The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Ultrasound Aids Diagnosis of Man with Knee Pain & Swelling

Ultrasound Aids Diagnosis of Man with Knee Pain & Swelling

November 17, 2019 • By Mark H. Greenberg, MD, RMSK, RhMSUS, Prem Patel, Elijah Mitcham, MD, James W. Fant Jr., MD, & Frank R. Voss, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF

A 56-year-old automobile mechanic was referred to our rheumatology service by his orthopedist to evaluate left posterior knee pain and swelling that had been present for three months. The patient had undergone bilateral total knee arthroplasties (TKAs) for sports-related osteo­arthritis three years before.

You Might Also Like
  • The Diagnostic View: Ultrasound of a Child’s Sore Knee
  • Rheumatologists’ Involvement Aids in Gout Diagnosis, Follow-up for Inpatients
  • Whole-Body MRI, Ultrasound Imaging May Aid in Early Rheumatic Disease Diagnosis, Treatment
Explore This Issue
November 2019

In addition to the knee pain, the patient described several years of bilateral hand swelling and stiffness, which had been worsening over the past few months. He also complained of significant malaise and fatigue over the past six months. He denied a history of spine pain or stiffness, psoriasis or bowel problems.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Physical examination revealed chronic synovitis of the bilateral wrists and metacarpophalangeal (MCP) joints and a swelling posterior to the left knee. There was no clinical or X-ray evidence of arthroplasty failure or loosening. Review of the surgical report revealed no posterior left knee mass or bursal enlargement.

Ultrasound of the left knee demonstrated a cystic mass superficial to the tendons of the medial gastrocnemius and the semi­membranosus muscles measuring 1.63 cm in depth and 6 cm in length. The cyst consisted of a mixture of hyper- and hypoechoic areas and a smaller relatively anechoic area. Power Doppler was negative. Careful inspection did not demonstrate a stalk connecting the mass to the arthroplasty (see Figures 1 & 2).

Figures 1 & 2: Transverse and longitudinal ultrasound views, respectively, of the left posterior knee, revealing a cystic mass with heterogeneous internal echotexture and no stalk.

Figures 1 & 2: Transverse and longitudinal ultrasound views, respectively, of the left posterior knee, revealing a cystic mass with heterogeneous internal echotexture and no stalk.

Ultrasound of the left hand confirmed the clinical finding of significant chronic synovitis, as noted by an enlarged dorsal synovial recess filled with hyperechoic material, as well as severe bony and cartilaginous erosion of the second and third MCP joints. Osteophyte formation was noted as well (see Figure 3). Power Doppler was only minimally positive. Left hand X-rays (see Figure 4) corroborated severe MCP narrowing and osteophytes at MCP joints 2 and 3, with mild osteoarthritic change at the proximal phalangeal joints. Opposite hand X-rays demonstrated peri­articular cortical erosions of MCP joints 2 and 3. Neither ultrasound nor the X-rays suggested calcium deposition in soft tissues.

Figure 3: Longitudinal ultrasound view of the left second metacarpophalangeal joint demonstrating diffuse synovitis (*), metacarpal head discontinuity due to bone and cartilage erosion (e), and a bony osteophyte (o).

Figure 3: Longitudinal ultrasound view of the left second metacarpophalangeal joint demonstrating diffuse synovitis (*), metacarpal head discontinuity due to bone and cartilage erosion (e), and a bony osteophyte (o).

Anti-nuclear antibody, anti-cyclic citrullinated peptide antibody, rheumatoid factor, serum calcium, angiotensin converting enzyme, Lyme serology, uric acid level, iron studies and a chest X-ray were negative or unremarkable. His erythrocyte sedimentation rate was normal at 15 mm/hour.

The patient declined cyst aspiration. With a working diagnosis of seronegative rheumatoid arthritis (RA), methotrexate (MTX) was prescribed. Weekly MTX administration of 20 mg subcutaneously effected substantial improvement of pain and swelling, but only mild improvement of hand stiffness. Fifty milligrams of subcutaneous etanercept weekly was ordered to improve joint stiffness and fatigue.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 3 4 5 | Single Page

Filed Under: Conditions, Rheumatoid Arthritis Tagged With: knee arthroplasty, knee swelling, popliteal cyst, synovitisIssue: November 2019

You Might Also Like:
  • The Diagnostic View: Ultrasound of a Child’s Sore Knee
  • Rheumatologists’ Involvement Aids in Gout Diagnosis, Follow-up for Inpatients
  • Whole-Body MRI, Ultrasound Imaging May Aid in Early Rheumatic Disease Diagnosis, Treatment
  • Liposomal Bupivacaine Helpful in Total Knee Arthroplasty

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2022 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.