MedWorm: Arthrocentesis

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)

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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)

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...

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)

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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 ...

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)

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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)

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)

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[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)

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)

[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

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)

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

Health News from Medical News Today — Fri, 05 Jun 2009 07:00:00 +0100

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)

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

Health News from Medical News Today — Thu, 28 May 2009 14:00:00 +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: Health 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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[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

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...

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)

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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)

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...

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[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)

Ultrasound-guided therapeutic procedures in the musculoskeletal system.

Current Problems in Diagnostic Radiology — Thu, 31 Jul 2008 10:57:46 +0100

Authors: del Cura JL Ultrasound allows the exploration of most of the musculoskeletal system, including lytic bone lesions. Its flexibility, availability, and low cost make it the best tool to guide interventional therapeutic procedures in any musculoskeletal system lesion visible on ultrasound. These techniques include drainages of abscesses, bursitis, hematomas or muscular strains, treatment of cystic lesions (ganglions, Baker's cysts), arthrocentesis, injection of substances in joints and soft tissues, and aspiration of calcific tendinitis. Although the puncture of joints for arthrocentesis and injection of substances are performed by clinicians using palpation, the use of ultrasound guidance improves the effectiveness of the technique especially for small or poorly accessible lesio...

Diagnosis of periprosthetic infection following total hip arthroplasty - evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection

BioMed Central — Mon, 21 Jul 2008 04:00:00 +0100

Conclusions: The detection of PJI is still a challenge in clinical practice. The histopathological evaluation emerges as a highly practical diagnostic tool in detection of PJI. Furthermore, we found a discrepancy between the pre-operative suspicion of PJI and the final post-operative diagnosis, resulting in a slight uncertainty in whether loosening is due to bacterial infection or not. The variation in accuracy of the single tests may influence the detection of PJI. Level of Evidence: Diagnostic Level I. (Source: BioMed Central)

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Stage-dependant management of septic arthritis of the shoulder in adults

International Orthopaedics — Fri, 04 Jul 2008 05:55:31 +0100

Abstract Diagnostic and therapeutic standards relating to septic conditions of the shoulder are rarely documented in the literature. For this study, patients suffering from septic shoulder arthritis were prospectively enrolled. Staging was based on the criteria of Gächter (Stutz et al., Knee Surg Sports Traumatol Arthrosc 8:270–274, 2000), and assessment of functional outcome was based on a self-assessed Constant score (Boehm et al., Unfallchirurg 107:397–402, 2004). Patients were separated into three groups according to the CEBI-classification reported by Pfeiffenberger and Meiss (Arch Orthop Trauma Surg 115:325–331, 1996). Forty-three patients were enrolled. Group I contained 21% of patients, while 23% were assigned to group II, and 56% to group III. Staphylococcus...

The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements.

The Journal of Bone and Joint Surgery. British volume — Tue, 01 Jul 2008 04:00:00 +0100

Authors: Fink B, Makowiak C, Fuerst M, Berger I, Schäfer P, Frommelt L We analysed the serum C-reactive protein level, synovial fluid obtained by joint aspiration and five synovial biopsies from 145 knee replacements prior to revision to assess the value of these parameters in diagnosing late peri-prosthetic infection. Five further synovial biopsies were used for histological analysis. Samples were also obtained during the revision and incubated and analysed in an identical manner for 14 days. A total of 40 total knee replacements were found to be infected (prevalence 27.6%). The aspiration technique had a sensitivity of 72.5% (95% confidence interval (CI) 58.7 to 86.3), a specificity of 95.2% (95% CI 91.2 to 99.2), a positive predictive value of 85.3% (95% CI 73.4 to 100), a nega...

A survey of the management of gout in primary care.

Ir Med J — Thu, 01 May 2008 04:00:00 +0100

This study aims to assess current practice in the context of the 2006 EULAR evidence based recommendations for diagnosis and management of gout. A 20 point questionnaire was circulated to all 170 general practitioners in the North Dublin GP Partnership assessing frequency of diagnostic and therapeutic interventions undertaken. 91% of practitioners manage gout exclusively in primary care. 89% make a diagnosis on clinical grounds and 77% routinely measure serum urate. Diagnostic joint aspiration is rarely performed (3%). 86% routinely assess and manage risk factors for gout. 66% initiate urate-lowering therapy. Only 32% routinely monitor urate levels in patients receiving urate-lowering therapy. Thus, although management of gout in primary care in Ireland is generally in line with the EULAR ...

