Gouty Achilles Tendinopathy: A Case Report

2019 ◽  
Vol 109 (4) ◽  
pp. 327-333 ◽  
Author(s):  
Chandana Halaharvi ◽  
Eric So ◽  
Cherreen Tawancy ◽  
Kurt A. Kibler ◽  
Daniel Logan
Keyword(s):  
Achilles Tendon ◽  
Operating Room ◽  
Fluid Collection ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Incision And Drainage ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
The Right ◽  
The Relationship

Tendinopathy in the presence of gouty arthropathy is relatively common, yet the clinical suspicion for gout involvement in acute tendon pain remains low. A 49-year-old man presented with an acute, tender, erythematous mass to the right posterior heel. A computed tomographic scan was obtained, which revealed a septated fluid collection superficial to the Achilles tendon. The patient was taken to the operating room for an incision and drainage with debridement, and the abscess was found to be filled with caseous material. The diagnosis of gout was confirmed with pathology. The calcaneus was submitted to biopsy, and the results were negative for osteomyelitis. The patient was returned to the operating room for repair of the Achilles tendon with flexor hallucis longus tendon transfer. Postoperatively, the patient was nonweightbearing for 6 weeks. Oral colchicine was used perioperatively, and a steroid taper was administered. The patient was started on allopurinol and colchicine for chronic treatment. At 14 months, the patient was walking without pain or recurrence of the mass. Although the relationship between hyperuricemia and tendinopathy is not completely understood, it is apparent that tendon involvement may be a sequela in patients with gout. When a patient presents with acute tendon pain, gout should be considered in the differential diagnosis.

Unusual Transoral Penetrating Injury of the Foramen Magnum: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (4) ◽  
pp. 989-991 ◽  
Author(s):  
Bradley J. Bartholomew ◽  
Charla Poole ◽  
Emilio C. Tayag
Keyword(s):  
Cerebrospinal Fluid ◽  
Unusual Case ◽  
Spinal Injury ◽  
Foramen Magnum ◽  
Penetrating Injuries ◽  
Computed Tomographic ◽  
Foreign Objects ◽  
Computed Tomographic Scan ◽  
Posterior Pharynx ◽  
The Right

Abstract OBJECTIVE AND IMPORTANCE Penetrating injuries of the cranium and spine are frequent to the civilian neurosurgical practice. Although a variety of unusual objects have been reported, to our knowledge, there has never been a craniocerebral or spinal injury caused by a fish. An unusual case of transoral penetration of the foramen magnum by a billed fish is described. The history, radiographic studies, and treatment are presented. CLINICAL PRESENTATION A fisherman struck by a jumping fish initially presented with severe neck pain and stiffness, bleeding from the mouth, and a laceration in the right posterior pharynx. A computed tomographic scan of the cervical spine revealed a wedge-shaped, hyperdense object extending from the posterior pharynx into the spinal canal between the atlas and the occiput. Because of the time factor involved, the fisherman was brought directly to surgery for transoral removal of the object. INTERVENTION The patient was placed under general anesthesia, and with a tonsillar retractor, a kipner, and hand-held retractors, the object was visualized and identified as a fish bill. Further dissection above the anterior aspect of the atlas permitted removal of the object by means of a grabber from an arthroscopic set. No expression of cerebrospinal fluid was noted, and a Penrose drain was placed. CONCLUSION The patient was treated under the assumption that penetrating foreign objects in continuity with the cerebrospinal fluid space and the outside environment should be removed as soon as possible. The patient was provided appropriate antibiotics to treat potential infection of normal pharyngeal flora and organisms unique to the marine environment. The patient recovered and did not experience any residual neurological deficit.

Fibrosarcoma of the Ovary Arising in a Fibrothecomatous Tumor With Minor Sex Cord Elements

2003 ◽  
Vol 127 (1) ◽  
pp. 81-84 ◽  
Author(s):  
Hwei-Yee Lee ◽  
Qasim Ahmed
Keyword(s):  
Ovarian Tumor ◽  
De Novo ◽  
Atypical Hyperplasia ◽  
Rare Entity ◽  
Postmenopausal Bleeding ◽  
Ovarian Mass ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
Well Differentiated ◽  
The Right

