MedWorm: Arthrocentesis

Gout and Organ Transplantation

Current Rheumatology Reports — Thu, 19 Jan 2012 06:55:35 +0100

Abstract Acute and chronic gout are common complications following organ transplantation. Risk factors include those shared with the general population (eg, diuretic use) and transplant-specific risk factors (eg, cyclosporine). Clinical features of gout are similar to those seen in the general population, although tophi may be more common. A definitive diagnosis requires demonstration of monosodium urate crystals within synovial fluid or tophi. Treatment is often empiric, although a poor response should prompt joint aspiration to exclude septic arthritis. Corticosteroids are commonly used to treat acute gout due to the adverse profile and drug interactions with NSAIDs and colchicine. Sustained reduction of serum urate (≤6 mg/dL) is critical in long-term management. ...

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Wrist joint aspiration.

British Journal of Hospital Medicine — Sun, 01 Jan 2012 05:00:00 +0100

Authors: Flint JD, Giles IP Abstract Wrist joint aspiration is a diagnostic procedure used in patients with a suspected wrist joint effusion to obtain a sample of synovial fluid for analysis. PMID: 22241297 [PubMed - in process] (Source: British Journal of Hospital Medicine)

Haemophilia-associated Yersinia pseudotuberculosis serotype O:1 septicaemia: the role of iron.

Journal of Medical Microbiology — Fri, 23 Dec 2011 08:06:13 +0100

We report a case of septic arthritis due to Y. pseudotuberculosis as an early manifestation of Yersinia septicaemia in a patient with severe haemophilia A. The patient had no history of immunosuppression and presented with a repeat case of haemarthrosis with a fever of unknown origin. Furthermore, he suffered from acute-on-chronic renal failure and non-ST segment elevation myocardial infarction. Arthrocentesis and blood culture tested positive for Y. pseudotuberculosis. Iron deposits at localized sites in the synovium in patients with haemophilia have been described, and as Yersinia infections are common in patients with secondary iron overload, we felt that a review of the literature was in order. Severe Yersinia infection is often associated with iron overload, a condition that might occ...

Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies

Rheumatology — Wed, 21 Dec 2011 05:00:00 +0100

Conclusion. The study highlights the relatively low prevalence of UGAJ as compared with the high (>80%) rate of rheumatologists performing conventional joint injection in most of the surveyed countries. The reported variations in practice and the lack of available structured training programmes for trainees in most countries indicates the need for standardization in areas including training guidelines. (Source: Rheumatology)

Percutaneous interface biopsy in dry-aspiration cases of chronic periprosthetic joint infections: A technique for preoperative isolation of the infecting organism

International Orthopaedics — Tue, 29 Nov 2011 22:20:23 +0100

Conclusion We conclude that PIB is a useful test for preoperative isolation of the infecting organism and could play a role in cases with dry-tap joint aspirations. Content Type Journal ArticleCategory Original PaperPages 1-6DOI 10.1007/s00264-011-1418-0Authors Pablo Corona, Department of Orthopedic Surgery, Reconstruction and Septic Division, Hospital de Traumatología y Rehabilitación Vall d’Hebron, Passeig Vall d’Hebron 119-129, 08035 Barcelona, SpainEmilia Gil, Department of Orthopedic Surgery, Reconstruction and Septic Division, Hospital de Traumatología y Rehabilitación Vall d’Hebron, Passeig Vall d’Hebron 119-129, 08035 Barcelona, SpainErnesto Guerra, Department of Orthopedic Surgery, Reconstruction and Septic Division, Hospital de Traumatología y ...

Does ultrasound guidance improve the outcomes of arthrocentesis and corticosteroid injection of the knee?

Scandinavian Journal of Rheumatology — Mon, 21 Nov 2011 05:00:00 +0100

Conclusions: US-guided arthrocentesis and injection of the knee are superior to anatomic landmark palpation-guided arthrocentesis, resulting in significantly less procedural pain, improved arthrocentesis success, greater synovial fluid yield, more complete joint decompression, and improved clinical outcomes. PMID: 22103390 [PubMed - as supplied by publisher] (Source: Scandinavian Journal of Rheumatology)

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Comparing non-enhanced and enhanced sequences in the assessment of effusion and synovitis in knee OA: associations with clinical, macroscopic and microscopic features

Osteoarthritis and Cartilage — Mon, 14 Nov 2011 05:00:00 +0100

Summary: Objective: The purpose of this study was to evaluate synovial membrane (SM) inflammation and joint effusion scores by semiquantitative magnetic resonance imaging (MRI) assessment with and without enhanced sequences. Gold standards used for comparison were microscopic examination of SM biopsies for SM inflammation and joint volume measurement (JVM) after arthrocentesis for effusion.Methods: Patients (n = 30) fulfilling ACR criteria for knee osteoarthritis (OA) and requiring joint lavage, were evaluated with MRI: (1) SM inflammation was assessed by Whole-Organ Magnetic Resonance Imaging Score (WORMS) on T2 weighted sequences (T2w) a composite score assessing together synovitis and effusion, and the MRI-synovitis score (based on synovitis thickening in five regions of interest) on ...

Practical Procedures in Orthopaedic Surgery

Springer Medicine titles — Fri, 11 Nov 2011 00:05:13 +0100

Joint Aspiration/Injection, Bone Graft Harvesting and Lower Limb AmputationsPractical Procedures in Orthopaedic Surgery will be an essential guide for surgeons in training, providing step by step approaches to performing Joint Aspiration/Injection, Bone Graft Harvesting and Lower Limb Amputations. Practical guidance will be given on Indications- Preoperative assessment, positioning and preparing the patient, approach required, tips and tricks, closure, postoperative ... (Source: Springer Medicine titles)

DECT Useful in Suspected Gout With Negative Joint AspirationDECT Useful in Suspected Gout With Negative Joint Aspiration

Medscape Today Headlines — Thu, 10 Nov 2011 13:23:37 +0100

Dual-energy CT scan can identify gout crystal deposition in selected patients suspected of gout but with undetectable disease on standard fluid aspiration. Medscape Medical News (Source: Medscape Today Headlines)

Identification of Intraarticular and Periarticular Uric Acid Crystals with Dual-Energy CT: Initial Evaluation [Musculoskeletal Imaging]

Radiology — Wed, 19 Oct 2011 04:00:00 +0100

Conclusion: Initial retrospective assessment suggests that dual-energy CT is a sensitive, noninvasive, and reproducible method for identifying uric acid deposits in joints and periarticular soft tissues in patients suspected of having gout. © RSNA, 2011 (Source: Radiology)

Arthrocentesis with or without additional drugs in temporomandibular joint inflammatory‐degenerative disease: comparison of six treatment protocols*

Journal of Oral Rehabilitation — Sat, 15 Oct 2011 04:00:00 +0100

Summary The aim of the present pilot investigation was to compare the effectiveness of six treatment protocols providing temporomandibular joint (TMJ) arthrocentesis with or without additional drugs to manage symptoms in patients with inflammatory‐degenerative TMJ disease. A consecutive series of 72 patients with TMJ osteoarthritis (axis group IIIb) with pain lasting from more than 6 months were randomly assigned to one of the groups receiving the following treatment protocols: single‐session two‐needle arthrocentesis (A), single‐session two‐needle arthrocentesis plus corticosteroid (B), single‐session two‐needle arthrocentesis plus low molecular weight hyaluronic acid (HA) (C), single‐session two‐needle arthrocentesis plus high molecular weight HA (D), 5 weekly tw...

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Chronic closed lock of the temporomandibular joint. Comparison of two therapeutical methods: arthrocentesis and arthroscopical lavage

International Journal of Oral and Maxillofacial Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Authors performed a prospective study in 100 patients with chronic anterior disc displacement without reduction. Patients with subjective problems lasting less than one year were assigned as group A (N=50) and patients with problems lasting more than one year were group B (N=50). 25 patients from group A and 25 patients from group B underwent arthrocentesis, 25 patients from group A and 25 patients from group B underwent arthroscopical lavage. Good result for both methods were pain in value 0–1 (pain score 0–5) and mouth opening minimally 30mm (interincisivaly). (Source: International Journal of Oral and Maxillofacial Surgery)

Glucosamine and Chondroitin Sulfate versus Arthrocentesis in internal derangement of TM joint: A 5 years experience

International Journal of Oral and Maxillofacial Surgery — Sat, 01 Oct 2011 04:00:00 +0100

This study shows that Arthrocentesis along with Chondroitin Sulfate and Glucosamine Sulfate is effective for internal derangement, however patients who are apprehensive about invasive procedures, Chondroitin Sulfate and Glucosamine Sulfate is an effective treatment modality. (Source: International Journal of Oral and Maxillofacial Surgery)

Comparative study of two arthrocentesis techniques

International Journal of Oral and Maxillofacial Surgery — Sat, 01 Oct 2011 04:00:00 +0100

The aim of this study was to compare the perioperative evolution of two different arthrocentesis techniques, one performed by direct palpation of the anatomical structures and the other by preestablished measurements. It was verified which of the techniques is the more accurate in respect of the serum flow established and the undesired accumulation of fluid through the tissue planes. Twenty-two patients with ages ranging from 23 to 52 years were analyzed. They were clinically diagnosed as having unilateral intra-articular temporomandibular joint pathology (TMJ pathology). The patients were randomly divided into two groups, each of them being submitted to a different arthrocentesis technique. The subjects were analyzed perioperatively and at 14 days after surgery, mouth opening and relief o...

Temporomandibular arthralgia treated by arthrocentesis

International Journal of Oral and Maxillofacial Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Objective: To evaluate the usefulness of arthrocentesis in the treatment of intra-articular temporomandibular pain and functional improvement of mandibular movements. Material and methods: Uncontrolled trial in 30 patients with signs and symptoms of temporomandibular joint pain, 24 women and 6 men, mean age 27.4±10.9 years. Maximum mouth opening was quantified with and without pain in millimeters, the presence or absence of pain in protrusion and lateral movements using visual analogue scale before and after the procedure. Arthrocentesis was performed using 100ml of 0.9% saline and intravenous sedation. (Source: International Journal of Oral and Maxillofacial Surgery)

Myositis ossificans traumatica of the temporalis muscle: a case report and diagnostic considerations

Oral and Maxillofacial Surgery — Wed, 21 Sep 2011 16:24:31 +0100

Discussion It is fundamental that patients suspected of having uncommon clinical pictures leading to mouth opening restriction are promptly referred to specialized centers, where the differential diagnosis process should be based on a comprehensive assessment taking into account for the potential etiologic factors described in the literature. Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s10006-011-0293-6Authors Luca Guarda-Nardini, TMD Clinic, Department of Maxillofacial Surgery, University of Padova, Padova, ItalyFabio Piccotti, TMD Clinic, Department of Maxillofacial Surgery, University of Padova, Padova, ItalyGiuseppe Ferronato, TMD Clinic, Department of Maxillofacial Surgery, University of Padova, Padova, ItalyDaniele Manfredini, TMD Clin...

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Approach to septic arthritis.

American Family Physician — Thu, 15 Sep 2011 04:00:00 +0100

Authors: Horowitz DL, Katzap E, Horowitz S, Barilla-Labarca ML Abstract Prompt diagnosis and treatment of infectious arthritis can help prevent significant morbidity and mortality. The acute onset of monoarticular joint pain, erythema, heat, and immobility should raise suspicion of sepsis. Constitutional symptoms such as fever, chills, and rigors are poorly sensitive for septic arthritis. In the absence of peripheral leukopenia or prosthetic joint replacement, synovial fluid white blood cell count in patients with septic arthritis is usually greater than 50,000 per mm3. Isolation of the causative agent through synovial fluid culture is not only definitive but also essential before selecting antibiotic therapy. Synovial fluid analysis is also useful to help distinguish crystal arthr...

Wound healing problems in total knee arthroplasty.

