Abstract
Objective: To probe into the significance of osteosis of the junctions of ligaments and tendons around elbow joints for the diagnosis of skeletal fluorosis. Methods: Analyses were conducted on X-ray signs of elbow joints in 23 cases with skeletal fluorosis and fluoridated elbow joints identified in March 2011 in an investigation of populations living in coal-burning-associated endemic fluorosis region(s).
Results: [The analyses revealed] seven cases with osteosis of the site over condylus medialis humeri for attachment of tendons, seven cases with osteosis of the site over condylus lateralis humeri for attachment of tendons, six cases with osteosis of annular ligament of radial head, 18 cases with narrowed elbow joint space, 10 cases with gross or dense changes in trabecula under elbow joint surface, four cases with osseous cystic change under elbow joint surface, four cases with osteophyte formation over trochlear lateral bone crest, eight cases with osteophyte formation in the inner margin of humero-ulnar joint, and three cases with osteophyte formation in the surface opposite to upper radio-ulnar joint.
Conclusion: The pathognomonic signs of fluoride-associated arthropathy include osteosis of annular ligament of radial head as well as osteosis of the sites over condylus medialis humeri and condylus lateralis humeri for attachment of flexor and extensor tendons, thus they are of major significance for the diagnosis of skeletal fluorosis.
Translated by Trans-Perfect Translations (2014).
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Brick tea fluoride as a main source of adult fluorosis
An epidemiological survey was conducted in Naqu County, Tibet in September 2001 to investigate the manifestations of fluorosis in adults caused by the habitual consumption of brick tea. Profiles were obtained for the total daily fluoride intake, environmental fluoride levels and average urinary fluoride concentration, and a physical examination and a
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An uncommon presentation of fluorosis
A 70 years old farmer from Yemen was referred as a case of osteoarthritis of both knees for preoperative rehabilitation procedures. Six years before he developed progressive skeletal stiffness. By 70 years he became dependent for ambulation and many other self-care activities. He showed quadriparesis resulting from compression of spinal cord
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Specific features of occupational fluorosis
Analysis of X-ray images of 397 patients suffering from fluorosis showed that 94.0% of cases exhibit degenerative-dystrophic impairments of the lumbar spine; 65.0% of cases – calcification of the anterior longitudinal ligament; and 91.0% of cases – impairments in the form of epicondylitis, periarthrosis, and deforming arthrosis. Impairment of the
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Skeletal fluorosis from instant tea
INTRODUCTION: Skeletal fluorosis (SF) can result from prolonged consumption of well water with >4 ppm fluoride ion (F(-); i.e., >4 mg/liter). Black and green teas can contain significant amounts of F(-). In 2005, SF caused by drinking 1-2 gallons of double-strength instant tea daily throughout adult life was reported in
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Skeletal fluorosis in relation to drinking water, nutritional status and living habits in rural areas of Maharashtra, India
The present study was carried out during May 2010 to December 2011 in three villages which were randomly selected from Warora tehsil of Chandrapur district which is one of the endemic district of Maharashtra. . . . All the presently available ground water samples were collected and the mean fluoride concentration
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Skeletal Fluorosis: The Misdiagnosis Problem
It is a virtual certainty that there are individuals in the general population unknowingly suffering from some form of skeletal fluorosis as a result of a doctor's failure to consider fluoride as a cause of their symptoms. Proof that this is the case can be found in the following case reports of skeletal fluorosis written by doctors in the U.S. and other western countries. As can be seen, a consistent feature of these reports is that fluorosis patients--even those with crippling skeletal fluorosis--are misdiagnosed for years by multiple teams of doctors who routinely fail to consider fluoride as a possible cause of their disease.
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"Pre-Skeletal" Fluorosis
As demonstrated by the studies below, skeletal fluorosis may produce adverse symptoms, including arthritic pains, clinical osteoarthritis, gastrointestinal disturbances, and bone fragility, before the classic bone change of fluorosis (i.e., osteosclerosis in the spine and pelvis) is detectable by x-ray. Relying on x-rays, therefore, to diagnosis skeletal fluorosis will invariably fail to protect those individuals who are suffering from the pre-skeletal phase of the disease. Moreover, some individuals with clinical skeletal fluorosis will not develop an increase in bone density, let alone osteosclerosis, of the spine. Thus, relying on unusual increases in spinal bone density will under-detect the rate of skeletal fluoride poisoning in a population.
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Fluoride & Osteoarthritis
While the osteoarthritic effects that occurred from fluoride exposure were once considered to be limited to those with skeletal fluorosis, recent research shows that fluoride can cause osteoarthritis in the absence of traditionally defined fluorosis. Conventional methods used for detecting skeletal fluorosis, therefore, will fail to detect the full range of people suffering from fluoride-induced osteoarthritis.
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X-Ray Diagnosis of Skeletal Fluorosis
In 1937, Kaj Roholm published his seminal study Fluorine Intoxication in which he described three phases of bone changes that occur in skeletal fluorosis. (See below). These three phases, which are detectable by x-ray, have been widely used as a diagnostic guide for detecting the disease. They describe an osteosclerotic bone disease that develops first in the axial skeleton (the spine, pelvis, and ribs), and ultimately results in extensive calcification of ligaments and cartilage, as well as bony outgrowths such as osteophytes and exostoses. Subsequent research has found, however, that x-rays provide a very crude measure for diagnosing fluorosis since the disease can cause symptoms and effects (e.g., osteoarthritis) before, and in the absence of, radiologicaly detectable osteosclerosis in the spine.
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Variability in Radiographic Appearance of Skeletal Fluorosis
Osteosclerosis (dense bone) is the bone change typically associated with skeletal fluorosis, particularly in the axial skeleton (spine, pelvis, and ribs). Research shows, however, that skeletal fluorosis produces a spectrum of bone changes, including osteomalacia, osteoporosis, exostoses, changes resulting from secondary hyperparathyroidism, and combinations thereof. Although the reason for this radiographic variability is not yet fully understood, it is believed to relate to the dose of fluoride consumed, the individual's nutritional status, exposure to aluminum, genetic susceptibility, presence of kidney disease, and area of the skeleton examined.
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