Search Results (14)

Lipoma arborescens (LA) is a rare, non-neoplastic, intra-articular, mass-like lesion with villous lipomatous proliferation that replaces and distends the synovium, particularly in the knee joint. A few cases have been sporadically reported to affect the shoulder, elbow, wrist, hip, and ankle. The authors would like to present a rare and unique case of LA in the elbow joint with significant osteoarthritis in a 24-year-old young man, which suggests that a longstanding pre-existing LA can give rise to severe degenerative arthritis even in young patients unless diagnosed early and adequately treated. Full article

Background: Total elbow arthroplasty (TEA) was initially introduced for end-stage rheumatoid arthritis but has since expanded to include osteoarthritis and complex distal humerus fractures, particularly in elderly patients. Over the past two decades, TEA utilization trends have fluctuated, with a recent decline attributed to advancements in disease-modifying antirheumatic drugs. Despite its benefits, TEA presents a high complication rate, necessitating further investigation into clinical outcomes, costs, and postoperative management. Methods: This retrospective cohort study analyzed TEA procedures from 2016 to 2019 using the National Inpatient Sample (NIS) database. Patients were identified via ICD-10 codes, with elective procedures included to ensure homogeneity. This study examined temporal trends, patient demographics, comorbidities, complication rates, length of stay (LOS), and hospitalization costs. Statistical analyses included chi-square tests, t-tests, and multivariate regression to assess associations between patient characteristics and outcomes. Results: A total of 4110 TEA procedures were analyzed, revealing a 16% decline in annual volume from 2016 to 2019 (p = 0.012). The cohort had a mean age of 65.99 years, with a predominance of female (75.3%) and White (72.6%) patients. The median LOS was two days, and median hospitalization costs were USD 78,473 (IQR: 56,935–115,671 USD). The most prevalent complications included mechanical loosening (12.5%), blood loss anemia (10.6%), cardiac complications (5.7%), and prosthetic-related pain (3.3%). Multivariate analysis identified hypertension, anemia, and respiratory disease as significant predictors of adverse outcomes. Conclusions: TEA utilization has declined, likely due to medical advancements in rheumatoid arthritis management. The procedure remains associated with substantial complication rates, particularly in trauma-related cases. Findings highlight the importance of patient optimization, surgical expertise, and postoperative monitoring to improve outcomes. Full article

Background: Total elbow arthroplasty (TEA) has evolved over time from a salvage procedure to a successful treatment of end-stage primary and secondary arthritis. However, the aseptic loosening and the associated reduced survival rate are still concerning. Thus, TEA is typically contraindicated in young and active patients where high-demand activities would promote aseptic loosening. For this reason, postoperative weightlifting limitations are often suggested, yet there is no consensus. The aim of this survey was to collect and analyze the current practice concerning the weightlifting restrictions following elbow arthroplasties among members of the Italian Society of Shoulder and Elbow Surgery (Società Italiana Chirurgia Spalla e Gomito, SICSeG). Methods: An online survey on the lifting restrictions after elbow arthroplasties was submitted to all members of the SICSeG. Results: In total, 36 members of the Italian society completed the survey. Only five consultants (13.8%) have experience with all the implants analyzed, of whom only three have experience with more than 10 implants per year. Concerning the comprehensive number of elbow arthroplasties performed per year, most of the respondents (45.7%) reported fewer than five surgeries per year, whereas only two surgeons claimed more than 20 procedures. Of the 36 respondents, 32 (88.9%) reported lifelong lifting limitations after linked TEA. In detail, these lifting restrictions were 10 lb in 14 responders (38.9%) and 5 lb in 15 responders (41.7%) performing linked TEA. A lifelong lifting limitation gradually decreased after unlinked TEA and hemiarthroplasty (HA) being advised by 82.8% (24/36) and 64.5% (20/36), respectively. Conclusions: To increase implant longevity, most Italian surgeons advise lifting restrictions after TEA. More than 80% of the responders agreed with suggesting lifelong limitations, but a greater variability was found in the amount of weight to which the patients are restricted. Currently, the lack of consensus on the optimal weightlifting restrictions after elbow replacements emphasizes the need for more studies focusing on elbow joint loading during different activities of daily life to improve implant survival rates. Full article

