•Le doigt à ressaut est une pathologie commune et fréquente en rhumatologie.•La section échoguidée de la poulie A1 à l’aiguille est rapide et efficace.•Cette technique permet d’éviter la chirurgie.
...L’objectif de ce travail est d’évaluer l’efficacité et la tolérance de la section de poulie A1 à l’aiguille sous contrôle échographique dans les doigts à ressaut symptomatiques.
Tous les patients inclus ont bénéficié d’une libération de poulie A1 à l’aiguille sous contrôle échographique. L’aiguille utilisée était une intramusculaire de 21 gauges (G). Le stade Quinnell (1–4), le QuickDASH (0–100) et l’EVA douleurs (0–10mm) ont été recueillis à l’inclusion. Le critère de jugement principal était la disparition du ressaut à 6 mois (M6).
Quatre-vingt-quatre patients (105 doigts traités) ont été inclus. L’âge moyen était de 63,3±10,7 ans. Avant traitement, l’EVA douleur moyenne était de 5,8±2,6mm et le QuickDASH moyen de 44,3±19,1. À M6, la disparition du ressaut était obtenue pour 85 des 91 doigts réévalués (93,4 %), et pour 85,7 % à 12 mois. La diminution à M6 de l’EVA douleur et du QuickDASH était respectivement de 4,1±3,1 (p < 0,001) et de 36,1±20,7 (p < 0,001), et 90 % des patients étaient satisfaits ou très satisfaits à M6. La durée d’évolution ancienne était significativement associée à la persistance du ressaut à M6. Les complications étaient peu fréquentes et mineures. Une ténosynovite apparaissait dans 5,7 % des cas, pour qui une infiltration dans un second temps d’un corticostéroïde dans la gaine du fléchisseur permettait une évolution rapidement favorable.
Le traitement du doigt à ressaut par libération de la poulie A1 à l’aiguille sous contrôle échographique apparaît comme une technique percutanée peu invasive, rapide, efficace et avec une bonne tolérance jusqu’à 12 mois.
To identify predictive factors of response to viscosupplementation (VS) in patients with hip osteoarthritis (HOA).
Prospective, multicentre, open-label trial, achieved in daily practice conditions. ...Patients with HOA were treated with a single intra-articular injection of a cross-linked hyaluronic acid combined with mannitol (HAnox-M-XL), using imaging guidance. WOMAC pain and function scores and patient global assessment (PGA) were assessed at baseline and day 90. Improvement, satisfaction and efficacy were self-assessed at day 90. Hip radiographs at baseline were scored using Kellgren-Lawrence grade and Osteoarthritis Research Society International (OARSI) score. Associations between clinical and radiological features and response to VS (pain improvement > 50% at day 90) were assessed in univariate analysis, and then using logistic regression, adjusted for confounding factors.
The intent-to-treat (ITT) population included 97 patients (57 females, mean age 63). Ninety completed the follow-up and 80 had full clinical and radiological data. Response to VS was achieved in 47.8% of patients. In univariate analysis, the only clinical outcome statistically and negatively related to response was PGA at baseline (p = 0.047). Radiologically, response to VS was negatively correlated with joint space narrowing (JSN) score (JSN < 2 vs. JSN ≥ 2, p = 0.01) and was related to the patterns of femoral head migration (p = 0.008). In multivariate analysis, only JSN grade (p = 0.03) remained significantly related to a poor response.
This pilot study, which needs further confirmation by larger scale trials, suggests that radiological features might be of importance for the decision of VS in patients with HOA.
ID RCB N°2013-A00165-40. Registered 31 January 2013.
Les tendinopathies dorsales du poignet Lellouche, Henri
Revue du rhumatisme monographies,
June 2012, 2012-06-00, Letnik:
79, Številka:
3
Journal Article
Recenzirano
Les tendons de la face dorsale du poignet peuvent être le siège de tendinopathies qui sont la pathologie la plus fréquente, secondaire à des microtraumatismes répétés. Les ténosynovites de la ...polyarthrite rhumatoïde ou infectieuse, voire tumorale apparaissent dans des contextes particuliers et doivent être formellement éliminées. Dans les formes liées à une hyper utilisation, l’examen clinique minutieux permet, en général, de poser le diagnostic et de préciser les tendons impliqués. Selon la localisation anatomique, le tableau clinique et les solutions thérapeutiques sont différents. Le repos et l’infiltration locale d’un dérivé cortisonique suffisent le plus souvent à obtenir une guérison. L’échographie permet de confirmer le diagnostic, d’apprécier l’état du tendon et d’aider au traitement en guidant le geste infiltratif. La chirurgie, en cas de résistance au traitement médical, ne doit pas être retardée.
Tendons of the dorsal face of the wrist can suffer of tendinopathies, mostly after repeated microtraumas. Tenosynovites of the rheumatoid arthritis, infectious tendinitis or even tumoral, appear in particular contexts and must be formally eliminated. In the mechanical forms, a meticulous clinical examination allows, generally, to make the diagnosis and to specify involved tendons. According to anatomical location, clinical and therapeutic solutions are different. Rest and local infiltration of steroid are mostly enough to obtain a cure. Echography confirms the diagnosis, appreciate the state of the tendon and help in the treatment by guiding the steroid injection. The surgery, in case of resistance in the medical treatment, must not be delayed.
Needle aponeurotomy in Dupuytren's disease Beaudreuil, Johann; Lellouche, Henri; Orcel, Philippe ...
