Browsing by Author "Bibi, Yasser"
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Item A Missed Case of Synovial Osteochondromatosis(2024-03-21) Alkhabbaz, Omar; Bibi, Yasser; Webb, Brian; Milhoan, MadisonBackground: Synovial osteochondromatosis is a benign, uncommon, and interesting disorder that presents challenges in diagnosis and treatment. It is a complication of the synovial membrane of joints, tendon sheath, and bursae that can cause dysfunction most commonly in the knee, hip, or shoulder that has the potential of transforming into chondrosarcoma. While the exact etiology of a primary synovial osteochondromatosis is still in question, hypotheses point toward the metaplasia of the synovial membrane and the detachment of cartilaginous fragments as potential causation. The cause of secondary synovial osteochondromatosis is associated with an underlying joint pathology or condition that triggers development such as osteoarthritis, rheumatoid arthritis, or traumatic joint injuries Patients with this condition usually present with a history of pain in the joint affected, swelling, crepitus, and limited range of motion (ROM).The pain is usually aching in nature and is exacerbated by weight-bearing activities such as prolonged periods of walking or standing. Case Information: A 62-year-old female with a past medical history of hypertension and hypothyroidism presented to the clinic with a chief complaint of bilateral knee pain and effusions, which was diagnosed as osteoarthritis based on clinical exam and past X-rays. The patient had been experiencing moderate relief from bilateral steroid injections that were administered approximately every four to six months. As for diagnostic imaging, she had two MRI scans of her left knee; the first in 2020 and the second in 2023. The differential diagnosis formulated in the clinic after the MRI scan (Fi [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10705034/figure/FIG1/]was pigmented villonodular synovitis (PVNS), rheumatoid arthritis (RA), or synovial chondromatosis. Conclusions: Although synovial osteochondromatosis is generally a benign condition, transformation to chondrosarcoma is still a possibility. Imaging may assist in identifying the loose bodies floating in the joint space, but this becomes much more difficult if the loose bodies are radiotransparent (chondromatosis). Calcified nodules (osteochondromatosis) are relatively less difficult to view on X-ray. T2 weighted MRI imaging can help identify synovial hyperplasia which can help clue clinicians in with other physical exam findings. Although an arthroscopy with histopathology is the gold-standard diagnostic modality, it is important to keep in mind that one or even two different types of imaging modalities may not be sufficient for synovial osteochondromatosis to make the differential. As seen in our case, it took three years after the pain from the onset of chondromatosis for suspicion to arise on MRI. Sometimes patients may not be so fortunate by the time it is noticed and, although uncommon, the formation of chondrosarcoma may already be in progress. If left untreated, patients can also develop severe osteoarthritis. Clinicians must not hesitate to diversify the imaging modalities in which they order, as a diagnosis may become more apparent in one versus the other. Another lesson to take from our case is to stay vigilant in regard to who can present with synovial osteochondromatosis. Although our patient did fit the expected location of the disease (larger joint, the knee in this case), she did not fit the expected gender or age group in which these processes arise.Item Platelet Releasate and ESWT for Treatment of a Partial Supraspinatus Tear in an Adolescent Baseball Player(2024-03-21) Bibi, Yasser; Al-Khabbaz, Omar; Clearfield, DanielBackground: Rotator cuff injuries are a prevalent orthopedic concern, often arising from repetitive overhead activities, traumatic events, or age-related degeneration with the supraspinatus muscle being the most frequently injured. As the muscle responsible for initiating abduction of the arm, the supraspinatus is particularly susceptible to strain and tears, contributing to the majority of rotator cuff injuries. The incidence of rotator cuff tears in the general population is 5-30%, the prevalence of the condition is about 25% in people over age 65 and above 50% in individuals over age 80. Case Presentation: An 18-year-old right-hand dominant male baseball player who plays the catcher position presents to the clinic with right shoulder pain. The patient reports that they had a rotator cuff injury in his anterior shoulder area about 9 months prior which led to him sitting out of his previous season. On ultrasound imaging, the supraspinatus muscle showed a twenty-five percent partial tear on the bursal surface of the anterior aspect, with no retraction seen on dynamic exam. There was no other tendinosis or tear noted, with normal muscle appearance without any atrophy or fatty infiltration, or evidence of impingement with dynamic imaging. The ESWT was conducted before the Platelet Releasate injection procedure. With the patient in a supine crass position, 3000 total pulses at 15 MHZ were applied to the affected area using 2.6-3.6 bars of energy with a D-Actor C15 tip. The patient portrayed good tolerance to treatment, with a reported decrease in pain and improved range of motion. Following ESWT, a platelet releasate procedure was conducted on the right shoulder. On imaging, the patient’s supraspinatus muscle showed significant improvement in the tear, with only ten percent of the tear in the anterior supraspinatus still apparent (15 percent reduction total in the supraspinatus tear). There was evidence of acute supraspinatus tendinitis, with no impingement on dynamic testing. There was also some newly acquired bursitis in the subacromial bursa. There was no other noted tendinosis or tear, with a normal-looking muscle appearance. Conclusion: Generally, it can be difficult to highlight specifics and attribute them to the therapeutic effects of a treatment that facilitates various regenerative and healing properties. The main point of this case is to surface a less popular therapy compared to PRP: platelet releasate/ESWT and their therapeutic effects for MSK-related injuries. Platelet releasate paired with ESWT is a minimally invasive outpatient procedure and should be presented as a potential therapeutic treatment option to patients before considering invasive alternatives.