Background: In recent years, the use of short cementless humeral components in reverse total shoulder arthroplasty (RTSA) has increased. This systematic review aimed to compare the radiological and clinical outcomes of uncemented RTSA using short versus standard humeral stems and assess the impact of these radiological changes on clinical outcomes. Methods: A systematic electronic search was performed by two independent reviewers using PubMed, Scopus, and Cochrane Library databases on 10 December 2024. Inclusion criteria involved studies that assessed the radiological and clinical outcomes and overall complication rates of cementless RTSA with short or standard stems in patients with osteoarthritis, cuff tear arthropathy, post-traumatic, and rheumatoid arthritis with a follow-up of at least 1 year. The following data were extracted: radiological parameters of stems including implant subsidence, humeral loosening, and humeral osteolysis and clinical outcomes as Visual Analog Scale pain, American Shoulder and Elbow Surgeons score, Constant Score and Single Assessment Numeric Evaluation score. Results: A total of 13 studies including 1485 shoulders in 1460 patients were analyzed with a median age at surgery of 74.5 years. The short stem group recorded worse radiological outcomes examined such as humeral loosening, lucencies around the implants, and osteolysis. No significant differences were observed in the clinical outcomes and overall complications between the two types of stems. Conclusions: Both short and standard stems are valid options in cementless RTSA. Minimal differences in radiological outcomes were found in favor of RTSA implanted with short stems, while postoperative clinical outcomes were similar between the two types of implants. Full article

The black skimmer (Rynchops niger) is a state-threatened, colonially nesting seabird in Florida, USA. Conservation threats include habitat alteration, human disturbances, severe weather, and predation. During nest monitoring (May–September, 2020–2022), black skimmer juveniles at colonies on Fort Myers Beach and Marco Island, Florida, had polyarthritis and died or were euthanized due to severe illness. Similarly-aged skimmers from geographically distant (considered unaffected) colonies were evaluated for comparison (2021–2023). We documented field, clinical, radiographical, and pathological findings to characterize disease and purported pathogenesis. The majority were lame and lethargic, in poor nutritional condition, and dehydrated. Additionally, 8/23 of the skimmers with dermatitis and arthritis from affected colonies also had penetrating sandspurs associated with skin ulceration, scabbing, and/or hemorrhage. The affected joints were often in limbs (interphalangeal and hock; less commonly stifle, elbow, carpus). A postmortem evaluation and bacteriology revealed Staphylococcal aureus-associated dermatitis, arthritis, tenosynovitis, and/or osteomyelitis in 21/22 of the juvenile skimmers from southwestern nest colonies. Staphylococcus aureus dissemination to internal organs occurred in 10/13 of the skimmers tested. Among skimmers evaluated from distant colonies, 5/10 that were examined histologically had skin crusting and inflammation but lacked arthritis. Occasional coinfections were documented (e.g., West Nile virus, Gram-negative bacilli). The results suggest that staphylococcal joint disease originated from sandspur-induced skin damage, followed by hematogenous dissemination to the joints and, occasionally, the internal organs. Additional nest sites should be tested to evaluate disease risk and potentially contributing environmental factors. We recommend that site managers employ techniques that reduce the risk of skimmer interactions with sandspurs. Full article

Background: In psoriatic arthritis (PsA), musculoskeletal ultrasound is a complementary tool to physical examination, useful even in patients in remission to detect subclinical activity. Objectives: The objective of the study was to assess the ultrasound prevalence of active enthesitis and synovitis in patients who reached the therapeutic target. Methods: This cross-sectional study included patients with at least 6 months of therapy with a targeted synthetic or biological disease-modifying antirheumatic drug who were in treatment target (i.e., DAPSA < 14). Patients underwent bilateral clinical and ultrasound examination of the elbow lateral epicondyle, quadriceps insertion, distal patellar tendon insertion, and Achilles enthesis for assessing enthesitis, and hand and foot joints for assessing synovitis. Enthesitis and synovitis were considered active if the power Doppler signal showed at least a score of one. Results: The study included 51 PsA patients, women (52.9%), with an average age of 55 years. Although the patients were within the DAPSA treatment target, 21.6% had at least one painful enthesis at clinical examination, 19.6% had ultrasound evidence of at least one active enthesitis and 15.7% had ultrasound signs of at least one active synovitis. Conclusions: Among PsA patients thought to be within the therapeutic target, ultrasound detected a non-negligible percentage of active enthesitis and synovitis. Full article

