed: 35256359
DOI: 10.1136/bcr-2021-244594 -
Journal of Clinical Medicine Jun 2023Temporomandibular joint disorders are a heterogenic group of clinical conditions, which impair physiological functioning of the masticatory system. Arthrocentesis of the... (Review)
Review
Temporomandibular joint disorders are a heterogenic group of clinical conditions, which impair physiological functioning of the masticatory system. Arthrocentesis of the temporomandibular joint has become a widely approved method for non-invasive treatment, bridging the gap between conservative and surgical approaches. Regardless of technique, treatment is based upon joint lavage and lysis of the inflammatory fibrous tissue adhesions, which, in turn, improves joint mobility and reduces pain and closed lock. Recently, approaches for intra-articular injections have been proposed as adjuvant or replacement therapy. The aim of this study was to assess the most efficient technique of arthrocentesis. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, a reference list search and a manual search, was performed. Relevant articles were selected after three search rounds for final review. The studies pulled for the analysis presented information about the relevant predictors, including the technique of arthrocentesis (single- or two-needle method), fluid used for lavage (Ringer lactate or saline), volume of the fluid, application of the injectable, number of interventions, pain (VAS) and mouth opening scores (MMO) and follow-up. All cohorts showed improvement in mouth opening, but significant pain reduction was observed only in cohorts treated either by arthrocentesis alone or arthrocentesis followed by intra-articular injectables. Intra-articular injectables used alone failed to reduce pain post-operatively when compared to other cohorts. We concluded that both double-needle and single-puncture arthrocentesis techniques are equally efficient. Application of the adjuvant injectable did not improve the outcomes of arthrocentesis performed alone. The volume of the fluid used for joint lavage and its chemical composition were not significant in clinical outcomes. However, due to the lack of homogeneity in the study settings, a meta-analysis could not be applied and a systematic review was conducted. We still, however, state that there is a knowledge gap in the current literature regarding the use of injectables alone, as well as a longitudinal follow-up, which provides information about treatment efficiency. More high-quality and randomized controlled trials are required to shed light on this subject.
PubMed: 37445474
DOI: 10.3390/jcm12134439 -
European Journal of Rheumatology Jun 2017Many conditions may affect the temporomandibular joint (TMJ), but its incidence in individual joint diseases is low. However, inflammatory arthropathies, particularly... (Review)
Review
Many conditions may affect the temporomandibular joint (TMJ), but its incidence in individual joint diseases is low. However, inflammatory arthropathies, particularly rheumatoid and psoriatic arthritis and ankylosing spondylitis, appear to have a propensity for affecting the joint. Symptoms include pain, restriction in mouth opening, locking, and noises, which together can lead to significant impairment. Jaw rest, a soft diet, a bite splint, and medical therapy, including disease-modifying antirheumatic drugs (DMARDs) and simple analgesia, are the bedrock of initial treatment and will improve most symptoms in most patients. Symptom deterioration does not necessarily follow disease progression, but when it does, TMJ arthroscopy and arthrocentesis can help modulate pain, increase mouth opening, and relieve locking. These minimally invasive procedures have few complications and can be repeated. Operations to repair or remove a damaged intra-articular disc or to refine joint anatomy are used in select cases. Total TMJ replacement is reserved for patients where joint collapse or fusion has occurred or in whom other treatments have failed to provide adequate symptomatic control. It yields excellent outcomes and is approved by the National Institute of Health and Care Excellence (NICE), UK. Knowledge of the assessment and treatment of the TMJ, which differs from other joints affected by inflammatory arthritis due to its unique anatomy and function, is not widespread outside of the field of oral and maxillofacial surgery. The aim of this article is to highlight the peculiarities of TMJ disease secondary to rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis and how to best manage these ailments, which should help guide when referral to a specialist TMJ surgeon is appropriate.
PubMed: 28638693
DOI: 10.5152/eurjrheum.2016.035 -
Journal of Functional Morphology and... Mar 2020Arthrocentesis in temporomandibular joint disorders can be associated with the intra-articular infiltration of various drugs with the objective of increase treatment...
