Excision Of Bursa Research Articles

Are There Any Significant Risk Factors Associated with Lateral Trochanteric Pain in Patients Who Have Undergone Primary Hip Replacement?

Introduction Lateral pain around the greater trochanter (LTP) is a common complication after total hip arthroplasty (THA) that can significantly reduce quality of life. The aim of this study was to analyze the relationship between lateral trochanteric bursa repair, subcutaneous fat thickness, and trochanteric pain during the THA procedure. Materials and methods A total of 98 patients who underwent THA for hip arthrosis between 2021 and 2022 were evaluated retrospectively. For all evaluated patients, subcutaneous thickness was measured between the fascia and the skin at the incision site. Bursa repair was performed in 47 patients, while bursa excision was done in 51 patients. The data obtained included demographic information, functional scores, comorbidities, bursa repair and skin thickness values, radiographic evaluations, and other specific markers. These were compared between patients diagnosed with LTP following THA and the controls. Results No difference was observed between the study groups in terms of subcutaneous fat thickness, bursa repair, and other demographic or radiographic evaluations. As expected, there were statistically significant differences between the groups in terms of the visual analog scale (VAS) score (p=0.030) and the Harris hip score (HHS) (p=0.045). When comparing the groups with and without LTP, the VAS score was higher in the group with LTP, while the HHS was found to be lower. Conclusion Trochanteric pain is not associated with bursa repair or subcutaneous thickness. LTP cannot be predicted based on comorbidities such as smoking, BMI, or radiographic measurements.

Clinical Outcomes Following Open Olecranon Bursa Excision for Septic and Aseptic Olecranon Bursitis: An Observational Study.

Background and objective Olecranon bursitis (aseptic or septic) is caused by inflammation in the bursal tissue. While it is typically managed with conservative measures, refractory cases may indicate surgical intervention. There is currently limited research about outcomes following bursal excision for both septic and aseptic etiologies. In light of this, the purpose of this study was to determine if patients experienced improvementfollowing surgical olecranon bursa excision and to compare outcomes between septic and aseptic forms. Materials and methods A retrospective review was performed involving patients who underwent olecranon bursa excision from 2014 to 2021. Demographic data, patient characteristics, surgical data, and outcome-related data were collected from themedical records. Patients were classified into subgroups based on the type of olecranon bursitis (septic or aseptic). Preoperative and one-year postoperative 12-item short-form survey (SF-12) resultsand range of motion (ROM) outcomes were evaluated for the entire cohort as well as the subgroups. Results We included 61 patients in our study and found significant improvement in the Physical Component Scale 12 (PCS-12) score for all patients (42.0 vs. 45.5, p=0.010) following surgery. However, based on subgroup analysis, the aseptic group improved in PCS-12 following surgery (41.5 vs. 46.8, p<0.001), but the septic group did not (43.6 vs. 40.5, p=0.277).No improvements were found in the Mental Component Scale 12 (MCS-12) scores following surgery in either group. Eighteen of the 61 patients experienced postoperative complications (29.5%), but only 6.5% required a second surgical procedure. Specifically, 14 of the 18 complications occurred in the aseptic group while two septic and two aseptic patients required additional surgeries. Elbow ROM did not change significantly after surgery but more patients were found to have full ROM postoperatively (83.0% to 91.8%, p=0.228). Conclusion Our findings suggest that patients with refractory olecranon bursitis, particularly if aseptic, tend to gain significant physical health benefits from open bursectomy.

Factors associated with revision surgery for olecranon bursitis after bursectomy

The primary aim of our study was to identify the factors associated with revision surgery after bursal excision in patients with olecranon bursitis. The secondary aims were to describe the revision rate after bursectomy and to assess which factors are associated with flap surgery after bursectomy and describe the most common complications after bursectomy of the olecranon bursa. We included 191 adult patients with olecranon bursitis who underwent olecranon bursa excision between January 2002 and October 2018. Patients who were pregnant, patients with incomplete records of the primary surgical procedure, and patients who underwent bursectomy during elbow arthroplasty were excluded. After manual chart review, we found that 22 patients had undergone revision surgery. Bivariate analysis was performed to assess the association between revision surgery and patient characteristics, comorbidities, and clinical characteristics. Additionally, we collected data regarding postoperative complications and intraoperative variables such as the use of drains, vacuum assisted closure therapy, and flap surgery. The overall revision rate in our cohort was 11.5% (22 of 191 patients). Bivariate analysis showed that patients who underwent revision surgery were more frequently women (P = .004), more often had a history of ipsilateral (P = .020) or contralateral (P = .012) olecranon bursitis, and more often received a diagnosis of rheumatoid arthritis (P = .001) or diabetes mellitus (P = .019). The most common complications were delayed wound healing (n = 8, 4.2%) and osteomyelitis (n = 8, 4.2%). Flap surgery was performed in 5 patients (2.6%). Bivariate analysis showed that patients with rheumatoid arthritis underwent flap surgery more frequently (P = .011). The revision rate after bursectomy for olecranon bursitis was 11.5% (22 of 191 patients). Patients with rheumatoid arthritis, diabetes mellitus, or a history of ipsilateral and contralateral olecranon bursitis and female patients underwent revision surgery after bursectomy for olecranon bursitis more frequently. In addition, patients with rheumatoid arthritis underwent flap surgery after bursectomy more frequently.