Native joint septic arthritis (NJSA) is a severe and rapidly progressing joint infection, predominantly bacterial but also potentially fungal or viral, characterized by synovial membrane inflammation and joint damage, necessitating urgent and multidisciplinary management to prevent permanent joint damage and systemic sepsis. Common in large joints like knees, hips, shoulders, and elbows, NJSA's incidence is elevated in individuals with conditions like rheumatoid arthritis, diabetes, immunosuppression, joint replacement history, or intravenous drug use. This review provides a comprehensive overview of NJSA, encompassing its diagnosis, treatment, antibiotic therapy duration, and surgical interventions, as well as the comparison between arthroscopic and open debridement approaches. Additionally, it explores the unique challenges of managing NJSA in patients who have undergone graft anterior cruciate ligament (ACL) reconstruction. The epidemiology, risk factors, pathogenesis, microbiology, clinical manifestations, diagnosis, differential diagnosis, antibiotic treatment, surgical intervention, prevention, and prophylaxis of NJSA are discussed, highlighting the need for prompt diagnosis, aggressive treatment, and ongoing research to enhance patient outcomes. Full article

Psoriatic disease is a chronic, relapsing inflammatory disorder, characterized mostly by cutaneous erythematous scaly plaques sometimes associated with arthritis. Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory disease of the apocrine glands, characterized clinically by painful abscesses, sinus tracts and scars. It typically occurs after puberty, affecting mainly intertriginous areas of the body. There is a strong association between HS and psoriasis since they share the same pathogenic inflammatory pathway. The patient presented: low birthweight, microcephaly, facial dysmorphisms, lumbar hyperlordosis, walking difficulties, global psychomotor developmental delay and learning disabilities. A genetic evaluation revealed a 2.5 Mb de novo microduplication in the 17q21.31 chromosomal region. Dermatological examination revealed HS (Hurley stage II-HS) distributed in the genital area and inguinal folds, psoriatic plaques on the retroauricolar folds, on the elbows bilaterally and on the lateral aspect of the right ankle and psoriatic arthritis. The patient was treated with adalimumab, with a marked improvement of both conditions. To our best knowledge, we report the first case of coexisting Psoriatic Arthritis Disease and Hidradenitis Suppurativa in a child with chromosome 17q21.31 microduplication syndrome. We hypothesize that gene CRHR1 duplication included in the 17q21.31 chromosomal region might be involved in the pathogenesis of both diseases. Full article

Ureaplasma parvum is usually part of the normal genital microbiota. Rarely, it can cause invasive infections such as septic arthritis or meningitis. A case of a 74-year-old woman with follicular lymphoma who developed cellulitis followed by elbow arthritis with negative routine bacterial cultures is described. U. parvum was identified in the synovial fluid using a broad-range 16S ribosomal RNA gene polymerase chain reaction (PCR) and also in vaginal fluid by a targeted PCR (Anyplex™ II STI-7). Multilocus Sequence Typing (MLST) revealed that isolates from both sources belonged to ST4, a worldwide distributed clone. Treatment consisted of surgery and targeted antibiotic therapy with doxycycline and azithromycin. Evolution showed initial clinical improvement in arthritis despite functional sequelae. Ureaplasma arthritis should be considered as a rare cause of arthritis in negative culture, especially in immunosuppressed patients. In these cases, the treatment is not well established, but according to this and previous works, patients could improve with doxycycline, azithromycin or fluoroquinolone therapy on a prolonged basis. Full article

Clinical examination (CE) and musculoskeletal ultrasound (MSUS) of ten joints (knee, ankle, wrist, elbow, II-MCP) and their extra-articular (EA) compartments (tendons and bursae) were performed on 35 consecutive patients with active juvenile idiopathic arthritis (JIA) (active group) to test how the extension of MSUS examinations to EA changes the concordance between MSUS and CE. The overall concordance between CE and MSUS, measured with Cohen’s Kappa (k), was moderate (k = 0.43); the addition of EA MSUS increased the concordance in all joints, with the exclusion of II-MCP (k = 0.49). In the ankle and wrist, the k increase was relevant (k from 0.13 to 0.27 and 0.11 to 0.41). In the active group patients, we observed 44 subclinical synovitis; the number of subclinical synovitis per patient was correlated with JADAS-27 (p = 0.03) and was higher in a control group composed of 15 patients with persistent disease remission (1.3 vs. 0.4 p = 0.03). Our results show that EA compartments should always be evaluated during MSUS. Furthermore, we demonstrate a moderate concordance between CE and MSUS in JIA; the finding of subclinical synovitis is common in patients with active diseases and is related to disease activity. Full article