Arthrocentesis of the temporomandibular joint: a proposal for a single-needle technique.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics — Thu, 17 Apr 2008 04:00:00 +0100

Authors: Guarda-Nardini L, Manfredini D, Ferronato G Arthrocentesis is a method of flushing out the temporomandibular joint (TMJ) that is currently performed by providing a double access to the joint space. Several studies have shown that arthrocentesis of the upper compartment of the TMJ may be a highly effective method to restore normal maximal mouth opening and functioning. Nonetheless, the classical 2-needle technique has some limits, such as the low tolerability and difficulty in performing it in the presence of intra-articular adherences. The adoption of a single-needle for both fluid injection and aspiration might have some advantages with respect to the traditional 2-needle approach in terms of time of execution, tolerability, and retention of medication. These potential advant...

[Extended reports] Septic arthritis in Iceland 1990-2002: increasing incidence due to iatrogenic infections

Annals of the Rheumatic Diseases — Fri, 11 Apr 2008 04:00:00 +0100

Conclusions: The incidence of SA has increased in recent years due to an increased number of arthroscopies and joint injections. Although the frequency of SA per procedure has not changed, these results emphasise the importance of sterile technique and firm indications for joint procedures. (Source: Annals of the Rheumatic Diseases)

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Inflammatory cytokines in juvenile idiopathic arthritis: Effects on physical growth and the insulin-like-growth factor axis.

Growth Hormone and IGF Research — Fri, 28 Mar 2008 04:00:00 +0100

CONCLUSION: Children with JIA and mild degree of growth retardation show decreased ALS and IGFBP-3. Cytokines did not show an association to systemic markers of GH secretion. However, this study reports the novel, preliminary association between serum levels of IL5 and IL15 and the extent of short stature. PMID: 18378173 [PubMed - as supplied by publisher] (Source: Growth Hormone and IGF Research)

Does the use of soft or hard splints affect the short-term outcome of temporomandibular joint arthrocentesis?

International Journal of Oral and Maxillofacial Surgery — Tue, 18 Mar 2008 04:00:00 +0100

Authors: Alpaslan C, Kahraman S, Güner B, Cula S Arthrocentesis is an effective treatment modality for temporomandibular joint (TMJ) disc displacement without reduction (DDw/oR), especially in patients who do not respond to non-surgical methods, and is nowadays regarded as a first-line treatment. Soft and hard stabilizing splints have also been used to treat TMJ disorders, but no data are available regarding the use of splints following arthrocentesis. The aim of this study was to compare the effect of the use of soft or hard stabilizing splints versus no appliance following TMJ arthrocentesis on the prognosis of the treatment. Forty-five patients with DDw/oR were included in the study. Pain was measured on a visual analog scale, and maximal mouth openings, lateral jaw movements a...

What is the significance of a positive Propionibacterium acnes culture around a joint replacement?

International Orthopaedics — Sat, 08 Mar 2008 10:04:17 +0100

Abstract The purpose of this study was to show the significance of a positive Propionibacterium acnes sample around a joint replacement. Records from the microbiology laboratory data over a 3-year period were reviewed to identify patients with prosthetic joints from whom Propionibacterium acnes was isolated at least once. The medical records of all those patients were retrieved and the demographic, clinical, microbiological and haematological data were collected and examined. The preoperative values of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded. Fifty patients underwent a routine revision of a joint arthroplasty; six patients had a joint aspiration. Only one patient had further revision surgery for infection. The preoperative values of ES...

Commentary: is there a role for arthrocentesis in recapturing the displaced disc in patients with closed lock of the temporomandibular joint.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics — Tue, 19 Feb 2008 22:16:02 +0100

Authors: Dolwick MF PMID: 18280959 [PubMed - as supplied by publisher] (Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics)

A case highlighting the influence of knee joint effusion on muscle inhibition and size.

Nature Clinical Practice. Rheumatology. — Tue, 29 Jan 2008 05:00:00 +0100

Authors: Reeves ND, Maffulli N, Background The patient sustained an injury that caused knee joint effusion. The patient had undergone reconstruction of the anterior cruciate ligament on the right knee approximately 8 years before this injury.Investigations The influence of knee joint effusion on the isometric and dynamic torque characteristics, neural drive and muscle size of the knee extensors was analyzed during the first 11 weeks of recovery. Maximum knee extensor torque and electromyographic (EMG) activity were assessed on a weekly basis. MRI scans of the thigh were taken to quantify vastus medialis muscle cross-sectional area.Diagnosis Initial knee joint aspiration resulted in an 85-399% increase in isometric knee extensor torque and a 9-706% increase in vastus lateralis and vast...

