The use of intra-articular aneshesia as a diagnostic tool in canine lameness

Lameness in dogs may be difficult to localize because of mild pathologic changes or inconclusive clinical findings. Intra-articular anesthesia is proposed as a diagnostic method to localize the source of lameness. After a description of the preparation, technique and puncture sites, an overview is given of a series of patients admitted for different joint problems. Intra-articular anesthesia proved to be applicable in any joint, provided that the clinician was experienced and the dog was under sedation. In 87% of the cases, intra-articular anesthesia was positive. Medial coronoid disease of the elbow joint was the most frequent indication for intra-articular anesthesia

Ultrasound-guided percutaneous treatment of a calcific acromioclavicular joint: A case report

Rationale:Calcific tendinopathy is one of the most frequent causes of nontraumatic shoulder pain. However, intra-articular calcifications appear to be an infrequent condition. We herein report a rare case study of an intra-articular calcification of the acromioclavicular joint.Patient concerns:A 46-year-old man presented with an acute pain in the anterior superior region of the left shoulder which also radiated to the left cervical region. The man during the physical evaluation also presented severe functional limitation of the shoulder movements in all planes of motion.Diagnoses:The diagnosis was carried out through a radiographic and an echotomographic examination, highlighting the intra-articular calcific formation associated to a reactive inflammatory reaction.Interventions:An ultrasound-guided percutaneous treatment following the guidelines for calcific tendinopathy of the shoulder was carried out.Outcomes:The posttreatment was satisfactory with the disappearance of the pain and the recovery of the shoulder movements in all planes of motion.Lessons:We can affirm that the ultrasound-guided percutaneous treatment in patients with calcification of the acromion-clavicular joint represents a valid and nonpainful therapeutic treatment

Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus : randomised controlled trial

Objective: To investigate whether surgery by open reduction and internal fixation provides benefit compared with non-operative treatment for displaced, intra-articular calcaneal fractures. Design: Pragmatic, multicentre, two arm, parallel group, assessor blinded randomised controlled trial (UK Heel Fracture Trial). Setting: 22 tertiary referral hospitals, United Kingdom. Participants: 151 patients with acute displaced intra-articular calcaneal fractures randomly allocated to operative (n=73) or non-operative (n=78) treatment. Main outcome measures: The primary outcome measure was patient reported Kerr-Atkins score for pain and function (scale 0-100, 100 being the best possible score) at two years after injury. Secondary outcomes were complications; hindfoot pain and function (American Orthopaedic Foot and Ankle Society score); general health (SF-36); quality of life (EQ-5D); clinical examination; walking speed; and gait symmetry. Analysis was by intention to treat. Results: 95% follow-up was achieved for the primary outcome (69 in operative group and 74 in non-operative group), and a complete set of secondary outcomes were available for 75% of participants. There was no significant difference in the primary outcome (mean Kerr-Atkins score 69.8 in operative group v 65.7 in non-operative group; adjusted 95% confidence interval of difference −7.1 to 7.0) or in any of the secondary outcomes between treatment groups. Complications and reoperations were more common in those who received operative care (estimated odds ratio 7.5, 95% confidence interval 2.0 to 41.8). Conclusions: Operative treatment compared with non-operative care showed no symptomatic or functional advantage after two years in patients with typical displaced intra-articular fractures of the calcaneus, and the risk of complications was higher after surgery. Based on these findings, operative treatment by open reduction and internal fixation is not recommended for these fractures

Fasceíte Necrosante após Mobilização e Infiltração Intrarticular do Ombro com Betametasona

Necrotizing Fasciitis is a rapidly progressive, potentially fatal infection of superficial fasciae and subcutaneous tissue, usually resulting from an inciting trauma to the skin. Medical literature refers few cases of necrotizing fasciitis related to intra-articular infiltrations, that often lead to patients death. This report describes the clinical events on a 55 year-old diabetic patient who developed upper extremity Necrotizing Fasciitis, 18 days after shoulder mobilization and intra-articular infiltration, due to Staphylococcus epidermidis. An early surgical debridement was performed and antibiotherapy was established, resulting in a successful outcome, despite the functional disability. We point out, through this case, the possibility of intra-articular injections of drugs causing Necrotizing Fasciitis, especially in risk patients

Outcomes of intra-articular corticosteroid injections for adolescents with hip pain.

Intra-articular injection of corticosteroid and anesthetic (CSI) is a useful diagnostic tool for hip pain secondary to labral tears or femoroacetabular impingement (FAI). However, the effectiveness of CSI as a stand-alone treatment for hip pain in adolescents is unknown. The purpose of this study is to evaluate the use of CSI for the treatment of hip pain and determine factors that may affect outcomes after injection. Retrospective analysis of 18 patients and 19 hips that underwent fluoroscopic guided hip injection for the treatment of pain at a single institution from 2012 to 2015 was carried out in this study. Mean age at the time of injection was 15.1 years (range 13-17) with mean follow-up of 29.4 months. Fifty-two percent (10/19 hips) went on to surgery after the injection. Average time to surgical conversion was 12.8 months after CSI. Cam or pincer morphologies were present in 90% (9/10 hips) of the operative group. Patients with FAI were more likely to need surgery than patients without bony abnormalities (RR= 10, 95% CI 1.6-64.2, P = 0.0001). There was no difference in the presence of labral tears in the operative and non-operative groups (100% versus 89%, P = 0.47). For adolescents without bony abnormalities, 90% improved with CSI alone and did not require further treatment within 2.4 years. Fluoroscopic guided corticosteroid hip injection may have limited efficacy for the treatment of hip pain secondary to FAI in adolescents. However, for patients without osseous deformity, CSI may offer prolonged improvement of symptoms even in the presence of labral tears