Arthrocentesis in temporomandibular joint disorders can be associated with the intra-articular infiltration of various drugs with the objective of increase treatment efficacy. The aim of this study was to evaluate the clinical indexes variation in patients affected by temporomandibular joint disorders treated with arthrocentesis and sodium hyaluronate (SH) injections. A total of 28 patients suffering from temporomandibular joint disorders underwent one cycle of five arthrocentesis and infiltrations of sodium hyaluronate. Spontaneous mouth opening improved from 36.3 ± 7.5 mm to 45.1 ± 1.9 mm at six months follow-up. A significant reduction in the pain at rest and during mastication mean values emerged at follow-up ( < 0.0001). The mean masticatory efficiency, evaluated through a visual analogic scale, showed improvement at the follow-up period, highlighted by the increase of mean value from a baseline of 3.1 ± 1.2 to a mean value of 8.5 ± 1.2 ( < 0.0001). The mean severity of the joint damage at baseline time was 2.4 ± 0.9 and decreased to 0.4 ± 0.3 at the end of the follow-up period. The decrease in values is confirmed by statistical test ( < 0.05). Our data show how arthrocentesis integrated with sodium hyaluronate infiltrations performed under local anesthesia is a valid method of treating temporomandibular joint disorders.
PubMed: 33467234
DOI: 10.3390/jfmk5010018 -
Journal of the Korean Association of... Jun 2020Joint injuries frequently lead to progressive joint degeneration that causes articular disc derangement, joint inflammation, and osteoarthritis. Such arthropathies that...
OBJECTIVES
Joint injuries frequently lead to progressive joint degeneration that causes articular disc derangement, joint inflammation, and osteoarthritis. Such arthropathies that arise after trauma are defined as post-traumatic arthritis (PTA). Although PTA is well recognized in knee and elbow joints, PTA in the temporomandibular joint (TMJ) has not been clearly defined. Interestingly, patients experiencing head and neck trauma without direct jaw fracture have displayed TMJ disease symptoms; however, definitive diagnosis and treatment options are not available. This study will analyze clinical aspects of PTA in TMJ and their treatment outcomes after joint arthrocentesis and lavage.
MATERIALS AND METHODS
Twenty patients with history of trauma to the head and neck especially without jaw fracture were retrospectively studied. Those patients developed TMJ disease symptoms and were diagnosed by computed tomography or magnetic resonance imaging. To decrease TMJ discomfort, arthrocentesis and lavage with or without conservative therapy were applied, and efficacy was evaluated by amount of mouth opening and pain scale. Statistical differences between pre- and post-treatment values were evaluated by Wilcoxon signed-rank test.
RESULTS
Patient age varied widely between 20 and 80 years, and causes of trauma were diverse. Duration of disease onset was measured as 508 posttrauma days, and 85% of the patients sought clinic visit within 2 years after trauma. In addition, 85% of the patients showed TMJ disc derangement without reduction, and osteoarthritis was accompanied at the traumatized side or at both sides in 40% of the patients. After arthrocentesis or lavage, maximal mouth opening was significantly increased (28-44 mm on average, <0.001) and pain scale was dramatically decreased (7.8-3.5 of 10, <0.001); however, concomitant conservative therapy showed no difference in treatment outcome.
CONCLUSION
The results of this study clarify the disease identity of PTA in TMJ and suggest early diagnosis and treatment options to manage PTA in TMJ.