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An Intervention to Improve Procedure Education for Internal Medicine Residents

Journal of General Internal Medicine — Thu, 24 Jan 2008 16:59:15 +0100

Conclusions A comprehensive procedure service rotation of 2 weeks duration substantially improved residents’ comfort and self-perceived knowledge in performing invasive procedures. These benefits persisted at least to the end of the academic year. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11606-008-0513-4Authors Amanda Lenhard, Case Western Reserve University at MetroHealth Medical Center Department of Medicine Cleveland OH USAMoayyed Moallem, Case Western Reserve University at MetroHealth Medical Center Department of Medicine Cleveland OH USARuth Ann Marrie, University of Manitoba Departments of Medicine & Community Health Sciences Winnipeg MB CanadaJeffrey Becker, Case Western Reserve University at MetroHealth Medical Center Department ...

Joint fluid antioxidants are decreased in osteoarthritic joints compared to joints with macroscopically intact cartilage and subacute injury.

Osteoarthritis and Cartilage — Thu, 17 Jan 2008 05:00:00 +0100

CONCLUSIONS: EC-SOD, the major scavenger of reactive oxygen species (ROS) in extracellular spaces and fluids, is decreased in late stage OA joint fluid compared to fluid from injured/painful joints with intact cartilage. Injured joints may be able to increase or maintain secretion of EC-SOD but it appears that late stage OA joints fail to do so in spite of increased oxidative stress seen in the disease. Associated age related declines in GSH and ascorbate might also contribute to the development of severe OA. The net effect of these changes in joint fluid antioxidants is likely to accelerate the damaging oxidant effects on extracellular matrix stability in cartilage tissue. PMID: 18203633 [PubMed - as supplied by publisher] (Source: Osteoarthritis and Cartilage)

[Concise reports] First metatarsophalangeal joint aspiration using a 29-gauge needle

Annals of the Rheumatic Diseases — Fri, 11 Jan 2008 05:00:00 +0100

Conclusions: A 29-gauge needle allows easy aspiration of the first MTP joint with only modest discomfort for the patients, and generally yields a SF sample of sufficient volume for crystal detection and identification. (Source: Annals of the Rheumatic Diseases)

[Septic arthritis: what is the role for the rheumatologist?]

Reumatismo — Tue, 01 Jan 2008 05:00:00 +0100

Authors: Schiavon F, Favero M, Carraro V, Riato L Septic arthritis (SA) is a clinical emergency with considerable morbidity and mortality that can lead to rapid joint destruction and irreversible loss of function. The reported incidence varies from 2-5 cases per 100.000 individuals per year in the general populations to 70 cases per 100.000 individuals annually among patients with rheumatoid arthritis (RA). Predisposing factors are immunosuppressive and corticosteroids therapy and RA "itself". The expected decrease in incidence of SA was not seen over the last 20 years period but we can, on the contrary, expect an increase in the frequency of its appearance because of the population ageing, the increasingly prosthetic joint replacement, the ability of the bacteria to evade clearance by...

Prosthetic joint infection: When to suspect it, how to manage it

Geriatrics Magazine — Sat, 15 Dec 2007 05:00:00 +0100

The number of prosthetic joint infections in the United States is rising because of our aging population and the increasing number of adults undergoing joint replacement surgery. The cardinal symptom of prosthetic joint infection is recurrent pain in the joint. Diagnosis requires joint aspiration or operative biopsy. Successful outcomes require expert orthopedic surgical management and prolonged antibiotic therapy. (Source: Geriatrics Magazine)

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Gout, have we met before? No, not like this…

Journal of General Internal Medicine — Fri, 30 Nov 2007 15:18:50 +0100

Abstract Extra-articular symptoms could be the first manifestation of gouty arthritis (GA); polyarticular GA can mimic an infectious arthritis; infection can complicate GA. A 66-year-old male with a history of gout presented with high fever and excruciating bilateral calf pain for 1 day. Examination revealed chronic knee effusions; range of motion in both knees was limited by calf pain. Joint aspiration showed negatively birefringent intracellular crystals and normal gram stain. While receiving empiric antibiotics fever continued and he developed bilateral knee, right ankle, and shoulder pain. After demonstration of urate crystals and exclusion of infection, antibiotics were discontinued and steroids initiated. Fever, calf pain, and polyarthritis quickly resolved. Polyarti...

