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Fulltext Meralgia paresthetica - importance of anatomical knowledge in diagnosis

Nurul Raihan, A.K., Narwani, H., Mohd Effendi, M.G., Chung, W.M.

Medicine & Health, 2020;15(1):280-287.
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Penekanan saraf lateral kutaneus femoral merupakan punca kepada penyakit meralgia parestetika. Gejala penyakit ini ialah kesakitan dan perubahan sensori pada bahagian lateral paha. Namun, gejala penyakit ini seakan menyerupai gejala penyakit lain seperti radikulopati lumbar, penyempitan ruang femoro-acetabular, bursitis trokanterik dan beberapa contoh lain. Meralgia parestetika merupakan diagnosis secara pengecualian setelah penyebab kepada kesakitan pada bahagian lateral paha tidak dapat dibuktikan melalui hasil penyiasatan yang terperinci. Pengetahuan anatomi tentang saraf yang mensarafi bahagian paha adalah amat penting untuk mengenalpasti punca kesakitan yang dialami. Kami ingin melaporkan satu kes yang melibatkan seorang pesakit lelaki berumur 46 tahun, telah didiagnos menghidap kencing manis, darah tinggi, masalah jantung yang telah datang ke Jabatan Kecemasan dan Trauma dengan aduan kesakitan akut pada bahagian lateral paha kanan. Kesakitan yang dialami digambarkan sebagai rasa seperti terbakar, dicucuk dan disertai dengan rasa kebas. Selain itu, terdapat pengurangan sensasi rasa pada bahagian paha yang sakit. Tiada aduan berkaitan sakit pada rangsangan ringan (allodinia) atau sakit yang berlebihan pada rangsangan kuat (hiperalgesia). Bacaan gula darah kapilari ialah 8.4 mmol/l dan keputusan HbA1c ialah 7%. Diagnosis meralgia parestetika telah disahkan setelah semua kemungkinan diagnosis lain tidak dapat dibuktikan melalui pemeriksaan fizikal, ujian makmal dan radiologi (x-ray, ultrasound dan MRI). Keadaan pesakit bertambah baik selepas diberikan rawatan ubat secara oral dan menjalani sesi fisioterapi.

Matched MeSH terms: Bursitis
Fulltext Cutaneous melioidosis in a healthy Danish man after travelling to South-East Asia

Bodilsen J, Langgaard H, Nielsen HL

BMJ Case Rep, 2015 Jan 16;2015.
PMID: 25596295 DOI: 10.1136/bcr-2014-207340

A healthy Danish man presented with infected prepatellar bursitis 8 months after being involved in a car accident in Malaysia resulting in exposure of a laceration of his knee to stagnant water. Tissue samples grew Burkholderia pseudomallei and diagnostic work up revealed no secondary foci. The patient was successfully treated with surgical debridement and 3 months of oral trimethoprim-sulfamethoxazole. At 6 months follow-up the patient was without relapse.

Matched MeSH terms: Bursitis/diagnosis*; Bursitis/drug therapy; Bursitis/microbiology; Bursitis/surgery
Fulltext Idiopathic frozen shoulder

Brun SP

Aust J Gen Pract, 2019 11;48(11):757-761.
PMID: 31722459 DOI: 10.31128/AJGP-07-19-4992

BACKGROUND: Shoulder pain and stiffness affects at least one-quarter of the Australian population, with the primary care physician seeing 95% of these patients. Idiopathic frozen shoulder affects >250,000 Australians, making it a significant burden on both the individual and society. The primary care physician plays a major part in recognising the condition and formulating an evidence-based management plan in conjunction with the physiotherapist.
OBJECTIVE: This article provides the reader with an understanding of the natural history, pathophysiology, phases and clinical features of idiopathic frozen shoulder. It also outlines patients at risk of developing idiopathic frozen shoulder and addresses an evidence-based conservative approach to the management of this condition.
DISCUSSION: The primary care physician plays a pivotal part in the identification and management of idiopathic frozen shoulder, with the vast majority of patients responding to conservative management. A shared care approach with a skilled physiotherapist is essential.

Matched MeSH terms: Bursitis/diagnosis*; Bursitis/therapy
Fulltext Effects of Inflammatory Disease on Clinical Progression and Treatment of Ischiogluteal Bursitis: A Retrospective Observational Study