Joint, bone, spine : revue du rhumatisme,
01/2012, Letnik:
79, Številka:
1
Journal Article
Recenzirano
Abstract Needle aponeurotomy (NA) is recommended as a nonsurgical treatment for Dupuytren's disease. The aim of the procedure is to cut the Dupuytren's cord by use of the bevel of a needle and to ...restore full extension of the metacarpophalageal or proximal interphalangeal joints. According to Lermusiaux's standard, NA is performed in an outpatient setting, with the patient under local anesthesia. It entails the use of a 25-gauge, 16 mm-long needle and an anesthetic mixture of lidocaine and acetate of prednisolone. Various modifications have been proposed since the description of Lermusiaux's standard. Lermusiaux's and modified standards demonstrated structural efficacy in Dupuytren's disease. Clinical studies indicate that the mean rate of good structural results of NA is 80% at short-term assessment and 69% at 5-year assessment. Most of the studies are case series and only one is a randomized trial. Better results are demonstrated in early stages of the disease. NA also reduces disability and patients are highly satisfied. The short-term results with Lermusiaux's standard do not appear to be impaired in digital involvement. This is not the case for modified standards providing better results with palmar involvement. Lermusiaux's standard appears to provide less recurrences and less adverse events. In the largest study, skin fissure was observed in 8% of hands, transient dysesthesia in 3%, local infection in 0.7%, and flexor tendon rupture in 0.2%. Values were lower if related to NA sessions or NAs during each session. We therefore recommend Lermusiaux's standard for safe and effective NA in patients with Dupuytren's disease.
Dupuytren contracture or disease of the hand is the retraction of the palmar aponeurosis. Its course is progressive and leads to an irreducible flexion deformity of one or more fingers. Early ...diagnosis is necessary for the table test, which determines the need for treatment. Needle aponeurotomy should be the first option treatment. This minimally invasive outpatient procedure minimizes sick leave and does not require immobilization or physical therapy. Several studies confirmed the short- and intermediate-term effectiveness of this treatment and the minimal side effects when performed by experienced operators. Multiple procedures for extensive disease (several knots) can be performed in the hospital. Close medical and surgical collaboration is necessary for treatment of severe forms, treatment failures, and multiple recurrences.
La maladie de Dupuytren est une rétraction de l’aponévrose palmaire moyenne entraînant la flexion progressive et irréductible d’un ou plusieurs doigts.
Le diagnostic doit être précoce pour enseigner ...au patient le test de la table qui détermine l’indication d’un traitement.
L’aponévrotomie percutanée à l’aiguille doit être proposé de première intention.
C’est une technique non chirurgicale, ambulatoire, sans immobilisation, sans rééducation et le plus souvent ne nécessitant pas d’arrêt de travail prolongé.
Son efficacité à court et à moyen termes et le peu d’effets indésirables entre des mains entraînées sont aujourd’hui confirmés.
Certaines formes sévères peuvent être prises en charge en hôpital de jour pour un traitement par multi-aponévrotomies.
Une étroite collaboration médicochirurgicale est nécessaire pour la prise en charge des formes sévères, des échecs et des récidives.
Dupuytren contracture or disease of the hand is the retraction of the palmar aponeurosis. Its course is progressive and leads to an irreducible flexion deformity of one or more fingers.
Early diagnosis is necessary for the table test, which determines the need for treatment.
Needle aponeurotomy should be the first option treatment. This minimally invasive outpatient procedure minimizes sick leave and does not require immobilization or physical therapy.
Several studies confirmed the short- and intermediate-term effectiveness of this treatment and the minimal side effects when performed by experienced operators.
Multiple procedures for extensive disease (several knots) can be performed in the hospital.
Close medical and surgical collaboration is necessary for treatment of severe forms, treatment failures, and multiple recurrences.
To assess predictors of response, according to hip MRI inflammatory scoring system (HIMRISS), in a sample of patients with hip osteoarthritis (OA) treated by hyaluronic acid (HA) injection.
Sixty ...patients with hip OA were included. Clinical outcomes were assessed at baseline and three months after HA injection by WOMAC. On hip MRI performed before HA injection, bone marrow lesion (BML) and synovitis were assessed by HIMRISS by four readers. The inter-reader reliability of HIMRISS was for HIMRISS total, acetabular BML, femoral BML and synovitis-effusion respectively 0.86, 0.64, 0.83 and 0.78. Associations between MRI features and clinical data were assessed. Logistic regression (univariate and multivariate) was used to explore associations between MRI features and response to HA injection, according to WOMAC50 response at three months.
In total, 45.5% of patients met WOMAC50 response. Five adverse events were reported. At baseline, WOMAC function correlated significantly to HIMRISS synovitis-effusion (r=0.27, P=0.03). In univariate analysis, BML femoral according to binary assessment (P=0.025), HIMRISS BML femoral (P=0.0038), HIMRISS BML acetabular (P=0.042), HIMRISS total (P=0.0092) were associated negatively with WOMAC50 response. In multivariate analysis, adjusted for age and BMI, HIMRISS femoral BML (P=0.02) and HIMRISS total (P=0.016) were negatively associated with response. At a HIMRISS threshold of<15, 82% of patients were responders, with specificity SP=0.97, sensitivity SN=0.39, and positive and negative predictive values of 0.91 and 0.64, respectively.
HIMRISS is reliable for total scores and sub-domains. It permits identification of responders to HA injection in hip OA patients.
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