Background: Carpal tunnel syndrome is the most prevalent peripheral nerve entrapment condition of the upper limb. Among metabolic risk factors, diabetes is considered the most relevant. Although wrist ultrasound assessment of the median nerve has demonstrated a good correlation with the gold standard for the diagnosis of this syndrome, neurophysiological study, its usefulness in patients with diabetes is questionable because the compressive phenomenon is not the predominant one. Method: We conducted a retrospective study to compare the clinical and median nerve ultrasound features of patients with carpal tunnel syndrome previously diagnosed or not diagnosed with diabetes. Additionally, a linear multivariate regression analysis was performed to determine to what extent the cross-sectional area of the median nerve was dependent on the condition of diabetes by fixing other variables such as sex, age, or time of evolution. Results: We included 303 records of patients (mean age 44.3 ± 11.7 years old, 57.89% female, mean of time of evolution 13.6 ± 8.3 months) from 2012 to 2020. The cross-sectional area of the median nerve was 10.46 ± 1.44 mm2 in non-diabetic patients and 8.92 ± 0.9 mm2 in diabetic patients (p < 0.001). Additionally, diabetic patients had a shorter time of evolution (7.91 ± 8.28 months vs. 14.36 ± 0.526 months, p < 0.001). In the multivariate analysis, the resultant model (fixed R-square = 0.659, p = 0.003) included a constant of the following four variables: the evolution time (Beta coeff. = 0.108, p < 0.001 95% CI 0.091 to 0.126, standardized coeff. = 0.611), the condition of diabetes (Beta coeff. = −0.623, p < 0.001 95% CI −0.907 to −0.339, standardized coeff. = −0.152), the severity (Beta coeff. = 0.359, p = 0.001 95% CI 0.147 to 0.571, standardized coeff. = 0.169), and the masculine sex (Beta coeff. = 0.309, p = 0.003, 95% CI 0.109 to 0.509, standardized coeff. = 0.103). Conclusions: Ultrasound assessment of the median nerve in patients with diabetes is not a useful tool to confirm whether carpal tunnel syndrome should be diagnosed or not diagnosed.

Background:Giant cell arteritis (GCA) is the most frequently diagnosed vasculitis in Spain. The highest incidence recorded in the country is 17 new cases per 100,000 inhabitants/year. Its delayed diagnosis exposes the patient to an increased risk of multiple ischaemic complications. Among them, vision loss has been reported in up to 1 in 6 cases. Most of these patients, according to unpublished local observations, presented with headache, visual disturbances or polymyalgic symptoms to an emergency department facility and were not correctly or prompted diagnosed.Objectives:To determine the level of knowledge, skills and diagnostic and therapeutic competencies of the medical staff of multiple emergency departments in our city in regard to giant cell arteritis.Methods:We designed an observational study based on a single survey carried out between February and March 2020 to medical staff from 12 emergency departments in the city of Madrid. Four private and eight public emergency departments were deliberately included. The selection of the surveyed staff was randomly selected to reach 50% of the total number of physicians in each department. A total of 229 surveys were distributed by e-mail. A total of 125 physicians responded (final response rate 54.5%). Twenty-two physicians (9.2%) did not respond to the request and the rest declined to participate, although they responded to the demographic section (35.8%).The survey included the following sections: respondent profile, knowledge of epidemiological aspects, identification of clinical manifestations, diagnostic and therapeutic skills, and educational interest.Results:Forty respondents (33.6%) worked in a privately managed emergency department and 79 (66.4%) in a public centre.The mean age of respondents was 37.3 SD 5.9 years, and the proportion of women was 62.4%. Mean length of service was 3.4 SD 1.2 years among physicians in private emergency departments and 5.7 SD 2.3 in a public management unit. Sixty-four respondents (53.7%) were specialists in Family and Community Medicine, and 46 (38.6%) in internal medicine. No significant differences in demographic characteristics were identified between respondents who agreed to participate and those who declined.In regard to epidemiological knowledge, 50.6% of respondents were unable to identify the age group at highest risk of GCA, 32.7% did not recognise its predominance in the female sex, and 26% did not know the approximate incidence of the disease.In terms of diagnostic suspicion, 46.2% of respondents were able to identify at least five clinical manifestations of the disease. Elevated ESR, CRP and the presence of anaemia were recognised as positive analytical data by 98.3%, 85.7% and 57.7% of respondents, respectively. Ultrasonography of temporal arteries was identified by 97.5% of respondents as a useful diagnostic technique.One hundred and two respondents (81.6%) indicated that they had not suspected GCA in the last month. In the last year, 34 respondents (27.2%) reported having diagnosed the disease on at least one occasion. Regarding treatment, in cases of absence of ischaemic lesion 85.7% indicated suboptimal corticosteroid therapy guidelines, however, 63.0% of the respondents self-rated their therapeutic skills as very good or excellent.Finally, 88.2% of respondents expressed interest in participating in training programmes in diagnosis and treatment of GCA.Conclusion:There are important areas for improvement in knowledge, diagnostic skills and therapeutic competencies among emergency physicians in relation to the suspicion and management of GCA.Disclosure of Interests:None declared