Is there a role for arthrocentesis in recapturing the displaced disc in patients with closed lock of the temporomandibular joint?

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics — Thu, 29 Nov 2007 05:00:00 +0100

CONCLUSIONS: The results indicate that arthrocentesis, in association with MM and IA, could be effective in improving function and reducing pain in patients with closed lock. Better results were obtained in terms of MMO, VAS, and questionnaire scores in acute closed lock cases than in chronic ones. Recapturing the anteriorly displaced disc is possible only in patients with acute closed lock. PMID: 18061492 [PubMed - as supplied by publisher] (Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics)

Influence of residency training on procedures performed by South Carolina family medicine graduates.

Famly Medicine — Thu, 01 Nov 2007 04:00:00 +0100

CONCLUSIONS: Increasing performance of exercise stress testing and ICU care by recent graduates and reported lack of training for several outpatient procedures may reflect evolving roles for family physicians. New residency training modalities may improve training for these roles. PMID: 17987415 [PubMed - in process] (Source: Famly Medicine)

Intracellular Oxidative Activation in Synovial Fluid Neutrophils from Patients with Rheumatoid Arthritis But Not from Other Arthritis Patients.

J Rheumatol — Mon, 15 Oct 2007 04:00:00 +0100

CONCLUSIONS: A novel finding with pathogenetic implications in our study is that SF neutrophils from patients with RA, but not other arthritides, are activated and produce ROS intracellularly. This implies that synovial neutrophils in RA are engaged in the processing of endocytosed material. PMID: 17937476 [PubMed - as supplied by publisher] (Source: J Rheumatol)

Arthrocentesis in the treatment of loose bodies of the temporomandibular joint associated with synovial chondromatosis.

The British Journal of Oral & Maxillofacial Surgery — Sat, 06 Oct 2007 04:00:00 +0100

We present a case that affected the temporomandibular joint (TMJ) and was treated with arthrocentesis, which is an efficient, conservative, and inexpensive treatment. PMID: 17920736 [PubMed - as supplied by publisher] (Source: The British Journal of Oral & Maxillofacial Surgery)

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Established rheumatoid arthritis - new imaging modalities.

Best Practice & Research. Clinical Rheumatology — Wed, 19 Sep 2007 01:10:50 +0100

Authors: McQueen FM, Ostergaard M New imaging modalities are assuming an increasingly important role in the investigation and management of rheumatoid arthritis. It is now possible to obtain information about all tissues within the joint in three dimensions using tomographic techniques such as magnetic resonance imaging (MRI) and high-resolution computerized tomography. Erosions are very clearly depicted using these modalities and MRI also allows imaging of soft tissues with assessment of joint inflammation. High-resolution ultrasound is a convenient clinical technique for the assessment of erosions, synovitis and tenosynovitis in real-time and facilitates diagnostic and therapeutic interventions such as joint aspiration and injection. Exciting experimental modalities are also being de...

[Laboratory diagnosis of rheumatic diseases : Part 3: arthritides caused by infection.]

Zeitschrift fur Rheumatologie — Sun, 26 Aug 2007 04:00:00 +0100

Authors: Hartung K, Ehrfeld H, Gerritzen A, Kuipers JG, Wolters B This third part of this series of articles on laboratory diagnostics of rheumatic diseases considers the rheumatic diseases caused by infection by microorganisms, or reactive arthritides.The basis for laboratory diagnostics of infection-reactive arthritides is the investigation of anti-infection antibodies. In some situations, DNA amplification methods may be helpful. Bacterially infected joints should be immediately examined by arthrocentesis and microscopic examination and laboratory culture of the synovial fluid. PMID: 17721785 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Rheumatologie)

Primer: pitfalls of aspiration and injection.

