Hematogenous spread of Neisseria gonorrhoeae, a sexually transmitted pathogen, results in disseminated gonococcal disease (DGD), also known as arthritis-dermatitis syndrome, due to the development of skin lesions, tenosynovitis, and arthritis. The most frequently affected population is young adults. We describe the case of an adolescent female who acutely developed skin lesions, arthritis, tenosynovitis, and constitutional symptoms. The causal agent was identified by a culture of vaginal secretion and treated with ceftriaxone for 7 days with complete recovery. It is important to differentiate this clinical picture from other types of arthritis developed in adolescence.

There is a plethora of treatment options for patients with de Quervain tenosynovitis (DQT), but there are limited data on their effectiveness and no definitive management guidelines.
To assess and compare the effectiveness associated with available treatment options for DQT to guide musculoskeletal practitioners and inform guidelines.
Medline, Embase, PubMed, Cochrane Central, Scopus, OpenGrey.eu, and WorldCat.org were searched for published studies, and the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, The European Union Clinical Trials Register, and the ISRCTN registry were searched for unpublished and ongoing studies from inception to August 2022.
All randomized clinical trials assessing the effectiveness of any intervention for the management of DQT.
This study was prospectively registered on PROSPERO and conducted and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) and PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSIST) guidance. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations tool were used for risk of bias and certainty of evidence assessment for each outcome.
Pairwise and network meta-analyses were performed for patient-reported pain using a visual analogue scale (VAS) and for function using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale. Mean differences (MD) with their 95% CIs were calculated for the pairwise meta-analyses.
A total of 30 studies with 1663 patients (mean [SD] age, 46 [7] years; 80% female) were included, of which 19 studies were included in quantitative analyses. From the pairwise meta-analyses, based on evidence of moderate certainty, adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically but not clinically significant functional benefits in the short-term (MD, 10.5 [95% CI, 6.8-14.1] points) and mid-term (MD, 9.4 [95% CI, 7.0-11.9] points). In the network meta-analysis, interventions that included ultrasonography-guided CSI ranked at the top for pain. CSI with thumb spica immobilization had the highest probability of being the most effective intervention for short- and mid-term function.
This network meta-analysis found that adding a short period of thumb spica immobilization to CSI was associated with statistically but not clinically significant short- and mid-term benefits. These findings suggest that administration of CSI followed by 3 to 4 weeks immobilization should be considered as a first-line treatment for patients with DQT.

BACKGROUND: Several studies reported the efficacy of exercise therapy in hand and wrist tendinopathy. However, no systematic review synthesized the effect of exercise therapy on these patients.
OBJECTIVE: This study aimed to perform a systematic review to summarize evidence if exercise therapy may be considered an effective treatment in conservative management for patients with hand and wrist tendinopathy.
METHODS: This was a systematic review.
METHODS: A literature search in MEDLINE, Cochrane Library, PEDro, and Embase was conducted from their inception until April 10, 2022. Two independent reviewers included the studies administering exercise therapy in patients with hand and/or wrist tendinopathy in the review and extrapolated the data. Methodological quality was assessed using the framework developed by Murad et al for case reports and case series and the PEDro score for clinical trials.
RESULTS: Seven case reports, 3 case series, and 2 randomized controlled studies were included and methodologically evaluated, obtaining a low score for all the analyzed studies. The total number of included patients in the analyzed studies was 106, of which 54 were female, 13 were male, and 39 were not specified. The type of exercise was widespread and often not really well described: it varies from eccentric forearm training to mobilization with movement, passing through strengthening exercises, grip proprioception training, and self-management exercises according to the McKenzie method. The dosage was often not precise, making it difficult to reproduce the therapeutic proposals. Exercise therapy was always administered together with different treatments; therefore, its efficacy alone is difficult to distinguish, although in some cases, the patients improved pain and functionality.
CONCLUSIONS: Evidence on the efficacy of exercise therapy in patients with hand and wrist tendinopathies is limited. Future research is strongly recommended to determine the appropriate dosage of the exercise therapy to determine clinical changes in these patients.