PubMed: 32606278
DOI: 10.5125/jkaoms.2020.46.3.174 -
Cureus Sep 2021Novel oral anticoagulants (NOACs) are increasingly prescribed blood-thinning medication. Surpassing Warfarin, NOACs are more favored and extensively used in paroxysmal... (Review)
Review
Novel oral anticoagulants (NOACs) are increasingly prescribed blood-thinning medication. Surpassing Warfarin, NOACs are more favored and extensively used in paroxysmal atrial fibrillation, acute coronary syndrome, and in elderly patients. Well-known benefits of novel oral anticoagulants include predictable pharmacokinetics, pharmacodynamics, and shorter half-life. However, as with any anticoagulant, there are bleeding risks with NOACs. There is a lack of evidence and consensus on the management of novel anticoagulants for intraarticular injections and arthrocentesis. This systematic review aims to analyze the risk of bleeding complications in patients on novel oral anticoagulants who underwent joint injections and arthrocentesis to help physicians in the decision-making and consenting process. A literature search of three online databases was completed using the Cochrane methodology for systematic reviews. Eligibility criteria included any study that reported bleeding complication rates in adult patients on novel oral anticoagulants that had a joint injection or aspiration whilst continuing their regular oral anticoagulation. All studies with any number of patients and published in any language were included. Review articles and systematic reviews were excluded. The search of databases resulted in a total of 310 articles. After screening, a total of four articles were deemed suitable to be included in the analysis. These described a total of 668 patients undergoing injections/aspiration procedures with patients on three different novel oral anticoagulants namely Rivaroxaban, Apixaban, and Dabigatran. Only one patient joint had a bleeding complication and the patient was on Dabigatran. The results of this systematic review show that it is relatively safe to perform joint injections and arthrocentesis whilst continuing on Novel oral anticoagulation.
PubMed: 34659968
DOI: 10.7759/cureus.17755 -
Medicina (Kaunas, Lithuania) Oct 2023: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular diseases involving the temporomandibular joint complex and the...
The Effect of Arthrocentesis Treatment for Maximum Mouth Opening and Pain in Temporomandibular Joint Diseases and the Effect of Splint, Drug, and Physical Therapy on This Treatment.
: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular diseases involving the temporomandibular joint complex and the surrounding muscle and osseous structure. TMD can be classified as intra-articular or extra-articular. The aim of this study was to evaluate the effect of arthrocentesis in terms of maximum mouth opening (MMO) and pain in patients with TMD of intra-articular origin. In addition to this treatment, the effects of factors such as splints, medication, and physical therapy on arthrocentesis were examined. : This retrospectively designed study was conducted with 79 patients who had previously undergone arthrocentesis. These patients were divided into three groups according to the Research Diagnostic Criteria for temporomandibular disorder: disc displacement (DD) with locking (Group 1), DD without locking (Group 2), and degenerative joint diseases (Group 3) groups. The maximum mouth opening (MMO) and visual analog score (VAS) values of the groups were recorded before arthrocentesis (Baseline: T0), on the third day after arthrocentesis (T1), and at the sixth month (T2) after arthrocentesis. Information about whether the patients received concurrent medical treatment, splint treatment, and physical therapy was also recorded. These data were compared between groups. : It was observed that the VAS scores in all three groups decreased from T1 compared to T0 ( < 0.05). Likewise, the MMO value increased in all groups at T1 compared to T0. ( < 0.05). It was observed that splint treatment, pain killer and muscle relaxant treatment, and physical therapy made no additional contribution to arthrocentesis in terms of reducing pain or increasing MMO value ( > 0.05). : Arthrocentesis was observed to be effective in terms of pain and function in TMJ patients in this study. It was observed that splint therapy, physical therapy, and medical therapy made no additional contribution to arthrocentesis in terms of MMO or pain.
Topics: Humans; Arthrocentesis; Splints; Retrospective Studies; Treatment Outcome; Range of Motion, Articular; Temporomandibular Joint Disorders; Pain; Physical Therapy Modalities; Mouth
PubMed: 37893485
DOI: 10.3390/medicina59101767 -
National Journal of Maxillofacial... 2022The aim of the study is to compare the efficacy of platelet-rich plasma (PRP) for the management of internal derangement of temporomandibular joint (TMJ).
Comparison of intraarticular injection of platelet-rich plasma following arthrocentesis, with sodium hyaluronate and conventional arthrocentesis for management of internal derangement of temporomandibular joint.
AIM
The aim of the study is to compare the efficacy of platelet-rich plasma (PRP) for the management of internal derangement of temporomandibular joint (TMJ).
SETTINGS AND DESIGN
Thirty-three patients were selected from the pool of patients visiting the department of oral and maxillofacial surgery. Simple randomization was done.
SUBJECTS AND METHODS
Patients with anterior disc displacement without reduction (DDWOR) were indicated for arthrocentesis. Group A patients are treated with PRP, Group B patients with sodium hyaluronate following arthrocentesis, and Group C patients were treated with arthrocentesis alone. Postoperative pain and maximal incisal opening are the primary outcomes evaluated.