Plantar pressure analysis after percutaneous repair of displaced intra-articular calcaneal fractures

Background: Clinical results for the treatment of displaced intra-articular calcaneal fractures are mainly expressed using disease-specific outcome scores, physical examination and radiographs. We hypothesized that plantar pressure and foot position analysis is a valuable tool in assessing foot function in patients with a unilateral displaced intra-articular calcaneal fracture treated percutaneously. Materials and Methods: With a followup of at least one year, 21 patients with a unilateral displaced intra-articular calcaneal fracture treated percutaneously participated in the study. The pedobarographic measurements in the injured foot were compared with the contralateral control foot. Correlations between the ratios (injured/control) of plantar pressure and foot position variables and outcome scores, the physical exam items ratios, the fracture classification, and the radiological parameters were calculated. Results: Statistically significant differences between the injured and the control foot were f

What is the initial approach to the treatment of shoulder pain?

There is some limited evidence supporting the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the initial treatment of shoulder pain. There is no evidence in support of most other therapies, including intra-articular or subacromial corticosteroid injection, intra-articular NSAID injection, oral corticosteroid treatment, physiotherapy, ultrasound, heat or ice therapy, laser treatment, electrotherapy, and iontophoresis (Grade of recommendation: B, based on extrapolation from systematic reviews and randomized clinical trials with inconsistent and inconclusive results

Clinical and Radiological Evaluation in Intra-Articular Distal Radial Fracture: Operative Treatment with Open Reduction Internal Fixation Using K-Wire and Bone Graft Compared with Non-operative Treatment Using Casting in Women Above 50 Years Old in Soehar

Introduction.The incidence of distal radius fractures is increasing together with the average age of population. Intra-articular incongruity is the most probable cause of unsatisfactory outcome of distal radius fractures. There is much debate regarding the optimal treatment of displaced, unstable distal radius fractures in the elderly. The purpose of this retrospective study was to compare outcome for elderly patients with intra-articular distal radial fracture who were treated with or without surgical intervention. Materials and methods. This cross sectional study examined patients over the age of fifty years old who were treated with or without surgery for intra-articular distal radial fracture. Patients who underwent non-operative treatment were treated with closed reduction and below elbow cast for six weeks. Patients who underwent surgery were treated with criss-cross K-wire and bone graft. Baseline radiographs with Scheck's score and functional scores with Mayo wrist score were obtained prior to treatment. Outcomes at fixed time points were compared between groups with standard statistical methods.Results.There are 27 patients intra-articular distal radial fracture between January to July 2011. 17 patients were treated conservatively with closed reduction and below elbow cast and 10 patients were treated operatively with criss-cross k-wire and bone graft. There is no significance differences between two groups in term of Scheck's score and Mayo wrist score.Conclusions.Both non-operative treatment with closed reduction and below elbow cast and operative treatment using criss-cross K-wire and bone graft provides good results in terms of radiological dan functional outcome in women patients older than 50 years old with intra-articular distal radius fracture

Does the relative density of periarticular bone influence the failure pattern of intra-articular fractures?

Introduction: The architecture of joints almost certainly influences the nature of intra-articular fractures, and the concavity is much more likely to fail than the associated convexity. However, local differences in periarticular bone density potentially also plays a critical role. The purpose of this study was to investigate if there was any difference in periarticular bone density in intra-articular fractures between the two opposing joint surfaces, comparing the convexity to the concavity. Materials and methods: We retrospectively identified a series of 1003 intra-articular fractures of the hip, knee, and ankle; 129 of these patients had previously undergone CT scanning during their routine clinical assessment. Periarticular bone density was assessed using Hounsfield Units (HU) as a measure of the composite density of the adjacent bone. Bone density was compared between the opposite sides of each joint, to determine if a relationship exists between local bone density and the risk of articular surface fracture. Results: There was a statistically significant difference in density between the two opposing surfaces, with the convexity 19% more dense than the concavity (p = 0.0001). The knee exhibited the largest difference (55%), followed by the hip (18%); in the ankle, an inverse relationship was observed, and the concave surface was paradoxically denser (5%). There was no significant difference between those cases where the concavity failed in isolation compared to those where the convexity also failed (p = 0.28). Conclusion: When the results were pooled for all three joints, there was a statistically significant higher local bone density demonstrated on the convex side of an intra-articular fracture. However, while this relationship was clearly exhibited in the knee, this was less evident in the other two joints; in the ankle the reverse was true, and the local bone adjacent to the concavity was found to have greater density. This suggests local bone density plays only a minor role in determining the nature of intra-articular fractures

Adverse events from diagnostic and therapeutic joint injections: a literature review

This review article classifies the various adverse reactions arising from intra-articular injections by severity, diagnostic category, and whether they are due to corticosteroid, local anesthetic or viscosupplementation injections. Life-threatening and serious adverse events from intra-articular injections are rare and range from local complications to systemic afflictions. Measures to reduce the likelihood of an adverse event occurring are outlined and patients with significant features in their clinical histories, predisposing them to adverse events, are highlighte