The first extensor wrist compartment (FEWC) displays significant variants. This review highlights all possible variants that may be associated with the occurrence and pathophysiology of de Quervain\'s tenosynovitis. A thorough search of PubMed and MEDLINE databases, following the PRISMA guidelines, was conducted from 2002 to 2022 to evaluate all FEWC variants, including the following: 1) the presence of an inter-tendinous septum, 2) the number of tendinous slips of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) muscles, 3) their distal insertions and 4) the presence of a bony ridge within the FEWC. A total of 3878 wrists (1277 cadaveric and 1296 de Quervain patients) were included. Of the 1234 cadavers, a total of 701 (56.8%) were males and 533 (43.2%) were females. Regarding the 883 patients, 178 (20.2%) of them were males and 705 (79.8%) were females. An inter-tendinous septum was identified in 42.9% (47% of the patients\' wrists compared to 39.3% of the cadaveric wrists, p<0.0001). Cadaveric wrists presented two or more slips for the APL in a significantly higher percentage (92.5%, p < 0.0001) compared to de Quervain patients\' wrists (74.5%). Regarding the EPB muscle, de Quervain patients\' wrists had a single slip in 93% (p=0.0007) and two or more slips in 3.6%, compared to cadaveric wrists (a single slip in 87%, and two or more slips in 11%, p< 0.0001). A bony ridge over the radial styloid process was recorded in 58.9% of the cadaveric wrists compared to 17.8% of the patients\' wrists (p < 0.0001). Remarkable diversity concerning the structures within the FEWC was reported. The presence of an inter-tendinous septum dividing the FEWC and a single EPB muscle slip is more likely to be found in patients with de Quervain\'s disease.

Synovitis and tenosynovitis are present in juvenile idiopathic arthritis (JIA), both as joint pain and/or inflammation, making them difficult to detect on physical examination. Although ultrasonography (US) allows for discrimination of the 2 entities, only definitions and scoring of synovitis in children have been established. This study was undertaken to produce consensus-based US definitions of tenosynovitis in JIA.
A systematic literature search was performed. Selection criteria included studies focused on US definition and scoring systems for tenosynovitis in children, as well as US metric properties. Through a 2-step Delphi process, a panel of international US experts developed definitions for tenosynovitis components (step 1) and validated them by testing their applicability on US images of tenosynovitis in several age groups (step 2). A 5-point Likert scale was used to rate the level of agreement.
A total of 14 studies were identified. Most used the US definitions developed for adults to define tenosynovitis in children. Construct validity was reported in 86% of articles using physical examination as a comparator. Few studies reported US reliability and responsiveness in JIA. In step 1, experts reached a strong group agreement (>86%) by applying adult definitions in children after one round. After 4 rounds of step 2, the final definitions were validated on all tendons and at all locations, except for biceps tenosynovitis in children <4 years old.
The study shows that the definition of tenosynovitis used in adults is applicable to children with minimal modifications agreed upon through a Delphi process. Further studies are required to confirm our results.

Avian reovirus (ARV) has been determined to be the etiologic agent of viral arthritis/tenosynovitis. In Israel, meat-type chickens, including broilers and breeders, are the most affected. Severe disease symptoms can appear in broiler flocks at a very young age because of early exposure and vertical transmission, causing significant welfare problems. Jewish laws define birds with inflamed, damaged, or torn gastrocnemius and digital flexor tendons as religious condemnations (non-kosher), resulting in severe economic losses for the poultry industry. Vaccination of breeders is a strategy to control the disease by reducing vertical transmission and providing maternal-derived antibodies to the progeny. This review describes Israel\'s ARV variants and the various vaccines developed over the years. Identification of co-circulating variants triggered the development of multivalent autogenous inactivated vaccines. However, the genotype-matched vaccines failed to provide protection, resulting in an increased prevalence of Cluster II ARV (classified as genotyping cluster 5 in the ARV common world classification). Since 2014, ARV Cluster II has been dominant in Israel. In 2015, the dominant variant s7585 tropism changed the virus pathogenesis and affected broilers with severe clinical signs between 12 and 15 days of age. A new vaccine approach developed in Israel used controlled exposure of the breeding flock to virulent ARV at the age when they are resistant to infection. This approach significantly reduced clinical field cases and reovirus isolations of breeding and broiler flocks between 2020 and 2022.
Estudio recapitulativo- Reovirus aviares en Israel, variantes y vacunas: Una revisión. Se ha determinado que el reovirus aviar (ARV) es el agente etiológico de la artritis/tenosinovitis viral. En Israel, los pollos de carne, incluidos los pollos de engorde y reproductores, son los más afectados. Los signos severos de la enfermedad pueden aparecer en parvadas de pollos de engorde a una edad muy temprana debido a la exposición temprana y la transmisión vertical, lo que causa problemas significativos de bienestar. Las leyes judías definen a las aves con gastrocnemio inflamado, dañado o desgarrado y tendones flexores digitales como decomiso religiosas (no kosher), lo que resulta en graves pérdidas económicas para la industria avícola. La vacunación de reproductoras es una estrategia para controlar la enfermedad al reducir la transmisión vertical y proporcionar anticuerpos derivados de las reproductoras a la progenie. Esta revisión describe las variantes de reovirus aviares de Israel y las diversas vacunas desarrolladas a lo largo de los años. La identificación de variantes co-circulantes desencadenó el desarrollo de vacunas inactivadas autógenas multivalentes. Sin embargo, las vacunas elaboradas con genotipos compatibles no brindaron protección, lo que resultó en una mayor prevalencia de reovirus aviares del grupo II. Desde 2014, el grupo II de los reovirus aviares ha sido dominante en Israel. En 2015, el tropismo de la variante dominante s7585 cambió la patogenia del virus y afectó a los pollos de engorde con signos clínicos severos entre los 12 y los 15 días de edad. Un nuevo enfoque de vacuna desarrollado en Israel utilizó la exposición controlada de la parvada reproductora a reovirus aviares virulentos a la edad en que son resistentes a la infección. Este enfoque redujo significativamente los casos clínicos de campo y los aislamientos de reovirus de parvadas de reproductores y pollos de engorde entre 2020 y 2022.

