Gout is a metabolic disorder caused by abnormalities in purine metabolism and/or impaired uric acid excretion. It is characterized by the deposition of monosodium urate crystals in joints or connective tissues, leading to recurrent episodes of acute arthritis. Gout can be categorized into two major types based on its etiology: primary and secondary. The majority of gout cases are associated with impaired uric acid excretion. The natural course of gout can be divided into three stages: (1) asymptomatic phase; (2) acute arthritis phase and intercritical phase; (3) chronic gouty arthritis and tophaceous phase. Acute gouty arthritis typically presents with sudden, severe joint pain, accompanied by redness, swelling, warmth, and tenderness of the affected joint and surrounding soft tissues. When large joints are involved, joint effusion may occur. Acute gouty arthritis often develops at night or in the early morning, is self-limiting, and usually resolves within two weeks. The most common site of acute gout flare-ups is the first metatarsophalangeal joint, followed by the midfoot, ankle, knee, wrist, fingers, and elbow joints. Acute gout attacks rarely affect the axial joints. Pain in these affected areas is often accompanied by limited function, significantly impacting a patient' s daily activities and quality of life. Uncommon sites of gout involvement, as well as gout with normal serum uric acid levels, can easily lead to misdiagnosis. Therefore, a comprehensive diagnosis requires a detailed medical history, physical examination, laboratory tests, and imaging studies. This case report describes a 19-year-old male who was admitted with recurrent anterior chest pain. The diagnosis at another hospital suggested ankylosing spondylitis. Physical examination revealed significant tenderness, redness, and swelling of the bilateral sternoclavicular joints, with local warmth and mildly restricted movement. MRI of the sacroiliac joints showed no significant abnormalities, and serum uric acid levels were normal. Chest dual-energy CT scans revealed multiple tophi in the sternum, bilateral clavicles, scapulae, multiple ribs, and along the edges of the sternum. Based on the patient' s medical history, physical findings, and imaging studies, a diagnosis of gout was confirmed. Treatment included urate-lowering therapy, pain management, and dietary adjustments. During a two-year follow-up period, the patient did not experience recurrent anterior chest pain, and multiple serum uric acid tests consistently showed levels below 300 μmol/L. Repeat chest dual-energy CT scans indicated significant reduction of tophi in the sternoclavicular joints and other affected areas.

Background: Lateral epicondylopathy is commonly approached as a tendinopathic disorder of the common extensor origin; however, persistent lateral elbow pain may also involve a superficial sensory nerve component related to the posterior antebrachial cutaneous nerve (PABCN). This proof-of-concept cadaveric anatomical feasibility study evaluated whether a single-window, humerus-parallel ultrasound-guided injectate pathway could simultaneously reach the superficial PABCN-related fascial plane and the common extensor origin. Methods: One fresh-frozen male cadaveric donor was used, and both elbows were injected under real-time ultrasound guidance. With the elbow flexed and the forearm pronated, the transducer was aligned parallel to the long axis of the humerus over the lateral epicondylar region. A 23-gauge, 6 cm needle was advanced in plane from distal to proximal over the common extensor aponeurosis, and 10 mL of 1% methylene blue was injected into each elbow. Layer-by-layer anatomical dissection was then performed by an anatomist who was not involved in the injection procedure. Gross linear dye spread was measured directly during dissection using the distal needle entry point as the reference point, and ruler-containing photographs were additionally reviewed using ImageJ software for supportive image-assisted assessment. Results: In both elbows, methylene blue stained the superficial PABCN-related fascial plane, including the anterior and posterior branches of the PABCN, and concomitantly covered the common extensor aponeurosis and lateral epicondylar enthesis. Dye spread measured approximately 10 cm proximally, 5 cm distally, and 4 cm anteriorly. No gross intra-articular dye deposition or focal intramuscular pooling was observed. Conclusions: This proof-of-concept cadaveric study demonstrates the anatomical plausibility of a single-window, enthesis-centered ultrasound-guided injectate pathway that includes both the superficial PABCN-related plane and the common extensor origin. These findings should be interpreted as descriptive anatomical feasibility observations and do not establish reproducibility across anatomical variants, clinical efficacy, safety, or procedural superiority.

Synovitis is a major contributor to pain and dysfunction in rotator cuff tears (RCTs), yet it remains unclear whether routine synovial fluid (SF) parameters reflect clinical features independent of tear size, operation method, and patient age. This prospective cohort study aimed to evaluate the associations between routine SF parameters and clinical features before and after rotator cuff repair. Preoperative glenohumeral SF was aspirated from 109 patients undergoing arthroscopic repair, and interleukin-6, total protein levels, and differential white blood cell counts were analyzed. Clinical features, including pain, active range of motion, strength, Constant score, and American Shoulder and Elbow Surgeons (ASES) score, were assessed preoperatively and at 3 and 6 months postoperatively. Associations between SF parameters and clinical features were examined after adjusting for tear size, operation method, and age. Higher interleukin-6 and total protein levels were associated with lower range of motion and functional score, and these relationships persisted at 3 and 6 months. A higher neutrophil percentage was negatively correlated with preoperative range of motion, strength; with range of motion and Constant score at 3 months. Routine SF parameters, including interleukin-6, total protein, and neutrophil percentage, were associated with poorer preoperative clinical features and remained related to early postoperative outcomes. These findings suggest that routine SF parameters are linked to the clinical features of RCT, independent of cuff tear size, operation method, and patient age, and may serve as practical biomarkers for predicting both preoperative and postoperative outcomes.

Olecranon nonunion is an uncommon complication of proximal ulna fractures that can cause pain, deformity, and functional limitation. It usually arises from inadequate fixation, comminution, or impaired healing biology. Timely surgical intervention is often required to restore elbow function. A 34-year-old female, right-hand dominant homemaker presented with persistent deformity, weakness in extension, and difficulty performing overhead activities 4 months after a conservatively managed right elbow injury. Clinical examination revealed a palpable olecranon defect, and radiographs confirmed an atrophic nonunion. She underwent revision open reduction and internal fixation with a locking compression plate and autologous iliac crest bone grafting. Early rehabilitation was commenced postoperatively. Radiographic union was achieved at 12 weeks, and by 6 months, the patient regained satisfactory function, with a Mayo Elbow Performance Score of 90. Revision fixation with bone grafting provides reliable union and functional recovery in cases of olecranon nonunion. Awareness of this rare but disabling complication is essential, as timely surgical management can restore elbow stability, strength, and patient independence in daily activities.