Abstract We report the case of a 69-year-old woman who presented with postmenopausal bleeding. Endometrial curettings showed complex atypical hyperplasia with focal well-differentiated adenocarcinoma. A computed tomographic scan of the abdomen revealed a right ovarian mass. Histologically, the right ovarian tumor was a fibrothecoma with minor sex cord elements showing focal fibrosarcomatous change. Fibrosarcoma of the ovary is a rare tumor that is considered to arise de novo or secondary to benign fibromatous tumors. Fibrothecoma of the ovary with minor sex cord elements is also a rare entity. To the best of our knowledge, this is the first reported case of a fibrosarcoma arising in a fibrothecoma with minor sex cord elements.

scholarly journals Anatomical Feasibility Study of Flexor Hallucis Longus Transfer in Treatment of Achilles Tendon and Posterior Ankle Arthroscopy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0033
Author(s):  
Haijiao Mao
Keyword(s):  
Achilles Tendon ◽  
Magnetic Resonance Images ◽  
Neurovascular Bundle ◽  
Flexor Hallucis Longus ◽  
Muscle Morphology ◽  
Musculotendinous Junction ◽  
Muscle Belly ◽  
Lateral Muscle ◽  
Significant Difference ◽  
The Relationship

Category: Hindfoot Introduction/Purpose: The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus (FHL) muscle, the relationship between FHL tendon or muscle and the tibial neurovascular bundle at the level of the posterior ankle joint in human cadavers. Methods: Seventy embalmed feet from 20 male and 15female cadavers, the cadavers’ mean age was 65.4 (range from 14 to 82) years, were dissected and anatomically classified to observe FHL muscle morphology define the relationship between FHL tendon or muscle and the tibial neurovascular bundle . The distance between the musculotendinous junction and thehe relationship between FHL tendon or muscle and the tibial neurovascular bundle was determined. Results: The three morphology types of FHL muscle were identified: a long lateral and shorter medial muscle belly, which was observed in 63 specimens (90%).; equal length medial and lateral muscle bellies, this variant was only observed in 5 specimens (7.1%); a lateral and no medial muscle belly, which was observed in 2 specimens (2.9%). No statistically significant difference was observed according to gender or side (p > 0.05). Two patterns were identified and described between FHL tendon or muscle and the tibial neurovascular bundle. Pattern 1, the distance between the neurovascular bundle and FHL tendon was 3.46 mm (range, 2.34 to 8.84, SD = 2.12) which was observed in 66 specimens (94.3%); Pattern 2, there was no distance which was observed in 4 specimens (5.7%). Conclusion: Knowing FHL muscle morphology variations provide new important insights into secure planning and execution of a FHL transfer for Achilles tendon defect as well as for the interpretation of ultrasound and magnetic resonance images. During posterior arthroscopic, posteriormedial portal may be introduced into the posterior aspect of the ankle without gross injury to the tibial neurovascular structures.

Ruptured S1-S2 Disc Presenting with S2 Radiculopathy

Neurosurgery ◽  
1989 ◽  
Vol 24 (2) ◽  
pp. 271-272 ◽  
Author(s):  
Michael W. Nabors ◽  
F. Donald Cooney
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Spinal Column ◽  
Resonance Imaging ◽  
Computed Tomographic ◽  
Recommended Treatment ◽  
Disc Material ◽  
Computed Tomographic Scan ◽  
The Right ◽  
Possible Cause

Abstract We report the case of a 61-year-old man in whom numbness developed on the right side of the penis, scrotum, and perineum after he jumped into a swimming pool. Magnetic resonance imaging and a computed tomographic scan disclosed a lesion at S1-S2 impinging on the right S2 nerve root. At surgery, ruptured disc material originating in an area normally occupied by the fixed fibrocartilaginous plate was identified and excised. Postoperatively, the numbness resolved. We discuss a possible cause of the rupturing of the sacral disc and recommended treatment by laminectomy and excision, as in other cases of ruptured disc at other levels of the spinal column.

scholarly journals Characterization of a Novel Model of Overuse-Induced Calcific Achilles Tendinopathy in Mice: Contralateral Tendinopathy Following Unilateral Tenotomy

2017 ◽  
Author(s):  
Liang Wang ◽  
Jie Zhang ◽  
Gang-hui Yin ◽  
Zhong-min Zhang ◽  
Tian-yu Chen ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Underlying Mechanism ◽  
Biomechanical Properties ◽  
Achilles Tendinopathy ◽  
Control Group ◽  
Human Beings ◽  
Achilles Tenotomy ◽  
The Right ◽  
Experimental Group