Orthopedics — Mon, 12 Sep 2011 13:04:03 +0100

Authors: Garbedian S, Sternheim A, Backstein D Abstract It is important to avoid underestimating the significance of wound complications following total knee arthroplasty (TKA). Expedient and aggressive care is recommended. Understanding the blood supply to the skin around the knee and measures to prevent wound complications are fundamental to preventing wound problems. A detailed patient history and physical examination will identify high-risk patients and any modifiable risk factors. Operative techniques such as raising full-thickness skin flaps and judicious placement of skin incisions in the presence of pre-existing scars can greatly reduce the incidence of wound problems. The first step in treating wound problems is recognizing when a problem is present and knowing when a mino...

Safety syringes and anti-needlestick devices in orthopaedic surgery.

The Journal of Bone and Joint Surgery. American volume — Wed, 07 Sep 2011 04:00:00 +0100

CONCLUSIONS: The most effective and reliable safety devices for orthopaedic syringe procedures are shielded safety needles, mechanical syringes, manual retractable syringes, and shielded syringes, but not automatic retractable syringes. Even when adopting safety-engineered devices for an orthopaedic clinic, conventional syringes larger than 20 mL and conventional needles longer than 1.5 in (3.8 cm) are necessary. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. PMID: 21915580 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Equimolar Nitrous Oxide/Oxygen versus Placebo for Procedural Pain in Children: A Randomized Trial: Reinoso-Barbero F, Pascual-Pascual SI, de Lucal R, et al. Pediatrics 2011;127:e1464–70.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

This Spanish randomized, placebo-controlled, double-blinded study evaluated the effectiveness of oxygen and nitrous oxide inhalation (EMONO) when used for short procedures including nevus excision, laceration repair, skin biopsy, venous cannulation, lumbar puncture, joint aspiration, or bone marrow aspiration. The study enrolled 100 children and randomized them to treatment with EMONO or placebo. For large cutaneous procedures, eutectic mixture of local anesthetic cream was applied. Two scales were used to evaluate the quality of sedation and pain control. Children 6 years of age and older used the faces pain scale-revised (rFPS). Those 6 years of age and younger used the Spanish version of an observational pain scale (LLANTO) based on five behavioral items (crying, psychological attitude,...

The effect of joint aspiration and corticosteroid injections in osteoarthritis of the knee

APLAR Journal of Rheumatology — Tue, 30 Aug 2011 23:00:00 +0100

Conclusion: This pilot study appears to show a beneficial trend in giving corticosteroid injections and to aspirate the knee in OA patients. Further studies are needed to address the mechanical benefits, quadriceps strengthening and pain reduction with knee aspiration, as well as the effects that different volumes of fluid may have on knee mechanics and symptoms. (Source: APLAR Journal of Rheumatology)

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[Hip joint infections - Results of a questionnaire among 28 university orthopedic departments.]

Der Orthopade — Fri, 12 Aug 2011 23:00:00 +0100

CONCLUSION: Treatment of hip joint infections among German and Austrian university orthopedic departments is only partly carried out in a similar manner. PMID: 21837461 [PubMed - as supplied by publisher] (Source: Der Orthopade)

Joint protection in haemophilia

Haemophilia — Wed, 10 Aug 2011 18:31:29 +0100

Summary. Haemarthroses (intra‐articular haemorrhages) are a frequent finding typically observed in patients with haemophilia. Diagnosis and treatment of these bleeding episodes must be delivered as early as possible. Additionally, treatment should ideally be administered intensively (enhanced on‐demand treatment) until the resolution of symptoms. Joint aspiration plays an important role in acute and profuse haemarthroses as the presence of blood in the joint leads to chondrocyte apoptosis and chronic synovitis, which will eventually result in joint degeneration (haemophilic arthropathy). Ultrasonography (US) is an appropriate diagnostic technique to assess the evolution of acute haemarthrosis in haemophilia, although magnetic resonance imaging remains the gold standard as far as ima...

The painful knee after TKA: a diagnostic algorithm for failure analysis

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 06 Aug 2011 05:52:52 +0100

Abstract Pain after total knee arthroplasty (TKA) represents a common observation in about 20% of the patients after surgery. Some of these painful knees require early revision surgery within 5 years. Obvious causes of failure might be identified with clinical examinations and standard radiographs only, whereas the unexplained painful TKA still remains a challenge for the surgeon. It is generally accepted that a clear understanding of the failure mechanism in each case is required prior considering revision surgery. A practical 10-step diagnostic algorithm is described for failure analysis in more detail. The evaluation of a painful TKA includes an extended history, analysis of the type of pain, psychological exploration, thorough clinical examination including spine,...

[Diagnosis of a crystal-induced arthritis.]

Presse Medicale — Mon, 01 Aug 2011 23:00:00 +0100

Authors: Lioté F Crystal-induced arthritis (CIA) is easy to diagnose as soon as the physician might suspect the diagnosis. Indeed, CIA can be readily ascertained since one single gold standard is available: identification of microcrystals in synovial fluid or in other materials (tophus, synovial tissue biopsy, periarticular tissues). It is therefore mandatory to perform joint aspiration and to get synovial fluid sample for microscopic examination. Monosodium urate crystals are the key feature of gout, and calcium pyrophosphate (CPP) crystals are associated with CPP disease, also called "chondrocalcinosis" in France. Diagnosis of gout can be readily suspected when considering typical clinical presentations such as podagra, presence of tophi, cardiovascular comorbidities, and diuretics ...

Evidence‐based Diagnostics: Adult Septic Arthritis

Academic Emergency Medicine — Sun, 31 Jul 2011 23:00:00 +0100

Conclusions: Recent joint surgery or cellulitis overlying a prosthetic hip or knee were the only findings on history or physical examination that significantly alter the probability of nongonococcal septic arthritis. Extreme values of sWBC (>50 × 109/L) can increase, but not decrease, the probability of septic arthritis. Future ED‐based diagnostic trials are needed to evaluate the role of clinical gestalt and the efficacy of nontraditional synovial markers such as lactate. (Source: Academic Emergency Medicine)

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Evidence-based Diagnostics: Adult Septic Arthritis.

Accident and Emergency Nursing — Sun, 31 Jul 2011 23:00:00 +0100

Conclusions: Recent joint surgery or cellulitis overlying a prosthetic hip or knee were the only findings on history or physical examination that significantly alter the probability of nongonococcal septic arthritis. Extreme values of sWBC (>50 × 10(9) /L) can increase, but not decrease, the probability of septic arthritis. Future ED-based diagnostic trials are needed to evaluate the role of clinical gestalt and the efficacy of nontraditional synovial markers such as lactate. PMID: 21843213 [PubMed - in process] (Source: Accident and Emergency Nursing)

[Serum and synovial adiponectin, resistin, and visfatin levels in rheumatoid arthritis patients : Relation to disease activity.]

Zeitschrift fur Rheumatologie — Tue, 26 Jul 2011 23:00:00 +0100

CONCLUSION: Our data demonstrated that adiponectin and visfatin are related to disease activity in RA patients and might be involved in the progression of RA. The English full-text version of this article is available at SpringerLink (under "Supplemental"). PMID: 21789720 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Rheumatologie)

Concentric-Needle Cannula Method for Single-Puncture Arthrocentesis in Temporomandibular Joint Disease: An Inexpensive and Feasible Technique

Journal of Oral and Maxillofacial Surgery — Tue, 19 Jul 2011 23:00:00 +0100

Management of temporomandibular joint (TMJ) disorders presenting with pain, restricted mouth opening, or simply asymptomatic clicking can be challenging even to the experienced surgeon. Many conservative and invasive techniques are available, but most cases can be treated by arthrocentesis of the joint locally. A simple process of joint irrigation enables lysis of intra-articular adhesions, change in the joint viscosity, and clearance of various substances in the joint fluid. Classically, arthrocentesis of the TMJ has been performed with 2 needles: an infusion needle and an aspiration needle. Various devices and techniques have been described in the literature, each with its own benefits and drawbacks. We introduce our technique of TMJ lavage using 2 different gauge needles placed in a con...

Definition of Periprosthetic Joint Infection: Is There a Consensus?

Clinical Orthopaedics and Related Research — Tue, 12 Jul 2011 23:00:00 +0100

CONCLUSIONS: The discrepancy between definitions of infection complicates interpretation of the literature and the treatment of failed TKAs owing to PJI. Based on our findings, we suggest establishing a common set of diagnostic criteria utilizing aspirate analysis to improve the treatment of PJI and facilitate interpretation of the literature. LEVEL OF EVIDENCE: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID: 21751038 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Technological Advances in Minimally Invasive TMJ Surgery

Dental Clinics of North America — Thu, 30 Jun 2011 23:00:00 +0100

The technologic advances in temporomandibular joint arthroscopy and arthrocentesis have given oral surgeons a treatment for patients who have not responded to conservative and pharmacologic treatment without the surgical risks and long-term recovery of open joint surgery. (Source: Dental Clinics of North America)

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[Musculoskeletal puncture, injection and infiltration : Swiss rheumatologists' point of view.]

Zeitschrift fur Rheumatologie — Thu, 30 Jun 2011 23:00:00 +0100

Authors: Ziswiler HR, Caliezi G, Villiger PM Arthrocentesis, injection and infiltration of joints and soft tissues belong to the basic procedures in rheumatology. The indications and the practical performance are based on experience and tradition. Nowadays, a crucial reappraisal and adaption of indications and technical aspects appear important in the light of new evidence and technical developments. The main indications for puncture remain the search of an infectious arthritis and reduction of intra-articular pressure due to effusion. Good indications for the injection of glucocorticoids are inflammation in sterile joints and activated osteoarthritis. The local infiltration with corticosteroids in mechanically induced enthesopathies at the lateral epicondyle of the humerus or at the p...

[Calcium pyrophosphate deposition disease.]

Presse Medicale — Wed, 15 Jun 2011 23:00:00 +0100

Authors: Richette P, Bardin T Definitive diagnosis of chondrocalcinosis (CC) is allowed by identification of calcium pyrophosphate (CPP) crystals in synovial fluid. In daily practice, X-Rays are the most frequent imaging used to detect CC. Most cases of CC are sporadic. If CC occurs before 60years of age, primary metabolic disorders such as hyperparathyroidism, hypomagnesemia, and hemochromatosis or a familial predisposition should be particularly considered. Treatment of CPP arthritis includes application of ice, rest, joint aspiration and intra-articular injection of corticosteroids. Oral NSAIDs can be used cautiously, in particular in the elderly. Prophylaxis against frequent recurrent acute CPP crystal arthritis can be achieved with low-dose oral colchicine. PMID: 21684108 [Pub...

Causes of Persistent Joint Pain After Arthrocentesis of Temporomandibular Joint

Journal of Oral and Maxillofacial Surgery — Sun, 12 Jun 2011 23:00:00 +0100

Conclusion: Persistent joint pain after arthrocentesis is generally associated with extensive amounts of joint effusion or erosive cortical changes of the condyle. (Source: Journal of Oral and Maxillofacial Surgery)

Effect of topical vapocoolant spray on response to arthrocentesis and intravenous catheterization in unsedated horses.

American Journal of Veterinary Research — Tue, 31 May 2011 23:00:00 +0100

Conclusions and Clinical Relevance-Vapocoolant spray was safe and effective in reducing horses' responses to arthrocentesis. The use of such products prior to joint injections may reduce procedural nociception and pain anticipation in unsedated horses and may improve the safety of personnel performing such procedures. PMID: 21627519 [PubMed - in process] (Source: American Journal of Veterinary Research)

Relationship between the Effectiveness of Arthrocentesis under Sufficient Pressure and Conditions of the Temporomandibular Joint

Infectious Diseases in Obstetrics and Gynecology — Tue, 31 May 2011 15:56:55 +0100

Conclusions. Pathologic conditions of the temporomandibular joint did not have an influence on the efficacy of the technique. This result suggests that this procedure has wider application than conventional arthrocentesis. (Source: Infectious Diseases in Obstetrics and Gynecology)

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Aspects of current management: orthopaedic surgery in haemophilia

Haemophilia — Tue, 26 Apr 2011 23:00:00 +0100

Summary. If continuous prophylaxis is not feasible due to expense or lack of venous access, we must aggressively treat major haemarthroses (including arthrocentesis) to prevent progression to synovitis, recurrent joint bleeds, and ultimately end‐stage osteoarthritis (haemophilic arthropathy). For the treatment of chronic haemophilic synovitis, radiosynovectomy should always be indicated as the first procedure. If, after three procedures with 6‐month interval, radiosynovectomy fails, an arthroscopic synovectomy must be indicated. Between the second and fourth decades, many haemophilic patients develop joint destruction (arthropathy). At this stage possible treatments include alignment osteotomy, arthroscopic joint debridement, arthrodesis (joint fusion) and total joint arthroplasty. ...