Rheumatoid arthritis and osteoarthritis can be treated through specific drug injection into the intra-articular space. Several failures during drug injection attempts with conventional fluoroscopy and ultrasonography in a small area of the intra-articular space have been reported. In this work we present an innovative impedance measurement-based method/algorithm for needle tip positioning to enhance image-guided intra-articular vaccination treatment. A novel algorithm for detecting the intra-articular space in the elbow and knee joints of a live porcine model is reported. An impedance measurement system was developed for biological tissue measurement. The electrical impedance in the intra-articular space was monitored and the needle tip was examined by ultrasonography. The contrast dye was vaccinated and checked using fluoroscopy to confirm that the dye was properly inoculated in the cavity. The electrical impedance was estimated for various needle inclusion profundity levels in saline solution, which were broadly used to evaluate the proposed device for in vivo examinations. Good efficiency was observed in the impedance-based measurements using a monopolar injection needle for intra-articular therapy. To enhance the needle tip positioning for intra-articular therapy, the intended impedance measurement device with a monopolar injection needle can be used as a complement to existing modalities. Full article

Several studies have underlined the interplay among host-microbiome and pathophysiological conditions of animals. Research has also focused specifically on whether and how changes in the gut microbiome have provoked the occurrence of pathological phenomena affecting cartilage and joints in humans and in laboratory animals. Here, we tried to evaluate the relationship between the gut microbiome and the hip and elbow arthritis in owned dogs. The study included 14 dogs suffering from chronic arthritis (AD) and 13 healthy dogs (HD). After the first visit and during the period of the study, the dogs, under the supervision of the owner, were fed a semi-moist complete diet supplemented with omega 3 fatty acids. Feces and blood samples were collected in the clinic at the first visit (T0) and after days (T45). The plasma C-reactive protein (CRP) was higher, and the serum vitamin B12 and folate concentrations were lower (p < 0.05) in the AD group in comparison to the HD group. Data of the fecal microbiome showed that the relative abundances of the genus Megamonas were higher in AD (p < 0.001), while the relative abundance of the families Paraprevotellaceae, Porphyromonadaceae, and Mogibacteriaceae was significantly lower in comparison to HD. The results of the study identified several bacterial groups that differed significantly in the fecal microbiome between healthy and diseased dogs. If the observed differences in fecal bacterial composition predispose dogs to hip and elbow arthritis or if these differences reflect a correlation with these conditions deserves further investigation. Full article

Objectives: The prevalence of elbow joint arthritis in rheumatoid arthritis (RA) assessed by ultrasound has not yet been investigated. Methods: We investigated 102 patients with RA and 50 patients without rheumatological disease. Both elbow joints were examined by ultrasound for effusion, hypervascularization, and enthesitis. A clinical examination was performed, and Disease Activity Score in 28 joints (DAS28), and visual analog scale for pain (VASp) were recorded. Arthritis was defined as joint effusion (≥grade II) and synovial hyperperfusion. Results: The RA cohort versus the control group displayed a joint effusion in 54.9% vs. 6.9%, a hypervascularization in 6.8% vs. 0%. Arthritis was detected in 36 RA patients (35.29%) and no one in the control group. Four (3.8%) RA patients and one (1%) control displayed enthesitis. The RA cohort showed a significant correlation between movement restriction and joint effusion (p-value = 0.001) as well as DAS28 (p-value = 0.02) and between DAS28 and ultrasound detected arthritis (p-value = 0.022). In an overall analysis, a highly significant correlation of VASp with movement restriction (MR) (p-value ≤ 0.001), the presence of joint effusion (p-value ≤ 0.001), and the diagnosis of RA (p-value ≤ 0.001) were observed. Interrater analysis of ultrasound imaging showed good agreement with Cohen’s kappa of 0.896. Conclusion: The prevalence of elbow arthritis in RA seems to be high, with 35.29%. Movement restriction is a good indicator, but not in all RA patients (32 vs. 70 patients without MR) compared to the control group (5 vs. 45 patients without MR). Reported pain correlates with joint effusion and MR (p-value ≤ 0.001). Full article

The elbow joint could be associated with degenerative processes of primary and post-traumatic aetiology. Among these, osteoarthritis may also be secondary to repeated use as well as trauma. Pain, discomfort and progressive loss of functionality are common signs of this condition. The evaluation of elbow osteoarthritis should comprise an in-depth study to detect the primary cause of the illness and to facilitate the decision-making process regarding personalized treatment. Discordance between clinical manifestations and radiological findings is common. Conservative approaches may provide symptomatic relief in the early stages of disease for most patients. The goal of the treatment is to reduce pain and ensure an adequate range of motion and proper functioning of the joint while preserving the anatomical structure, to postpone elbow arthroplasty interventions for as long as possible. According to treatment guidelines, surgery should be considered depending on aetiology and severity, patient age, and functional demands. This narrative review aims to investigate the current literature regarding the pathogenesis and treatment of primary and post-traumatic arthritis of the elbow. Full article