Nature Clinical Practice. Rheumatology. — Wed, 01 Aug 2007 04:00:00 +0100

Authors: Roberts WN This review on joint aspiration and injection focuses on three common clinical problems: how to deal with 'dry taps', especially when a septic joint is suspected in the differential diagnosis; how to avoid rare complications associated with these techniques; and how to reduce pain in patients who are particularly sensitive. Solutions to these problems are proposed, and although no new data or insights are provided, this article could be used as a noncomprehensive check list for trainee rheumatologists. This review focuses on the knee, because of the common appearance of septic joints in the differential diagnosis of inflammatory knee effusion, and the paramount importance of septic joints in this setting. The five reasons for failing to aspirate fluid from a difficu...

[Musculoskeletal Imaging] Septic Arthritis Versus Transient Synovitis of the Hip: Gadolinium-Enhanced MRI Finding of Decreased Perfusion at the Femoral Epiphysis

American Journal of Roentgenology — Mon, 23 Jul 2007 04:00:00 +0100

CONCLUSION. Decreased perfusion at the femoral epiphysis on fat-suppressed gadolinium-enhanced coronal T1-weighted MRI is useful for differentiating septic arthritis from transient synovitis. (Source: American Journal of Roentgenology)

[Extended reports] Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout

Annals of the Rheumatic Diseases — Thu, 12 Jul 2007 04:00:00 +0100

Conclusions: In gout, reduction of SUA to normal levels results in disappearance of urate crystals from SF, requiring a longer time in those patients with gout of longer duration. This indicates that urate crystal deposition in joints is reversible. Normalisation of SUA levels results in a decrease in the concentration of MSU crystals in SF in the asymptomatic gouty joints. This may partially explain the reduced frequency of gouty attacks when a patient has been treated with SUA-lowering drugs. (Source: Annals of the Rheumatic Diseases)

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Treatment of acute gout in hospitalized patients.

J Rheumatol — Sun, 01 Jul 2007 04:00:00 +0100

DISCUSSION: Crystal analysis, the gold standard for diagnosing gout, was performed in only 25% of patients suspected of acute gout. Combination antiinflammatory agents are used in over 50% of patients despite the absence of evidence to support use of such combinations. Renal failure was present in 73% of patients with acute gout. Colchicine and NSAID should therefore be used with caution in these patients. Practice patterns vary widely and often appear to be in conflict with recommended diagnostic and treatment measures for acute gout. PMID: 17610315 [PubMed - in process] (Source: J Rheumatol)

Arthrocentesis for the treatment of temporomandibular joint closed lock: a review article.

International Journal of Oral and Maxillofacial Surgery — Mon, 18 Jun 2007 04:00:00 +0100

Authors: Al-Belasy FA, Dolwick MF Although arthrocentesis is not a panacea, it has been widely used for a variety of temporomandibular joint (TMJ) disorders. Uncritical acceptance of the procedure has been cautioned against, as further analysis and clarification of published studies was required. The aim of this article was to review the efficacy of arthrocentesis in the treatment of patients with TMJ closed lock. The rationale behind this approach was based on the notion that TMJ surgical results should be reported by the specific category of TMJ disorder. After a Medline search of the international literature, 14 articles were found fulfilling the criteria set forth by this article. Another five articles were added after an additional hand search based on the available references of ...

Arthroscopic Lavage Plus Corticosteroids Was More Effective Than Arthroscopic Lavage Plus Placebo or Joint Aspiration Plus Corticosteroids for Arthritis of the Knee

JBJS [Am] — Tue, 01 May 2007 04:00:00 +0100

(Source: JBJS [Am])

THE RATIONAL CLINICAL EXAMINATION: Does This Adult Patient Have Septic Arthritis?

JAMA — Tue, 03 Apr 2007 04:00:00 +0100

Conclusions Clinical findings identify patients with peripheral, monoarticular arthritis who might have septic arthritis. However, the synovial WBC and percentage of polymorphonuclear cells from arthrocentesis are required to assess the likelihood of septic arthritis before the Gram stain and culture test results are known. (Source: JAMA)

Effect of repeated arthrocentesis and single joint lavage on cytologic evaluation of synovial fluid in 5 young calves.