Ankle Joint Sepsis with Subsequent Osteomyelitis in an Adult Patient without Identifiable Etiologies: A Case Report

Journal of Foot and Ankle Surgery — Sun, 03 Apr 2011 23:00:00 +0100

Abstract: Ankle sepsis can lead to rapid joint destruction with long-term articular degeneration and dysfunction. Timely diagnosis by means of joint aspiration can be helpful. In this article, we describe the case of an otherwise healthy adult male with isolated ankle sepsis. The case illustrates how a high clinical suspicion for a septic joint can justify prompt invasive diagnostic intervention, namely joint aspiration, which guides definitive treatment. (Source: Journal of Foot and Ankle Surgery)

Patient satisfaction with a hospitalist procedure service: Is bedside procedure teaching reassuring to patients?

Journal of Hospital Medicine — Thu, 31 Mar 2011 23:00:00 +0100

CONCLUSIONS:Patients are highly satisfied with procedure performance by supervised trainees, and many patients were reassured by physician communication during the procedure. These results suggest that patient experience and teaching can be preserved with a hospitalist‐supervised procedure service. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

EULAR recommendations for calcium pyrophosphate deposition. Part II: Management

Annals of the Rheumatic Diseases — Thu, 03 Mar 2011 00:00:00 +0100

Conclusion Nine key recommendations for management of CPP crystal associated arthritis were developed using both research evidence and expert consensus. Strength of recommendations was provided to assist the application of these recommendations. (Source: Annals of the Rheumatic Diseases)

[Periprosthetic infection.]

Der Chirurg — Wed, 23 Feb 2011 00:00:00 +0100

Authors: Perka C, Haas N Periprosthetic infections represent the most feared complications in orthopedic surgery. Frequently, the substantial challenges result more from a delayed diagnosis and an inadequate therapy than from the infection itself. The guiding symptom is pain. The determination of C-reactive protein (CRP) and the blood sedimentation rate (BSR) is the basic screening test for infection while joint aspiration is commonly used to confirm the diagnosis. Infection treatment with implant preservation is only promising and justifiable in the early postoperative infection period. The current concept of infection treatment consists of a two-stage revision with 6-8 weeks implant-free interval and an accompanying antibiotic therapy. The one-stage revision is the patient friendlies...

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Management of acute haemarthrosis in haemophilia A without inhibitors: literature review, European survey and recommendations

Haemophilia — Tue, 15 Feb 2011 00:00:00 +0100

Summary. Acute haemarthrosis is a frequent type of bleeding in individuals with haemophilia. Delayed and/or inadequate treatment can trigger a series of pathological changes within the joint, leading to a painful and disabling arthropathy. The early management of intra‐articular bleeding has the potential to prevent chronic joint disease and may include a combination of factor replacement, rest, ice, rehabilitation and, in certain cases, joint aspiration. Little data are, however, available regarding the optimal management of acute haemarthrosis, especially with respect to replacement therapy and the use of adjunctive therapies (aspiration, avoidance of weight bearing and immobilization, as well as the use of anti‐inflammatory medication and embolization). To provide more insight in...

What are the Benefits and Drawbacks of Ultrasound-Guided Arthrocentesis?

Consultant Live — Wed, 09 Feb 2011 20:00:02 +0100

In the next 5 minutes, Wilmer L. Sibbitt, Jr, MD--one of the world's leading authorities on the subject--offers succinct answers to questions. (Source: Consultant Live)

Lyme arthritis in children presenting with joint effusions.

The Journal of Bone and Joint Surgery. American volume — Tue, 01 Feb 2011 00:00:00 +0100

Authors: Milewski MD, Cruz AI, Miller CP, Peterson AT, Smith BG The present study was designed to evaluate the prevalence of Lyme arthritis in children who had a joint aspiration at a tertiary care children's hospital in an endemic area and to identify clinical factors useful to differentiate Lyme arthritis from septic arthritis at the time of the initial presentation. PMID: 21266639 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Reoperative Temporomandibular Joint Surgery

Oral and Maxillofacial Surgery Clinics — Fri, 28 Jan 2011 16:04:04 +0100

This article focuses on the reoperation of the TMJ primarily in cases of internal derangement and discusses TMJ arthrocentesis, arthroscopy, modified condylotomy, and open joint procedures. (Source: Oral and Maxillofacial Surgery Clinics)

Lyme Arthritis in Children Presenting with Joint Effusions

JBJS [Am] — Tue, 25 Jan 2011 00:00:00 +0100

Conclusions: For any child presenting with a joint effusion in a Lyme-endemic area of the Northeastern United States, the likely prevalence of Lyme arthritis is 31% overall and 45% in the presence of knee effusion. Children with joint effusions resulting from Lyme disease are more likely to have knee involvement, a lower peripheral white blood-cell count, and a lower joint fluid cell count, and they are less likely to have fever or complete refusal to bear weight, when compared with children with septic arthritis. Level of Evidence: Diagnostic Level II. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

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The outcomes and cost-effectiveness of intraarticular injection of the rheumatoid knee

Rheumatology International — Fri, 21 Jan 2011 15:19:44 +0100

Abstract Although intraarticular injections are important to the management of rheumatoid arthritis, there are few studies regarding the cost-effectiveness of alternative injection techniques. This randomized controlled study addressed the cost-effectiveness of two different low-cost, anatomic landmark palpation-directed intraarticular injection techniques. Ninety-six symptomatic rheumatoid knees were randomized to two different low-cost, palpation-guided intraarticular injection techniques utilizing (1) a conventional syringe or (2) a mechanical syringe, the RPD (the reciprocating procedure device). Three milliliters of 1% lidocaine were used to anesthetize the synovial membrane, followed by arthrocentesis and hydrodissection, and injection of 80 mg of triamcinolone ...

Epidemiology of Suspected Wrist Joint Infection Versus Inflammation

The Journal of Hand Surgery — Mon, 27 Dec 2010 00:00:00 +0100

Conclusions: In this series of emergency department patients with suspected wrist joint infection, gout, pseudogout, and cellulitis were the most common etiologies. The cumulative incidence of septic wrist arthritis was low. (Source: The Journal of Hand Surgery)

Accidental use of alcohol during arthrocentesis of the temporomandibular joint

The British Journal of Oral and Maxillofacial Surgery — Mon, 20 Dec 2010 00:00:00 +0100

A 34-year-old woman was treated by arthrocentesis of the temporomandibular joint (TMJ). The trainee physician assistant had poured pure alcohol into the sterile container instead of saline solution, and the surgeon, the nurse, and the other staff were unaware. After local anaesthesia with articaine hydrochloride (2ml) and adrenaline (0.005mg/ml) (Maxicaine, VEM, Ankara, Turkey), there was no sign of facial paralysis or asymmetry. A 21G needle with a 10ml syringe was inserted 10mm anterior and 2mm inferior along the canthal-tragal line until bony contact had been made at the medial wall of the glenoid fossa. The upper joint space was confirmed with pure alcohol (5ml) instead of saline solution. At this time the patient was free of complaints. (Source: The British Journal of Oral and Maxillo...

Gout: A Primary Care Primer, Part 2

Consultant Live — Fri, 03 Dec 2010 12:00:00 +0100

The gold standard for diagnosis is joint aspiration and synovial fluid analysis; however, compensated polarized light microscopy is not available in most primary care practices. In part 2 of his 3-part podcast, Dr Lieberman discusses the diagnosis of gout in real-world practice. (Source: Consultant Live)

Rational use of laboratory testing in the initial evaluation of soft tissue and joint complaints.

Primary Care — Sat, 13 Nov 2010 16:36:33 +0100

Authors: Waits JB The rational use of laboratory testing to investigate early, undifferentiated joint pain depends heavily on a detailed history and careful physical examination. Nevertheless, several diagnostic tests have some discriminatory function in the initial evaluation of soft tissues and joint complaints, given the correct clinical context. Arthrocentesis frequently gives the best results when compared with other tests in the differential diagnosis of monoarticular and polyarticular joint pain. There is also a role for radiographs, and less frequently, magnetic resonance imaging. Although overuse of an arthritis panel is not recommended, for an appropriately chosen patient, complete blood cell count, serum uric acid, C-reactive protein (or erythrocyte sedimentation rate), rheu...

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Beyond osteoarthritis: recognizing and treating infectious and other inflammatory arthropathies in your practice.

Primary Care — Sat, 13 Nov 2010 16:36:05 +0100

Authors: Haile Z, Khatua S About 15% of patients presenting in a primary care clinic have joint pain as their primary complaint (level B). Disseminated gonorrhea is the most common cause of infectious arthritis in sexually active, previously healthy patients (level B). Prompt arthrocentesis, microscopic examination, and the culture of any purulent material plus appropriate antibiotic therapy are the mainstay of treatment in infectious arthritis (level C). Detailed history, including family history and comprehensive examination, is more useful in accurate diagnosis than expensive laboratory and radiological investigations for noninfectious arthritis (level C). Regarding inflammatory noninfectious arthritis with the potential to cause destructive joint damage, early referral to a subspec...

Monoarticular Arthritis: Which Patients to Treat for Gout?

Medscape Rheumatology Headlines — Fri, 12 Nov 2010 11:02:59 +0100

A new diagnostic rule reduces the need for joint aspiration to diagnose gouty arthritis. Journal Watch (Source: Medscape Rheumatology Headlines)

Arthrocentesis and therapeutic joint injection: an overview for the primary care physician.

Pain Physician — Sun, 07 Nov 2010 07:40:06 +0100

Authors: Bettencourt RB, Linder MM Athrocentesis and therapeutic joint injection is a safe and useful primary care procedure. Fluid collection and analysis from effused joints is important to establish a cause and therefore inform appropriate management. Therapeutic joint injection can give patients significant, rapid, localized pain relief. PMID: 21050951 [PubMed - in process] (Source: Pain Physician)

Arthrocentesis and Therapeutic Joint Injection: An Overview for the Primary Care Physician

Primary Care: Clinics in Office Practice — Thu, 04 Nov 2010 00:15:21 +0100

Athrocentesis and therapeutic joint injection is a safe and useful primary care procedure. Fluid collection and analysis from effused joints is important to establish a cause and therefore inform appropriate management. Therapeutic joint injection can give patients significant, rapid, localized pain relief. (Source: Primary Care: Clinics in Office Practice)

Beyond Osteoarthritis: Recognizing and Treating Infectious and Other Inflammatory Arthropathies in Your Practice

Primary Care: Clinics in Office Practice — Thu, 04 Nov 2010 00:15:21 +0100

About 15% of patients presenting in a primary care clinic have joint pain as their primary complaint (level B). Disseminated gonorrhea is the most common cause of infectious arthritis in sexually active, previously healthy patients (level B). Prompt arthrocentesis, microscopic examination, and the culture of any purulent material plus appropriate antibiotic therapy are the mainstay of treatment in infectious arthritis (level C). Detailed history, including family history and comprehensive examination, is more useful in accurate diagnosis than expensive laboratory and radiological investigations for noninfectious arthritis (level C). Regarding inflammatory noninfectious arthritis with the potential to cause destructive joint damage, early referral to a subspecialist, when indicated, increas...