AbstractObjectiveTo develop a simple but reproducible overuse induced animal model of Achilles tendinopathy in mice for better understanding the underlying mechanism and prevention of calcific Achilles tendinopathy.Methods80 C57/B6 mice (8-9 weeks old) were employed and randomly divided into control group and experimental group. Unilateral Achilles tenotomy was performed on the right hindlimb of experiment group. After 12 weeks, the onset of Achilles tedinopathy in the contralateral Achilles tendon was determined by radiological assessment, histological analysis, electron microscopy observation and biomechanical test.ResultsThe onset of calcific Achilles tendinopathy in contralateral Achilles tendon was confirmed after 12 weeks unilateral tenotomy. The contralateral Achilles tendon of experimental group was characterized as hypercelluarity, neovascularization and fused collagen fiber disarrangement, compared to the control group. Importantly, intratendon endochondral ossification and calcaneus deformity was featured in contralateral Achilles tendon. Additionally, poor biomechanical properties in the contralateral Achilles tendon revealed the incidence of Achilles tedinopathy.ConclusionWe hereby introduce a novel simple but reproducible spontaneous contralateral calcific Achilles tendinopathy model in mice, which represents the overuse conditions during the tendinopathy development in human-beings. It should be a useful tool to further study the underlying pathogenesis of calcific Achilles tendinopathy.

Repair of Chronic Achilles Ruptures Has a High Incidence of Venous Thromboembolism

2016 ◽  
Vol 10 (5) ◽  
pp. 415-420 ◽  
Author(s):  
Mark J. Bullock ◽  
William T. DeCarbo ◽  
Mark H. Hofbauer ◽  
Joshua D. Thun
Keyword(s):  
Venous Thromboembolism ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Achilles Tendon Repair ◽  
Elective Repair ◽  
High Incidence ◽  
Tendon Ruptures

Background. Despite the low incidence of deep vein thrombosis (DVT) in foot and ankle surgery, some authors report a high incidence of symptomatic DVT following Achilles tendon rupture. The purpose of this study was to identify DVT risk factors inherent to Achilles tendon repair to determine which patients may benefit from prophylaxis. Methods. One hundred and thirteen patient charts were reviewed following elective and nonelective Achilles tendon repair. For elective repair of insertional or noninsertional Achilles tendinopathy, parameters examined included lateral versus prone positioning and the presence versus absence of a flexor hallucis longus transfer. For nonelective repair, acute Achilles tendon ruptures were compared to chronic Achilles tendon ruptures. Results. Of 113 Achilles tendon repairs, 3 venous thromboembolism (VTE) events (2.65%) occurred including 2 pulmonary emboli (1.77%). Seventeen of these repairs were chronic Achilles tendon ruptures, and all 3 VTE events (17.6%) occurred within this subgroup. Elevated body mass index was associated with VTE in patients with chronic Achilles ruptures although this did not reach significance ( P = .064). No VTE events were reported after repair of 28 acute tendon ruptures or after 68 elective repairs of tendinopathy. Two patients with misdiagnosed partial Achilles tendon tears were excluded because they experienced a VTE event 3 weeks and 5 weeks after injury, prior to surgery. Conclusion. In our retrospective review, chronic Achilles ruptures had a statistically significant higher incidence of VTE compared with acute Achilles ruptures ( P = .048) or elective repair ( P = .0069). Pharmaceutical anticoagulation may be considered for repair of chronic ruptures. Repair of acute ruptures and elective repair may not warrant routine prophylaxis due to a lower incidence of VTE. Levels of Evidence: Prognostic, Level III: Case Control Study

Gout in the Flexor Hallucis Longus Tendon Mimicking Cellulitis: A Case Report

2020 ◽  
Vol 110 (1) ◽  
Author(s):  
Jun Ohnishi ◽  
Naoto Ishimaru ◽  
Hiroyuki Seto ◽  
Yohei Kanzawa ◽  
Saori Kinami
Keyword(s):  
Case Report ◽  
Synovial Fluid ◽  
Fluid Collection ◽  
Final Diagnosis ◽  
Tendon Sheath ◽  
Flexor Hallucis Longus ◽  
Fluid Analysis ◽  
Synovial Fluid Analysis ◽  
First Case ◽  
The Right

A 65-year-old Japanese man was admitted to our hospital with fever and inflammation of the right ankle. We initiated antibiotics on suspicion of cellulitis. After no clinical improvement, we performed magnetic resonance imaging, which showed a fluid collection in the flexor hallucis longus (FHL) tendon sheath. Synovial fluid analysis revealed monosodium uric crystals. Final diagnosis was FHL tendonitis secondary to gout proven by synovial fluid analysis. To our knowledge, this is the first case report of FHL tendonitis caused by gout. When ankle inflammation is examined in clinical situations, FHL tendonitis caused by gout should be considered.