Roh YH, Yoo SJ, Choi YH, Yang HC, Nam KW

Malays Orthop J, 2020 Nov;14(3):32-41.
PMID: 33403060 DOI: 10.5704/MOJ.2011.007

Introduction: The symptoms of Ischiogluteal Bursitis (IGB) are often nonspecific and atypical, and its diagnosis is more challenging. Moreover, it is difficult to predict cases of chronic progression or poor treatment response. Therefore, the aim of this study was to investigate the clinical course of IGB patients and identify factors that are predictive of failure of conservative treatment.
Materials and Methods: Our study consisted of IGB patients diagnosed between 2010 March and 2016 December who had been followed-up for at least one year. Structured questionnaires and medical records were reviewed to analyse demographic characteristics, lifestyle patterns, blood tests, and imaging studies. We categorized the cases into two groups based on the response to conservative treatment and the need for surgical intervention.
Results: The most common initial chief symptoms were buttock pains in 24 patients (37.5%). Physical examinations showed the tenderness of ischial tuberosity area in 59 (92.2%) patients, but no specific findings were confirmed in 5 patients (7.8%). 51 patients (79.7%) responded well to the conservative management, 11 patients (17.2%) needed injection, and 2 patients (3.1%) had surgical treatment performed due to continuous recurrence. There was no difference in demographic and blood lab data between the two groups. However, the incidence of inflammatory diseases (response group: 10.3% vs non-response group: 66.7%, p=0.004) was significantly different between the two groups.
Conclusion: The diagnosis of IGB can be missed due to variations in clinical symptoms, and cautions should be exercised in patients with inflammatory diseases as conservative treatment is less effective in them, leading to chronic progression of IGB.

Matched MeSH terms: Bursitis
Fulltext Precontoured Clavicular Locking Plate with Broad Lateral End: A Newly Designed Plate for Lateral Third Clavicle Fractures

Kapil-Mani KC, Acharya P, Arun S

Malays Orthop J, 2018 Mar;12(1):15-20.
PMID: 29725507 DOI: 10.5704/MOJ.1803.003

Introduction: Various treatment modalities are available but no consensus has been reached for optimal treatment of lateral third clavicle fractures. Precontoured locking plates with broad lateral end for multiple screws fixation is a newly designed plate for lateral third clavicle fractures. The objective of our study was to analyse the functional outcomes as well as complications of this technique in a significant number of cases with long follow-up duration. Materials and Methods: Forty-six patients with distal third clavicle fractures were treated by precontoured clavicular locking plate with broad lateral end. Functional outcomes were assessed on the basis of Constant-Murley Shoulder Outcome Score and University of California, Los Angeles (UCLA) Shoulder Rating Score, active shoulder range of motion, time for fracture union and coraco-clavicular distance. Results: The mean Constant-Murley score was 92.56±4.47 (range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coraco-clavicular distance at final follow-up was 10.52±1.13 mm (range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm (range 9.6 to 11.2 mm) in normal side. Mean UCLA Shoulder Rating Score was 32.55±2.12 (range: 27-34) for injured side and 33.46±1.88 (range: 31- 35) on normal side with p value 0.58. No major complications that necessitated revision of surgery occurred in our study. Conclusion: This newly designed plate seemed extremely useful in successful union of lateral third clavicle fractures, with reduced rate of complications like fixation failures, iatrogenic rotator cuff injury, AC joint osteoarthritis and sub-acromial bursitis, with good functional outcomes.

Matched MeSH terms: Bursitis
A Case of Posterior Tibial Nerve Injury After Arthroscopic Calcaneoplasty

Retrouvey H, Silvanathan J, Bleakney RR, Anastakis DJ

J Foot Ankle Surg, 2018 01 05;57(3):587-592.
PMID: 29307741 DOI: 10.1053/j.jfas.2017.10.004

We report the first case of distal posterior tibial nerve injury after arthroscopic calcaneoplasty. A 59-year-old male had undergone right arthroscopic calcaneoplasty to treat retrocalcaneal bursitis secondary to a Haglund's deformity. The patient complained of numbness in his right foot immediately after the procedure. Two years later and after numerous assessments and investigations, a lateral plantar nerve and medial calcaneal nerve lesion was diagnosed. In the operating room, the presence of an iatrogenic lesion to the distal right lateral plantar nerve (neuroma incontinuity involving 20% of the nerve) and the medial calcaneal nerve (complete avulsion) was confirmed. The tarsal tunnel was decompressed, and both the medial and the lateral plantar nerve were neurolyzed under magnification. To the best of our knowledge, our case report is the first to describe iatrogenic posterior tibial nerve injury after arthroscopic calcaneoplasty. It is significant because this complication can hopefully be avoided in the future with careful planning and creation of arthroscopic ports and treated appropriately with early referral to a nerve specialist if the patient's symptoms do not improve within 3 months.

Matched MeSH terms: Bursitis/surgery*
Fulltext Painful Pes Anserine Bursitis Following Total Knee Replacement Surgery: Two cases

Ariff MAM, Ros MIAC, Yahaya NHM

Sultan Qaboos Univ Med J, 2018 Feb;18(1):e97-e99.
PMID: 29666689 DOI: 10.18295/squmj.2018.18.01.016

Pes anserine bursitis (PAB) is an inflammation of the bursa located between the medial aspect of the tibia and the hamstring muscles. It is common in patients with degenerative or inflammatory knee arthritis, usually has a self-limiting course and tends to respond well to conservative treatment. However, painful PAB directly following total knee replacement surgery is rare. We report two such cases who were diagnosed via ultrasonography at the Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, in 2015. Both patients were treated locally with triamcinolone acetonide under ultrasound guidance and responded well to treatment.

Matched MeSH terms: Bursitis/diagnosis*