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Rational Use of Laboratory Testing in the Initial Evaluation of Soft Tissue and Joint Complaints

Primary Care: Clinics in Office Practice — Thu, 04 Nov 2010 00:15:20 +0100

The rational use of laboratory testing to investigate early, undifferentiated joint pain depends heavily on a detailed history and careful physical examination. Nevertheless, several diagnostic tests have some discriminatory function in the initial evaluation of soft tissues and joint complaints, given the correct clinical context. Arthrocentesis frequently gives the best results when compared with other tests in the differential diagnosis of monoarticular and polyarticular joint pain. There is also a role for radiographs, and less frequently, magnetic resonance imaging. Although overuse of an arthritis panel is not recommended, for an appropriately chosen patient, complete blood cell count, serum uric acid, C-reactive protein (or erythrocyte sedimentation rate), rheumatoid factor, antiecy...

Incidence of Scapholunate Ligament Dissociation in Patients With Aspiration-Confirmed Gout

The Journal of Hand Surgery — Mon, 25 Oct 2010 00:00:00 +0100

Conclusions: This study establishes the incidence of SL dissociation in patients with gouty arthropathy of the wrist as 60% and 25%, respectively, based on the above definitions. In addition, our study suggests that, as a result of the systemic nature of gout, a patient with aspiration-confirmed gout at a joint remote from the wrist might have subclinical effects in the wrist, leading to SL dissociation over time.Type of study/level of evidence: Prognostic IV. (Source: The Journal of Hand Surgery)

Analysis of synovial fluid in culture-negative samples of suspicious periprosthetic infections.

Orthopedics — Thu, 21 Oct 2010 05:15:10 +0100

Authors: Lee SC, Jung KA, Yoon JY, Nam CH, Hwang SH, Park IS Synovial fluid analysis can help to rule out a periprosthetic infection. The goal of this study was to evaluate the prognostic significance of synovial fluid suspicious for a periprosthetic infection given the synovial leukocyte count and percent of neutrophils.From August 2006 to November 2008, patients who had synovial fluid aspirated for painful knees and elevated C-reactive protein levels after total knee arthroplasty but revealed no growth of any microorganism were retrospectively evaluated by medical record review. Mean follow-up period was 827.7±250.6 days from the date of joint aspiration results. The optimal cut-off values for synovial leukocyte counts and percent neutrophils were determined using receiver operating...

Septic knee-induced deep venous thrombosis in a young adult.

Orthopedics — Thu, 21 Oct 2010 05:15:10 +0100

This article describes a case of a 26-year-old man presenting with left knee pain of 1 week's duration, fever, and acute onset of shortness of breath the day of admission. An arthrocentesis of the knee joint was grossly positive for methicillin-resistant Staphylococcus aureus. A left lower extremity venous duplex showed thrombosis of the superficial femoral, popliteal, posterior tibial, peroneal, and gastrocnemius veins. Pulmonary computed tomography-angiography was positive for acute pulmonary emboli. Initial management consisted of anticoagulation, intravenous antibiotics, and 2 arthroscopic irrigation and debridement procedures. After a normal transesophageal echocardiogram, a diagnosis of septic knee-induced deep venous thrombosis (DVT) of the left lower leg with subsequent septic pulm...

[Ultrasound-guided interventional procedures in the musculoskeletal system.]

Radiologia — Wed, 13 Oct 2010 23:00:00 +0100

Authors: Del Cura JL, Zabala R, Corta I Ultrasonography is the most appropriate tool for interventional procedures in the musculoskeletal system when the lesion is visible on ultrasonography. Procedures performed under ultrasonographic guidance include: taking biopsies; draining abscesses; bursitis; hematomas or muscle tears; treating cystic lesions; diagnostic or therapeutic arthrocentesis; injecting substances into joints or lesions; aspirating calcium deposits and extracting foreign bodies. Although some of these procedures are often carried out without imaging guidance, ultrasonographic guidance improves their efficacy. Drainage can be performed with catheters or needles and makes it possible to avoid more aggressive treatments in most cases. Urokinase is useful for draining hemato...

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A structured course teaching junior doctors invasive medical procedures results in sustained improvements in self-reported confidence.

Clinical Medicine — Fri, 01 Oct 2010 00:00:00 +0100

Authors: Garrood T, Iyer A, Gray K, Prentice H, Bamford R, Jenkin R, Shah N, Gray R, Mearns B, Ratoff JC Pressure on working hours has led to a decrease in opportunities for training in invasive medical procedures for junior doctors. The effect of a structured course on immediate and medium-term changes in self-reported confidence was investigated. A one-day model-based practical course was run on two separate occasions teaching central venous line placement, lumbar puncture, Seldinger-technique chest drain insertion and knee joint aspiration. Attendees were asked to indicate their confidence in each procedure on a 10-point Likert scale before, immediately after and three months after the course. Significant improvements in self-reported confidence were seen for all procedures which we...

Kynurenine inhibits chondrocyte proliferation and is increased in synovial fluid of patients with septic arthritis.

Cell Research — Wed, 29 Sep 2010 21:55:17 +0100

In this study, we analyzed the putative diagnostic value of kynurenine for bacterial joint infection and its potential harmful effects on cartilage. In a prospective study 41 patients with a joint effusion who had undergone arthrocentesis were included. Tryptophan and kynurenine levels from synovial fluid were quantified by HPLC. Diagnostic value of kynurenine was evaluated and its effects on the proliferation of the chondrocyte cell line ATDC5 were determined. Synovial fluid kynurenine values from patients with septic arthritis (4.1âÂ±â0.8âÂµmol/L, nâ=â9) were significantly increased compared to patients with non-infectious inflammatory arthropathy (1.8âÂ±â0.2âÂµmol/L, nâ=â17) or osteoarthritis (1.2âÂ±â0.1âÂµmol/...

Wound healing in total joint arthroplasty.

Orthopedics — Sat, 18 Sep 2010 04:12:03 +0100

Authors: Jones RE Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing problems can occur and the consequences can be devastating. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no healing compromises; and type B, systemic or local healing compromising factors present. Local factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon should encourage positive choices such as smoking cessation and nutrition...

Approach to a Child with Monoarthritis

Indian Journal of Pediatrics — Wed, 08 Sep 2010 05:27:49 +0100

Abstract Arthritis in childhood is common. The pattern, presentation and duration of arthritis help differentiate between the various possible diagnoses. When only one joint is involved, i.e., monoarthritis, it may be difficult to make a diagnosis as there are many possibilities both acute and chronic in nature. A detailed history and clinical examination is important to reach a correct diagnosis and the single most important investigation when a child presents acutely is a joint aspiration to rule out septic arthritis that may destroy the joint in hours. Inflammatory markers, antinuclear antibody testing, test for tuberculosis and imaging (in specific cases) play an important role in the diagnosis of a child that presents with a chronic monoarthritis. In this article we p...

Prognostic indicators of the outcome of arthrocentesis with and without sodium hyaluronate injection for the treatment of disc displacement without reduction: a magnetic resonance imaging study

International Journal of Oral and Maxillofacial Surgery — Wed, 11 Aug 2010 23:00:00 +0100

This study analysed the prognostic factors for successful arthrocentesis with and without sodium hyaluronate (SH) injection for the treatment of temporomandibular joint (TMJ) disc displacement without reduction (DDwoR) using clinical and radiological results. 29 TMJs in 25 patients with DDwoR were included. Patients were treated with arthrocentesis or arthrocentesis followed by intra-articular (i.a.) injection of SH. Treatment was evaluated for postoperative range of maximum mouth opening and the degree of postoperative pain on a VAS. Prognostic factors analysed were age, sex, duration of locking, trauma history, previous TMJ treatment, depression, bruxism, malocclusion and missing teeth. Degenerative changes were evaluated as probable prognostic factors. After treatment, 24 joints (83%) f...

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Therapy of the osteoarthritis of the temporomandibular joint

Journal of Cranio-Maxillofacial Surgery — Mon, 09 Aug 2010 00:00:00 +0100

Abstract: Osteoarthritis is a common condition of the mandible. The treatment of osteoarthritis primarily consists of rest therapy (restricting jaw movements), the use of pharmaceuticals (analgesics, antiinflammatories), splint therapy, thermotherapy or mini-invasive therapy.Our study investigated the effectiveness of the various therapeutic options in the treatment of osteoarthritis. We compared the effectiveness of rest therapy (restricting mouth opening, analgesic therapy), splints, arthrocentesis of the upper joint space, and arthrocentesis in combination with splint therapy.We looked at 80 patients diagnosed with osteoarthritis of the temporomandibular joint. We only included patients with symptoms in one temporomandibular joint (TMJ).This 3 months long-term study shows that arthrocen...

Managing Gout in the Primary Care Setting: What You and Your Patients Need to Know

The American Journal of Medicine — Wed, 28 Jul 2010 05:58:41 +0100

Abstract: The US prevalence of gout, a rapidly progressive inflammatory arthritic condition linked to serum uric acid levels, has grown in recent years, in part due to the increasing prevalence and incidence of predisposing factors in the population, such as metabolic syndrome, obesity, and the use of diuretics. Left untreated, gout can be debilitating and cause deformity. Although a definitive diagnosis requires joint aspiration, only ∼11% of patients with suspected gout undergo this procedure, and a presumptive diagnosis based on patient medical history and presentation with characteristic symptoms and comorbidities is a reasonable guidelines-based approach that has utility in the primary care setting, where approximately 70% of all cases and nearly 3,000,000 visits occur. The therapeu...

TMJ arthroscopy in patients with Ehlers Danlos syndrome: case series

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics — Tue, 27 Jul 2010 05:41:40 +0100

Conclusion: For patients where conservative measures of treating TMD are not effective, arthroscopy is a minimally invasive surgical procedure that has been shown to result in a satisfactory outcome, with no need to resort to open joint surgery. This case series is limited by its size and further research on surgical intervention on EDS patients with temporomandibular disorders is recommended. (Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics)

Re: A new anatomical landmark to simplify temporomandibular joint arthrocentesis

The British Journal of Oral and Maxillofacial Surgery — Wed, 07 Jul 2010 23:00:00 +0100

We read with interest the technical note from Alkan and Etöz. Temporomandibular joint arthrocentesis is used in the management of joint disorders. This procedure, if performed correctly, it can alleviate pain and increase mouth opening. As it is stated by the authors in some cases it is difficult to insert the needle in the desirable position in the joint and the procedure fails to provide some benefit. The two needle technique was described by Nitzan et al. and may used effectively in a large group of patients. In our experience the Shepard cannula is a more effective way of performing joint lavage and has been used in our practice for many years. The authors stated in this technical note that the size of the Shepard cannula may be a risk to the facial nerve and blunting of its tip may i...

Arthrocentesis and stabilizing splint are the treatment of choice for acute intermittent closed lock in patients with bruxism

Journal of Cranio-Maxillofacial Surgery — Sun, 04 Jul 2010 23:00:00 +0100

This study aimed to evaluate the long-term outcome of arthrocentesis and stabilizing splints for the treatment of acute closed lock in patients with bruxism. This study included 20 female patients who were divided into two equal groups and who underwent temporomandibular joint (TMJ) arthrocentesis. Patients in the first group wore a full coverage stabilizing splint following arthrocentesis. The second group underwent arthrocentesis only. The scores for preoperative maximal mouth opening (MMO), protrusive movement (PM), contra-lateral (CL) movement (CLM) and visual analogue scale (VAS) scores for pain and dysfunction were compared with the follow-up scores obtained by the questionnaire and clinical examination. Statistical evaluation of the baseline and follow-up data was made with the t-te...

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Ferritin concentrations in synovial fluid are higher in osteoarthritis patients with HFE gene mutations (C282Y or H63D).

