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Ear, Nose, & Throat Journal Mar 2023Tumoral calcinosis is a rare benign disease defined as calcium salt deposits in the periarticular soft tissue region. Tumoral calcinosis is rare in the neck and larynx....
Tumoral calcinosis is a rare benign disease defined as calcium salt deposits in the periarticular soft tissue region. Tumoral calcinosis is rare in the neck and larynx. In this case, we described a 58-year-old man who had numerous calcified nodules in the larynx.
PubMed: 36961766
DOI: 10.1177/01455613231166586 -
Orthopaedics & Traumatology, Surgery &... Oct 2022Total hip arthroplasty (THA) on a minimally invasive anterolateral (MIAL) approach frequently leads to gluteus minimus and gluteus medius lesions, and sometimes to...
INTRODUCTION
Total hip arthroplasty (THA) on a minimally invasive anterolateral (MIAL) approach frequently leads to gluteus minimus and gluteus medius lesions, and sometimes to tensor fasciae latae (TFL) denervation. We therefore developed compensatory strategies, which we assessed on pre- and post-operative MRI: 1) to assess gluteus minimus and gluteus medius fatty infiltration (FI), 2) to assess TFL FI, and 3) to assess FI in the other periarticular muscles.
HYPOTHESIS
The modified MIAL approach reduces the rate of gluteus minimus and gluteus medius lesion.
MATERIALS AND METHODS
A continuous prospective single-surgeon series of THA using a MIAL approach included 25 patients. Femoral implantation was performed with the hip in extension so as to distance the proximal femur from the gluteals, avoiding muscle trauma. The superior gluteal nerve branch in the space between the gluteus medius and TFL, running toward the TFL, was systematically released and protected. MRI was performed preoperatively and at 3 months and 1 year post-surgery. FI was analyzed according to the Goutallier classification in all periarticular muscles.
RESULTS
One patient lacked preoperative MRI and was excluded, leaving 24 patients, for 72 MRIs. In 10/24 patients (41.7%) the gluteus minimus and in 8/24 patients (33.3%) the anterior third of the gluteus medius showed ≥2 grade increase in FI between preoperative and 1-year MRI, with significant increases in both at 3 months (p<0.001) and 1 year (p<0.001). At least a 2 grade increase in FI at 1 year was seen in 1 patient (4.2%) in the TFL, in 2 (8.3%) in the piriformis, and in 1 (4.2%) in the obturator internus. There were no significant differences in FI between preoperative, 3-month or 1-year MRI in any other periarticular muscles.
CONCLUSION
Femoral implantation in hip extension did not reduce the rate of gluteal lesions, which remained frequent. In contrast, release of the superior gluteal nerve branch could be effective in conserving TFL innervation. Some rare lesions of the proximal part of the pelvi-trochanteric muscles were also observed.
LEVEL OF EVIDENCE
IV, Prospective case series.
Topics: Arthroplasty, Replacement, Hip; Buttocks; Hip; Hip Joint; Humans; Magnetic Resonance Imaging; Muscle, Skeletal
PubMed: 35724839
DOI: 10.1016/j.otsr.2022.103356 -
Clinics (Sao Paulo, Brazil) Dec 2017This study examined periarticular multimodal drug injection and the use of nonsteroidal anti-inflammatory drugs for an early analgesic effect after total knee...
OBJECTIVES
This study examined periarticular multimodal drug injection and the use of nonsteroidal anti-inflammatory drugs for an early analgesic effect after total knee arthroplasty and total hip arthroplasty. Patient satisfaction and benefits from the treatment were also assessed.
METHODS
A total of 110 patients who were scheduled to undergo total knee arthroplasty and 86 patients who were scheduled to undergo total hip arthroplasty were divided into two groups, the study group and the control group. The study group received a periarticular multimodal drug injection during surgery. The control group received an equal volume of normal saline. All patients received an analgesia pump and a moderate dose of nonsteroidal anti-inflammatory drugs. Resting and motion Numeric Rating Scale scores, the Western Ontario and McMaster Universities Arthritis Index, knee or hip joint range of motion, length of postoperative hospital stay, patient satisfaction, total nonsteroidal anti-inflammatory drug consumption and side effects were recorded.
RESULTS
Both study groups exhibited significant improvement in pain Numeric Rating Scale scores during rest and exercise several days after the surgery. The range of joint motion was greater in the study group, and the length of postoperative hospital stay was shorter than that in the control group. Patients in the study group consumed fewer nonsteroidal anti-inflammatory drugs and reported greater satisfaction with surgery.
CONCLUSION
Intraoperative periarticular multimodal drug injection significantly relieved pain after surgery and reduced nonsteroidal anti-inflammatory drug consumption. These patient had a better postoperative experience, including satisfaction and rehabilitation.
