1/11. Aseptic synovitis after meniscal repair using the biodegradable meniscus arrow.We report a case of aseptic synovitis in a 19-year-old man. The synovitis of the left knee developed 13 months after meniscal repair using the biodegradable Meniscus Arrow (Bionx Inc, Malvern, PA). Histologic examination revealed chronic nonspecific synovitis and birefringent materials. Immunohistochemical tests were positive in lysozyme, alpha-1-antitrypsin, and alpha-1-antichymotrypsin. After arthroscopic synovectomy, pain and swelling of the knee joint were relieved and the patient's range of motion fully recovered. We have found no previous report of aseptic synovitis accompanying meniscal repair using the biodegradable Meniscus Arrow.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/11. A symptomatic cyclops lesion 4 years after anterior cruciate ligament reconstruction.The cyclops lesion is a fibrous nodule with central granulation tissue located anterolateral to the tibial tunnel after intra-articular reconstruction of the anterior cruciate ligament (ACL) that has been shown to be a cause of failure to regain full extension in the early postoperative period. We present the case of a 23-year-old woman who had undergone arthroscopic ACL reconstruction with a patellar tendon autograft 4 years prior to presentation. Following her reconstruction, she regained full range of motion and returned to collegiate cheerleading. At presentation, she complained of a gradual loss of full extension and joint-line pain with terminal extension. On examination, her graft was stable and she lacked 3 degrees of extension. magnetic resonance imaging documented a 1-cm mass of low signal intensity immediately anterior to the ACL graft within the intercondylar notch. At arthroscopy, a large amount of thick, immobile scar tissue was found immediately anterior to the ACL, consistent with a cyclops lesion. The lesion was debrided and the patient did well postoperatively. patients who present with delayed-onset loss of extension after ACL reconstruction should undergo careful evaluation including radiographs and magnetic resonance imaging. If a cyclops lesion is diagnosed, arthroscopic resection should be undertaken.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/11. Atraumatic hemarthrosis caused by a large mediopatellar plica.hemarthrosis of the knee has various etiologies and is classified into atraumatic or post-traumatic. Among atraumatic factors, hemarthrosis due to synovial plica is extremely rare. We report a case of atraumatic hemarthrosis caused by the mediopatellar plica. A 21-year-old male truck driver was referred to our hospital, because of swelling and pain of the right knee without history of trauma. Bloody synovial fluid was aspirated by arthrocentesis. However, his symptoms recurred and persisted. The range of motion was normal, but the patient complained of anteromedial knee pain during maximum flexion. Routine biochemical analyses were within normal limits. Plain radiographs were normal. magnetic resonance imaging (MRI) of the knee showed the hypertrophic mediopatellar plica and an irregular signal of the infrapatellar fat pad. arthroscopy revealed a voluminous mediopatellar plica trapped between the patella and the medial femoral condyle. It attached to the center of the infrapatellar fat pad, the so-called tongue. When the tourniquet was released, fresh bleeding was observed from the region between the mediopatellar plica and the tongue. Because that region was considered to be the cause of the hemarthrosis, the mediopatellar plica and the tongue were excised. A histologic examination of the tongue showed evidence of bleeding with nonspecific synovitis. After the procedure, the patient was asymptomatic and there were no clinical signs of recurrence.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/11. Intraarticular osteoid osteoma: clinical features, imaging results, and comparison with extraarticular localization.OBJECTIVE: Intraarticular osteoid osteoma is uncommon and presents diagnostic difficulties, which are important for both rheumatologists and orthopedic surgeons. Clinical symptoms, imaging procedures, differential diagnostic problems, and treatment results of intraarticular as compared with extraarticular osteoma are analyzed in this retrospective study. methods: Nineteen patients with intraarticular osteoid osteomas (Group A), with a mean followup period of 34 months, are compared with 15 others with extraarticular lesions (Group B). RESULTS: Nine intraarticular tumors were located in the hip, 3 in the elbow, 6 in the ankle, and one in the first metatarsal head. The nonspecific symptoms in Group A, such as chronic synovitis, decreased range of motion, joint effusion, contractures, and lack of the intense perifocal sclerotic margin on radiographs, led to significant delay in diagnosis (on average 26.6 mo in Group A, 8.5 mo in Group B). The extreme variety of previous diagnoses at referral reflect the problems of differential diagnosis. A detectable nidus is often absent on conventional radiograph. Bone scintigraphy is unspecific and often fails to visualize the nidus. Computed tomography scans were accurate in two-thirds of the intraarticular and in 90% of extraarticular cases. Magnetic resonance image findings, although sometimes controversial, provided essential additional information for the correct diagnosis and therapy. CONCLUSION: Clinical symptoms and imaging signs of intraarticular osteoid osteomas were significantly different from the classical hallmarks of extraarticular lesions. The 10% intraarticular occurrence of osteoid osteomas in this series is not as rare as some investigators suggest. The radiological and clinical findings are uncharacteristic and misleading, and the lesions are difficult to identify. Careful search for history data, such as nocturnal pain and positive salicylate test, in addition to extensive imaging procedures, led to the correct diagnosis prior to surgery in two-thirds of our patients with intraarticular osteoid osteomas.