Scandinavian Journal of Rheumatology — Sun, 20 Jun 2010 23:00:00 +0100

Conclusions: A predicted difference in SF ferritin concentrations in patients with knee OA was confirmed. Concentrations of ferritin in the SF were found to be two- to threefold higher in knee OA patients with HFE gene mutations compared to wt patients. This finding is consistent with the possibility that, in OA patients with HFE gene mutations, localized iron overload may contribute either directly or indirectly to osteochondral damage, possibly in a similar way to that which occurs in the arthropathy that complicates HH. PMID: 20560808 [PubMed - as supplied by publisher] (Source: Scandinavian Journal of Rheumatology)

Kynurenine inhibits chondrocyte proliferation and is increased in synovial fluid of patients with septic arthritis

Journal of Orthopaedic Research — Mon, 17 May 2010 23:00:00 +0100

In this study, we analyzed the putative diagnostic value of kynurenine for bacterial joint infection and its potential harmful effects on cartilage. In a prospective study 41 patients with a joint effusion who had undergone arthrocentesis were included. Tryptophan and kynurenine levels from synovial fluid were quantified by HPLC. Diagnostic value of kynurenine was evaluated and its effects on the proliferation of the chondrocyte cell line ATDC5 were determined. Synovial fluid kynurenine values from patients with septic arthritis (4.1 ± 0.8 µmol/L, n = 9) were significantly increased compared to patients with non-infectious inflammatory arthropathy (1.8 ± 0.2 µmol/L, n = 17) or osteoarthritis (1.2 ± 0.1 µmol/L, n = 15, p < 0.01). At a cut-off value of 2.28 µmol/L kynurenine had a sen...

Accuracy of CT-guided joint aspiration in patients with suspected infection status post-total hip arthroplasty

Skeletal Radiology — Fri, 07 May 2010 08:15:09 +0100

Conclusion Computed tomography aspiration is accurate to preoperatively diagnose septic hip prosthesis on the basis of volume and bacterial cultures of aspirated joint fluid. Furthermore, imaging findings such as periprosthetic fluid collections and prosthetic acetabular malposition strongly suggest infected prosthesis. Content Type Journal ArticleCategory Scientific ArticleDOI 10.1007/s00256-010-0940-2Authors Xavier Tomas, Universidad de Barcelona Department of Radiology, Hospital Clinic Villarroel 170 Barcelona 08036 SpainGuillem Bori, Universidad de Barcelona Department of Orthopaedics, Hospital Clinic Villarroel 170 Barcelona 08036 SpainSebastián Garcia, Universidad de Barcelona Department of Orthopaedics, Hospital Clinic Villarroel 170 Barcelona 08036 SpainAna...

Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection

International Orthopaedics — Mon, 26 Apr 2010 05:56:25 +0100

Abstract During a two-stage revision for prosthetic joint infections (PJI), joint aspirations, open tissue sampling and serum inflammatory markers are performed before re-implantation to exclude ongoing silent infection. We investigated the performance of these diagnostic procedures on the risk of recurrence of PJI among asymptomatic patients undergoing a two-stage revision. A total of 62 PJI were found in 58 patients. All patients had intra-operative surgical exploration during re-implantation, and 48 of them had intra-operative microbiological swabs. Additionally, 18 joint aspirations and one open biopsy were performed before second-stage reimplantation. Recurrence or persistence of PJI occurred in 12 cases with a mean delay of 218 days after re-implantation, but on...

[The usefulness of ultrasonography in synovial disease.]

Radiologia — Mon, 05 Apr 2010 23:00:00 +0100

Authors: Bargiela A Synovial disease is common in clinical practice and can have different causes. The development of high resolution ultrasonography (US) has led to greater use of US in the study of synovial disease. In this context, US is useful because (1) it can detect not only synovial disease, but also its consequences as tissue damage (erosions); (2) it can guide arthrocentesis when clinical attempts to obtain joint fluid have been unsuccessful, especially in joints that are difficult to access (hips), or sometimes when joint infections are clinically suspected; (3) it enables the efficacy of treatment for synovitis to be evaluated; and (4) it makes it possible to distinguish benign cystic lesions from other tumors. The overall evaluation of synovial disease is based on semiolog...

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Teaching knee joint aspiration to medical students—an effective training with long-term benefits

Clinical Rheumatology — Fri, 02 Apr 2010 08:49:01 +0100

The objective of this study was to assess the effectiveness of undergraduate training in knee aspiration and to determine the impact this had on subsequent postgraduate clinical practice. This paper is a cohort study of undergraduate training with a cross-sectional questionnaire study of postgraduate practice. The study was held at the University of Cambridge and NHS hospitals in the Eastern Region Postgraduate Deanery (England). The main outcome measures are the undergraduate competence in practical skills in a simulated setting and the differences in postgraduate practice with or without prior undergraduate training in knee aspiration. Implementing an undergraduate training programme in knee aspiration resulted in student competence in this skill. Undergraduate teaching of knee asp...

Monoarticular septic arthritis in a patient with juvenile rheumatoid arthritis under etanercept treatment

Rheumatology International — Sun, 28 Mar 2010 05:50:59 +0100

Abstract A 7-year-old girl with polyarticular type juvenile rheumatoid arthritis (JRA) presented with acute onset of right hip pain with limited range of motion and fever within the past two days. She had received etanercept for more than one year. Percutaneous arthrocentesis was performed and showed a white blood cell count of 84150/μL in the synovial fluid, although the culture showed negative results. The fever and right hip pain completely resolved after antibiotic treatment. Herein, we report the first case of septic monoarthritis of JRA under etanercept treatment. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00296-010-1459-5Authors Kai-Cheng Lin, Chang Gung Memorial Hospital-Kaohsiung Medical Center Department of Family Medicine Kaohsiung Taiwan...

Dual-Energy CT as a Potential New Diagnostic Tool in the Management of Gout in the Acute Setting

American Journal of Roentgenology — Mon, 22 Mar 2010 18:02:29 +0100

CONCLUSION. The ability of dual-energy CT to diagnose early gout and its use as a problem-solving tool is shown here. Diagnosis of subclinical gout could avert associated long-term complications, thereby reducing disease burden and improving overall quality of life. (Source: American Journal of Roentgenology)

Effect of Needle Size and Type, Reuse of Needles, Insertion Speed, and Removal of Hair on Contamination of Joints with Tissue Debris and Hair after Arthrocentesis

Veterinary Surgery — Fri, 19 Mar 2010 00:00:00 +0100

To assess joint contamination with tissue and hair after arthrocentesis of equine fetlock joints. Experimental. Limb specimens from 8 equine cadavers. Soft tissues including the joint capsule were harvested from the dorsal aspect of the fetlock joints and mounted on a wooden frame. Needles inserted through the joint tissue preparation were flushed into tissue culture plates that were examined for tissue and hair debris. Variables evaluated were gauge and type of needle (16, 18, 20, and 22 G sharp disposable needles and 20 G disposable spinal needles with stylet), number of times each needle was used (1, 2, 3, 4), length of hair (unclipped, clipped, shaved with razor), and needle insertion speed (fast, slow). Descriptive and statistical evaluations were performed. Tissue contamination was i...

Intra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study

International Journal of Oral and Maxillofacial Surgery — Mon, 08 Mar 2010 00:00:00 +0100

This study examined the clinical and radiological effects of intra-articular tenoxicam injection following arthrocentesis and compared them with arthrocentesis alone in patients with disc displacement without reduction (DDwoR). 24 temporomandibular joints (TMJs) in 21 patients with DDwoR were studied. Patients were divided randomly into Group A in which only arthrocentesis was performed (14 TMJs in 14 patients) and Group AT which received arthrocentesis plus intra-articular injection of tenoxicam (10 TMJs in 7 patients). Patients were evaluated before the procedure, on postoperative day 7, then 2, 3, 4 weeks, and 2, 3, 4, 5, 6 months postoperatively. Intensity of joint pain was assessed using a visual analog scale. Maximum mouth opening was recorded at each follow-up. TMJ sounds and palpat...

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Centesis Studies in Critical Care

Critical Care Nursing Clinics of North America — Mon, 01 Mar 2010 00:00:00 +0100

Critical care nurses have a vital role in caring for patients undergoing centesis studies. Any centesis procedure involves puncturing a body cavity, joint, organ, or space with a hollow needle to withdraw fluid. All centesis studies are invasive procedures, typically performed for either therapeutic or diagnostic purposes. Because there are a variety of centesis procedures that the critical care nurse might encounter, the following centesis procedures are discussed in depth: amniocentesis, arthrocentesis, lumbar puncture, paracentesis, pericardiocentesis, and thoracentesis. By becoming more familiar with each of these procedures, the critical care nurse gains confidence in caring for clients when these procedures are indicated. (Source: Critical Care Nursing Clinics of North America)

Analgesic Effects of Intra-Articular Morphine in Patients With Temporomandibular Joint Disorders: A Prospective, Double-Blind, Placebo-Controlled Clinical Trial

Journal of Oral and Maxillofacial Surgery — Tue, 23 Feb 2010 14:21:41 +0100

Conclusions: Independent of the applied substances, initial pain relief can be registered in the TMJ: either from the arthrocentesis effect or at least the placebo effect. Morphine at a dosage of 10 mg showed the best and most long-lasting analgesic efficiency. Morphine, in general (5 and 10 mg), and, with limitations, Carbostesin were more or less efficient for postoperative pain control but without distinct effects in the long term. With regard to our results, we can recommend intra-articular morphine application at a dose of 10 mg for pain management. Carbostesin showed no promising long-term effects. (Source: Journal of Oral and Maxillofacial Surgery)

Synovial fluid tests

Medicine — Wed, 17 Feb 2010 16:03:03 +0100

Abstract: Infection, crystal arthropathies, osteoarthritis, trauma and a variety of systemic diseases can create a painful, swollen peripheral joint of which septic arthritis is the most serious cause. Synovial fluid (SF) analysis is widely used to aid the diagnosis and management of both acute and chronic arthritis, and can be diagnostic in patients with bacterial infections or crystal-induced synovitis. Most native joints can be aspirated by any physician competent to do so, but where there is difficulty, joints can be aspirated under ultrasound guidance. In cases of suspected infected prosthetic joints, these must be referred to the orthopaedic surgeons for aspiration in theatre under strict asepsis. The SF should be sent to the laboratory promptly for microscopy, culture and crystal se...

A case of gouty arthritis following percutaneous radiofrequency ablation for hepatocellular carcinoma.

World Journal of Gastroenterology : WJG — Sun, 07 Feb 2010 00:26:11 +0100

We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency. Regular surveillance of the patient detected a 3.5 cm HCC lesion. Because the patient had declined surgery, RFA was chosen for therapy. On the third post-procedural day, the laboratory results showed increases in his uric acid and potassium levels, which were compatible with a tumor lysis syndrome. On the 6th post-procedural day, the patient complained of new right knee pain. Subsequent joint aspiration revealed monosodium urate monohydrate crystals. We made the diagnosis of acute gouty arthritis arising from tumor lysis and liver infarction caused by HCC ablation, which was aggravate...

Is There a Role for Tissue Biopsy in the Diagnosis of Periprosthetic Infection?

Clinical Orthopaedics and Related Research — Thu, 04 Feb 2010 00:00:00 +0100

CONCLUSIONS: Our data suggest tissue biopsy alone offers no clear advantage over joint aspiration. However, the combination of both techniques provides improved sensitivity and accuracy. We recommend the use of tissue biopsy as an adjunct to joint aspiration in the diagnosis of total joint infection. LEVEL OF EVIDENCE: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID: 20131022 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

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Supervising the Supervisors—Procedural Training and Supervision in Internal Medicine Residency

Journal of General Internal Medicine — Fri, 15 Jan 2010 00:47:25 +0100

CONCLUSIONS Residents report low levels of comfort and experience with procedures, and frequently report supervising prior to feeling comfortable. Our findings suggest a need to examine best practices for procedural supervision of trainees. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-009-1226-zAuthors Michelle Mourad, University of California San Francisco Department of Medicine, Division of Hospital Medicine 533 Parnassus Ave Box 0131 San Francisco CA 94143 USAJeffrey Kohlwes, University of San Francisco California Department of Medicine, Division of General Internal Medicine San Francisco USAJudith Maselli, University of California San Francisco Department of Medicine, Division of Hospital Medicine 533 Parnassus Ave Box 0131 San Francisc...

