[Sonographic criteria of omarthritis]

The sonographic examination of the shoulder has established itself in the diagnostic variety of imaging methods. Especially the results of the rotator cuff have contributed to the fact that arthrosonography is now indispensable for the shoulder examination. In this paper, another scan--the examination of the fossa axillaris--is added to the standard ones to find the early changes in the shoulder capsule in order to obtain efficient results in discovering the omarthritis.

[Ultrasound in inflammatory rheumatic joint diseases]

Inflammatory changes of the shoulder joint could be detected at a very early stage, when the clinical and radiological examinations were unremarkable. In 50% of the cases a rupture of the rotator cuff could be demonstrated. Only 10% of the shoulder joints had normal sonographic findings, whereas 50% were normal on clinical or radiological examination. Synovitis and effusion of the hand can be diagnosed very well by clinical examination, and can be documented in ultrasound. The sonographic diagnostic accuracy in tendon ruptures of the hand is lower than accuracy of the clinical examination. New technical developments may yield better results. Inflammatory changes of the hip joint are very difficult to diagnose by clinical examination. Synovitis, effusion and changes of the capsule can be better detected by ultrasound. Sonography of the hip joint has become part of our routine diagnostic programme, especially because early changes of the joint do not present clear symptoms.

[Value of arthrosonography of the shoulder in rheumatologic diagnosis. Examination technique, findings and their interpretation]

The sonographic examination of the shoulder has established itself in the diagnostic spectrum of the imaging methods. Especially the results of the rotator cuff have contributed to the fact, that arthrosonography is now indisputable for the shoulder examination. In this paper another scan--the examination through the fossa axillaris--is added to the standard ones, to find the early changes of the shoulder capsule in order to receive efficient results in discovering the omarthritis.

[Scapular exostosis complicated by bursitis. Apropos of a case]

We present one case of bursa formation secondary to a scapular osteochondroma. This rare condition can simulate, clinically and radiologically, a sarcomatous transformation. CT scan is helpful to demonstrate the scapular osteochondroma and the adjacent bursa.

[Ultrasonic diagnosis of inflammatory rheumatic diseases]

During the last two decades, sonography has become more and more important in the diagnosis of rheumatic diseases. With the development of high-frequency realtime transducers, detailed images of the musculoskeletal system can be provided. Furthermore, sonography or echocardiography is able to detect systemic manifestations of connective tissue diseases. Compared to plain films, which mainly evaluate bony lesions of inflammatory joint diseases, sonography is used to assess non-bony abnormalities (synovial membrane, cartilage, menisci, tendons) and synovial space. Pannus and effusion as indicators of inflammatory rheumatic disease can easily be examined by sonography. However, sonographic findings in rheumatic diseases are mostly nonspecific and can rarely be used to distinguish between different diagnoses, which is sometimes possible using plain x-rays (i.e., pencil-in-cup). Sonography has proven to be a meaningful diagnostic tool in evaluating tumors in subcutaneous tissue or muscles. The diagnostic results of musculoskeletal sonography are today compared to those obtained by computed tomography (CT) and magnetic resonance imaging (MRI). Although musculoskeletal MRI can visualize bony and non-bony structures at the same time, sonography is still of particular interest in the diagnosis of rheumatic diseases, because it is a noninvasive, widely available, relatively inexpensive imaging modality which can be rapidly performed and repeated.

CT appearance of the distended trochanteric bursa

The CT appearance of the distended trochanteric bursa noted in an asymptomatic patient is reported. The bursal distension was noted incidentally in a patient undergoing staging for renal cell carcinoma. On CT the distended bursa was noted as a septated low attenuation lesion at the site of insertion of the gluteus medius and minimus muscles on the greater trochanter of the femur. The lesion was not associated with any degenerative changes in the hip or greater trochanter. Distension of the trochanteric bursa may occur in asymptomatic patients and the appearance of the distended bursa must be recognized on imaging studies to avoid confusing it with other lesions.

Occupationally related ultrasonic findings in carpet and floor layers' knees

Soft-tissue changes in the anterior aspect of the knees were evaluated with ultrasonography among 96 randomly selected carpet and floor layers and 72 painters. The ultrasonography showed thickening of the prepatellar or superficial infrapatellar bursa in 49% of the carpet and floor layers and 7% of the house painters. Fluid collection in the prepatellar or superficial infrapatellar bursa was noted for 10 carpet and floor layers, and this ultrasonographic finding was associated with knee pain in kneeling postures.

Calcaneal ostectomy for Haglund disease

From 1967 to 1987, operative treatment was performed on 28 feet in 22 patients with retrocalcaneal bursitis due to prominent posterior superior margin of the calcaneus (Haglund disease). Through a lateral or medial approach, the prominent bone was removed. The results indicated that excision of the retrocalcaneal bursa was not necessary. Preoperative planning and intraoperative examination was necessary in order to remove an adequate amount of bone, which was the key for a successful result.

CT imaging of soft tissue pathology of the ankle. A pictorial essay

Despite the increasing importance of MR imaging, CT investigation remains a very useful and frequently applied method in the study of ankle pathology. In a short pictorial essay, the contribution of this technique to the diagnosis of soft tissue pathology of the ankle is discussed and illustrated.

Retrocalcaneal bursitis in juvenile chronic arthritis

Retrocalcaneal bursitis has been described in various adult rheumatic diseases and septic bursitis unrelated to previous bursal disease has been reported in children. The case is reported here of a girl with juvenile chronic arthritis who developed non-septic retrocalcaneal bursitis; the diagnosis was suggested by a combination of clinical and radiographic studies and was confirmed by ultrasonography.

