Gout occurs mainly in monoarthritis and is found in more than 50% of cases in hallux of the foot. In addition, symptoms sometimes begin in the hand, wrist, and elbow, but they are rarely observed in the spine. The patient was referred for tuberculous polyarthritis due to antituberculosis drug failure. Inflammatory findings were observed in the lumbar, elbow, wrist, hand and foot areas. Surgery was performed on the foot area and a pathology diagnosis revealed gouty arthritis. We report this case with a review of the relevant literature.
Arthritis* ; Arthritis, Gouty* ; Diagnosis ; Elbow ; Foot ; Gout ; Hallux ; Hand ; Humans ; Pathology ; Spine ; Wrist

The natural course of lateral epicondylitis is widely regarded to be self-limiting within 1 year of symptom duration in 90% of all patients. The spectrum of treatments include simple ‘wait and see', bracing, physical therapy, corticosteroid injection, and recently some biologic injection such as autologous blood and platelet rich plasma. However, recalcitrant lateral epicondylitis which are not responding to conservative treatments can be treated with surgical treatment although much remains unclear regarding the ideal treatment. Debates surrounding open procedures are the management for the defect after resection of pathologic tissue, necessity of decortication, selective denervation procedure, etc. Since the trend is changing to minimal invasive surgery and arthroscopic release of extensor carpi radialis brevis tendon are becoming more popular these days, surgical tips and pitfall to obtain good results and avoid complications have been reported recently. Bipolar radiofrequency (RF)-based microtenotomy or percutaneous tendon release is another surgical procedures reported to be effective in lateral epicondylitis. However, there are some patients who present with persistent pain after surgical treatment. Thus, selection of ideal candidates for surgery, thorough evaluation of all pathologies prior to surgery, and adequate surgical procedures would be essential in the surgical treatment of lateral epicondylitis.
Braces ; Denervation ; Humans ; Pathology ; Platelet-Rich Plasma ; Tendons ; Tennis Elbow ; Tenotomy

Myositis ossificans circumscripta (MOC) is a kind of self-localized, benign and tumor-like lesions often seen in adults, with approximately 75% of cases caused by trauma. We reported a case of non-traumatic MOC occurred at the elbow joint in a 9-year old child and it has been excised by surgery. After 18 months follow-up, a favorable outcome has been achieved with the Broberg-Morrey score of 100. We suggest that surgical resection should be done as soon as the diagnosis is confirmed.
Arthralgia ; diagnostic imaging ; physiopathology ; Biopsy, Needle ; Child ; Elbow Joint ; diagnostic imaging ; pathology ; surgery ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; methods ; Male ; Myositis Ossificans ; diagnostic imaging ; surgery ; Orthopedic Procedures ; methods ; Pain Measurement ; Postoperative Care ; methods ; Range of Motion, Articular ; physiology ; Tomography, X-Ray Computed ; methods ; Treatment Outcome

Adult ; Arnold-Chiari Malformation ; diagnosis ; Elbow Joint ; pathology ; Female ; Humans ; Syringomyelia ; diagnosis

OBJECTIVETo evaluate the clinical effects of closed reduction and percutaneous pinning in treatment of "irreducible" supracondylar humeral fractures in children.

METHODSSeventy-six consecutive children of Gartland III supracondylar humeral fractures treated in the Department of Pediatric Orthopedics of the Third Affiliated Hospital of Southern Medical University from July 2011 to July 2013 were analyzed retrospectively, of which 69 were extension type fractures and 7 were flexion type. There were 52 male and 24 female patients with an average age of 6.5 years (range 1.6 to 13 years). The average time from injury to operation was 6.8 hours (range 4 to 48 hours). The mechanism of injury included 15 cases of high falling, and 61 cases of falling to the ground while walking or running. All cases were treated via closed reduction and percutaneous pinning. The radiographs were assessed every follow-up, including the healing and function of the elbow.

RESULTSNo major complications such as osteofascial compartment syndrome or neurovascular injuries occurred in these patients. Two cases with neurological injuries before the surgery were recovered fully after the surgery. According to Flynn criteria at follow-up evolution, 71 cases were excellent, and 5 were good.

CONCLUSIONSFor the treatment of Gartland type III supracondylar humerus fractures in children, including "irreducible" supracondylar fractures of the humerus, closed reduction and percutaneous pinning is a safe and minimally invasive procedure, by which good fractures reductions and postoperative functions of the elbow can be achieved.