Canadian Journal of Veterinary Research — Sun, 01 Apr 2007 04:00:00 +0100

This study demonstrated that, although arthrocentesis induces a moderate inflammatory response, the joints seem to rapidly adapt. A 4-d interval between arthrocenteses is suitable when studying cellular components of the synovial fluid. However, when arthrocentesis is repeated daily, a minimal interval of 8 d should be respected. PMID: 17479776 [PubMed - indexed for MEDLINE] (Source: Canadian Journal of Veterinary Research)

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Joint Aspiration (Arthrocentesis)

MedicineNet Arthritis General — Wed, 21 Mar 2007 07:00:00 +0100

Title: Joint Aspiration (Arthrocentesis)Category: Procedures and TestsCreated: 10/17/1998 3:13:00 PMLast Editorial Review: 3/21/2007 (Source: MedicineNet Arthritis General)

Oxidant and anti-oxidant systems of synovial fluid from patients with knee post-traumatic arthritis

Journal of Orthopaedic Research — Thu, 22 Feb 2007 07:00:00 +0100

This study aimed to establish whether this is really the case. Synovial fluid samples were obtained by transdermal arthrocentesis from 69 patients with PA (36 of them had HA) and 22 control subjects. The activities of synovial fluid zinc-copper superoxide dismutase (ZnCuSOD) and manganese superoxide dismutase (MnSOD) isoenzymes, catalase (CAT), glutathione peroxidase (GPX), glutathione reductase (GR) and glutathione-S-transferase (GST) enzymes, and malondialdehyde (MDA) concentration and synovial fluid viscosity were measured in the study groups. Patients with PA had significantly increased activities of all antioxidant enzymes, except CAT, and MDA concentration than did the controls. However, synovial fluid viscosity was found to be decreased in the study group, mainly in the HA subgroup....

Reduced Pain of Intraarticular Hyaluronate Injection With the Reciprocating Procedure Device.

JCR: Journal of Clinical Rheumatology — Tue, 06 Feb 2007 03:29:01 +0100

Patients report more pain during arthrocentesis than many recognize. This recently developed reciprocating syringe for joint aspiration and injection was shown to produce less discomfort during the procedure than the usual method. (Source: JCR: Journal of Clinical Rheumatology)

The Value of Joint Aspirations in the Diagnosis and Management of Arthritis in a Hospital-based Rheumatology Service.

Ann Acad Med Singapo... — Thu, 01 Feb 2007 05:00:00 +0100

Conclusion: Joint aspiration provides a definitive diagnosis or information that aids diagnosis in a significant number of patients in a hospital-based rheumatology service. PMID: 17364076 [PubMed - in process] (Source: Ann Acad Med Singapo...)

[Original articles] Diagnostic utility of laboratory tests in septic arthritis

Emergency Medicine Journal — Wed, 24 Jan 2007 07:00:00 +0100

Conclusions: jWBC was the best diagnostic test for septic arthritis, WBC and ESR were poor tests. However, no test was diagnostic, and the clinician must be careful with patients with a potential septic joint. (Source: Emergency Medicine Journal)

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Topical ethyl chloride fine spray. Does it have any antimicrobial activity?

Clinical Radiology — Mon, 22 Jan 2007 16:46:02 +0100

CONCLUSION: The use of ethyl chloride shows bacterial count reduction but the clinical implication of this needs to be determined. The authors postulate that any statistically significant reduction can only be helpful in reducing the infection rates. This coupled with the already proven local anaesthetic effects of ethyl chloride will make it an important tool for procedures like arthrocentesis and venepunctures. PMID: 17097428 [PubMed - in process] (Source: Clinical Radiology)

Temporomandibular joint arthrocententesis: evaluation of results and review of the literature.

Revista Brasileira de Otorrinolaringologia — Thu, 18 Jan 2007 17:59:02 +0100

CONCLUSION: Arthrocentesis was shown to be effective in reducing pain and increasing jaw motion in this series of cases. PMID: 17221055 [PubMed - in process] (Source: Revista Brasileira de Otorrinolaringologia)

[Temporomandibular joint arthrocententesis: evaluation of results and review of the literature.]

Revista Brasileira de Otorrinolaringologia — Tue, 16 Jan 2007 15:41:03 +0100

CONCLUSION: Arthrocentesis was shown to be effective in reducing pain and increasing jaw motion in this series of cases. PMID: 17221055 [PubMed - as supplied by publisher] (Source: Revista Brasileira de Otorrinolaringologia)

Ultrasound-guided hip arthrocentesis in the ED.

