Azeem Nazia, Ariff Madiha
Radiology, Sir Syed Hospital, Karachi, PAK.
Internal Medicine, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2020 Apr 16;12(4):e7692. doi: 10.7759/cureus.7692.
Objectives To assess the clinical and radiological features of repetitive stress injuries (RSIs), specifically de Quervain's (DQ) disease, tennis elbow (TE), and plantar fasciitis (PF). Methods This was an observational study conducted for eight months (March 2019 to September 2019) at the Orthopedic Department in collaboration with the Radiology Department. Clinically diagnosed RSI patients from both genders, aged between 30 and 50 years, were included in the study. Clinical features that were considered include pain, swelling, and site of injury. Radiological findings from ultrasound, X-ray, and magnetic resonance imaging (MRI) were identified in all participants of the study. Data were analyzed using SPSS Version 21 (IBM Corp., Armonk, NY, USA). Data were represented as frequency and percentages. Results There were a total of 82 patients (40 males,42 females) with repetitive stress injury (RSI), with a mean age of 42.63±8.53 years. Of the 82 patients, 34 (41.4%) had DQ disease, 28 (34.1%) had TE, and 20 (24.4%) had PF. Pain and swelling were observed in all patients. In TE, the most affected site was the right lateral epicondyle process. The common radiological findings were hypoechoic fascia, increased fluid within the first extensor tendon compartment, cortical erosion, sclerosis in soft tissues, and calcification in soft tissues. Cozen's test was positive in most patients. In DQ, the most affected sites were left and right radial styloid processes. The common radiological findings were hypoechoic fascia, increased fluid within the first extensor, cortical erosion, and periosteal reaction. Finkelstein's test was also positive in most patients. In PT, the most affected site was the left heal plantar surface. The common radiological findings were hypoechoic fascia, increased thickness of fascia (>4.5 mm), increased fluid within the first extensor tendon compartment, cortical erosion, sclerosis in soft tissues, calcaneal spur, periosteal reaction, and calcification in soft tissues. Cozen's and Finkelstein's tests were also positive in most patients. Conclusions History, physical examination, laboratory findings, and imaging modalities all are important tools for the differential diagnosis of RSI. Our study results showed that if some clinical findings fail to diagnose any RSI, then ultrasound, X-ray, and magnetic resonance imaging (MRI) are the best and useful options before treatment.
目的 评估重复性应力损伤（RSIs）的临床和放射学特征，特别是桡骨茎突狭窄性腱鞘炎（DQ）、网球肘（TE）和足底筋膜炎（PF）。方法 这是一项于2019年3月至2019年9月在骨科与放射科合作开展的为期八个月的观察性研究。纳入年龄在30至50岁之间、临床诊断为RSI的男女患者。所考虑的临床特征包括疼痛、肿胀和损伤部位。在研究的所有参与者中确定超声、X线和磁共振成像（MRI）的放射学结果。使用SPSS 21版（美国纽约州阿蒙克市国际商业机器公司）分析数据。数据以频率和百分比表示。结果 共有82例重复性应力损伤（RSI）患者（40例男性，42例女性），平均年龄为42.63±8.53岁。在这82例患者中，34例（41.4%）患有桡骨茎突狭窄性腱鞘炎，28例（34.1%）患有网球肘，20例（24.4%）患有足底筋膜炎。所有患者均观察到疼痛和肿胀。在网球肘患者中，最常受累的部位是右侧肱骨外上髁。常见的放射学表现为低回声筋膜、第一伸肌腱鞘内液体增多、皮质侵蚀、软组织硬化和软组织钙化。多数患者Cozen试验呈阳性。在桡骨茎突狭窄性腱鞘炎患者中，最常受累的部位是左右桡骨茎突。常见的放射学表现为低回声筋膜、第一伸肌内液体增多、皮质侵蚀和骨膜反应。多数患者Finkelstein试验也呈阳性。在足底筋膜炎患者中，最常受累的部位是左足跟足底表面。常见的放射学表现为低回声筋膜、筋膜增厚（>4.5mm）、第一伸肌腱鞘内液体增多、皮质侵蚀、软组织硬化、跟骨骨刺、骨膜反应和软组织钙化。多数患者Cozen试验和Finkelstein试验也呈阳性。结论 病史、体格检查、实验室检查结果和影像学检查方法都是RSI鉴别诊断的重要工具。我们的研究结果表明，如果某些临床检查结果无法诊断任何RSI，那么在治疗前超声、X线和磁共振成像（MRI）是最佳且有用的选择。
