The effects of local glucocorticoid on tendon appear broadly negative and this supports the emerging clinical evidence which points toward significant long term harms associated with this treatment modality. The use of locally administered glucocorticoid is widespread in the treatment of painful tendinopathy. Despite evidence of short term benefit, the emerging evidence points toward significant long term harms associated with this method of treatment, including an increased risk of recurrence, rupture and worsened clinical outcomes (1, 2). Our primary purpose was to summarise the known effects of locally administered glucocorticoid on tendon tissue and tendon cells.Summary Statement
Introduction
The peripheral neuronal phenotype is significantly altered in rotator cuff tendinopathy (RCT) with a clear upregulation of the Glutaminergic system being present in disease. Shoulder pain is the third most frequent cause of chronic musculoskeletal pain in the community and is usually caused by rotator cuff tendinopathy (RCT). The central and peripheral nervous system play an important role in both tissue homoeostasis and tendon healing. The Glutaminergic system is of key importance in driving the peripheral and central neuronal changes which increase the body's sensitivity to pain (1, 2). No study to date has investigated the role of the glutaminergic system in human RCT. We hypothesised that the peripheral neuronal phenotype would be altered in RCT, and would vary according to disease stage as measured by size of tear. The term ‘peripheral neuronal phenotype’ is used to refer to refer to specific characteristics of the peripheral nervous system, neuronal mediators and the receptors for these mediators in peripheral tissueSummary Statement
Introduction
A case series with functional and radiographic outcomes, of modular endoprosthetic distal femoral replacement in complex cases of periprosthetic fracture. Sixteen cases were identified of endoprosthetic replacement (EPR) from the bone and soft tissue cancer implant registry. A retrospective review was undertaken.Aim
Method
Although originally designed to aid the management of primary malignant bone tumours, the indications for modular endoprosthetic replacement (EPR) have expanded to include complex periprosthetic fractures and failed internal fixation. The incidence of these challenging cases is increasing with an aged population. We reviewed retrospectively our experience with the use of EPR in patients who had undergone limb salvage following complex trauma presentations. Between 2003 and 2008 twenty one patients underwent EPR following referral to the Oxford Sarcoma Service following lower limb trauma. The average age was 71 years (44–87). The average number of previous surgical procedures was 3 (range 0–11). The mean Harris Hip Score was 89.5 (range 64–85). The mean American Knee Society Score was 82 (range 62–100) and the mean functional score was 62 (range 30–75). Complications included two cases of deep infection; one resulted in a two stage revision procedure, while the other retained the EPR following a washout. EPR is an effective salvage procedure for failed trauma fixation and periprosthetic fractures. Immediate weight bearing and a good functional outcome can be expected in this difficult group of patients.
The infrapatellar (Hoffa’s) fat pad can be affected by a variety of tumours and tumour-like conditions which can occasionally present a diagnostic and therapeutic challenge to the treating surgeon. The fat pad can be affected by diffuse or solitary disease. Solitary tumours are relatively uncommon but with widespread uptake of Magnetic Resonance Imaging Scans (MRI) an increasing number of Hoffa’s fat pad tumours (HFP) are being recognized. Between 1999 and 2008, 20 patients with HFP pathology referred to Oxford bone and soft tissue tumour service underwent resection and histological examination. Clinical records, imaging and histological findings were reviewed. Histology showed eight different diagnoses with Pigmented Villonodular Synovitis (PVNS) and ganglia being the most common pathology. In one patient, MRI identified the cause of hypophosphataemic osteomalacia as an HFP phosphaturic mesen-chyma tumour despite the lack of local symptoms. In conclusion, the majority of solitary HFP tumours are benign and maybe cystic or solid. MRI and plain radiographs are the imaging of choice. Cystic tumours maybe aspirated but the definitive treatment of both cystic and solid tumours should be open arthrotomy and excision biopsy. Arthroscopic resection is not advised, as complete excision is not always possible. None of the 20 patients in this series had a malignant tumour but this has been reported in the literature. Calcification on plain radiographs may indicate a malignant lesion. All patients in our series reported substantial improvement in symptoms following open tumour resection.