Fluoroquinolone Therapy and Achilles Tendon Rupture

2003 ◽  
Vol 93 (4) ◽  
pp. 333-335 ◽  
Author(s):  
Diane Vanek ◽  
Amol Saxena ◽  
John M. Boggs
Keyword(s):  
Achilles Tendon ◽  
Bacterial Infections ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Achilles Tendinopathy ◽  
The Relationship

Fluoroquinolones have been associated with tendinopathies. The authors present three cases of Achilles tendinopathy in which the patients’ symptoms were preceded by treatment for unrelated bacterial infections with ciprofloxacin. Although the exact mechanism of the relationship is not understood, those who engage in sports or exercise should be advised of the risk of quinolone-induced tendinopathy. (J Am Podiatr Med Assoc 93(4): 333-335, 2003)

scholarly journals Achilles Tendon Structure Differs Between Runners And Non-Runners Despite No Clinical Signs Or Symptoms Of Mid-Substance Tendinopathy

2018 ◽  
Author(s):  
Todd J. Hullfish ◽  
Kenton L. Hagan ◽  
Ellen Casey ◽  
Josh R. Baxter
Keyword(s):  
Young Adults ◽  
Achilles Tendon ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Achilles Tendinopathy ◽  
Ultrasound Images ◽  
Distance Running ◽  
Distance Runners ◽  
Structural Differences ◽  
The Right

AbstractAchilles tendinopathy affects many running athletes and often leads to chronic pain and functional deficits. While changes in tendon structure have been linked with tendinopathy, the effects of distance running on tendon structure is not well understood. Therefore, the purpose of this study was to characterize structural differences in the Achilles tendons in healthy young adults and competitive distance runners using quantitative ultrasound analyses. We hypothesized that competitive distance runners with no clinical signs or symptoms of tendinopathy would have quantitative signs of tendon damage, characterized by decreased collagen alignment and echogenicity, in addition to previous reports of thicker tendons. Longitudinal ultrasound images of the right Achilles tendon mid-substance were acquired in competitive distance runners and recreationally-active adults. Collagen organization, mean echogenicity, and tendon thickness were quantified using image processing techniques. Clinical assessments confirmed that runners had no signs or symptoms of tendinopathy and controls were only included if they had no history of Achilles tendon pain or injuries. Runner tendons were 40% less organized, 48% thicker, and 41% less echogenic compared to the control tendons (p < 0.001). Young adults engaged in competitive distance-running have structurally different tendons than recreationally-active young adults. While these structural differences have been associated with tendon damage, the lack of clinical symptoms of tendinopathy may suggest that these detected differences may either be precursors of tendinopathy development or protective adaptations to cyclic tendon loading experienced during running.

Subarachnoid Hemorrhage in the Presence of a Cerebral Arteriovenous Malformation and an Intraventricular Oligodendroglioma: Case Report

Neurosurgery ◽  
1986 ◽  
Vol 19 (1) ◽  
pp. 125-128 ◽  
Author(s):  
Juan F. Martinez-Lage ◽  
Máximo Poza ◽  
Juan A. Esteban ◽  
Joaquin Sola
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Arteriovenous Malformation ◽  
Parietal Lobe ◽  
Cerebral Arteriovenous Malformation ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
Diagnostic Difficulties ◽  
The Right

Abstract The authors report a case of a ventricular oligodendroglioma associated with a cortical arteriovenous malformation. The patient presented with subarachnoid hemorrhage. Computed tomographic scan showed an intraventricular hyperdense lesion, mimicking a hematoma. Angiography revealed a superficial arteriovenous malformation in the right parietal lobe, unrelated to ventricular cavities. Both lesions were treated during the same operation. The diagnostic difficulties and the significance of this uncommon association are discussed.

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