Extra-articular Location Research Articles

AB0733 Treatment monitoring of fluorescence optical imaging (foi) using automated, computer-based quantitative assessment

BackgroundFluorescence optical imaging (FOI) with the Xiralite® system is clinically available for diagnostic imaging of inflammation and has been shown to be a suitable tool to assess treatment response in...

Comparison of positron emission tomography/CT and bremsstrahlung imaging following Y-90 radiation synovectomy

The aim of this study is to compare the results of positron emission tomography (PET)/CT with bremsstrahlung imaging following Y-90 radiation synovectomy. All patients referred to our institution for Y-90 radiation synovectomy between July 2011 and February 2012 underwent both PET/CT and bremsstrahlung planar (± single photon emission computed tomography (SPECT) or SPECT/CT) imaging at 4 or 24 h following administration of Y-90 silicate colloid. PET image acquisition was performed for between 15 and 20 min. In patients who underwent SPECT, side-by-side comparison with PET was performed and image quality/resolution scored using a five-point scale. The distribution pattern of Y-90 on PET and bremsstrahlung imaging was compared with the intra- or extra-articular location of Y-90 activity on fused PET/CT. Thirteen joints (11 knees and two ankles) were imaged with both PET/CT and planar bremsstrahlung imaging with 12 joints also imaged with bremsstrahlung SPECT. Of the 12 joints imaged with SPECT, PET image quality/resolution was superior in 11 and inferior in one. PET demonstrated a concordant distribution pattern compared with bremsstrahlung imaging in all scans, with the pattern classified as diffuse in 12 and predominantly focal in one. In all 12 diffuse scans, PET/CT confirmed the Y-90 activity to be located intra-articularly. In the one predominantly focal scan, the fused PET/CT images localised the Y-90 activity to mostly lie in the extra-articular space of the knee. PET/CT can provide superior image quality compared with bremsstrahlung imaging and may enable reliable detection of extra-articular Y-90 activity when there are focal patterns on planar bremsstrahlung imaging.

A 63-year-old woman presenting with a synovial sarcoma of the hand: a case report

IntroductionSynovial sarcoma is a high-grade, soft-tissue sarcoma that most frequently is located in the vicinity of joints, tendons or bursae, although it can also be found in extra-articular locations. Most patients with synovial sarcoma of the hand are young and have a poor prognosis, as these tumors are locally aggressive and are associated with a relatively high metastasis rate. According to the literature, local recurrence and/or metastatic disease is found in nearly 80% of patients. Current therapy comprises surgery, systemic and limb perfusion chemotherapy, and radiotherapy. However, the 5-year survival rate is estimated to be only around 27% to 55%. Moreover, most authors agree that synovial sarcoma is one of the most commonly misdiagnosed malignancies of soft tissues because of their slow growing pattern, benign radiographic appearance, ability to change size, and the fact that they may elicit pain similar to that caused by common trauma.Case presentationWe describe an unusual case of a large synovial sarcoma of the hand in a 63-year-old Caucasian woman followed for 12 years by a multidisciplinary team. In addition, a literature review of the most pertinent aspects of the epidemiology, diagnosis, treatment and prognosis of these patients is presented.ConclusionAwareness of this rare tumor by anyone dealing with hand pathology can hasten diagnosis, and this, in turn, can potentially increase survival. Therefore, a high index of suspicion for this disease should be kept in mind, particularly when evaluating young people, as they are the most commonly affected group.

Tumors and diseases of the joint

A variety of different diseases affect the synovium, including infection, noninfectious immunologic inflammatory conditions, degenerative arthroses, crystal deposits, trauma, and tumors. Tumors of the synovium are relatively uncommon. Any mesenchymal tumor may arise in the synovium, but most recapitulate its normal counterpart including synoviocytes, blood vessels, fat, and fibrous tissue. These tumors can arise in any synovial lined structures both within joints and in extraarticular locations. Most synovial tumors are benign. Malignant tumors are rare but important to recognize because many are aggressive and must be treated appropriately. Among common nonneoplastic conditions that affect the synovium and surrounding structures are crystal deposits such as monosodium urate crystals, calcium pyrophosphate dihydrate crystals, and hydroxyapatite crystals. These crystal deposits may be asymptomatic or cause severe pain or chronic joint destruction. Their accurate identification is important to guide appropriate therapy.

MRI of Ankle and Lateral Hindfoot Impingement Syndromes

The objective of this article is to review the pathophysiology and clinical presentation of impingement syndromes at the ankle joint (anterolateral, anterior, anteromedial, posteromedial, and posterior) and the role of MRI in evaluating impingement at the ankle joint and at extraarticular locations, lateral to the ankle joint (talocalcaneal and calcaneofibular). MRI is valuable in assessing both osseous and soft-tissue abnormalities associated with impingement syndromes.

