Excision of trochanteric bursa during total hip replacement:Does it reduce the incidence of post-operative trochanteric bursitis?

BACKGROUND Trochanteric bursitis is a common complication following total hip replacement(THR),and it is associated with high level of disability and poor quality of life.Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis.AIM To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.METHODS This retrospective cohort study was conducted in the secondary care setting at a large district general hospital.Between January 2010 and December 2020,954 patients underwent elective primary THR by two contemporary arthroplasty surgeons,one excising the bursa and the other not(at the time of THR).All patients received the same post-operative rehabilitation and were followed up for 1 year.We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis.Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups.RESULTS 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not.A total of 5 patients(incidence 0.5%)developed trochanteric bursitis following THR;4 of whom had undergone bursectomy as part of their surgical approach,1 who had not.There was no statistically significant difference between the two groups(Z value 1.00,95%CI:-0.4%to 1.3%,P=0.32).There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR;all of whom were treated with THR and synchronous trochanteric bursectomy,and 7 had resolution of their lateral buttock pains but 1 did not.CONCLUSION Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis.However,it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.

Atypical presentation of shoulder brucellosis misdiagnosed as subacromial bursitis:A case report

BACKGROUND Brucella infections in the shoulder joint are uncommon,and few have been reported in the literature.CASE SUMMARY A 26-year-old male was admitted to our hospital with complaint of recurrent pain and limited movement of the right shoulder.The patient reported the pain to have first occurred as an isolated event 6 mo previously and to have reoccurred 5 mo later,when it was accompanied by limited movement of the shoulder.Findings from physical examination and magnetic resonance imaging(referred to as MRI)suggested the diagnosis of subacromial bursitis,and diagnostic paracentesis and arthroscopic debridement were performed.Surprisingly,synovial fluid culture detected brucella,and the finding was confirmed by mass spectrometry of a colony sample.The diagnosis was corrected to brucellosis of the shoulder joint,and antibiotic drug treatment(oral rifampicin and doxycycline)was administrated for 6 wk.The 4-mo postoperative follow-up examination(MRI)yielded normal findings.The 2-year follow-up showed no signs of recurrence.CONCLUSION This rare case of brucellosis infection in shoulder highlights the importance of increasing awareness to help avoid misdiagnosis.

Olecranon Bursitis Causing Reflex Sympathetic Dystrophy Syndrome in a Hemiplegic Extremity

Olecranon bursitis is rarely seen in patients with stroke, but reflex sympathetic dystrophy syndrome is not. Here, we report a stroke case, which represented the clinical symptom of reflex sympathetic dystrophy syndrome after development of olecranon bursitis in few days, and describe his clinical association between both conditions. Sonographicpicture of the right elbow in this case is shown.

Treatment of Hip Trochanteric Bursitis Using Hyaluronate Injections

Trochanteric bursitis is a common cause of musculoskeletal pain and often requires medical intervention and should be distinguished from sciatica and irradiating pain of pelvic and spinal origin. Previously, the etiology of the trochanteric pain syndrome was thought to be caused by inflammation. The current study was performed in order to assess the efficacy of trochanteric injections. Methods: 158 patients were treated for trochanteric bursitis (132 females/26 males, range 22 - 88 years). 59b were treated with corticosteroid injection, 60 with hyaluronate and 39 were injected using a combination of both. Patients were followed by the HOOS score for a minimum of 12 months. Results: Pre-operative HOOS scores were similar in all groups. Following injection, the HOOS score increased from 27 ± 4 to 66 ± 2 after six months and 77 ± 4 after a year. At 12-month follow-up, the average score of patients treated by corticosteroids injection was 44 ± 7 compared with 62 ± 8 for the hyaluronate injected group and 64 ± 6 for the combination injection group. Discussion: It appears that injection therapy is highly efficacious for treating trochanteric bursitis. The effect of hyaluronate or hyaluronate and steroid combination appears to be longer lasting than that of steroid alone.