The American Journal of Emergency Medicine — Mon, 01 Jan 2007 07:00:00 +0100

Authors: Freeman K, Dewitz A, Baker WE In patients presenting with atraumatic joint pain and swelling, diagnosis is typically made by synovial fluid analysis. Management of an acute suspected hip joint arthritis can present a challenge to the emergency physician (EP). Hip joint effusions are somewhat more difficult to identify and aspirate than effusions in other joints that are commonly managed by EPs. Identification and aspiration of a hip joint effusion under ultrasound guidance is a well-established procedure in the fields of orthopedic surgery and interventional radiology. Here, we report 4 cases of ultrasound-guided hip arthrocentesis at the bedside by EPs; relevant technical details of the procedure are reviewed. These cases demonstrate the feasibility of ultrasound-guided hip a...

Results of treatment of septic knee arthritis: a retrospective series of 40 cases

Knee Surgery, Sports Traumatology, Arthroscopy — Thu, 07 Dec 2006 08:48:31 +0100

Abstract??We studied a consecutive series of 40 patients presenting a septic knee arthritis, with a mean age of 49???20 (range 19?81) years. The aetiologies were: 18 postoperative arthritis, 12 haematogenous infections, 7 arthritis following aspiration or infiltration, and 3 articular wounds. The most common organisms wereStaphylococcus aureusandepidermidis(23 cases). Surgical procedures consisted in 20 arthroscopic debridements, 6 open debridements, 14 synovectomies. According to G?chter?s classification, there were 8 stage I, 18 stage II, 11 stage III and 3 stage IV cases. Fifteen patients had to be reoperated after the index procedure at our institution: one open debridement, six open synovectomies, one open arthrolysis, one arthrodesis and six total knee arthroplasties (TKA). Final exa...

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Comparison of efficacy of arthroscopic lavage plus administration of corticosteroids, arthroscopic lavage plus administration of placebo, and joint aspiration plus administration of corticosteroids in arthritis of the knee: A randomized controlled trial

Arthritis Care and Research — Thu, 30 Nov 2006 07:00:00 +0100

To compare the efficacy of arthroscopic lavage plus administration of corticosteroids (ALC), arthroscopic lavage plus administration of placebo (ALP), and joint aspiration plus administration of corticosteroids (JAC) in knee arthritis, and to evaluate whether clinical or histologic characteristics determine outcome.Patients with knee arthritis (not due to gout, osteoarthritis, or septic arthritis) were randomized over 3 treatment arms: ALC, ALP, and JAC. The primary end point was event-free survival, with events defined as 1) recurrence or persistence of symptomatic knee swelling necessitating local re-treatment, or 2) nonimprovement of the knee joint score. Synovial tissue specimens were collected and analyzed histologically to identify predictive factors of responsiveness.A total of 78 p...

Preoperative application of EMLA((R)) cream and the temporomandibular arthrocentesis procedure.

The British Journal of Oral & Maxillofacial Surgery — Thu, 26 Oct 2006 06:00:00 +0100

Authors: Fanzca JS PMID: 17070629 [PubMed - as supplied by publisher] (Source: The British Journal of Oral & Maxillofacial Surgery)

Anchored disc phenomenon with a normally positioned disc in the temporomandibular joint: Characteristics and behaviour.

The British Journal of Oral & Maxillofacial Surgery — Fri, 20 Oct 2006 06:00:00 +0100

Authors: Kaneyama K, Segami N, Shin-Ichi T, Fujimura K, Sato J, Nagao T We aimed to elucidate the pathogenesis and evaluate the therapeutic behaviour of patients with an anchored disc phenomenon but a normally positioned disc of the temporomandibular joint (TMJ). Fourteen patients with internal derangement including closed lock of one TMJ were examined. All had normally positioned discs. Synovial fluid was collected from the TMJ by arthrocentesis. Their symptoms, and the protein concentration in the synovial fluid, were evaluated. Their median duration of illness was 3 months (range 0.5-12), and the median protein concentration was low (343mug/ml; range 36-791). Arthrocentesis was successful in nine. Arthroscopic findings in the five unsuccessful cases showed severe intra-articular adh...

[Usefulness of anti-cyclic citrullinate peptide antibody determination in synovial fluid analysis of patients with rheumatoid arthritis]

Reumatismo — Sat, 07 Oct 2006 15:39:03 +0100

CONCLUSION: Our study give evidence for a preferential production of anti-CCP antibodies at RA joint level, confirming the pathogenetic role of these autoantibodies. Moreover, SF determination of anti-CCP, corrected for the total amount of the corresponding immunoglobulin, may be helpful as diagnostic tool in selected cases. PMID: 16829989 [PubMed - in process] (Source: Reumatismo)

[Milwaukee shoulder syndrome (apatite associated destructive arthritis): therapeutic aspects.]