A New Option for the Reconstruction of Primary or Recurrent Ischial Pressure Sores: Hamstring-Adductor Magnus Muscle Advancement Flap and Direct Closure.

Owing to the high recurrence rates of ischial pressure sores, surgeons should consider the possibility of future secondary flap surgery during flap selection. The purpose of this article is to present a new surgical option for the reconstruction of primary or recurrent ischial pressure sores using a simple hamstring-adductor magnus advancement flap and direct closure. After horizontal fusiform skin excision, complete bursa excision and ischiectomy were performed. The tenomuscular origin of the adductor magnus and the conjoined tenomuscular origin of the biceps femoris long head and semitendinosus were isolated and completely detached from the inferior border of the ischial tuberosity. They were then advanced in a cephalad direction without detachment of the distal tendon or muscle and securely affixed to the sacrotuberous ligament. The wound was directly closed without further incision or dissection. Twelve ischial pressure sores (6 primary and 6 recurrent; 12 patients) were surgically corrected. The follow-up period was 12 to 65 months. All patients healed successfully without early postoperative complications, such as hematoma, seroma, infection, wound dehiscence, or partial necrosis. Late complications included wound disruption 5 weeks after surgery that spontaneously healed in 1 case and recurrence 3 years later in another case. The new surgical option presented herein, which involves hamstring-adductor magnus advancement flap and direct closure, is a simple and reliable method for providing sufficient muscle bulk to fill the dead space and proper padding to the bone stump while preserving the main vascular perforators and pedicles as well as future surgical options.

Ulnar-sided Wrist pain due to Extensor Carpi Ulnaris tendon subluxation: A case report

Traumatic Extensor Carpi Ulnaris (ECU) sublaxation is often missed and undiagnosed or wrongly diagnosed. ECU muscle plays a key role in active movement of wrist extension, ulnar deviation and also in providing suport to the ulnar side of wrist. Its position relative to the other structures in the wrist changes with forearm pronation and supination. As such it must be mobile yet stable. This structure can be injured in a variety of different athletic activity and following fall on outstretched hand. It lies subcutaneously and easily palpated and visualized, allowing early diagnosis and management. We in our study report a case of traumatic ECU sublaxation. An 18 year old female patient presented to our OPD with ulnar side wrist pain. MRI showed volar subluxed ECU tendon with ruptured ECU sheath. We had done open ECU sheath repair and excision of bursa. Very few literature shows traumatic ECU sublaxation report. The case is reported for the rarity of presentation and likely to misdiagnose in day to day clinical scenario.

Azygos lobe presenting as right para-tracheal shadow.

CASE SUMMARY Fifty-seven years old male patient, non-addict, unemployed, was referred to Pulmonary Medicine OPD by anesthesiologist, in view of right paratracheal shadow, detected as an incidental finding during routine preanesthetic check up. The patient was posted for left malleolar bursa excision surgery. The patient did not have any respiratory complains, when he visited Pulmonary Medicine OPD. The patient had undergone angiography 7 months ago which did not reveal any abnormality. He was operated for fracture neck femur 13 years ago. On examination the patient was afebrile, with a pulse rate of 80 beats per minute, regular, and had blood pressure of 140/90 mmHg, respiratory rate of 20/min. Rest of general examination and respiratory system examination did not reveal any abnormality. Breath sounds were equal on both sides. INVESTIGATIONS Hb: 9.6 gm%, WBC: 11,000, N: 70, L: 20, E: 03, M: 05, ESR: 79, Platelets: 2,80000, BUN: 18 mg, Serum creatinine: 1.0 mg/dl, Total proteins: 7.5 gm/dl Albumin: 3.6 gm/dl, Globulin: 3.9 gm/dl, Total Bilirubin: 0.6 mg/dl, Direct Bilirubin: 0.2 mg/dl, SGPT: 13 IU, SGOT: 19 IU, Alkaline phosphatase: 77 KA, FBS: 93 mg%, PLBS: 155 mg%, Spirometry was within normal limits. CXR: Right paratracheal shadow HRCT Chest: Figure 1a and bFigure 1: (a) CXR: Right paratracheal shadow. (b) CT thorax imageQUESTIONS What is the diagnosis? Q1. Enlarged thymus Q2. Substernal goitre Q3. Pleural Bands Q4. Azygos lobe ANSWER Right azygos lobe HRCT chest: Right azygos lobe DISCUSSION An azygos lobe is a rare anomaly of lung and the incidence of the same varies from 0.4% to 1%.[1]. Azygos lobe was first mentioned by Wrisberg in1778 from anatomical studies, described as “Lobus Wrisbergi.” An azygos lobe is formed when a precursor of the azygos vein fails to migrate over the apex of the lung during fetal life, instead of course through the lung dragging lung with it, the parietal and visceral pleura [Figure 2]. The four layers of pleura are known as “Azygos Fissure.” Since there is no corresponding alteration in segmental architecture, “Lobe” is a misnomer.[1] Embryologically, a part of upper lobe of the right lung may come to lie medial to the azygos vein. This part is called the azygos lobe. In this condition, the azygos vein is suspended from the wall of the thorax by a fold of parietal pleura (mesoazygous).[2] It is commonly seen in males and has also been reported on the left side.[3] An azygos lobe is not susceptible to disease.[1] However, multiple authors have reported spontaneous pneumothorax associated within the azyos lobe in adult and pediatric patients.[456] Clinically, the knowledge of azygos lobe anatomy is important during thoracic surgical approaches.[3]Figure 2: Formation of an azygos lobe