Reoviral-induced tenosynovitis/viral arthritis is an economically significant disease of poultry. Affected birds present with lameness, unilateral or bilateral swollen hock joints or shanks, and/or reluctance to move. In severe cases, rupture of the gastrocnemius or digital flexor tendons may occur, and significant culling may be necessary. Historically, vaccination with a combination of modified live and inactivated vaccines has successfully controlled disease. Proper vaccination reduced vertical transmission and provided maternal-derived antibodies to progeny to protect against disease, at an age when they were most susceptible. Starting in 2011-2012, an increased incidence of tenosynovitis/viral arthritis was observed in chickens and turkeys. In chickens, progeny from reovirus-vaccinated breeders were affected, suggesting commercial vaccines did not provide adequate protection against disease. In turkeys, clinical disease was primarily in males, although females can also be affected. The most significant signs were observed around 14-16 wks of age and include reluctance to move, lameness, and limping on one or both legs. The incidence of tenosynovitis/viral arthritis presently remains high. Reoviruses isolated from clinical cases are genetically and antigenically characterized as variants, meaning they are different from vaccine strains. Characterization of the field isolates reveals multiple new genotypes and serotypes that are significantly different from commercial vaccines and each other. In 2012, a single prevalent virus was isolated from a majority of the cases submitted to the Poultry Diagnostic and Research Center at the University of Georgia. Genetic characterization of the σC protein revealed the early isolates belonged to genetic cluster (GC) 5. Soon after the initial identification of the GC5 variant reovirus, many broiler companies incorporated these isolates from their farms into their autogenous vaccines and continue to do so today. The incidence of GC5 field isolates has decreased significantly, likely because of the widespread use of the isolates in autogenous vaccines. Unfortunately, variant reoviruses belonging to multiple GCs have emerged, despite inclusion of these isolates in autogenous vaccines. In this review, an overview of nomenclature, sample collection, and diagnostic testing will be covered, and a summary of variant reoviruses isolated from clinical cases of tenosynovitis/viral arthritis over the past 10 yrs will be provided.
Estudio recapitulativo- Reovirus aviares de casos clínicos de tenosinovitis: una descripción general de los enfoques de diagnóstico y una revisión de 10 años de aislamientos y caracterización genética. La tenosinovitis/artritis viral inducida por reovirus es una enfermedad económicamente significativa de la avicultura. Las aves afectadas presentan cojera, articulaciones de corvejones o patas inflamadas unilateral o bilateralmente y/o renuencia a moverse. En casos severos, puede ocurrir la ruptura de los tendones del gastrocnemio o del flexor digital, y puede ser necesario una eliminación de aves afectadas significativa. Históricamente, la vacunación con una combinación de vacunas vivas modificadas e inactivadas ha controlado con éxito la enfermedad. La vacunación adecuada redujo la transmisión vertical y proporcionó anticuerpos derivados de las reproductoras a la progenie para protegerlos contra la enfermedad, a una edad en la que eran más susceptibles. A partir de los años 2011-2012, se observó una mayor incidencia de tenosinovitis/artritis viral en pollos y pavos. En los pollos, la progenie de reproductores vacunados con reovirus se vio afectada, lo que sugiere que las vacunas comerciales no brindaron una protección adecuada contra la enfermedad. En pavos, la enfermedad clínica fue principalmente en machos, aunque las hembras también pueden verse afectadas. Los signos más significativos se observaron alrededor de las 14 a 16 semanas de edad e incluyen renuencia a moverse y cojera en una o ambas piernas. La incidencia de tenosinovitis/artritis viral actualmente sigue siendo alta. Los reovirus aislados de casos clínicos se caracterizan genética y antigénicamente como variantes, lo que significa que son diferentes de las cepas vacunales. La caracterización de los aislamientos de campo revela múltiples genotipos y serotipos nuevos que son significativamente diferentes de las vacunas comerciales y entre sí. En 2012, se aisló un solo virus prevalente de la mayoría de los casos presentados al Centro de Investigación y Diagnóstico Avícola de la Universidad de Georgia. La caracterización genética de la proteína sigma C reveló que los primeros aislamientos pertenecían al grupo genético 5 (GC5). Poco después de la identificación inicial de la variante GC5 del reovirus, muchas empresas de pollos de engorde incorporaron estos aislamientos de sus granjas en sus vacunas autógenas y continúan haciéndolo en la actualidad. La incidencia de aislamientos de campo de GC5 ha disminuido significativamente, probablemente debido al uso generalizado de los aislamientos en vacunas autógenas. Desafortunadamente, han surgido variantes de reovirus que pertenecen a múltiples grupos genéticos, a pesar de la inclusión de estos aislados en vacunas autógenas. En esta revisión, se cubrirá una descripción general de la nomenclatura, la recolección de muestras y las pruebas de diagnóstico, y se brindará un resumen de las variantes de reovirus aisladas de casos clínicos de tenosinovitis/artritis viral durante los últimos 10 años.

