0:02

<v ->The next case,

0:05

is a 49-year-old man,

0:09

with about two months of constant hip pain.

0:14

He has posterior and lateral pain.

0:18

The physical examination, he has limited range of motion.

0:24

As comorbidity, he has psoriatic arthritis.

0:30

Show you images again.

0:36

We made some large figure of your images,

0:40

Coronals tear, and coronal two, one,

0:51

to show the other sacroiliac joints,

1:03

and the hip.

1:15

Well, what I can see here,

1:17

is a bilateral sacroiliitis,

1:24

with inflammation in both sides.

1:30

And, we can see a joint fusion, maybe

1:35

with synovial thickening.

1:38

I did inject gadolinium,

1:42

and there is a thickening of the capsule,

1:46

with pericapsular edema,

1:50

mainly anterior and anterior inferior.

2:00

Since this guy has psoriatic arthritis

2:05

and, limited external rotation,

2:12

we made the hypothesis of adhesive capsulitis.

2:21

And, he was treated with corticosteroids and get better.

2:31

So,

2:34

let me show you the sagittal.

2:40

I think this aspect is very typical,

2:44

the thickening of the capsule and pericapsular edema,

2:50

exactly as we see in the shoulder.

2:54

The first case I made a diagnosis, was my father.

2:58

He is diabetic, was in 1999,

3:04

and I was afraid he had,

3:11

infection in the joints,

3:20

he had kidney failure.

3:21

So, I didn't make contrast injection.

3:26

And, he had exactly the same aspect of this

3:30

and this was adhesive capsulitis of the hip,

3:33

just like him, as well.

3:36

And, the orthopedic guys used to talk

3:40

about adhesive capsulitis of the hip

3:45

when they have,

3:51

pain, minor radiological finding

3:56

and decrease in the external rotation.

4:00

We don't see very frequently, these findings.

4:06

And, some times you can see thickening of the capsule

4:11

without the pericapsular edema.

4:15

We should take care to make this diagnosis.

4:18

It could be secondaries of some instability of the hip

4:24

or other cause.

4:26

Or maybe post-capsulitis or post, some inflammation.

4:32

So,

4:36

I had few cases about six or seven

4:39

but it's not very common.

4:41

Most part of them in diabetic guys

4:44

and patients with psoriatic arthritis.

4:49

That's it, done, any comments?

4:52

<v ->You know, this is an interesting case for me

4:54

and I will show another disease that can be associated

5:00

with thickening of the capsule about the hips later on

5:05

in this course, which I don't think is the diagnosis here.

5:07

But what I think you're right, is

5:10

when you look at patients who have spondyloarthropathy

5:14

and patients particularly, psoriasis,

5:17

that the capsule often is thick.

5:20

And, if you look at the enthesitis,

5:24

remember an enthesis is a site

5:26

of tendon, ligament, or capsular attachment to bone.

5:30

And, I think when you look at the whiskering

5:33

and the bone proliferation that you see

5:35

in the spondyloarthropathies,

5:38

a lot of it is at the attachment of a thick capsule.

5:41

So, I'm not surprised

5:43

that patients who have spondyloarthropathies

5:46

and again, the classic psoriasis,

5:48

that they would have capsular changes.

5:52

The disease that I'm gonna show

5:55

that had capsular thickening is amyloid.

5:58

I've seen amyloid produce thickening of the capsule

6:02

but not with edema, more as an infiltrative process.

6:07

And, I've seen gout also produce thickening of the capsule.

6:10

But, I think this may be a characteristic

6:13

of the spondyloarthropathy, not sure.

6:18

<v ->Yeah, and in some patients we have edema exactly here,

6:24

in this area when we have adhesive capsulitis.

6:27

I don't know exactly why,

6:28

but two patients with psoriasis,

6:30

I saw some edema here, well.

6:33

<v ->Yeah, it's probably enthesitis,

6:35

it's probably what you're dealing with here.

6:38

That's a beautiful case and thanks for showing it.