Irfan Chhipa

Abstract

Introduction: Reactive arthritis classically includes a triad of conjunctivitis, urethritis, and arthritis in a young, adult male patient following a urogenital or gastrointestinal infection. This paper reports a case of reactive arthritis in a young, sexually active, male patient who presents atypically, with a chief complaint of three-month lower back pain. Case Report: A 30-year-old male presents to the office with a complaint of three-month lower back pain despite conservative treatment and a negative workup in the emergency department, two months prior. After a thorough assessment and laboratory workup, the patient was diagnosed and treated for reactive arthritis. Suspicion for reactive arthritis included a positive Chlamydia trachomatis urinalysis and a positive HLA-B27. Three weeks after appropriate treatment, the patient is now symptom-free. Conclusion: In conclusion, it is important to thoroughly assess a patient who presents with continued pain despite previous workup and treatment. Lower back pain is a common diagnosis and therefore other possible diagnoses are often times written off. Establishing the correct diagnosis may require thinking outside of the box and obtaining multiple labs. However, getting the correct diagnosis is of utmost importance for both the patient and medical community so that further complications and progression of disease do not occur. Keywords: Reactive arthritis, Chlamydia trachomatis, Young male, Sexually active, Classic triad.

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Abstract

Introduction: Lateral elbow tendinopathy is a common condition affecting two to three percent of the population. While non-operative management is the mainstay of treatment, 10-15% remain refractory. Ultrasonic percutaneous tenotomy is a recent therapeutic option for clinicians to treat lateral elbow tendinopathy. The goal of this study was to evaluate the survival rate of ultrasonic percutaneous tenotomy in the treatment of lateral elbow tendinopathy. Materials and Methods: 83 patients underwent ultrasonic percutaneous tenotomy from September 2015 to August 2018 and met full inclusion criteria to participate. 63 patients consented to enroll in the study, with 50 (79.4%) completing the postoperative questionnaire. Data obtained included range of motion, patients’ report of improvement, Quick Dash Score (Q-Dash), Visual Analogue Scale (VAS) pain, VR 12, Mayo Elbow Performance, patient satisfaction, further post-operative adjunct procedures which included additional steroid injections, platelet-rich plasma (PRP) injections or need for reoperation at a minimum of 12 months post procedure. Results: Overall survival rate for ultrasonic percutaneous tendinopathy was 94% (47/50). Three patients required post-operative adjunct procedures, two received steroid injections and one required PRP injection. Mean VAS score improved from 8.1 to 2.8 in the no failure group vs 7.9 to 2.7 in the failure group. Mean postoperative Mayo Elbow score and Q-DASH score was 89 (range 60 to 100) and 12.7 (range 2.3 to 61.4), respectively. 84 percent of patients were either very satisfied (N=31) or satisfied (N=11) with their procedure. Conclusion: This three year study demonstrates that ultrasonic percutaneous tenotomy appears to be a safe and efficacious therapeutic option with a high survival rate for patients with recalcitrant lateral elbow tendinopathy.   Keywords: Tennis elbow, Tendinopathy, Tenotomy, Ultrasound.

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