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    Ortho Angle

    Where rheumatology and orthopedics meet

    Using Ultrasound to Diagnose Carpal Tunnel Syndrome

    Note: Updated May 2, 2018, to correct a link in the reference section. The error was introduced in editing. A 44-year-old Caucasian woman presented to the outpatient rheumatology clinic that had followed her for several years for rheumatoid arthritis. She was compliant with her regimen of hydroxychloroquine, etanercept and salsalate. Her chief complaint was worsening…

    Clockwise from top: Image A shows the periungual ulceration (arrow) of the fifth digit, as well as the prior amputation of the second digit. Image B shows a longitudinal ultrasound of the palmar aspect of the ulnar right wrist. In the center of the image, the ulnar artery is in view and color Doppler flow is visualized within the vessel until there is a reversal of flow demonstrated by color change, followed by severe attenuation of flow distally. Distal to the cessation of flow, the vessel appears hypoechoic due to proliferation of the intima to the point of occluding the lumen. Image C shows a transverse view at the level of white line in Image B, with endothelial proliferation seen around a central lumen of the artery (a), next to the vein (v) and ulnar nerve (n). Image D, shows a transverse view at the level of the black line in Image B, where the arterial lumen (a) is occluded.

    Insights Into Ulnar Artery Occlusion in Systemic Sclerosis

    A 51-year-old man with a history of limited systemic sclerosis with Raynaud’s phenomenon and pulmonary hypertension being treated with tadalafil and macitentan presented to a clinic with ulceration of his right pinkie. The patient had injured the finger two months earlier. He reported poor healing and the presence of a persistent ulcer since the injury….

    Insights on the Diagnosis & Treatment of Low Back & Hip Pain

    CHICAGO—Two experts presented insights on the diagnosis and treatment of low back and hip pain, including a refresher course on the mechanical structures involved, in Anatomy in a Day: Demystifying Low Back Pain and Lateral Hip Pain: New Patho-Anatomical Perspectives, a session at the 2018 ACR/ARHP Annual Meeting. Low Back Pain Avoid using such terms…