Background:Peritenon enlargement has been considered as a specific ultrasound finding associated with psoriatic arthritis based on studies in patients. Recent observations in athletes have demonstrated the existence of this finding although its relationship with the type of physical activity performed has not been determined.Objectives:To determine to what extent manual physical activity is associated with the prevalence of peritenon thickening in the fingers of healthy athletic subjects.Methods:Thirty-five healthy young male volunteers were recruited from a local sports centre in the community of Madrid. All of them performed sports activities with their hands for more than 12 hours a week.A digital dynamometer was used to determine the flexion strength of the fingers of the dominant hand. A single observer performed an ultrasound scan of this hand to determine the presence or absence of a hypoechoic image surrounding the extensor digitorum tendon of the 2nd, 3rd, 4th and 5th fingers, according to previous definitions. Mean flexion strengths were compared with the number of positive ultrasound findings.Results:Fifteen volunteers (mean age 24.3 years, BMI 24.4) did not present peritenon enlargement (42.8%). The mean ± standard deviation of the fingers flexor strength according to the number of peritenon enlargement detected were 43.5 ± 6.2, 49.2 ± 3.8, 53.2 ± 1.64 and 63.0 ± 4.83 Kg for volunteers with none, 1, 2, 3 and 4 peritenon enlargements, respectively. (ANOVA P<0.001; Pearson’s coefficient 0.827, P<0.001). Correlation between BMI, body fat percentage or training hours per week and the number of peritenon enlargement detected was not demonstrated.Conclusion:Peritenon enlargement, also knew as peritenon tendon inflammation, is detectable by ultrasound scan in healthy subjects and it seems to be associated to the physical activity intensity, indirectly measured by the flexor strength of the fingers.References:[1]Gutierrez et al. Ann Rheum Dis. 2011;70:1111-4[2]Zabotti et al. Clin Exp Rheumatol. 2016;34:459-65[3]Husic et al. Ann Rheum Dis. 2014;73:1529-36Disclosure of Interests:None declared

Background:Achilles enthesitis is the most accessible psoriatic arthritis hallmark to assess through ultrasound scan. Recently it has been demonstrated that continuous mechanical stress such as experimented by runners can drive to the development of physiological morphological changes that resembles those observed in psoriatic arthritis. In a subject with the suspicious diagnostic of psoriatic arthritis who practice any sports associated to continuous impact over the heels, the challenge to determine in what extent the morphological changes are linked to the exercise or to the disease, is remarkable.Objectives:To determine morphological differences between patients with psoriatic arthritis, trained runners and sedentary volunteers through ultrasound scan of the Achilles tendon.Methods:An ultrasound scan of the Achilles tendon was performed to the following subjects: Patients with diagnosis of psoriatic arthritis with a DAPSA score of low activity in at least six months and with history of heel pain in the past, volunteers runners with not less of 3-year sport activity at least three times a week and sedentary volunteers. In the group of patients, ultrasound scan was performed over the feet with history of heel pain. In the case of volunteers, the ultrasound scan was performed in the dominant feet. The selection of volunteers was not randomly-based in order to match their age and sex to the patients as much as possible. Besides demographic features, a comparison between tendon thickness at the level of the calcaneus bone border and the height of the retrocalcaneus bursae in the longitudinal axis were performed through ANOVA test. Power Doppler signal was scaned in all subjects before and after a controlled mechanical stress of the Achilles tendon by climbing stairs (100 steps, two times).Results:Female/male distribution of the group of patients, runners and sedentary people were: 12/10, 18/18 and 20/18, respectively. Achilles tendon mean thickness ± standard deviation was 6.61 ± 1.05, 5.91 ± 1.44 and 4.61 ± 2.1mm, respectively (P=0.01). Retrocalcaneus bursae height was 3.42 ± 0.21, 3.22 ± 0.27 and 2.21 ± 0.31 (P=0.01). Basal PD signal was present into the enthesis of 2/22, 1/36 and 0/38, respectively (P not significant). After exercise, PD signal was present in 8/22, 5/36 and 0/38, respectively (P<0.001).Conclusion:Power Doppler signal after exercise was identified as the most relevant ultrasound hallmark to distinguish a patient with psoriatic arthritis from a trained runner, even when psoriatic arthritis were considered as low activity. Post exercise ultrasound scan should be considered as a diagnosis tool in sportsmen with suspicious of psoriatic arthritis, until further studies confirm our findings.Disclosure of Interests:None declared