Calcaneoplasty and reattachment of the Achilles tendon for insertional tendinopathy.

To report the one-year outcome of 44 patients treated with a novel technique of calcaneoplasty and reattachment of the Achilles tendon. 15 men and 29 women (mean age, 53 years) with insertional tendinopathy of the Achilles tendon underwent calcaneoplasty, retrocalcaneal bursa excision, debridement and reattachment of the Achilles tendon with suture anchors via a lateral approach. Outcome was measured using the visual analogue score (VAS) for pain, the SF-36 health survey, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. Patient expectation and satisfaction were also assessed. Of the 44 patients, 37, 43, and 21 were followed up at 3, 6, and 12 months. The mean VAS for pain and AOFAS ankle-hindfoot score improved significantly up to 6 months. The mean SF-36 score improved significantly up to 6 months for physical functioning, role functioning (physical), and bodily pain. Patient expectation and satisfaction also improved significantly. No patient had postoperative infections or rupture. Three patients had delayed wound healing, which resolved after simple dressings. Calcaneoplasty and reattachment of the Achilles tendon via a lateral approach for insertional tendinopathy enables early weight bearing and achieves good outcome and pain relief.

Achilles Tendon Reattachment after Surgical Treatment of Insertional Tendinosis Using the Suture Bridge Technique: A Case Series

Achilles tendinopathy is a clinical diagnosis characterized as a triad of symptoms including pain, swelling, and impaired performance of the diseased tendon. Achilles tendinopathy is divided into Achilles tendonitis and tendinosis based on histopathological examination. Achilles tendinosis is viewed microscopically as disorganized collagen, abnormal neovascularization, necrosis, and mucoid degeneration. Insertional Achilles tendinosis is a degenerative process of the tendon at the junction of the tendon and calcaneus. This disease is initially treated conservatively with activity modification, custom orthotic devices, heel lifts, and immobilization. After 3 to 6 months of conservative therapy has failed to alleviate symptoms, surgical management is indicated. Surgical management of insertional Achilles tendinosis includes Achilles tendon debridement, calcaneal exostosis ostectomy, and retrocalcaneal bursa excision. In this case series, we present 4 patients who underwent surgical management of insertional Achilles tendinosis with complete tendon detachment. All patients underwent reattachment of the Achilles tendon with the suture bridge technique. The Arthrex SutureBridge® (Arthrex, Inc., Naples, FL) device uses a series of 4 suture anchors and FiberWire® (Arthrex Inc.) to reattach the Achilles tendon to its calcaneal insertion. This hourglass pattern of FiberWire® provides a greater area of tendon compression, consequently allowing greater stability and possible earlier return to weightbearing activities. The patients were followed up for approximately 2 years’ duration. There were no intraoperative or postoperative complications. At final follow-up there was no evidence of Achilles tendon ruptures or device failures. All patients were able to return to their activities of daily living without the use of assistive devices. The patients’ average visual analog pain scale was 1 (range 0 to 4), and their average foot functional index score was 3.41 (range 0 to 10.71). The suture bridge technique is a viable option for Achilles tendon repair after surgical management of insertional Achilles tendinosis.

