We describe two cases of bursitis at the insertion of the biceps tendon. They presented as swellings in the cubital fossa with symptoms of median nerve irritation. The aetiology was probably mechanical trauma; both patients were cured by operation

1. Three cases of fatty infiltration of the median nerve are reported. 2. One patient had symptoms of median nerve compression. 3. The intimate association of fibro-fatty tissue within the nerve precludes enucleation of the swelling

Six patients, aged between 3 and 51 years, with tuberculosis of the upper cervical spine were studied. Prominent features of the disease included pain and stiffness, paralysis, swelling of the retropharyngeal soft tissue, osteolytic erosions, and atlanto-axial subluxation. Cure was obtained with antibiotics, transoral decompression and C1-2 fusion

We have reviewed 21 cases of dorsal dislocation of carpometacarpal joints. In 15 of them the diagnosis was missed when they were first seen in an accident and emergency department. General swelling may obscure the characteristic clinical deformity and routine radiographs may not show the displacement clearly. It is recommended that a true lateral radiograph of the hand be requested when this injury is suspected

We report a case of anterior compartment syndrome in the ipsilateral leg after a revision total hip arthroplasty. Possible causes include postchaemic swelling after occlusion of the vessels during prolonged surgery and vigorous repetitive stretching of the muscles of the anterior compartment from the intraoperative use of electrical calf stimulators. Epidural infusions for postoperative analgesia may mask symptoms, but when there is clinical suspicion, we recommend measurement of the compartment pressures and early fasciotomy

We report six cases of contralateral limb involvement during total hip arthroplasty including swelling of the gluteal muscle compartments, rhabdomyolysis, myoglobinuria, and sciatic nerve palsy. The risk factors for such complications include obesity, prolonged operative time, and positioning in the lateral decubitus position. The laboratory and clinical findings are consistent with a gluteal muscle crush-injury with consequent compartment syndrome. The patients should be treated conservatively as symptoms can be expected to resolve

1. A method of constricting sciatic nerves of rats was devised which produced lesions resembling macroscopically and electromyographically those of carpal tunnel and related syndromes. 2. The nerves became swollen and hyperaemic proximal and distal to the constriction. The swellings were largely caused by an accumulation of fluid between the axons, but the axons themselves were also increased in size. 3. This accumulation of fluid was an oedema secondary to a partial obstruction of the vasa nervorum

Thirty-four neonates with osteomyelitis were reviewed. The hip (19) was the most common site involved. Swelling and pseudoparalysis were the most significant local signs. Radiographic abnormalities, such as metaphyseal rarefaction and/or joint subluxation were found on the initial radiographs in 18 of the 19 hips involved. All patients were treated with antibiotics and all infections involving joints were drained surgically. Good results were achieved in 75% of all sites and in 68% of hips

Condensing osteitis of the clavicle was first described as a disease entity in 1974. There is painful localised swelling of the clavicle of undetermined origin, with increased radio-density, but an infective aetiology has not been excluded by previous authors. We report three children with the clinical and radiological findings of 'condensing osteitis'. Two of them had raised levels of antistaphylolysin titres and all responded to antibiotic therapy. We conclude that condensing osteitis is due to low-grade staphylococcal osteomyelitis; biopsy and treatment by antibiotics is recommended

The suppression of the immediate postmeniscectomy synovial reaction by a potent prostaglandin inhibitor (flurbiprofen 400 mg daily) resulted in significantly less knee pain and swelling in 50 patients compared to 50 age-matched controls taking a simple analgesic (paracetamol 4 g daily) (P less than 0.001), thus enhancing recovery by three to four weeks. In the patients undergoing partial meniscectomy knee function was restored by 27 days, a figure comparable with endoscopic methods

The imaging techniques available to aid the diagnosis of ruptures of tendo Achillis, the rotator cuff and the tendon of tibialis posterior in rheumatoid patients are well described. However, ruptures of tendon or muscle at other sites are uncommon and may be overlooked. Diagnosis is often made by localised tenderness, swelling and a lack of active movement associated with a palpable defect. Clinical examination may be inconclusive and can be aided by imaging studies. We report two cases in which ruptures of a tendon were suspected, and ultrasound imaging demonstrated the palpable defect to be a cleavage plane in the subcutaneous fat – a ‘fat fracture’

We reviewed 17 patients after arthroscopic resection for anterior impingement in the ankle. All had had painful limitation of dorsiflexion which had failed to respond to conservative treatment. Review at an average of 39 months showed very significant improvements in levels of pain, swelling, stiffness, limping and activity. There was a significant improvement in the range of dorsiflexion but not of plantar flexion. One poor result was due to a superficial infection, and two other patients had residual numbness of the foot which persisted for several months

We describe six knees in five patients, referred to us after accidental irrigation with chlorhexidine 1% in aqueous solution during arthroscopy. All six knees developed persisting pain, swelling and crepitus with loss of range of movement. Radiographs showed loss of joint space in all three compartments due to extensive chondrolysis, with many loose bodies and synovitis. Histological examination showed partial necrosis of the cartilage, with slight non-specific inflammation and fibrosis of synovial specimens. Care is needed in checking irrigation fluids, and these should have a distinctive colour

Bilateral posterior interosseous nerve palsy in a rheumatoid patient is described. Six previous case reports and our experience indicate that steroid injection into the elbow may not produce lasting recovery and may lead to unacceptable delay before surgical decompression. An anterolateral approach for division of the arcade of Frohse is effective in cases with diffuse synovitis; where there is a local cystic swelling a posterolateral approach provides better access. Good recovery of nerve function can be expected after early operation

Chronic recurrent multifocal osteomyelitis (CRMO) is characterised by an insidious onset of fever, local swelling and pain in affected bones, and radiological abnormalities suggestive of osteomyelitis. The histopathological features in 14 patients are described. Morphologically CRMO begins as an acute inflammatory process with a predominance of polymorphonuclear leucocytes, which occasionally form an abscess and osteoclastic bone resorption. At a later stage the predominant features are lymphocytes in the inflammatory infiltrates and occasional granulomatous foci and sigans of bone formation. The clinical course may be prolonged for many years

Chronic non-specific tenosynovitis of the posterior tibial tendon is a well-known clinical entity, characterised by pain, swelling and tenderness behind the medial malleolus. There are no reports in the literature of any case associated with any radiological abnormality. Three such cases are discussed, each presenting with the clinical findings typical of the syndrome but with associated radiological changes. These changes may pose diagnostic problems and several primary conditions need to be excluded. Surgical decompression of the tendon may be necessary to relieve symptoms, to prevent erosion and rupture of the tendon, and to establish the diagnosis

Aims

The James Lind Alliance aims to bring patients, carers, and clinicians together to identify uncertainties regarding care. A Priority Setting Partnership was established by the British Association for Surgery of the Knee in conjunction with the James Lind Alliance to identify research priorities related to the assessment, management, and rehabilitation of patients with persistent symptoms after knee arthroplasty.

Primary subacute haematogenous osteomyelitis (PSHO) of the small bones of the foot is a rare and infrequently considered cause of a limp in children. We describe 11 patients with PSHO, of whom nine were under three years of age, who had a limp with few symptoms. The talus was involved in 36%. Bone scans were positive in all patients and led to localisation of the lesion in two. The radiological features included soft-tissue swelling, an osteolytic lesion in the talus and the calcaneus and a sclerotic appearance of the cuboid and the navicular bones. All patients except one were cured with antibiotics