Tennis-synovitis: Shoulder Pain And Finger Swelling In A Female Athlete

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Tennis-synovitis: Shoulder Pain And Finger Swelling In A Female Athlete - Page #3

Lab Studies: Abnormal labs included an elevated ESR at 42, elevated CRP at 51.9, elevated anti-CCP IgG at 3.3, and positive HLA-B27 antigen. Normal labs included WBC, hemoglobin, blood uric acid level, ANA titer, and rheumatoid factor (quantitative). Other Studies: MRI of the right shoulder Case Photo #2 revealed soft tissue edema of acromioclavicular joint. Superior and inferior acromioclavicular ligaments were edematous without full-thickness defects in the capsule consistent with acromioclavicular joint sprain with surrounding edema. There was marrow edema in the acromion and distal clavicle. The remainder of the exam is normal. There was no rotator cuff tear or labral tear. An MRI of the lumbar spine Case Photo #3 demonstrated grade 2 L5-S1 prominent anterolisthesis with bilateral L5 pars defects, anterior and posterior disk bulging of L5-S1 disk, and prominent bilateral L5-S1 foraminal narrowing. There was heterogeneous bilateral anterior SI joint signal intensity. This was read as possibly degenerative although inflammatory arthropathy could not be excluded. MRI of the right ankle Case Photo #4 revealed a large tibiotalar effusion with synovial proliferation along the anterior joint recess. There was mild soft tissue edema anterior to the anterior syndesmotic ligament and mild posterior tibialis tenosynovitis. Noted within the talar body was nonspecific marrow edema, however no fracture line was seen. Consultations: Rheumatology Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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