A patient comes to the rheumatoid consulting centre because of
pains in the shoulder which suddenly began during one day 3 years ago. Since the
time she has had permanent pains. Numerous steroid peritendinous injection into the shoulder
joint which has only a minimal effect. The patient cannot lie on the shoulder,
she has a feeling of a swollen shoulder on the inner side. Once she had
“water” in the knee a few years ago which disappeared after a peritendinous injection by
orthopaedist. But she thinks that it was due to an injury from that time. She
has no pain in other joints.
A painful palpation of the long head of the biceps, a swelling
in the medial area of the shoulder.
An elevation in flexion and also in abduction is restricted, a painful arc is there.
isolated movements in the glenohumeral articulation
An active and passive flexion, an outer rotation and an abduction in the glenohumeral articulation is restricted and painful in the outer position.
movements against the resistance
A painful abduction 12 and a flexion, outer rotation against the resistance.
Clear tenosynovitis of the long head of the biceps, other structures during the ultrasound are in norm.
picture and scheme of tenosynovitis of the long head of the biceps in the transversal section at the ultrasound
videosequence of tenosynovitis of the long head of the biceps in the transversal section at the ultrasound
A highly viscid liquid, pellucid, colourless.
Without any presence of cells and crystals.
Cultivation and sensibility
At the patient an aspiration and an injection of 12 mg Depomedrol was made for several times, but without any success, therefore she was sent to the orthopaedics to solve the problem with an operation. A revision was made there, and tenosynovitis with a presence of highly viscid exudate was confirmed. A good resulting effect of carried out tenosynovectomy.
3 years lasting tenosynovitis of the long head of the biceps.
At the described patient arthritis of a right wrist has occurred
during a last half of a year, and we close its diagnosis as undifferentiated
monoarthritis with tenosynovitis of the long head of the biceps in the
anamnesis. Progress of hydrops of the knee in the anamnesis does not eliminate a
bit active undifferentiated rheumatoid affection for the time being.