Topics: Adult; Analgesia; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Case-Control Studies; Female; Humans; Injections, Intra-Articular; Male; Morphine; Pain Management; Pain, Postoperative; Young Adult
PubMed: 29319718
DOI: 10.6061/clinics/2017(12)03 -
American Family Physician Oct 2008Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular,... (Review)
Review
Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection.
Topics: Adrenal Cortex Hormones; Anesthetics, Local; Carpal Tunnel Syndrome; Contraindications; Diabetes Complications; Humans; Injections, Intra-Articular; Injections, Intramuscular; Musculoskeletal Diseases
PubMed: 18953975
DOI: No ID Found -
Advances in Orthopedics 2022Topical tranexamic acid (TXA) has been widely used to reduce postoperative blood loss following total knee replacement (TKA). This study aimed to evaluate the effect of...
Efficacy of a Combined Intramedullary, Periarticular Injection, and Intraarticular Tranexamic Acid Application on Postoperative Bleeding in Total Knee Arthroplasty: A Retrospective Case-Matched Study.
BACKGROUND
Topical tranexamic acid (TXA) has been widely used to reduce postoperative blood loss following total knee replacement (TKA). This study aimed to evaluate the effect of combined intramedullary, periarticular injection, and intraarticular TXA application in patients who underwent TKA as compared to those who did not.
METHODS
This was a retrospective case-matched study of 111 patients. We evaluated the transfusion rate and postoperative drainage of 56 patients who underwent TKA using combined topical tranexamic acid application (directly pushed into the femoral intramedullary canal and tibia base, with periarticular soft tissue injection and injected into the knee cavity via a drain tube) and the control group of 55 patients.
RESULTS
In the control and TXA groups, 7.14% and 1.81% of the patients received blood transfusions, respectively (=0.176). The closed-suction drainage output at 0-8 h and total drainage output were significantly lower in the TXA group than those in the control group ( < 0.001).
CONCLUSION
Application of topical TXA with the combined method (intramedullary, periarticular injection, and intraarticular) in TKA decreases postoperative suction drainage and may reduce the need for postoperative blood transfusion.
PubMed: 36536826
DOI: 10.1155/2022/9175189 -
JBJS Essential Surgical Techniques 2019Intramedullary nailing is used to stabilize distal femoral, proximal tibial, and distal tibial periarticular fractures with short proximal or distal segments, as well as...
Intramedullary nailing is used to stabilize distal femoral, proximal tibial, and distal tibial periarticular fractures with short proximal or distal segments, as well as some intra-articular fractures in which a stable articular block can be created. Intramedullary nailing may be beneficial in complex fracture patterns with diaphyseal extension, segmental injuries, or patients who might benefit from a decreased incision burden. Step 1: Preoperative planning. Review imaging and make sure there is a nail with adequate interlocks. Consider the use of adjunctive techniques to obtain and maintain alignment, and how intra-articular fracture lines will be stabilized. Step 2: Position and prepare the patient. Step 3: Exposure for nailing via suprapatellar, infrapatellar, or knee arthrotomy approaches. Limited exposure of fracture planes may also be necessary for adjunctive techniques. Step 4: Convert an OTA/AO C-type fracture to an A-type fracture if needed. Step 5: Obtain appropriate starting point and trajectory with the nail starting wire and use the opening reamer. Step 6: Obtain reduction, if not yet done, and pass the ball-tipped reaming wire across the fracture. Step 7: Ream while holding reduction. Step 8: Pass nail. Step 9: Verify reduction is maintained and correct if needed. Step 10: Place interlocks, preferably multiplanar, in the short segment. Create a fixed angle construct if desired and convert adjunctive techniques/provisional fixation to definitive fixation as needed. Step 11: Perform final checks. Step 12: Closure. Step 13: Postoperative plan. For extra-articular fractures, one may expect healing with maintained alignment from what was present at the case end intraoperatively in the vast majority of cases. For intra-articular fractures, development of posttraumatic arthritis is an additional concern.
PubMed: 32051781
DOI: 10.2106/JBJS.ST.18.00112 -
International Journal of Molecular... Feb 2018Osteoarthritis (OA) is the most prevalent joint disease in older people and is characterized by the progressive destruction of articular cartilage, synovial... (Review)
Review
Osteoarthritis (OA) is the most prevalent joint disease in older people and is characterized by the progressive destruction of articular cartilage, synovial inflammation, changes in subchondral bone and peri-articular muscle, and pain. Because our understanding of the aetiopathogenesis of OA remains incomplete, we haven't discovered a cure for OA yet. This review appraises novel therapeutics based on recent progress in our understanding of the molecular pathogenesis of OA, including pro-inflammatory and pro-catabolic mediators and the relevant signalling mechanisms. The changes in subchondral bone and peri-articular muscle accompanying cartilage damage are also reviewed.