Relationship of Synovial Tumor Necrosis Factor α and Interleukin 6 to Temporomandibular Disorder

Journal of Oral and Maxillofacial Surgery — Wed, 23 Dec 2009 00:00:00 +0100

Conclusion: In our analysis of 2 proinflammatory cytokines, TNF-α and IL-6, in the synovial fluid of temporomandibular disorder patients with symptoms of pain, mouth opening limitation, and clicking, both were elevated without statistical significance. (Source: Journal of Oral and Maxillofacial Surgery)

Single, intra-articular treatment with 6 ml hylan G-F 20 in patients with symptomatic primary osteoarthritis of the knee: a randomised, multicentre, double-blind, placebo controlled trial

Annals of the Rheumatic Diseases — Thu, 10 Dec 2009 06:07:05 +0100

Conclusions: This placebo-controlled study demonstrated that, in patients with knee osteoarthritis, a single 6 ml intra-articular injection of hylan G-F 20 is safe and effective in providing statistically significant, clinically relevant pain relief over 26 weeks, with a modest difference versus placebo. Trial registration number: NCT00131352. (Source: Annals of the Rheumatic Diseases)

Septic Arthritis of the Temporomandibular Joint: A Retrospective Review of 40 Cases

Journal of Oral and Maxillofacial Surgery — Thu, 03 Dec 2009 00:00:00 +0100

Conclusions: Septic arthritis of the temporomandibular joint mainly arises from hematogenous spread, but the original infection is often occult. Antibiotic therapy, arthrocentesis under low pressure, and joint immobilization are recommended for patients in the acute stage. The common sequela is osteoarthritis. (Source: Journal of Oral and Maxillofacial Surgery)

Musculoskeletal Complications of Hemophilia

HSS Journal — Tue, 17 Nov 2009 23:39:56 +0100

Abstract The most important clinical strategy for management of patients with hemophilia is the avoidance of recurrent hemarthroses by means of continuous, intravenous hematological prophylaxis. When only intravenous on-demand hematological treatment is available, frequent evaluations are necessary for the early diagnosis and treatment of episodes of intra-articular bleeding. The natural history of the disease in patients with poorly controlled intra-articular bleeding is the development of chronic synovitis and, later, multi-articular hemophilic arthropathy. Once arthropathy develops, the functional prognosis is poor. Treatment of these patients should be conducted through a comprehensive program by a multidisciplinary hemophilia unit. Although continuous prophylaxis can ...

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Septic Arthritis in Adults with Sickle Cell Disease Often is Associated with Osteomyelitis or Osteonecrosis.

Clinical Orthopaedics and Related Research — Tue, 03 Nov 2009 00:00:00 +0100

CONCLUSIONS: The incidence of septic arthritis in adults with SCD is low, but often is associated with osteomyelitis or osteonecrosis. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. PMID: 19885711 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Certification Is Good for Hospital Medicine

Hospitalist News — Sun, 01 Nov 2009 00:00:00 +0100

DR. DEITELZWEIG is vice president for medical affairs and chairman of hospital medicine at the Ochsner Clinic Foundation in New Orleans The development of a new pathway for certification with Focused Practice in Hospital Medicine is good news for hospitalists. Ideally, hospital medicine would be its own subspecialty, especially since it involves specialized knowledge and the performance of procedures that aren't done in a typical office-based practice, such as vascular access, lumbar puncture, ECG interpretation, and arthrocentesis. But this credential does provide recognition of what we do, and it reflects a natural evolution of hospital medicine. (Source: Hospitalist News)

Short-term effects of arthrocentesis plus viscosupplementation in the management of signs and symptoms of painful TMJ disc displacement with reduction. A pilot study

Oral and Maxillofacial Surgery — Sun, 11 Oct 2009 07:12:34 +0100

Conclusions A cycle of five weekly hyaluronic acid injections performed immediately following arthrocentesis is effective to improve signs and symptoms in patients with painful temporomandibular joint disc displacement with reduction and to maintain them over a 3-month follow-up. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10006-009-0179-zAuthors Luca Guarda-Nardini, University of Padova TMD Clinic, Department of Maxillofacial Surgery Padova ItalyDaniele Manfredini, University of Padova TMD Clinic, Department of Maxillofacial Surgery Padova ItalyGiuseppe Ferronato, University of Padova TMD Clinic, Department of Maxillofacial Surgery Padova Italy Journal Oral and Maxillofacial SurgeryOnline ISSN 1865-1569Print ISSN 1865-1550 (Source: Oral a...

MRI-Guided Injection Procedures of the Temporomandibular Joints in Children and Adults: Technique, Accuracy, and Safety

American Journal of Roentgenology — Sun, 20 Sep 2009 23:00:00 +0100

CONCLUSION. We accept the hypothesis that real-time MRI-guided selective injection procedures of the temporomandibular joints are feasible, accurate, and safe when performed on a clinical open-bore 1.5-T MR system. (Source: American Journal of Roentgenology)

TMJ hemi-arthroplasty with metal fossa-eminence prothesis for degenerative joint changes: a six-year retrospective audit

The British Journal of Oral & Maxillofacial Surgery — Fri, 11 Sep 2009 16:32:08 +0100

We report 65% of the patients experienced an improvement in pain, 58% had an improvement in mouth opening and 19% had an improvement in joint clicking. Seventy percent of the joints operated on did not need further revision surgery. We also present the improvement of these symptoms based on the analog scale. (Source: The British Journal of Oral & Maxillofacial Surgery)

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Therapeutic benefits of TMJ arthroscopy and arthrocentesis: a prospective outcome assessment

The British Journal of Oral & Maxillofacial Surgery — Fri, 11 Sep 2009 16:32:08 +0100

Patients who fail to respond to routine conservative measures for TMJ related pain, restriction and locking may be submitted to diagnostic arthroscopy or arthrocentesis, both of which are associated with significant therapeutic improvement in 70% or more patients. There is no current data on improvements in mouth opening and lateral deviations achieved during and following arthroscopy. This prospective audit presents 140 patients treated between 2006 and 2008 from one surgeon's practice who have been followed up at least once at 6 weeks following arthroscopy or arthrocentesis. (Source: The British Journal of Oral & Maxillofacial Surgery)

The management of septic arthritis in children: systematic review of the English language literature.

The Journal of Bone and Joint Surgery. British volume — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Kang SN, Sanghera T, Mangwani J, Paterson JM, Ramachandran M We performed a systematic review of the optimal management of septic arthritis in children as recommended in the current English literature using MEDLINE, EMBASE, CINAHL, the Cochrane Library and reference lists of retrieved articles without date restrictions up to 31 January 2009. From 2236 citations, 227 relevant full-text articles were screened in detail; 154 papers fulfilled the inclusion criteria, from which conclusions were drawn on the management of infected joints in children. Our review showed that no single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively joint infection. The roles of aspiration, arthrotomy and arthroscopy in treatment are not clear cut, and the i...

Concerns About Management of Septic Arthritis After ACL Reconstruction

Arthroscopy — Mon, 31 Aug 2009 23:00:00 +0100

I have serious concerns about the article “Septic Arthritis After Arthroscopic Anterior Cruciate Ligament Reconstruction: A Retrospective Analysis of Incidence, Presentation, Treatment, and Cause” by Wang et al. They report on 21 patients with a postoperative infection, and yet only 16 patients had positive cultures. Of the 21 patients, 6 were treated by simple arthrocentesis and irrigation. I think this is very worrisome to present as a potential treatment for an infected ACL reconstruction. In my opinion, this would clearly be below the standard of care. The authors also state that IV antibiotics were only continued for a mean period of 19.4 days. For some of these serious infections with serious potential complications, this seems like an inordinately short period of time for the IV...

Synovial apoptosis in temporomandibular joint disc displacement without reduction

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics — Sun, 30 Aug 2009 23:00:00 +0100

Conclusion: Considering reports that increased sFas blocks apoptosis by inhibiting binding of FasL to Fas on the cell membrane, low level of sFas in our patients' synovial fluid (compared with amounts reported in joint inflammation or degeneration) suggests vulnerability to apoptosis in patients with internal derangement. (Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics)

[Histopathological diagnosis of periprosthetic joint infection following total hip arthroplasty : Use of a standardized classification system of the periprosthetic interface membrane.]

Der Orthopade — Wed, 19 Aug 2009 23:00:00 +0100

CONCLUSION: In the diagnosis of PJI, histopathological evaluation of the periprosthetic interface membrane proved very effective. To analyse the cause of prosthesis loosening, tissue samples of the periprosthetic interface membrane should be evaluated on the basis of the consensus classification in all revision surgeries. PMID: 19690832 [PubMed - as supplied by publisher] (Source: Der Orthopade)

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How Common is MRSA in Adult Septic Arthritis?

Annals of Emergency Medicine — Mon, 10 Aug 2009 00:00:00 +0100

Conclusion: In this 2-ED population from a single geographic region, MRSA was the most common cause of community-onset adult septic arthritis. Synovial fluid cell counts were unexpectedly low in MRSA septic arthritis cases. (Source: Annals of Emergency Medicine)

A new anatomical landmark to simplify temporomandibular joint arthrocentesis

The British Journal of Oral and Maxillofacial Surgery — Tue, 28 Jul 2009 23:00:00 +0100

Arthrocentesis of the temporomandibular joint (TMJ) was first described by Nitzan et al. and is an accepted treatment for various disorders of the TMJ. Their technique includes insertion of two needles along the canthal-tragal line, the first of which is placed into the upper joint compartment of the TMJ, and the second anterior to the first to allow effective lavage of the joint (). However, in some cases it is difficult to insert the second needle, which means that lavage fails, the operation takes longer, the patient is uncomfortable, and there may be increased postoperative morbidity and possible damage to the facial nerve. For this reason single needle arthrocentesis has been proposed, in which inflow and outflow go through the same cannula. The joint is lavaged with a single needle u...

[Case Report] The emergence of lymphogranuloma venereum in Europe

LANCET — Thu, 23 Jul 2009 23:00:00 +0100

A 42-year-old white homosexual man presented to our clinic in April, 2008, with a 12-day history of right knee and back pain, conjunctivitis, and proctitis. 10 days earlier, after a normal radiograph, an arthrocentesis of his right knee had been done; 40 mL of clear synovial fluid was aspirated and corticosteroids were injected locally. There was no history of recent injury, febrile illness, or rheumatological conditions. He reported anonymous unprotected receptive anal sex 1 month earlier. Since 2000, he had had three episodes of uncomplicated urethritis, secondary syphilis, HIV, and an episode of primary syphilis (rapid plasma reagin [RPR] 1/32 in August, 2007). He had been taking antiretrovirals since October, 2007, with a CD4 count of 300 per μL (31%) and undetectable viral load in Ma...

Single-Puncture Arthrocentesis—Introducing a New Technique and a Novel Device

Journal of Oral and Maxillofacial Surgery — Fri, 17 Jul 2009 10:54:55 +0100

Arthrocentesis of the temporomandibular joint was introduced in 1991 by Nitzan et al and has since gained widespread popularity among practitioners who treat temporomandibular joint disorders. It is considered by many as the first-line surgical treatment for patients who do not respond to conservative treatment (physical therapy, occlusal splint therapy, pain medication, and lifestyle and behavioral changes). It is regarded as a minimally invasive procedure and is easily performed in an office setting. It allows lavage of the joint space and lysis of adhesions via hydraulic distension. (Source: Journal of Oral and Maxillofacial Surgery)

Emergency Joint Aspiration: A Guide for Radiologists on Call1 [RSNA Education Exhibits]

Radiographics recent issues — Wed, 15 Jul 2009 17:02:36 +0100

Septic arthritis is a disabling and possibly life-threatening disease that requires early diagnosis for optimal management. It is important that clinical and imaging features of septic arthritis be promptly identified. In addition, because other disease entities may have characteristics similar to those of septic arthritis, analysis of a needle biopsy specimen may be necessary for differential diagnosis. Radiologists may be asked to perform emergent aspiration of a possibly infected joint. It is important that those who perform aspiration procedures be familiar with a safe and effective imaging-guided arthrocentesis technique that is tailored to the individual patient and the specific joint affected. © RSNA, 2009 (Source: Radiographics recent issues)

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[RSNA Education Exhibits] Emergency Joint Aspiration: A Guide for Radiologists on Call

Radiographics recent issues — Tue, 14 Jul 2009 23:00:00 +0100

Emergency Joint Aspiration: A Guide for Radiologists on Call [RSNA Education Exhibits]

Radiographics recent issues — Tue, 14 Jul 2009 23:00:00 +0100

Evaluation of persistent pain after hip resurfacing.