Adolescent ; Child ; Child, Preschool ; Elbow ; Female ; Fracture Fixation, Intramedullary ; Humans ; Humeral Fractures ; surgery ; Humerus ; pathology ; Infant ; Male ; Retrospective Studies

BACKGROUNDConventional ultrasonography or magnetic resonance (MR) imaging is commonly performed to obtain information about the severity of the disease, location of the injury, and differential diagnosis. The aim of this research was to investigate the diagnostic confidence of sonoelastography as an adjunct to greyscale ultrasonography in lateral elbow tendinopathy.

METHODSA single experienced physiatrist performed greyscale ultrasonography and sonoelastography in 28 patients (9 men, 19 women; mean age, 48.5 years; age range, 36-67 years) with unilateral symptoms of lateral elbow tendinopathy; the asymptomatic elbows were used as controls. Greyscale images were described as normal, tendinosis, partial-thickness tear, and full-thickness tear. Sonoelastographic images of the common extensor tendon were analyzed qualitatively (scoring of the elastic spectrum) and quantitatively (based on a color histogram).

RESULTSBoth the imaging methods had high sensitivity, specificity, and accuracy for diagnosing lateral elbow tendinopathy. Considering the clinical diagnosis of lateral elbow tendinopathy, sonoelastography showed significantly higher diagnostic accuracy (96.4%) than ultrasonography (89.5%, P < 0.01). Quantitative analysis showed objective interpretation of the sonoelastographic images that revealed greater intensity of green and blue pixels in symptomatic elbows (P < 0.01).

CONCLUSIONSonoelastography increases diagnostic confidence in tennis elbow pathology over greyscale ultrasonography alone and may be an additional powerful diagnostic tool in cases of lateral elbow tendinopathy with inconclusive greyscale ultrasonographic findings.

Adult ; Aged ; Elasticity Imaging Techniques ; methods ; Elbow ; pathology ; Female ; Humans ; Male ; Middle Aged ; Tendinopathy ; diagnosis ; diagnostic imaging ; Tendons ; pathology ; Tennis Elbow ; diagnosis ; diagnostic imaging

Open anterior dislocation of the hip is a very rare injury, especially in adults. It is a hyperabduction, external rotation and extension injury. Its combination with open posterior dislocation of the elbow has not been described in English language-based medical literature. Primary resuscitation, debridement, urgent reduction of dislocation, and adequate antibiotic support resulted in good clinical outcome in our patient. At 18 months follow-up, no signs of avascular necrosis of the femoral head or infection were observed.
Accidents, Traffic ; Elbow Joint ; injuries ; Hip Dislocation ; complications ; pathology ; Humans ; Joint Dislocations ; complications ; Male ; Soft Tissue Injuries ; complications ; Young Adult

Mycobacterium longobardum is a slow-growing, nontuberculous mycobacterium that was first characterized from the M. terrae complex in 2012. We report a case of M. longobardum induced chronic osteomyelitis. A 71-yr-old man presented with inflammation in the left elbow and he underwent a surgery under the suspicion of tuberculous osteomyelitis. The pathologic tissue culture grew M. longobardum which was identified by analysis of the 65-kDa heat shock protein and full-length 16S rRNA genes. The patient was cured with the medication of clarithromycin and ethambutol without further complications. To the best of our knowledge, this is the first report of a M. longobardum infection worldwide.
Aged ; Anti-Bacterial Agents/therapeutic use ; Bacterial Proteins/genetics ; Chaperonin 60/genetics ; Clarithromycin/therapeutic use ; Elbow/pathology ; Ethambutol/therapeutic use ; Humans ; Male ; Mycobacterium Infections, Nontuberculous/*microbiology ; Nontuberculous Mycobacteria/classification/genetics/*isolation & purification ; Osteomyelitis/diagnosis/drug therapy/*microbiology/pathology ; RNA, Ribosomal, 16S/genetics ; Treatment Outcome