Reumatismo — Sat, 07 Oct 2006 15:39:03 +0100

Authors: Epis O, Viola E, Bruschi E, Benazzo F, Montecucco C Milwaukee shoulder is a well defined clinical entity that can be observed in particular in older women. It is a destructive arthropathy associated with the deposition of calcium pyrophosphate dihydrate cristals, characterized by the presence of large amount of synovial fluid and a complete tear of the rotator cuff. Clinical features include pain, swelling and progressive functional impairment. The first-line treatment include the use of analgesic drugs and repeated arthrocentesis followed by intra-articular steroid administration; closed-needle tidal irrigation has been reported to be useful. In late phase we can observe narrowing of the acromion-humeral and of the gleno-humeral joint and progressive degenerative changes at t...

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[Extended reports] EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT)

Annals of the Rheumatic Diseases — Thu, 14 Sep 2006 06:00:00 +0100

Conclusions: 12 key recommendations for management of gout were developed, using a combination of research based evidence and expert consensus. The evidence was evaluated and the SOR provided for each proposition. (Source: Annals of the Rheumatic Diseases)

Gout, Have We Met before? No, Not Like This…

Journal of General Internal Med — Mon, 21 Aug 2006 23:00:00 +0100

Extra-articular symptoms could be the first manifestation of gouty arthritis (GA); polyarticular GA can mimic an infectious arthritis; infection can complicate GA. A 66-year-old male with a history of gout presented with high fever and excruciating bilateral calf pain for 1 day. Examination revealed chronic knee effusions; range of motion in both knees was limited by calf pain. Joint aspiration showed negatively birefringent intracellular crystals and normal gram stain. While receiving empiric antibiotics fever continued and he developed bilateral knee, right ankle, and shoulder pain. After demonstration of urate crystals and exclusion of infection, antibiotics were discontinued and steroids initiated. Fever, calf pain, and polyarthritis quickly resolved. Polyarticular gouty attack is an u...

Gout, Have We Met before? No, Not Like This…

Journal of General Internal Med — Mon, 21 Aug 2006 23:00:00 +0100

CORRESPONDENCE: Arthrocentesis Video

New England Journal of Medicine — Thu, 10 Aug 2006 12:05:05 +0100

To the Editor: In the video of arthrocentesis of the knee by Thomsen et al. (May 11 issue),1 a folded ... (Source: New England Journal of Medicine)

Reciprocating Syringe Better Than Conventional Syringe for Arthrocentesis

Medscape Medical News Headlines — Sun, 30 Jul 2006 12:31:01 +0100

In a randomized study, the reciprocating syringe prevented significant pain, reduced procedure time, and improved clinician performance of arthrocentesis. (CME)Medscape Medical News (Source: Medscape Medical News Headlines)

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[Extended reports] A randomised controlled trial of the reciprocating syringe in arthrocentesis

Annals of the Rheumatic Diseases — Wed, 12 Jul 2006 06:00:00 +0100

Conclusions: Arthrocentesis with a conventional syringe results in moderate to severe pain in 60% of subjects. The reciprocating syringe prevents significant pain, reduces procedure time, and improves physician performance of arthrocentesis. The reciprocating syringe is superior to the conventional syringe in arthrocentesis. (Source: Annals of the Rheumatic Diseases)

Pediatric Hip Pain: Transient Synovitis Versus Septic Arthritis

Journal of Diagnostic Medical Sonography — Tue, 09 May 2006 06:00:00 +0100

Although there are many causes of an irritable hip in children, transient synovitis and septic arthritis are the two most common etiologies. Both present with inability or difficulty to bear weight on the affected leg, pain, stiffness, limp, and fluid within the synovium. Because of potential serious complications associated with septic arthritis, accurate and early differentiation between the two processes is important. The workup for pediatric hip pain includes a thorough history and physical examination, appropriate laboratory studies, pelvis/hip radiography, hip sonography, and possible arthrocentesis. (Source: Journal of Diagnostic Medical Sonography)

Rationale and indications for arthrocentesis of the temporomandibular joint.

The Alpha Omegan — Tue, 01 Jul 2003 04:00:00 +0100

Authors: Nitzan DW PMID: 12955783 [PubMed - indexed for MEDLINE] (Source: The Alpha Omegan)