BACKGROUND: Acupotomy was used to treat tenosynovitis of hand flexor tendons (THFT) in China. But it\'s uncertain about the efficacy of acupotomy for THFT. We plan to evaluate the efficacy and safety about acupotomy therapy in the treatment of THFT through this review.
METHODS: The protocol about this review was registered in PROSPERO (registration number: CRD42022330568). We searched 6 databases from their respective inception dates to January 11, 2022. Studies searched was screened by our reviewers, and then the raw data was filtered out. We used RevMan 5.3 software to perform statistical analysis.
RESULTS: 11 studies involving 828 patients were shortlisted. The experimental group showed obvious advantages compared with the control group, such as effective rate (odds ratio [OR] = 6.77, 95% CI [confidence intervals] = [3.89, 11.77], P < .00001), cure rate (OR = 3.32, 95% CI = [1.81, 6.11], P = .0001) and Vas score (MD = -1.21, 95% CI = [-2.00, -0.42], Z = 3.01, P < .003).
CONCLUSIONS: According to the above results, Acupotomy is an effective and safe treatment for THFT. So it should be recommended for the treatment of THFT patients.

Rice bodies, a rare finding in clinical practice, are commonly observed in the shoulders and knees of affected individuals. However, they can occur in the wrist as well. Herein, we report a case of a female presenting with painful swelling in the right wrist that lasted with a history of carpal tunnel syndrome, rheumatoid arthritis, and history of median nerve decompression two years ago. A potential diagnosis of infectious diseases and gout was excluded through negative cultures and laboratory findings. X-rays showed no significant findings; however, magnetic resonance imaging revealed findings suggestive of rice bodies that were confirmed by additional proton dense fat-saturated imaging. The mass was then removed by extensive debridement and sent for pathological assessment, which showed multiple nodules containing fibrin and polymorphonuclear cells. The patient did not experience recurrence during the follow-up period. Rice bodies, although rare, can occur in the wrist, and this imposes several challenges associated with their diagnostic and management protocols.

Rice body formation is a rare response to chronic inflammation of the synovial membrane. It is most commonly associated with rheumatoid arthritis and tuberculosis. Recently, there have been reports of rice bodies caused by non-tuberculous mycobacterial infection. We describe a case of rice body formation in a 69-year-old man who presented with pain and swelling in his third finger for six months after being punctured by a wire 1 year ago. He had no other notable recent medical history. Magnetic resonance imaging showed a large amount of fluid collection with diffuse thickening and enhancement of the synovium and rice bodies along the flexor tendon of the third finger. During surgery, multiple granular white rice bodies were found from the third carpal bone to the distal phalanx. Mycobacterium intracellulare was identified through mycobacterial culture and the patient was treated with rifampin, ethambutol, and clarithromycin, without recurrence. This case reveals that Mycobacterium intracellulare infection can cause tenosynovitis with rice bodies.