Longitudinal tendon tear concurrent with bilateral medial luxation of the superficial digital flexor muscle tendon in a dog

Luxation of the superficial digital flexor muscle tendon (SDFMT) is a rarely reported condition in dogs, and tendon tear concurrent with SDFMT luxation had never been reported. Abnormal conformation of both calcanei and strenuous activity were suspected as contributing factors in this case. Bilateral medial SDFMT luxation was surgically treated with bursa medial incision release, redundant lateral bursa excision and apposition to the edge of the SDFMT with nonabsorbable sutures. The unilateral longitudinal tendon tear of the SDFMT associated with medial SDFMT luxation was successfully treated with horizontal mattress sutures, and a good outcome was reported for both hindlimbs.

Iliopsoas bursitis-associated femoral neuropathy exacerbated after internal fixation of an intertrochanteric hip fracture in rheumatoid arthritis: a case report

We present the case of a 63-year-old woman with a six-year history of rheumatoid arthritis (RA) and a left iliopsoas bursitis. Radiography had detected destructive changes in her hip joint associated with her bursitis, and she had reported some paresthesia along the left anterior distal thigh. Her pain and numbness remained tolerable, and her disease activity was well controlled until she accidentally fell on the floor, which resulted in an unstable intertrochanteric fracture of left femur with displacement of the proximal portion. The fracture was successfully treated with open reduction and internal fixation, but after the surgery, her femoral nerve palsy worsened. She subsequently underwent bursa excision after the failure of conservative treatment. Accordingly, after bursa excision, the postoperative course was uneventful, and her neurological symptoms gradually disappeared. We would recommend that bursa excision be considered even in cases of iliopsoas bursitis associated with mild femoral neuropathy when destructive changes in the hip joint are also present.

Der therapieresistente Fersenschmerz - eine Operationsindikation der Sporttraumatologie

Posterior heel pain can be caused by inflammation or pathology of the achilles tendon, the tendon sheath, the retrocalcaneal and subcutaneous tendoachilles bursa, can be caused by osteophytes or stress fracture of the os calcis and by rheumatoid or metabolic diseases. The majority of patients can be treated successful nonoperatively; however, there is a small group of patients who are refractory to nonoperative managements. In the years 1984 to 422 patients with posterior heel pain were treated conservatively, 26 of these patients were refractory to that management. There were 9 cases of achilles tendinitis and/or tenosynovitis, 7 cases of bursitis, 3 cases of osteophyte of the os calcis. In 7 cases there was seen a combination of these three diseases. The following operative procedures were performed: discision of the tendon sheath, excision of thickened parts by inflammation, excision of degenerative and necrotic pain-producing areas in the achilles tendon, excision of bursa and ostectomy of osteophyte at the posterior-superior angle of the os calcis. The mean follow-up was 2.7 years (range, 1/2 to 5 years). Overall there were 79% good results. In our opinion cases of posterior heel pain refractory to non-operative treatment are an indication of sports surgery, especially in patients who like to continue sports without pain.

So-Called Calcifying Subacromial Bursitis

Codman, in 1906, was the first to describe the symptom-complex which he designated as “subacromial bursitis.” He had not found any calcareous deposits in the cases he then reported. The following year Painter and Baer both reported cases of calcareous deposits and, in the light of present-day knowledge, they were probably both in error in stating that the deposits were situated in the wall of the bursa. They each reported having excised the entire subdeltoid bursa in four cases. Unfortunately many writers have wrongly followed their lead and described the deposits as occurring in the wall of the subacromial bursa and advised total excision of the bursa. Codman was the first to point out that the deposit is located beneath the bursa, in or on the supraspinatus tendon. It is most important for surgeons to realize that the deposit is not in the bursa but beneath its floor, in, on, or even under the supraspinatus tendon, otherwise they are likely to miss it at operation as did Painter in two of his four early operations, in which he reported excision of the subdeltoid bursa, and as did Stern, who probably limited his search to the interior of the bursa. Some confusion has arisen in the literature because various authors use the terms “subacromial bursa” and “subdeltoid bursa” as synonymous and interchangeable, whereas others regard them as separate entities. Experience has shown that there is only the one bursa and the general trend of opinion is to call it “subacromial.” The subacromial bursa is nearly as large as the palm of the hand of the individual in whom it is located, and, except for a small projection beneath the deltoid muscle, lies between the acromion process and the head of the humerus, where it is inaccessible for the complete excision so commonly and wrongly advised by numerous writers. In many of the cases with typical acute or chronic symptoms that are studied carefully at operation, the opened subacromial bursa is found to be entirely free from any pathologic changes, and the deposit is found in or even under the supraspinatus tendon. It, therefore, seems obvious that the symptoms must be caused by the tendon lesion and that the term “bursitis” is really a misnomer. Often a localized or rarely a diffused bursitis may co-exist and is probably induced by the adjacent tendon lesion, but the symptoms in no way differ from the cases in which the tendon alone is affected. Codman believes the deposits are due primarily to acute traumatic rupture of a few fibers of the supraspinatus tendon, with the occurrence at the site of rupture of a hematoma in which calcium salts are deposited.