Giant Bursitis of Wrist and Multiple Tenosynovitis of Hand with Rice Body Formation: Unusual Case of an Atypical Mycobacteria Infection

We report an unusual manifestation of nontuberculous mycobacterial infection characterized by a giant bursitis on wrist and multiple tenosynovitis with many rice bodies formations. The clinical and radiological examinations are neither rather sensitive nor rather specific. The nuclear imagery of rice bodies formations provides elements of guidance. Cause of absence of the germ isolation, diagnosis was retained on probability items based on a suspicion of arguments beam: clinical, biological, bacteriological and histological. The patient was treated with medical and surgical procedure and provided a satisfactory evolution. At follow-up of 15 months, there were no clinical signs of local recurrence. Through a literature review, the problem of diagnosis of certainty will be discussed.

Frozen shoulder:A systematic review of therapeutic options

Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely unclear. This systematic review of current treatments for frozen shoulder reviews the evidence base behind physiotherapy, both oral and intra articular steroid, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release. Key areas in which future research could be directed are identified, in particular with regard to the increasing role of arthroscopic capsular release as a treatment.

Treatment of a rotator cuff tear combined with iatrogenic glenoid fracture and shoulder instability:A rare case report

BACKGROUND The brisement manipulation is an effective treatment for refractory shoulder stiffness.Rotator cuff tears can sometimes exist in combination with adhesive capsulitis.Arthroscopic capsular release combined with rotator cuff repair has achieved good outcomes in published reports.CASE SUMMARY We report the case of a patient with right shoulder pain for more than 1 year that was suspected to have adhesive capsulitis and a rotator cuff tear that was treated with brisement manipulation and arthroscopic management.An iatrogenic glenoid fracture with shoulder instability occurred during the manipulation.Arthroscopic treatment for fracture fixation,capsular release,and rotator cuff repair was performed,and the functional results are reported.CONCLUSION Arthroscopic fixation for iatrogenic glenoid fracture and repairing coexisting rotator cuff tear can provide the stability needed for early rehabilitation.

Trochanteric area pain,the result of a quartet of bursal inflammation

Bursitis is quite responsive to therapeutic intervention, once the afflicted area is accurately identified. This is especially notable for some hip complaints. Patients' use of the term "hip" can relate to anything from the low back to groin to lateral thigh pain. Trochanteric area surface localization of "hip" pain may afford an opportunity for immediate cure. Effectiveness of therapeutic intervention is predicated upon injection of not one or two, but all four peri-trochanteric bursa with a depot(minimally water-soluble) corticosteroid. The term trochanteric bursitis suggests that the inflammation is more focal than what is clinically observed. While easier to express, perhaps it is time to refer to inflammation in this area, naming all four affected bursae.

Ultrasound and Color Doppler-Guided Surgery for Insertional Achilles Tendinopathy-Results of a Pilot Study

Background: Treatment of insertional achilles tendinopathy is known to be difficult. Eccentric calf muscle exercises and extracorporeal shockwave therapy have been proposed as the primary treatments for this condition, but surgery is indicated after failed conservative management. There is no consensus about the most efficient surgical treatment. Objectives: To evaluate a new ultrasound and color Doppler-guided surgical treatment for insertional achilles tendinopathy. Patients and methods: 24 consecutive patients (13 men and 11 women, mean age 47 years) with a long duration of insertional achilles tendon pain (median 18 months) were included in the study. The surgical procedure consisted of extirpation of the subcutaneous and retrocalcaneal bursa, scraping of the ventral distal achilles tendon and removal of prominent bone at the upper calcaneal tuberosity (Haglund’s deformity). In 13 patients, the plantaris tendon was also cut and excised. VAS for pain during activity, satisfaction with the treatment result and the SF-36 score to measure quality of life were used for evaluation. Results: The mean VAS had decreased from 72 before surgery to 19 after surgery (p 0.001), and 20/24 (83%) patients were satisfied with the result and had returned to full tendon loading activity at the one-year follow-up. The SF-36 score had improved significantly. Conclusion: Ultrasound and color Doppler-guided surgical treatment seems to be a good method for treatment of chronic painful insertional achilles tendinopathy. Longer follow-up studies on larger materials are needed.