PURPOSE: Displaced medial humeral epicondyle fractures with or without elbow dislocation have been treated with open reduction and fixation using K-wires or screws. The purpose of this study is to evaluate the clinical and radiological outcomes of surgical treatments of medial humeral epicondyle fracture without elbow dislocation according to the fixation methods. MATERIALS AND METHODS: Thirty-one patients who had undergone open reduction and fixation of the displaced medial humeral epicondyle fracture without elbow dislocation were included. Group I consisted of 21 patients who underwent fixation with K-wires, and Group II comprised 10 patients who underwent fixation with cannulated screws. Immediate postoperative, final follow-up and normal anteroposterior radiographs were compared and the clinical outcome was assessed using the final Japanese Orthopaedic Association (JOA) elbow assessment score. RESULTS: On the immediate postoperative radiographs, the distal humeral width in Group II was larger than that in Group I. On the final follow-up radiographs, the epicondylar position in Group I was lower than that in Group II. There was no significant difference in the distal humeral width, epicondylar position and joint space tilt between the immediate postoperative, final follow-up radiographs and the normal side within each group. There was no significant difference in the final JOA score between groups. CONCLUSION: Open reduction followed by K-wire fixation or screw fixation of the displaced medial humeral epicondyle fracture without elbow dislocation in older children and adolescents resulted in improved radiologic outcome and good elbow function in spite of diverse radiologic deformities.
Adolescent ; Bone Screws ; Bone Wires ; Child ; Dislocations/*prevention & control ; Elbow Joint/*pathology ; Female ; Humans ; Humeral Fractures/*surgery ; Male

BACKGROUND AND OBJECTIVEAmyloid deposition is rare. If there was a great amount of amyloid depositions in the skin tissue, it would be considered to be amyloid deposition disease at first, and then primary cutaneous marginal zone B-cell lymphoma (PCMZL). This study was to analyze the diagnosis and differential diagnosis of two cases of PCMZL with amyloid deposition.

METHODSClinicopathologic characteristics and follow-up of two cases of PCMZL were analyzed. Immunohistochemical staining was performed by EnVision method using antibodies LCA, CD19, CD20, CD79a, CD3, CD7, MUM1, kappa, lambda, Ki-67. IgH and TCRgamma gene rearrangement was detected by polymerase chain reactive (PCR).

RESULTSCase 1, a 71-year-old Chinese male, had a subcutaneous mass on the right elbow that was initially diagnosed with "amyloidosis" in 2004. Three years after the initial diagnosis, he developed recurrences on the right para-auxillary that was still diagnosed with "probably amyloidosis". Four years after the first diagnosis, the patient presented a lesion on the right para-auxillary with a diameter of 2 cm and a lesion on the temporal-parietal dural with a size of 6.0 cmx3.0 cmx3.0 cm. Case 2, a 68-year-old Chinese male, had a subcutaneous mass next to back of the left ear with a size of 9.0 cmx5.0 cm, and he underwent a operation one year previously because of subcutaneous mass in the same site. Microscopically, the tumors of both cases were located in dermis and subcutaneous, tumor cells were medium size with a nodular or diffuse distribution, and some of tumor cells were plasmacytoid/plasma cells. Morphologically, the temporal-parietal dural lesion was similar to subcutaneous lesion and infiltrated into cranial (case 1). Juxtaposed the tumor cells of two cases, there were the large amyloid deposits of amorphous hyaline material and concentrically laminated hyaline spherules in case 1, while cord-like amyloid deposits in case 2. Reactive lymphoid follicles with germinal centers and foreign body giant cells in the stroma were found surrounding the amyloid deposits. Congo red staining showed positive of amyloid deposition in tumor tissues of both cases. Immunohistochemical staining revealed that LCA, CD19, CD20, CD79a and MUM1 expressions were positive in tumor cells, and Ki-67 expression was about 8%-10%. IgL restricted expression as kappa positive while lambda negative was found in both cases. PCR results showed monoclone gene rearrangement of IgH gene in both cases.

CONCLUSIONSOur findings suggest that amyloid deposition rarely present in both primary and metastatic tumors in PCMZL, and its diagnosis should be considered to avoid misdiagnosis. The patients with PCMZL should undergo regular examinations and chemotherapy as well as a long-term follow-up since it is apt to recur or relapse.

Aged ; Amyloidosis ; complications ; drug therapy ; metabolism ; pathology ; surgery ; Antigens, CD ; metabolism ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Diagnosis, Differential ; Doxorubicin ; therapeutic use ; Elbow ; Follow-Up Studies ; Head and Neck Neoplasms ; complications ; drug therapy ; metabolism ; pathology ; surgery ; Humans ; Interferon Regulatory Factors ; metabolism ; Leukocyte Common Antigens ; metabolism ; Lymphoma, B-Cell, Marginal Zone ; complications ; drug therapy ; metabolism ; pathology ; surgery ; Magnetic Resonance Imaging ; Male ; Neoplasm Recurrence, Local ; Prednisone ; therapeutic use ; Skin Neoplasms ; complications ; drug therapy ; metabolism ; pathology ; surgery ; Vincristine ; therapeutic use