Bulletin of the NYU Hospital for Joint Diseases — Thu, 09 Jul 2009 17:40:09 +0100

Authors: Evaluation and treatment of pain following hip resurfacing arthroplasty can be challenging, even for the most experienced arthroplasty surgeon. As in any total hip replacement, there are a number of investigative tools at the disposal of orthopaedic surgeons to elicit the underlying causes of pain for diagnosis and treatment. A detailed history and physical examination are the most important frst steps in the differential diagnosis of the intrinsic and extrinsic etiologies of hip pain. Serial radiographs from the time of surgery also should be reviewed and compared for changes indicative of loosening, migration, and osteolysis, in combination or alone. Diagnostic injections with local anesthetic agents additionally can be performed to localize the origin of pain. Bone scintig...

Effect of Repeated Arthrocentesis on Cytologic Analysis of Synovial Fluid in Dogs

Journal of Veterinary Internal Medicine — Thu, 25 Jun 2009 23:00:00 +0100

Serial arthrocentesis and synovial fluid examination can be used to monitor treatment efficacy in immune-mediated polyarthritis (IMPA), but whether this procedure induces inflammation that interferes with test result interpretation is unknown. The aim of this study was to determine the effect of repeated arthrocentesis on synovial fluid cytology in healthy dogs. Nine healthy client-owned dogs. Prospective study. Arthrocentesis was performed under sedation on 4 joints (both carpi, 1 tarsus, 1 stifle) on each dog every 3 weeks, a total of 4 times. Automated cell counts were done on stifle fluid, smears were made, and differential cell counts done on smears from all joints. Slides were evaluated microscopically for erythrocyte numbers, total nucleated cell count, differential cell count, and ...

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New Diagnostic Method For Gout: Dual Energy Computed Tomography Instead Of Joint Aspiration

Gout News From Medical News Today — Fri, 05 Jun 2009 08:00:00 +0100

The most reliable method of diagnosing gout is to aspirate the joint in order to obtain fluid to verify the presence of monosodiumurate crystals (uric acid). Up to now, computed tomography (CT) has played a limited role in the evaluation of gout, since conventional CT systems cannot reliably verify deposits of uric acid... (Source: Gout News From Medical News Today)

Arthrocentesis for the Treatment of Internal Derangements of the Temporomandibular Joint

Alpha Omegan — Mon, 01 Jun 2009 04:00:00 +0100

Internal derangements of the temporomandibular joint (TMJ) are characterized by displacement of the intra-articular disc, which acts as an obstacle to normal joint movement and results in clicking and popping sounds or locking and an inability to open the mouth widely. These conditions may be painless or they may be associated with pain, especially during function. The most common causes are trauma, which results in an immediate displacement of the disc, or chronic parafunction, which results in degenerative changes in the articular surfaces, increased friction, and gradual disc displacement. (Source: Alpha Omegan)

Arthrocentesis for the treatment of internal derangements of the temporomandibular joint.

The Alpha Omegan — Sun, 31 May 2009 23:00:00 +0100

Authors: Laskin DM Internal derangements of the temporomandibular joint (TMJ) are characterized by displacement of the intra-articular disc, which acts as an obstacle to normal joint movement and results in clicking and popping sounds or locking and an inability to open the mouth widely. These conditions may be painless or they may be associated with pain, especially during function. The most common causes are trauma, which results in an immediate displacement of the disc, or chronic parafunction, which results in degenerative changes in the articular surfaces, increased friction, and gradual disc displacement. PMID: 19591327 [PubMed - in process] (Source: The Alpha Omegan)

Aspiration alone versus aspiration and bupivacaine injection in the treatment of undisplaced radial head fractures: A prospective randomized study

Journal of Shoulder and Elbow Surgery — Sun, 31 May 2009 23:00:00 +0100

Discussion: Intra-articular use of local anaesthetic after joint aspiration does not offer any benefit over aspiration alone in the treatment of undisplaced radial head fractures and its routine application is not supported by the clinical data.Level of evidence: Level 1. (Source: Journal of Shoulder and Elbow Surgery)

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New Diagnostic Method For Gout: Dual Energy Computed Tomography Instead Of Joint Aspiration

Gout News From Medical News Today — Thu, 28 May 2009 15:00:00 +0100

The most reliable method of diagnosing gout is to aspirate the joint in order to obtain fluid to verify the presence of monosodium urate crystals (uric acid). Up to now, computed tomography (CT) has played a limited role in the evaluation of gout, since conventional CT systems cannot reliably verify deposits of uric acid... (Source: Gout News From Medical News Today)

Diagnostic accuracy of neutrophil-derived circulating free DNA (cf-DNA/NETs) for septic arthritis

Journal of Orthopaedic Research — Wed, 06 May 2009 04:00:00 +0100

In this study, we analyzed the putative diagnostic value of synovial cf-DNA/NETs for identification of septic arthritis. Forty-two patients with a joint effusion who had undergone arthrocentesis were included. From synovial fluid, cf-DNA/NETs (j-cf-DNA) levels were directly quantified. Diagnostic value of j-cf-DNA was compared with white blood cells (WBC), synovial white blood cells (j-WBC), C-reactive protein (CRP), j-IL-6, j-TNF alpha, j-IL-1 beta, and myeloperoxidase (j-MPO). Sensitivity, specificity, positive and negative predictive value, as well as ROC-curves for each parameter were calculated. Synovial fluid cf-DNA/NETs values from patients with septic arthritis (3,286 ± 386 ng/ml, n = 9) were significantly increased compared to patients with noninfectious joint inflammation (1,040...

Validity of tumour necrosis factor as a biomarker for joint disease

International Journal of Oral and Maxillofacial Surgery — Fri, 01 May 2009 04:00:00 +0100

The objectives of this study was to detect soluble tumour necrosis factor receptors in synovial fluids aspirates from temporomandibular joints with internal derangements after arthrocentesis with injection of sodium hyaluronate or cyclooxygenase-2 inhibitor in patients suffering from temporomandibular joint internal derangements. (Source: International Journal of Oral and Maxillofacial Surgery)

Combined splint and arthrocentesis therapy versus splint or arthrocentesis for treatment of temporomandibular joint internal derangement

International Journal of Oral and Maxillofacial Surgery — Fri, 01 May 2009 04:00:00 +0100

This study was designed to evaluate the efficacy of combined splint and arthrocentesis with sodium hyaluronate (SH) injection therapy versus splint or arthrocentesis with SH injection for treatment of temporomandibular joint (TMJ) internal derangement (ID). (Source: International Journal of Oral and Maxillofacial Surgery)

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Muscular disorders of temporomandibular joint treated with electroacupuncture

International Journal of Oral and Maxillofacial Surgery — Fri, 01 May 2009 04:00:00 +0100

Background and Objectives: Temporomandibular joint (TMJ) pain and dysfunction syndrome (PDS) is a common disorder of TMJ. Treatment options include: counselling, physiotherapy, pharmacotherapy, splint therapy, intra-articular steroids, arthrocentesis, surgery and further referral (orthodontic, neurology, ENT, etc.). Physiotherapy is beneficial to any patient with PDS of TMJ in which there is muscular involvement; electroacupuncture (EA) is one physiotherapy treatment and many international studies have demonstrated its effectiveness. Our group used EA since 2001 associated with surface electromyography of the masticatory muscles. (Source: International Journal of Oral and Maxillofacial Surgery)

[Evaluation of intra-articular collagenase, TIMP-1, and TNF-alpha levels before and after anterior cruciate ligament reconstruction.]

Acta Orthopaedica et Traumatologica Turcica — Thu, 30 Apr 2009 23:00:00 +0100

CONCLUSION: This study showed elevated levels of TNF-alpha, collagenase, and TIMP-1 due to the presence of ruptured ACL. Our findings showed how these levels changed in the acute postoperative period. PMID: 19717938 [PubMed - in process] (Source: Acta Orthopaedica et Traumatologica Turcica)

Temporomandibular joint osteoarthritis: an open label trial of 76 patients treated with arthrocentesis plus hyaluronic acid injections

International Journal of Oral and Maxillofacial Surgery — Wed, 29 Apr 2009 23:00:00 +0100

This study is an open-label trial on a sample of 76 consecutive patients with temporomandibular joint (TMJ) osteoarthritis treated with a cycle of five weekly arthrocenteses plus hyaluronic acid injections. Patients had a diagnosis of osteoarthritis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD Axis I Group IIIb). They underwent a cycle of five arthrocenteses with injections (1 per week) of 1ml hyaluronic acid and four follow-up assessments after the end of the treatment (at 1 week, 1 month, 3 months, 6 months). At each appointment, several subjective and objective outcome variables were assessed to test the efficacy of the treatment protocol. Marked improvements were reported for all variables during the treatment phase. The improvements were maint...

Joint aspiration and injection and synovial fluid analysis

Best Practice & Research. Clinical Rheumatology — Wed, 01 Apr 2009 04:00:00 +0100

Joint aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of joint disease. This chapter addresses: (1) the indications, the technical principles and the expected benefits and risks of aspiration and injection of intra-articular corticosteroid; and (2) practical aspects relating to SF analysis, especially in relation to crystal identification. Intra-articular injection of long-acting insoluble corticosteroids is a well-established procedure that produces rapid pain relief and resolution of inflammation in most injected joints. The knee is the most common site to require aspiration, although any non-axial joint is accessible for obtaining SF. The technique requires a knowledge of basic anatomy and should not be unduly painful ...

Septic arthritis as a severe complication of elective arthroscopy: Clinical management strategies.

Patient Safety in Surgery — Tue, 31 Mar 2009 04:00:00 +0100

Authors: Kirchhoff C, Braunstein V, Paul J, Imhoff AB, Hinterwimmer S ABSTRACT: Infection of a peripheral joint following arthroscopic surgery presents with an incidence of approximately 0.42% an extremely rare entity. However, septic arthritis is a serious situation possibly leading to an irreparable joint damage. Especially at delayed diagnosis patients' safety can be endangered severely. Only few precise statements regarding diagnosis and therapy have been published so far. Besides an accurate analysis of the patient's anamnesis and the assessment of the C-reactive protein especially arthrocentesis is required for diagnostic workup. For early stage infections arthroscopic therapy is proven to be of value. In addition a calculated and consecutive germ-adjusted antibiotic therapy is e...

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Arthrocentesis versus nonsurgical methods in the treatment of temporomandibular disc displacement without reduction

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics — Mon, 09 Mar 2009 00:00:00 +0100

Conclusion: We conclude that early treatment either with conservative methods or with arthrocentesis is beneficial in DDw/oR. However, arthrocentesis seems to be superior regarding pain management. Therefore, arthrocentesis may be indicated in patients where painful complaints overwhelm despite other conservative treatments. (Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics)

Arthrocentesis versus nonsurgical methods in the treatment of temporomandibular disc displacement without reduction.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics — Sat, 07 Mar 2009 05:00:00 +0100

CONCLUSION: We conclude that early treatment either with conservative methods or with arthrocentesis is beneficial in DDw/oR. However, arthrocentesis seems to be superior regarding pain management. Therefore, arthrocentesis may be indicated in patients where painful complaints overwhelm despite other conservative treatments. PMID: 19272808 [PubMed - as supplied by publisher] (Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics)

Use of a calibrated beaker in TMJ arthrocentesis.

The British Journal of Oral & Maxillofacial Surgery — Fri, 06 Mar 2009 05:00:00 +0100

Authors: Chhabra N, Chhabra S, Kumar YR PMID: 19269722 [PubMed - as supplied by publisher] (Source: The British Journal of Oral & Maxillofacial Surgery)

Micafungin plus Fluconazole in an Infected Knee with Retained Hardware due to Candida albicans (March).