Topics: Animals; Anti-Inflammatory Agents; Biomarkers; Bone Remodeling; Bone and Bones; Cartilage, Articular; Gene Expression Regulation; Humans; Molecular Targeted Therapy; Muscle, Skeletal; Osteoarthritis; Signal Transduction
PubMed: 29495538
DOI: 10.3390/ijms19030674 -
Arthritis and Rheumatism Nov 2013Bone loss in arthritis is a complex process characterized by bone erosions and periarticular and generalized bone loss. The antigen-induced arthritis (AIA) model is...
OBJECTIVE
Bone loss in arthritis is a complex process characterized by bone erosions and periarticular and generalized bone loss. The antigen-induced arthritis (AIA) model is mainly used to study synovitis and joint destruction, including bone erosions; however, periarticular bone loss has been less extensively investigated. The objectives of this study were to characterize and establish AIA as a model for periarticular bone loss, and to determine the importance of NADPH oxidase 2 (NOX-2)-derived reactive oxygen species (ROS) in periarticular bone loss.
METHODS
Arthritis was induced in mice by local injection of antigen in one knee; the other knee was used as a nonarthritis control. At study termination, the knees were collected for histologic assessment. Periarticular bone mineral density (BMD) was investigated by peripheral quantitative computed tomography. Flow cytometric analyses were performed using synovial and bone marrow cells.
RESULTS
AIA resulted in decreased periarticular trabecular BMD and increased frequencies of preosteoclasts, neutrophils, and monocytes in the arthritic synovial tissue. Arthritis induction resulted in an increased capability to produce ROS. However, induction of arthritis in Ncf1 / mice, which lack NOX-2-derived ROS, and control mice resulted in similar reductions in periarticular trabecular BMD.
CONCLUSION
The initiation of AIA resulted in periarticular bone loss associated with local effects on inflammatory cells and osteoclasts. Furthermore, based on our observations using this model, we conclude that NOX-2-derived ROS production is not essential for inflammation-mediated periarticular bone loss. Thus, AIA can be used as a model to investigate the pathogenesis of local inflammation-mediated bone loss.
Topics: Animals; Antigens; Arthritis, Experimental; Bone Density; Disease Models, Animal; Female; Femur; Membrane Glycoproteins; Mice; Mice, Inbred C57BL; Mice, Mutant Strains; Monocytes; NADPH Oxidase 2; NADPH Oxidases; Neutrophils; Osteoarthritis, Knee; Osteoclasts; Osteoporosis; Reactive Oxygen Species; Serum Albumin, Bovine; Synovial Membrane; Synovitis
PubMed: 23918694
DOI: 10.1002/art.38114 -
Arthritis Research & Therapy 2008Osteoporosis can manifest in two ways in rheumatoid arthritis: generalized bone loss, which may result from immobility, the inflammatory process per se and/or treatments...
Osteoporosis can manifest in two ways in rheumatoid arthritis: generalized bone loss, which may result from immobility, the inflammatory process per se and/or treatments such as steroids; and periarticular demineralization, which is probably due to local release of inflammatory agents. Digital X-ray radiogrammetry (DXR) is an effective and sensitive modality for monitoring periarticular osteoporosis, which is among the earliest features of rheumatoid arthritis, preceding bone erosions. DXR is a promising technique, which can provide quantitative data that allow early diagnosis. During the course of rheumatoid arthritis it can be deployed in combination with established X-ray scoring methods to inform decisions regarding the optimal therapy to prevent joint destruction.
Topics: Arthritis, Rheumatoid; Bone Density; Diagnosis, Computer-Assisted; Humans; Metacarpal Bones; Osteoporosis; Radiographic Image Enhancement
PubMed: 18254923
DOI: 10.1186/ar2352 -
Journal of ISAKOS : Joint Disorders &... Feb 2024In elbow stiffness, pre-operative assessments should identify the articular and peri-articular tissues involved and, more specifically, they should determine how...
In elbow stiffness, pre-operative assessments should identify the articular and peri-articular tissues involved and, more specifically, they should determine how preserved the articular surfaces and osteo-articular congruity are. We will focus on the most important conditions and tissue reactions after trauma in order to understand the causes of joint stiffness. A logical surgical planning is based upon a deep knowledge of the anatomical obstacles and of the associated lesions that the trauma provoked with. The peri-articular soft tissue contractures. The osteo-articular incongruity.
Topics: Humans; Elbow; Elbow Joint; Elbow Injuries; Treatment Outcome; Joint Dislocations; Arthritis; Ossification, Heterotopic
PubMed: 37879605
DOI: 10.1016/j.jisako.2023.10.009