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/11. The use of MRI to assist in diagnosis of pigmented villonodular synovitis of the knee joint.Pigmented villonodular synovitis (PVNS) of the knee joint remains a difficult and elusive entity to define and characterize. This entity most often appears in the young adult knee with nonspecific clinical features, including a painful range of motion and perhaps a sensation of locking. Detection and diagnosis of this localized soft-tissue mass are difficult because plain roentgenograms may be totally within normal limits. The case of a 21-year-old woman illustrates the use of magnetic resonance imaging (MRI) as an effective technique to define and characterize PVNS. Advantages of MRI include high-resolution/high-contrast multiplanar sections that depict bone, marrow, ligaments and tendons, fat, menisci, and articular cartilage in one image. In addition, MRI is noninvasive and requires no ionized radiation. MRI is an excellent clinical tool for the evaluation of intraarticular tumors of the knee joint.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/11. Villonodular synovitis of the shoulder in the elderly.Villonodular synovitis of the shoulder developed in two elderly patients. Huge soft tissue mass, marked joint effusion, and radiographs demonstrating severe osteoarthritic changes characterized these patients. Localized shoulder muscle atrophy accounts for residual painfree limitation of active shoulder motion following synovectomy of the shoulder joint.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/11. Osteoid osteoma of the femoral neck stimulating an inflammatory synovitis.The case report presents a nine-year-old child with an osteoid osteoma of the femoral neck, simulating an inflammatory synovitis. Osteoid osteoma is a common benign bone tumor. However, when intracapsular lesions occur they may pose a diagnostic challenge. Nonspecific clinical signs and symptoms, such as inflammatory synovitis, joint effusion, and soft tissue swelling, may pose a problem in diagnosis and treatment. The delay in diagnosis can range from six months to two years. When the hip is involved, the patient may have nonspecific pain, limp, restricted motion, and thigh atrophy. An accurate diagnosis may be difficult to elicit, requiring detailed history and physical examination and culminating in the use of computed tomography.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/11. hip joint fluid in the presence of the vacuum phenomenon.A 3-year old boy with an acute onset of hip pain and limitation of motion had 4 mm of crescent shaped intra-articular gas produced by manual traction radiography. Hip aspiration produced more than 2 ml of fluid from the hip. Manual traction radiography producing the vacuum phenomenon with release of crescent shaped intra-articular gas did not exclude joint fluid in this patient.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/11. Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome.Eight elderly men and two elderly women presented with symmetrical polysynovitis of acute onset involving most of their appendicular joints and flexor digitorum tendons associated with pitting edema of the dorsum of both hands and both feet. Onset of seven of the ten cases could be pinpointed almost to the hour. Rheumatoid factors were absent from serum samples in all, and no radiologically evident erosions developed. Clinical and laboratory signs of inflammation and the edema disappeared gradually in each case. Treatment consisted of aspirin or other nonsteroidal anti-inflammatory drugs. hydroxychloroquine, 200 to 400 mg/day, was given in six and gold therapy in two cases. Painless limitation of motion of the wrists and/or fingers persisted in all, although the patients were both unaware of and unhampered by this abnormality. Six of eight cases where typing was possible were positive for HLA-B7, CW7, and DQW2 (relative risk for B7, 9.5). Three cases of this syndrome were found in a consecutive series of 52 men diagnosed as having definite "rheumatoid arthritis," and thus represent a distinctive condition with an excellent prognosis.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/11. Familial hypertrophic synovitis.We describe here a 14-year old male patient with a life-long history of deformities of hands and feet, swelling of both knees and both wrists and limited motion of hips and elbows. His paternal aunt has similar findings. A two-month-old brother developed flexion deformities of the hands similar to those of the patients.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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