Giant Synovial Cyst of the Anterior Compartment: An Unusual Cause of Chronic Knee Pain After Trauma

There is almost no literature describing the management and rationale for intervention for posttraumatic, extra-articular synovial cysts of the knee. We describe the very rare case of a 45-year-old blind man who developed chronic knee pain after a traumatic injury. He was found to have a giant, posttraumatic, true synovial cyst of the knee in an extra-articular location and migrating down the anterior compartment. The surgical management, potential complications, and rationale for intervention are discussed.

Distale Humerusfrakturen

Distal humeral fractures are problematic both in children and in adults. While in children these fractures are very common and most of them have an extraarticular location, in adults their incidence is much lower and they more often compromise the joint. Good results cannot be achieved without due consideration for the complex anatomy of the elbow joint, the quality of the bone, the concomitant soft tissue lesions and the biomechanical aspects of the injury, to allow selection of appropriate therapy and a correctly structured aftertreatment. The soft tissue injuries that are frequently involved and the high rate of intra- and postoperative complications need particular attention. This paper reviews the epidemiology, the current standards in diagnosis and therapy, the possible complications and the results that can be expected in patients with fractures of this type.

The arthroscopic extraarticular Bankart repair.

The arthroscopic extraarticular Bankart procedure tries to imitate the open Bankart procedure. An anterior-inferior transmuscular approach through the subscapular muscle permits to implant self-locking tacks into the anterior inferior third of the glenoid rim. The extraarticular location of the implants makes a superomedial capsular shift possible, if required. A total of 257 arthroscopic repairs following traumatic recurrent anterior shoulder dislocation have been carried out between 1992 and 1996. 177 patients were treated only with bioabsorbable Suretac device. Clinical and radiological follow up was possible in 165 patients. According to the Rowe score 69,7 % were classified as excellent, 10,9 % as good, 9,7 % fair and 9,7 % poor. Postoperative complications: the recurrence rate was 9,7 %, allergic reactions representing a foreign body reaction to the synthetic material were seen in 5 cases (3 %) and a frozen shoulder in 6 cases 3,6 %). 61 % of the patients involved in overhead or contact sports returned to their preoperative sport activities.

Arthroscopic extra-articular Bankart procedure

The arthroscopic extraarticular Bankart procedure tries to imitate the open Bankart procedure. An anterior-inferior transmuscular approach through the subscapular muscle permits to implant self-locking tacks into the anterior inferior third of the glenoid rim. The extraarticular location of the implants makes a superomedial capsular shift possible, if required. A total of 257 arthroscopic repairs following traumatic recurrent anterior shoulder dislocation have been carried out between 1992 and 1996. 177 patients were treated only with bioabsorbable Suretac device. Clinical and radiological follow up was possible in 165 patients. According to the Rowe score 69.7% were classified as excellent, 10.9% as good, 9.7% fair and 9.7% poor. Postoperative complications: the recurrence rate was 9.7%, allergic reactions representing a foreign body reaction to the synthetic material were seen in 5 cases (3%) and a frozen shoulder in 6 cases 3.6%). 61% of the patients involved in overhead or contact sports returned to their preoperative sport activities.

Review Biologicals & Immunologicals: Patenting gene therapy for arthritis

The application of gene therapy to the treatment of arthritis and related disorders is a novel therapeutic approach of considerable promise. Genes may be delivered locally to diseased joints, or systemically to extra-articular locations, by ex vivo or in vivo strategies using a variety of viral and non-viral vectors. A small number of patent applications have been filed which seek to protect these concepts, but none have yet been issued. A number of potentially anti-arthritic genes have been patented and more may be expected to receive patent protection in the future. Improvements in vector delivery systems are likely to be a major focus of future patent applications.

Progress toward the treatment of arthritis by gene therapy.

Gene therapy offers several novel advantages to the treatment of arthritis and other joint diseases. Therapeutic genes may be delivered locally to diseased joints or systemically to extra-articular locations using viral or non-viral vectors by ex vivo or in vivo strategies. Pre-clinical experiments with rabbits have demonstrated the utility of using a retrovirus to deliver the human interleukin-1 receptor antagonist to the synovial lining of joints. A human trial based on this principle has been approved by the Recombinant DNA Advisory Committee of NIH and should begin this year.

Synovial sarcoma of the hypopharynx in an 11-year-old boy: treatment by partial snpraglottic laryngopharyngectomy

Synovial sarcoma in an extra-articular location is a very rare tumor, particularly in relation to childhood tumors. We report our experiences with an 11-year-old boy who suffered from swallowing difficulties caused by a polypoid tumor of the hypopharynx. Biopsy demonstrated a fusocellular carcinoma, while the epithelial components showed cytokeratin and neuron-specific enolase positivity. A correct final diagnosis could only be established by the histology of the surgical preparation following partial laryngopharyngectomy. The presence of spindle cells associated with glandular-like ones proved the synovial character of the tumor. The spindle cells were negative for epithelial marker but were positive for vimentin. S-100 protein positivity could only be demonstrated in the nerve elements encapsulated in the tumor. Ultrastructural examinations confirmed the presence of the different cell types. The spindle cells were rich in intermediate fibers, as demonstrated by electron microscopy.