Anterior disc displacement without reduction can cause acute functional limitations and may coexist with inflammatory and early degenerative changes in young patients. We report a 22-year-old woman with right preauricular pain, a closed lock, and a maximum unassisted interincisal opening of 19 mm. Cone-beam computed tomography and magnetic resonance imaging confirmed Stage II osteoarthritis of the right temporomandibular joint, right anterior disc displacement without reduction with limited opening, left anterior disc displacement with reduction, and bilateral joint effusion consistent with synovitis. Hormonal testing showed values discordant with the expected follicular-phase ranges after recent discontinuation of injectable contraception; this finding was interpreted as a potential modulatory factor rather than evidence of causation. Management included bilateral temporomandibular joint arthrocentesis, intra-articular administration of betamethasone and sodium hyaluronate, a stabilization splint, pharmacological therapy, physical therapy, and behavioral modification. Pain decreased markedly within the first week. At the 3-month follow-up, maximum unassisted mouth opening was 42 mm, with a straight opening path, pain-free function, and resolution of the right masseter spasm. This case highlights the value of early imaging-based diagnosis and individualized multimodal management in young patients with concomitant mechanical, inflammatory, and early degenerative temporomandibular joint changes.

Recently, a synovitis model using 75 ng intra-articular recombinant equine interleukin-1 (reIL 1β), showed promise for inducing a mild, self-limiting inflammatory response without overtly altering upper-body movement asymmetry in n = 3 horses. This study aimed to evaluate the effect of this 75 ng reIL-1β model on gait biomechanics and synovial fluid (SF) inflammatory, pro-resolution, and cartilage turnover biomarkers in a larger equine sample. SF samples were collected from the left intercarpal joint of n = 11 horses at baseline and at 6- and 12-hours following 75 ng reIL-1β injection and were analyzed for prostaglandin E2 (PGE2), nitric oxide (NO), glycosaminoglycan (GAG), chondroitin sulfate 846, and resolvin D1. Prior to each arthrocentesis, horses underwent subjective (AAEP) and objective (inertial measurement unit (IMU)) gait analysis during in-hand trot trials. Upper-body movement asymmetry parameters (MinDiff and MaxDiff) were calculated from poll and pelvis IMU data. Linear mixed models and Spearman correlation coefficient compared biomarker concentration and asymmetry parameters between timepoints. At 6-hours, PGE2 and NO concentrations and pelvis MinDiff increased significantly compared to baseline (p < 0.05). At 12-hours, GAG concentration significantly decreased and poll and pelvis MinDiff significantly increased compared to baseline (p < 0.05). Importantly, changes in poll and pelvis movement asymmetry (<7 and ±1.2 mm, respectively) fell within thresholds associated with between-session variability, and changes in intra-articular PGE2 and NO concentrations were comparable to those observed following mild exercise. These findings provide further evidence to support the use of this ethically acceptable 75 ng reIL-1β model for inducing a low-grade, transient inflammatory response, without overtly altering movement.

Previous studies have demonstrated improvements in quality of life (QoL) following temporomandibular joint (TMJ) surgery for patients with temporomandibular disorders (TMDs). The aim of this study was to identify factors associated with postoperative improvement in QoL after TMJ surgery. This prospective longitudinal study observed patients with TMDs who underwent TMJ surgery at a German tertiary referral centre over a 10-year period. Predictor variables were categorised as demographic, clinical, operative and postoperative factors. The primary outcome was postoperative improvement in QoL. Appropriate statistical analyses were performed, with significance set at P ≤ 0.05. A total of 61 patients (mean age 40.9 years, range 15-74 years) were included, 68.9% of whom were female. Overall, 82.0% of patients reported an improved QoL following surgery. No significant associations were identified between QoL improvement and age, sex, preoperative diagnosis, surgical procedure or postoperative functional improvement. All patients reported postoperative pain relief; therefore, the association between pain relief and QoL improvement could not be statistically tested because there was no variability in the pain-relief variable. Descriptive analyses indicated that higher proportions of patients experienced QoL improvement following arthroplasty and total TMJ replacement than following arthroscopy with arthrocentesis. These findings suggest that postoperative QoL improvement was common after TMJ surgery, whereas the small subgroup sizes and absence of variability in postoperative pain relief limited the identification of independent predictors.

We present the case of a 75-year-old patient who presented with recurrent arthralgia. Additional findings included chronic renal impairment of unknown cause and a history of partial small bowel resection. Arthrosonography raised suspicion of crystal arthropathy; however, no crystals were detected in the knee aspirate. Further investigation revealed previous findings of oxalate nephropathy, most likely as a result of increased reabsorption following abdominal surgery. Subsequently, Von Kossa staining of the aspirate confirmed oxalate arthropathy.

