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Surgical Inflammation (Skeletal and Muscular system)Arthritis,Bursitis,Tendonitis,Tenosynovitis.

Arthritis is an acute or chronic inflammation of a joint; 2. Etiology and pathology The etiology could be noninfectious or infectious. 2.1. Noninfectious arthritis are: 2.1.1. Hypertrophic arthritis (osteoarthritis): - which affects the weight-bearing joints in older patients; - and is observed erosion of articular cartilage which becomes soft, thin and frayed with eburnation of subchondral bone and overgrowths of marginal osteophytes; 2.1.2. The other type of Noninfectious arthritis is Rheumatoid arthritis which is a systemic disease occurring more often in women and affective connective tissues; 2.1.3. Psoriatic arthritis observed in the case of psoriasis; 2.1.4. Traumatic and others; 2.2.he microorganisms that cause Infectious arthritis or suppurative arthritis are: 2.2.1. Staphylococci, streptococci, gonococci, etc.; Aerobic gram-negative rods are involved in 20-25% of cases. Most of these infections occur in people who are very young, who are very old. 2.2.2. The typical locations are the knee joint, the hip joint and the elbow joint; Of cases of nongonococcal suppurative arthritis, 85-90% are monoarticular. If the disease affects more than one joint, S aureus is most commonly implicated. Polyarticular arthritis is usually observed in gonococcal disease, various viral infections, Lyme disease, reactive arthritis. 2.2.3. The infectious agent could reach the joint: - direct in the case of trauma (penetrating wounds); - hematogenic through the blood; - lymphogenic through the lympa; - or spreading infection (from osteomyelitis); 2.2.4. The Predisposing factors are: - insufficient local immunity and the presence of closed cavity; - The another predisposing factor is that the synovial fluid is the good substance for bacterial invasion and development 2.2.5. The Types of inflammation could be: serous, fibrinous and suppurative 3. Clinical signs of acute suppurative arthritis are: 3.1. General and. Local which are pain, redness, swelling, heat, loss of function, fluctuation; 3.3. The possible complications could be: - phlegmon and/or fistule,pathological dislocation (luxation),osteomyelitis, other infections, chronic infection or inflammation; 4. Diagnosis of acute suppurative arthritis: 4.1. The diagnosis is based on the Clinical signs and laboratory tests, which are sufficient; Culture of the synovial fluid or of synovial tissue itself is the only definitive method of diagnosing septic arthritis. Examining the synovium histologically often establishes a diagnosis of fungal or mycobacterial joint infections.Secondly On X-rays it is observed dilated intraarticular space, osteomyelitis or luxation. CT scans and MRIs are more sensitive for distinguishing osteomyelitis, periarticular abscesses, and joint effusions. 5. Treatment of acute suppurative arthritis include: 5.1. Immobilization of the affected joint; 5.2. Antibiotic therapy -antibiotics usually need to be administered parenterally for at least 2 weeks. Initial antibiotic choices must be empirical. Because many isolates of group B streptococci have become tolerant of penicillin, use a combination of penicillin and gentamicin or a later-generation cephalosporin / Cefixime/. Nonsteroidal inflammatory agents are the primary therapeutic agents for reactive arthritis. 5.3. Physiotherapy; 5.4. Puncture of the articular cavity which purpose is: - to collect the sample for microbiological tests,to evacuate the pus , and to installate antiseptics in the joint; 5.5. In case of unsuccessful puncture the surgical treatment which include incision + evacuation + installation of antiseptics + drainage is indicated; Routine arthroscopic lavage is rarely indicated. However, drainage through the arthroscope is replacing open surgical drainage. With arthroscopic

drainage, the operator can visualize the interior of the joint and can drain pus, debride, and lyse adhesions. Gonococcal-infected joints rarely require surgical drainage. Bursitis acute or chronic inflammation of a bursa; 2. Etiology and pathology The etiology could be noninfectious or infectious: 2.1. Noninfectious bursitis are: - most of the traumatic bursitis; - in which initially there is acute serous inflammation which could progress to the chronic fibrinous inflammation; - the typical locations are prepatellar, suprapatellar, elbow (olecranon); - An acute noninfectious bursitis may be complicated with infection and develop into an acute infectious bursitis; 2.2.The Infectious bursitis or suppurative bursitis are caused by: 2.2.1. Staphylococci, streptococci, etc.; 2.2.2. The typical Locations are the same as in acute noninfectious bursitis; 2.2.3. The infectious agent could reach the joint: - direct in traumatic cases (penetrating wounds), hematogenic, lymphogenic, or spreading infection (from arthritis); 2.2.4. The Predisposing factors are: - insufficient local immunity and the presence of closed cavity; - The another predisposing factor is that the synovial fluid is the good substance for bacterial invasion and development; 2.2.5. The types of inflammation could be: seros , fibrinous , suppurative; 3. Clinical signs of acute suppurative bursitis: 3.1. General and; 3.2. Local which are pain, redness, swelling, heat, loss of function, fluctuation; 3.3. The possible complications are: - phlegmon +/- fistule , acute arthitis , other infections , chronic infection / inflammation; 4. Diagnosis of acute suppurative arthritis is based on the: 4.1. Clinical signs and Laboratory tests; 5.The treatment must be more active than in acute arthritis and includes: 5.1. Immobilization , Antibiotics therapy, Puncture of the bursa, or surgical treatment with Incision + evacuation + installation of antiseptics + drainage ,In the case of chronic inflammation the treatment is extirpation of the bursa. Tendonitis and tenosynovitis 1.tendonitis is an inflammation of a tendon; tenosynovitis is an inflammation of a tendon and its enveloping sheath; 2. The different types of tenosynovitis are traumatic and infectious: 2.1.The Traumatic one is:the most common especially in the case of chronic trauma and it is observed an acute serous inflammation which can progress to chronic fibrinous inflammation; 2.2. Infectious tenosynovitis, in which the etiology, routs of infection, predisposing factors and types of exudation are similar to those of arthritis and bursitis; 3.1. Clinical signs in the case of Acute tenosynovitis are: - general, nonspecific signs and local signs the common ones plus crepitations; 3.2. . Clinical signs in the case of Chronic tenosynovitis are: - entrapment syndrome due to stenosis- it is observed loss of mobility of small joints of the fingers of the upper limb and it causes the so called trigger finger (in which the flexion or extension is difficult momentarily with a sudden release) to total blocking; 4. Diagnosis of tenosynovitis is based on the local clinical signs which are typical; 5. Treatment of tenosynovitis: 5.1. The treatment of Acute noninfectious forms includes: -immobilization, physiotherapy; - and non-steroid anti-inflammatory drugs; 5.2. . The treatment of Acute infectious forms includes: - immobilization, physiotherapy ,antibiotics , and surgery in the case of presence of pus; 5.3. The treatment of Chronic forms includes: - immobilization, physiotherapy, non-steroid anti-inflammatory drugs , or surgical procedure.