STATISTICAL ANALYSIS USED
The collected data were analyzed with IBM. SPSS statistics software 23.0 version and the one-way ANOVA with Tukey's test were used.
RESULTS
The mean age is 33 years, with female predominance. The statistical significant differences ( < 0.05) in pain and MIO between the 3 groups at the end of 3week, 4week, and 3 month postoperatively are seen in PRP group comparative to other groups.
CONCLUSIONS
Our study has concluded that the intraarticular injection of PRP is an effective management for anterior DDWOR of TMJ than intraarticular injection of sodium hyaluronate and arthrocentesis in, reducing the pain and improving the interincisal distance in patients with DDWOR, thus providing a rapid recovery and improved quality of life.
PubMed: 36051804
DOI: 10.4103/njms.NJMS_94_20 -
JB & JS Open Access 2021The use of ultrasound guidance during knee arthrocentesis has proven to increase operator confidence and accuracy, particularly in novice healthcare providers. Realistic... (Review)
Review
BACKGROUND
The use of ultrasound guidance during knee arthrocentesis has proven to increase operator confidence and accuracy, particularly in novice healthcare providers. Realistic and practical means of teaching this procedure to medical trainees are needed. This study is intended to assess the feasibility and efficacy of using formalin-embalmed human cadavers in the instruction of ultrasound-guided knee arthrocentesis to medical trainees.
METHODS
Twenty participants received a 30-minute didactic orientation detailing the principles of ultrasound-guided knee arthrocentesis, followed by a training practicum performed on human cadavers. The practicum included a 25-minute training period, followed by a 15-minute assessment period. Participants were objectively assessed on their ability to independently aspirate synovial fluid from the suprapatellar bursa using ultrasound guidance. Digital pretraining and posttraining questionnaires were administered to evaluate each participant's confidence in their ability to independently locate the site of optimal needle placement and successfully aspirate synovial fluid with the guidance of ultrasound imaging.
RESULTS
An analysis via the Wilcoxon rank sum testing revealed that participant self-confidence increased significantly after training across all assessment items (p < 0.0001). Fifteen participants (75%) successfully aspirated 1 mL of synovial fluid on their first attempt, whereas 3 participants (15%) were successful on their second attempt. Two participants (10%) failed to perform a successful aspiration within the 15-minute time limit. The average time required to aspirate 1 mL of synovial fluid was 41 seconds.
CONCLUSIONS
Ultrasound images of the formalin-embalmed suprapatellar bursa are of sufficient quality to use in the instruction of arthrocentesis to medical trainees. Brief instruction using formalin-embalmed cadaver models significantly increases trainee confidence and prepares first-year medical students to successfully and independently perform ultrasound-guided knee arthrocentesis.
PubMed: 34522834
DOI: 10.2106/JBJS.OA.20.00071 -
Seminars in Interventional Radiology Dec 2012With advances in imaging technology, there has been a significant increase in the number and range of interventional musculoskeletal image-guided procedures. One of the... (Review)
Review
With advances in imaging technology, there has been a significant increase in the number and range of interventional musculoskeletal image-guided procedures. One of the most commonly performed image-guided musculoskeletal interventions is the diagnostic and therapeutic percutaneous aspiration and drainage of multiple types of intra-articular, juxta-articular, and intramuscular pathologic fluid collections. These procedures may be performed under fluoroscopic, ultrasound, computed tomography, or even magnetic resonance guidance depending on the location to be accessed, type of pathology, patient characteristics, and operator preference. Musculoskeletal image-guided aspiration and drainage procedures are minimally invasive and generally very safe while offering valuable diagnostic information as well as therapeutic benefit. This article focuses on the appropriate indications, contraindications, and general technique for accessing the major joints via imaging guidance. For each joint, we discuss pertinent anatomy, appropriate imaging modalities, and preferred approaches to gaining intra-articular access. Additionally, the article discusses some of the more frequently encountered juxta-articular and intramuscular fluid collections that can be accessed and aspirated via percutaneous intervention, with mention of the importance of recognizing extremity sarcomas that can mimic these benign collections.
PubMed: 24293800
DOI: 10.1055/s-0032-1330061