The Annals of Pharmacotherapy — Tue, 03 Mar 2009 05:00:00 +0100

CONCLUSIONS: Although micafungin plus fluconazole showed positive results in our patient, more data are needed regarding combination therapy for fungal prosthetic joint infections. PMID: 19261955 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)

Acute Pediatric Monoarticular Arthritis: Distinguishing Lyme Arthritis From Other Etiologies

PEDIATRICS — Mon, 02 Mar 2009 05:00:00 +0100

CONCLUSIONS. Lyme arthritis shares features with both septic and nonseptic non-Lyme arthritis. This overlap prevents the creation of a clinically useful predictive model for Lyme arthritis. In endemic areas, Lyme testing should be performed on all patients presenting with acute monoarticular arthritis. (Source: PEDIATRICS)

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Arthrocentesis and synovial fluid analysis in clinical practice.

Annals of the New York Academy of Sciences — Sun, 01 Feb 2009 05:00:00 +0100

Authors: Punzi L, Oliviero F Joint aspiration, or arthrocentesis, is one of the most useful and commonly performed procedures for the diagnosis and treatment of joint diseases. The synovial fluid aspirated may be examined to evaluate the degree of inflammation and, mainly, to detect the presence of some relevant pathogenic agents, such as crystals or microorganisms. In these cases, synovial fluid analysis still represents the best diagnostic procedure. Arthrocentesis is thus particularly required for the diagnosis and management of the acute "hot red joint," which may be considered a true medical emergency because of the morbidity and mortality related to septic arthritis. The most recent recommendations on arthrocentesis confirm the need for the procedure in the presence of synovial e...

Arthrocentesis and synovial fluid analysis in clinical practice: value of sonography in difficult cases.

Annals of the New York Academy of Sciences — Sun, 01 Feb 2009 05:00:00 +0100

[Clinical features of gout in a cohort of Italian patients]

Reumatismo — Thu, 01 Jan 2009 00:00:00 +0100

CONCLUSIONS: The diagnosis of gout is not always easy because of its changing clinical spectrum. Identification of MSU crystals in joint aspirates was obtained only in a minority of patients. In this setting the diagnosis with gout was often based on the observation of an acute intermittent monoarthritis involving mainly the first metatarsophlangeal joint, associated with hyperuricaemia and responsive to colchicine. PMID: 19370187 [PubMed - indexed for MEDLINE] (Source: Reumatismo)

A new approach to arthrocentesis of the temporomandibular joint.

International Journal of Oral and Maxillofacial Surgery — Mon, 22 Dec 2008 05:00:00 +0100

We describe a new temporomandibular joint (TMJ) arthrocentesis technique using the irrigation pump from a surgical and dental implant motor, providing the highest hydraulic pressure reported in the literature for TMJ lavage. PMID: 19108990 [PubMed - as supplied by publisher] (Source: International Journal of Oral and Maxillofacial Surgery)

[Reviews] Aspiration of normal or asymptomatic pathological joints for diagnosis and research: indications, technique and success rate

Annals of the Rheumatic Diseases — Tue, 16 Dec 2008 05:00:00 +0100

Although joint aspiration is a basic clinical skill, aspiration of normal joints, or asymptomatic clinically quiescent joints, is only rarely undertaken. There are two main indications for this procedure. Firstly, for definitive diagnosis of crystal-associated arthritis (gout and pseudogout) during the intercritical period and for subsequent monitoring of treatment success of gout; and secondly, to obtain normal synovial fluid for biomarker research. The justification for these indications, the success rate and the technical aspects related to this procedure are presented in this article. (Source: Annals of the Rheumatic Diseases)

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Comparison of Ultrasound-Guided and Standard Landmark Techniques for Knee Arthrocentesis

The Journal of Emergency Medicine — Mon, 08 Dec 2008 00:00:00 +0100

Conclusion: US-guided knee arthrocentesis technique does not improve overall success of obtaining joint fluid aspirate vs. the standard LM and palpation technique. An US-guided approach does not result in more pain for the patient, takes no additional time to perform and, at least for novice physicians, leads to more fluid aspiration and greater novice provider confidence with the procedure. Further studies with more participants and standardization of anesthetic quantity are required to validate these findings. (Source: The Journal of Emergency Medicine)

Q&A: Billing for arthrocentesis

Modern Medicine Medical Economics — Fri, 05 Dec 2008 05:00:00 +0100

To receive payment for arthrocentesis and related procedures, attach a modifier –59 to the successive services. (Source: Modern Medicine Medical Economics)

Canine immune-mediated polyarthritis: clinical and laboratory findings in 83 cases in western Canada (1991-2001).

The Canadian Veterinary Journal — Mon, 01 Dec 2008 05:00:00 +0100

Authors: Stull JW, Evason M, Carr AP, Waldner C A hospital-based, case-control study was used to describe clinical and laboratory findings in 83 dogs diagnosed with noninfectious, nonerosive, immune-mediated polyarthritis (IMPA) in western Canada. Case medical records were reviewed. Cases were analyzed as total IMPA cases and as subgroups [breed, systemic lupus erythematosus (SLE), reactive, and idiopathic] and compared with the general canine hospital population. Dogs with IMPA differed in age (P = 0.004) and weight (P = 0.01) from other hospital admissions. Idiopathic IMPA cases were older (4-10 y; P < 0.05), compared with the general canine hospital population, and their common laboratory abnormalities included the following: leukocytosis, nonregenerative anemia, increased alkali...

Should local anesthesia be used for arthrocentesis and joint injections?

Rheumatology International — Thu, 27 Nov 2008 09:20:45 +0100

Content Type Journal ArticleCategory Short CommunicationDOI 10.1007/s00296-008-0785-3Authors Kye S. Park, University of New Mexico Health Sciences Center Department of Internal Medicine MSC 10 5550, 5th FL ACC Albuquerque NM 87106 USAAndres Peisajovich, University of New Mexico Health Sciences Center Department of Internal Medicine MSC 10 5550, 5th FL ACC Albuquerque NM 87106 USAAdrian A. Michael, University of New Mexico Health Sciences Center Department of Internal Medicine MSC 10 5550, 5th FL ACC Albuquerque NM 87106 USAWilmer L. Sibbitt, University of New Mexico Health Sciences Center Department of Internal Medicine MSC 10 5550, 5th FL ACC Albuquerque NM 87106 USAArthur D. Bankhurst, University of New Mexico Health Sciences Center Department of Internal Medicine MSC 10 5550, 5th FL...

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Long-term results of arthrocentesis in degenerative temporomandibular disorders.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics — Thu, 06 Nov 2008 05:00:00 +0100

CONCLUSIONS: Arthrocentesis was found to be a useful method for the treatment of degenerative TMDs, and the outcomes of treatment provide long-term cure for degenerative temporomandibular joints. PMID: 18996032 [PubMed - as supplied by publisher] (Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics)

Single needle arthrocentesis

The British Journal of Oral & Maxillofacial Surgery — Mon, 03 Nov 2008 00:00:00 +0100

Disorders of the temporomandibular joint (TMJ) secondary to internal derangements of the joint are common. Patients often present with pain, clicking, or locking, or both, of the joint, and management can be challenging. The conditions are usually managed conservatively by jaw exercises, occlusal splints, and the use of simple drugs such as tricyclic antidepressants. If all these fail, patients are offered minimally invasive procedures such as arthrocentesis and manipulation of the joint. (Source: The British Journal of Oral & Maxillofacial Surgery)

Single needle arthrocentesis.

The British Journal of Oral & Maxillofacial Surgery — Fri, 31 Oct 2008 04:00:00 +0100

Authors: Rehman KU, Hall T PMID: 18977563 [PubMed - as supplied by publisher] (Source: The British Journal of Oral & Maxillofacial Surgery)

Tuberculous knee arthritis presenting as staphylococcal infection

European Journal of Orthopaedic Surgery & Traumatology — Thu, 09 Oct 2008 10:30:55 +0100

We present the case of a 40-year-old female immigrant with a long-standing arthritis of her right knee. An arthrocentesis failed to grow any microorganism, but fluid from an arthroscopic lavage later grew initially coagulase-negative Staphylococcus and Mycobacterium tuberculosis after 3 weeks. Failure to ask for cultures of acid-fast bacilli from the beginning and to take biopsies due to low index of suspicion led to delayed diagnosis of tuberculosis with resultant osteoarthritic changes of the joint. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00590-008-0359-9Authors Athanassios Papanikolaou, Hellenic Red Cross Hospital Erythrou Stavrou 1 Athens GreeceIlias Galanopoulos, Hellenic Red Cross Hospital Erythrou Stavrou 1 Athens GreeceGeorge Arealis, Hellenic Red C...

Evaluation of a knee and shoulder arthrocentesis training program for primary care providers.

J Rheumatol — Wed, 01 Oct 2008 04:00:00 +0100

Authors: Schumacher HR, Chen LX, Glick L PMID: 18843770 [PubMed - in process] (Source: J Rheumatol)

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Primary septic arthritis of the acromio-clavicular joint: case report and review of literature

Archives of Orthopaedic and Trauma Surgery — Tue, 23 Sep 2008 10:14:45 +0100

We report a case of primary septic arthritis of the acromio-clavicular (A-C) joint caused by Staphylococcus aureus without any predisposing factors. The patient was admitted with left shoulder pain, restricted movements and fever. Laboratory parameters showed high C-reactive protein, raised erythrocyte sedimentation rate and leucocytosis. Blood cultures were positive for Staphylococcus-aureus. Magnetic resonance imaging (MRI) using Gadolinium enhancement revealed marked effusion in the A-C joint. Aspiration from the A-C joint revealed a heavy growth of Staphylococcus-aureus. The patient was successfully treated with 8 weeks of appropriate antibiotics with complete resolution of infection and return to full function. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.100...

[Aspiration of joint fluid for detection of the pathogen in periprosthetic infection.]

Der Orthopade — Sun, 14 Sep 2008 04:00:00 +0100

Authors: Frommelt L Periprosthetic infection is a rare but severe complication of a frequently performed procedure. The diagnosis of this mostly chronic infection is difficult due to the absence of classic signs of infection in one-third of the cases. In this context, periprosthetic infection may be proven by detecting the bacterial pathogen. Aspiration of joint fluid is a suitable method to obtain a representative specimen from the infection site. The puncture must be performed free of contamination, and microbiological processing must respect the special condition of these pathogens. For proof of infection in clinically doubtful cases, cytology of the joint fluid is useful. Aspiration of joint fluid is, apart from biopsy, one of the most important methods for detecting bacterial path...

[Infection after arthroscopy.]

Der Orthopade — Fri, 12 Sep 2008 04:00:00 +0100

Authors: Paul J, Kirchhoff C, Imhoff AB, Hinterwimmer S Infection of a peripheral joint following arthroscopic surgery is extremely rare, with an incidence of up to 0.42%. However, the consequences of delayed diagnosis can be dramatic. Besides taking an exact patient history, C-reactive protein determination and, especially, diagnostic arthrocentesis are required. For early-stage infections, arthroscopic therapy has been proven valuable. In addition, calculated and antibiogram-adjusted antibiotic therapy is essential. In the case of persisting signs of infection, re-arthroscopy should be considered quickly, with indications broad. The number of necessary revisions depends on the initial stage of infection. Postoperative immobilisation of the affected joint is occasionally essential for...

Degeneration of normal articular cartilage induced by late phase osteoarthritic synovial fluid in beagle dogs.

Tissue and Cell — Thu, 07 Aug 2008 04:00:00 +0100

CONCLUSION: Based on these results, we conclude that OA degeneration of normal articular cartilage can be independently induced by late phase OA SF. Endogenous OA biological etiological factor may be one of the reasons causing degenerative cartilage extending in OA joint. PMID: 18692211 [PubMed - as supplied by publisher] (Source: Tissue and Cell)