Arthritis is a recognised extraintestinal manifestation of inflammatory bowel disease and can rarely precede gastrointestinal recognition, mimicking septic arthritis. Communication barriers in patients with learning disabilities may obscure systemic symptoms.A man in his early 30s with a mild learning disability presented with acute left-knee pain, swelling, erythema and fevers with concurrent low-back and hip pain. Arthrocentesis yielded turbid fluid with a white blood cell count (WBC) of 20.4×10[9]/L (93% neutrophils); Gram stain, crystals and cultures (including gonococcal testing) were negative. CT abdomen/pelvis showed mild colonic wall thickening suggestive of colitis. He received empiric antibiotics, but synovial and blood cultures remained negative. A repeat, simplified interview with collateral history uncovered a year of intermittent diarrhoea. Colonoscopy and biopsy findings were compatible with Crohn's disease. Antibiotics were stopped and prednisone plus methotrexate, then infliximab, led to clinical and laboratory improvement with no active bowel inflammation on follow-up MR enterography.

SYNOPSIS: This viewpoint presents a turning point in clinical training and practice, where an attending physician faced difficulty performing an arthrocentesis in front of a trainee, highlighting challenges and vulnerabilities inherent in practice. The situation was resolved by enlisting the expertise of a colleague, who successfully completed the procedure. This experience prompted reflections on the concept of intellectual humility in health professional education-the ability to acknowledge limitations, seek help, and embrace collaborative learning and teaching. This article examines how intellectual humility can shape clinicians' responses to failure, particularly when role modeling for learners. It also raises critical questions about how educators and trainees navigate intellectual humility. By examining a moment of failure and related reflection, this article invites musculoskeletal rehabilitation clinicians to consider how intellectual humility can strengthen teaching, learning, and clinical practice. JOSPT Open 2026;4(2):128-132. Epub 19 February 2026. doi:10.2519/josptopen.2026.0206.

Temporomandibular joint (TMJ) internal derangement frequently leads to orofacial pain, joint dysfunction, and limited mandibular movement. Conservative treatment is first, but arthrocentesis may help refractory cases. This case report describes one year of conservative therapy and arthrocentesis with intra-articular hyaluronic acid (HA) and 12.5% dextrose. A 21-year-old woman had right-sided preauricular pain, joint clicking, and intermittent locking for one year. Clinical and magnetic resonance imaging findings confirmed anterior disc displacement with reduction and intermittent locking with osteoarthritis of the right TMJ. After 8 months of physiotherapy, pharmacotherapy, occlusal splint, and diet modification, maximum mouth opening improved from 13 to 36 mm, but symptoms persisted. Two arthrocentesis sessions with prolotherapy were performed: one with HA alone, followed by HA and 12.5% dextrose. At 4-month follow-up, function was restored, symptoms resolved, and joint clicking disappeared. Arthrocentesis with intra-articular HA and 12.5% dextrose relieved pain, improved mouth opening, and restored function in refractory TMJ internal derangement. This case highlights the value of a staged, minimally invasive strategy, though larger controlled studies are needed to validate its efficacy and to standardize treatment protocols. A stepwise approach, from conservative therapy to arthrocentesis with intra-articular HA and 12.5% dextrose, can effectively manage TMJ internal derangement.

Joint aspiration remains the gold standard and an urgent step in the diagnosis of paediatric septic arthritis (SA). Unlike in acute haematogenous osteomyelitis, it has both diagnostic and therapeutic value. No previous review has specifically addressed when bacteriological sampling is essential and when it may reasonably be omitted. The bacteriological profile in children is highly age-dependent: Kingella kingae predominates before 4 years of age, whereas Staphylococcus aureus-including Panton-Valentine leukocidin (PVL)-producing and methicillin-resistant (MRSA) strains-predominates thereafter. We critically review the evidence through nine clinical questions and propose a conceptual risk-stratified framework in which the sampling approach is tailored to age and clinical context. In children younger than 4 years with a positive oropharyngeal K. kingae PCR and a mild clinical presentation-defined as CRP < 20 mg/L, absence of fever, and preserved weight-bearing-non-invasive confirmation may be sufficient. This proposal is explicitly hypothesis-generating: it is derived from observational data, it has not been validated prospectively, and it is not endorsed by current PIDS/IDSA or ESPID guidance. A positive oropharyngeal PCR alone is never sufficient, given the 10-12% asymptomatic carriage rate and the limited reliability of the Kocher-Caird criteria in this age group; the decision requires a cluster of concordant findings together with mandatory clinical and laboratory reassessment at 48-72 h and a low threshold for escalation to arthrocentesis. In children older than 4 years, arthrocentesis under general anaesthesia remains the standard approach, with pathogen identification and antimicrobial susceptibility testing as the primary microbiological determinants of therapy and toxin profiling as an adjunctive investigation in selected cases.