Joint effusion

Intraarticular corticosteroid injections can provide relief, particularly when a joint effusion is present. Average doses for injection of large joints in adults are methylprednisolone acetate 20 to 40 mg or triamcinolone hexacetonide 10 to 20 mg. After aseptic aspiration of the effusion and corticosteroid injection, initial pain relief may occur within 24 to 72 hours, with peak relief occurring in about 1 week and lasting for 4 to 8 weeks. The patient should minimize joint activity and stress on the joint for several days after the injection. Therapy is generally limited to three or four injections per year because of the potential systemic effects of the drugs and because the need for more frequent injections indicates poor response to therapy. 

Schiavon F. Transient joint effusion a forgotten side effect of high dose corticosteroid treatment. Ann Rheum Dis 2003 62 491-2. 

Intra-articular corticosteroids may be useful in some patients, particularly if there is an acute flare of the disease. The joint is injected with a steroid and this can reduce inflammation and joint effusion. The joint should not be injected more than once every three months... 

A small proportion of patients develop troublesome myalgia when taking cimetidine (27). There have been incidental reports of polymyositis and a form of myopathy probably of motor neuron origin. Myalgia can also be associated with arthritis and joint effusion, but this is extremely unusual (SED-12, 942) (28). 

A joint effusion developed in one of 14 children using deferiprone (24). 

After intra-articular injection, sodium hyaluronate can cause hemarthrosis, increased joint effusion volume, and possibly phlebitis. Other adverse effects are joint pain. 

Patellofemoral compartment involvement Pain related to climbing stairs Medial compartment involvement Genu varum (bowlegged deformity) Lateral compartment involvement Genu valgum (knock-knee deformity) Transient joint effusions Typically noninflammatory... 

W30. Wood, D. D., Ihrie, E. J., Dinarello, C. A., and Cohen, P. L. Isolation of an interleukin-1-like factor from human joint effusions. Arthritis Rheum. 26, 975-983 (1983). 

Hangarter s first experiences with Permalon resulted in remission of fever, alleviation of pain, increased mobility, inhibition of exudation of joint effusions, and a decrease in the ESR in various stages [243] of rheumatic diseases [245]. His clinical results demonstrated therapeutic success, as shown in Table 6.12. 

Kaneyama K, Segami N, Sun W, et al. (2005). Levels of soluble cytokine factors in temporomandibular joint effusions seen on magnetic resonance images. Oral Surg., Oral Med., Oral Pathol., Oral Radiol., Endodont. 99 411-418. 

Bacterial superinfection of pox lesions was relatively uncommon except in the absence of proper hygiene and medical care. Arthritis and osteomyelitis developed late in the course of disease in about 1% to 2% of patients, more frequently occurred in children, and was often manifested as bilateral joint involvement, particularly of the elbows.70 Viral inclusion bodies could be demonstrated in the joint effusion and bone marrow of the involved extremity. This complication reflected infection and inflammation of a joint followed by spread to contiguous bone metaphyses, and sometimes resulted in permanent joint deformity.71 Cough and bronchitis were occasionally reported as prominent manifestations of smallpox, with attendant implications for spread of contagion however, pneumonia was unusual.72 Pulmonary edema occurred frequently in hemorrhagic- and flat-type smallpox. Orchitis was noted in approximately 0.1% of patients. Encepha-... 

Plain radiographs provide many indications suggestive of acute ACL rupture avulsion fracture of the lateral tibial plateau, or Segond fracture, which is in fact an injury to the lateral joint capsule, avulsion of the Gerdy s tubercle and a lateral notch lesion, which is a compression fracture of the lateral femoral condyle of more than 2 mm seen on lateral radiograph. A tibial rim lesion on the posterolateral lip of the lateral tibial plateau can also be found alone or associated with the lateral notch lesion and is termed a kissing contusion. Joint effusions can also be detected on simple radiographs (Fig. 20.6). 

Fractures in the region of the elbow can be particularly difficult to diagnose and delineate accurately. Ultrasound has been shown to be a useful adjunct to plain radiography, particularly if clinical suspicion is high and radiographs are indeterminate (Davidson et al. 1994 Markowitz et al. 1992 Vocke-Hell and Schmid 2001). With supracondylar fractures of the humerus, ultrasound may demonstrate the fracture line in association with a joint effusion and elevation of the fat pads (Figs. 4.5,4.6). 

Fig. 18.4. a A lateral radiograph of the elbow, the black section represents the fat pad made visible by the distended joint capsule (hashed lines), b Joint effusion with visible dark fat pads, c Fat pads outlined... 

Fractures involving the epiphysis and physis of the finger metacarpals are uncommon (Mahabir et al. 2001). Epiphyseal fractures are rare, and non displaced fractures may heal well (Fig. 19.19). Displaced split fractures of the epiphysis may need open reduction to restore articular congruity (Graham and Waters 2001). Intra-articular fractures of the epiphysis are important to identify as they are associated with joint effusions. If these effusions are under enough pressure, blood flow to the epiphysis maybe sufficiently compromised to cause avascular necrosis. Preventative joint aspiration may be considered (McElfresh and Dobyns 1983). 

A pathologic barrier may also occur as the result of disease or trauma. An example is joint fusion caused by spondylitis or the joining of osteophytes in an arthritic joint. Inflammation or joint effusion will restrict normal motion. The osteopathic restrictive barrier is one that lies within the physiologic range of motion and that prevents a joint from moving symmetrically within the physiologic range of motion (Fig. 4-3). 

Knee Joint Effusion Test (Bounce-Home Test)... 

The knee joint effusion test is performed by supporting the patient s heel in one hand and the calf in the other. The knee is semi-flexed. The hand under the calf is removed carefully and the knee allowed to extend in the same manner as the recurvatum tests. Failure of the knee to extend fully indicates increased joint fluid. Normally the knee should extend fully and end, with a slight "bounce back" at the end point. 

Tuberculosis, especially as a pulmonary infection, is an important side effect in rheumatoid arthritis patients treated with anti-TNFa agents. Pulmonary tuberculosis and tuberculous arthritis of a knee joint were diagnosed with the aid of chest X-ray and tuberculos/polymerase chain reaction (PCR) of joint fluid in a 72-year-old woman being treated with adalimumab/etanercept. The patient had a 10-year history of seropositive rheumatoid arthritis but also type 2 diabetes mellitus, left knee pain, joint effusion and fatigue. The anti-TNFa therapy was believed to be the initiator of the infection [87 ]. 

Histologic Considerations 150 Normal US Anatomy and Scanning Technique 153 Pathologic Changes 156 Joint Effusion 156 Rheumatoid Arthritis and Other Inflammatory Arthropathies 158 Septic Arthritis 162 Traumatic Injuries 163 Degenerative Joint Disease (Osteoarthritis) 166 Deposition Diseases 169 Postoperative Complications 173... 

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