Combination treatment for adhesive capsulitis of the shoulder

Twenty-two patients (23 shoulders) with arthrographically verified adhesive capsulitis of the glenohumeral joint were treated by a combination of distention-arthrography, local anesthetics and steroids intraarticularly, and manipulation. The mean duration of the disease at the time of treatment was 14 months, and all patients suffered from disabling pain and stiffness. A rapid improvement was seen after treatment and at four to six weeks: 91% (21/23) of the patients had no or slight pain and 83% (19/23) of the patients had normal, or almost normal, range of motion. The treatment was well tolerated and no complications were recorded. The combination treatment for adhesive capsulitis of the shoulder is safe, yields immediate results, and is cost effective.

The retrocalcaneal bursa: anatomy and bursography

The retrocalcaneal bursae, located between the posterior angle of the os calcis and the Achilles tendon, may become inflamed and hypertrophied. There are few objective tests available for the diagnosis of pain syndromes involving the hindfoot and it is often difficult to differentiate Achilles tendinitis and retrocalcaneal bursitis. Retrocalcaneal bursograms can provide further insight into chronic changes in the bursae associated with traumatic and inflammatory conditions. This report describes the anatomy of the retrocalcaneal bursa, the technique of its opacification, and the application of this technique to the diagnosis and treatment of painful hindfoot syndromes. In addition, the anatomy of the retrocalcaneal bursa was investigated further using latex casting techniques. Twelve cadaver limbs were injected with radiopaque latex casting material or renografin into the retrocalcaneal bursae. AP, lateral, and oblique radiographs were then obtained on the specimens. The size, capacity, and configuration of the postmortem bursae were measured and recorded. Subsequently, the cadaver limbs injected with the latex material were cooled and dissection was made of the retrocalcaneal bursae. The latex bursal molds were measured, graphically recorded, and photographed. Fifteen patients with signs and symptoms of retrocalcaneal bursitis and eight asymptomatic patients were selected for this study and injected with radiopaque material into the bursae. Anteroposterior, lateral, and oblique radiographs were then obtained. The size, capacity, and configuration of the retrocalcaneal bursae were measured and recorded. The anatomic characteristics noted from the latex bursal molds correlated well with the findings on bursography. Bursographic findings in patients with retrocalcaneal bursitis can provide insight into the diagnosis and clinical management of this disorder.

[Osteoid osteoma of the elbow]

The osteoid osteoma is a rare, benign neoplasm of bone, most frequently located in the lower extremity (head of the tibia). Because of its rarity and its mostly rather unspecific clinical symptoms, diagnosis of the tumor is frequently problematic. Ideally, osteosclerosis surrounding a central focus (nidus) is revealed by radiology. Radiological imaging seems to be the most effective tool in reaching the correct diagnosis. Operative resection of the nidus is the only known curative therapy for osteoid osteoma.

Infective iliopsoas bursitis. A case report

We report a case of infective iliopsoas bursitis, and to our knowledge a similar case has not been described. The anatomical relation between the bursa and the hip, and related pathological conditions are reviewed. The contribution of CT-guided catheterisation is emphasised as it allows aspiration of fluid, injection of radio-opaque material and lavage.

Injury of the Achilles tendon: diagnosis with sonography

We determined the diagnostic accuracy of sonography for the assessment of injury to the Achilles tendon. After anatomic investigations in three human cadavers, we performed a clinical study in 24 healthy volunteers and 73 symptomatic patients referred for achillodynia or signs of heel thickening or both in whom a clinical diagnosis of acute total rupture was excluded. High-resolution real-time sonography was performed and the results were compared with final clinical diagnoses (55 patients) and surgical findings (18 patients). Fifty-two of the patients had been involved in various sporting activities (long-distance runners, jumpers, and basketball players), three patients had familial hypercholesterolemia, five patients had systemic inflammatory disease, and 13 patients had no known underlying cause. Anatomic investigation demonstrated accurate assessment of tendon structure and thickness. Sonograms were abnormal in 53 patients (sensitivity, 0.72; specificity, 0.83), and the extent of structural disorders of the tendon could be assessed properly. Abnormalities occurred in the form of tendon swelling (45%), abnormal tendon structure (42%), rupture (15%), and peritendinous lesions (47%). No changes were detected in low-grade disease of short duration, which suggests symptoms caused by functional disorders. Sonography is valuable in the diagnosis of various lesions of the Achilles tendon and its surrounding tissue. Furthermore, it can be used to estimate the degree of tendon abnormality and to differentiate between functional and morphologic conditions.

Iliopsoas bursitis: clinical features, radiographic findings, and disease associations

Inflammation of the iliopsoas bursa is a common manifestation of a wide array of inflammatory, degenerative, and traumatic musculoskeletal conditions. The clinical presentation of iliopsoas bursitis is variable, and includes pain, mass lesion, or compression syndromes of the inguinal compartment. Affected individuals frequently have underlying synovitis of the hip or a history of occupational or recreational injury. Early and accurate diagnosis is facilitated by appropriate radiographic studies.

[Painful shoulders. Clinico-echographic evaluation]

Painful shoulders are a frequent pathology and its specific diagnosis and therapeutic control are common challenges to medical professionals. To solve these problems a non invasive morphologic method of study--Real Time Ultrasonography--is presented. A standardized routine ultrasonographic technique using static and dynamic imaging was applied to the analysis of fifty patients whose clinical data suggested soft tissue pathology of that joint. Initial sonographic diagnostic data were compared with clinical signs and x-ray information and in some cases arthrographic and surgical observation as well. The utility of sonography in the therapeutic control was specially evaluated in a sub-group of twenty patients with clinical and ultrasonographic evidence of tendinitis or bursitis at that location and submitted to physiatric treatment. Sonographic criteria established in terms of echogenicity, dimensions and dynamic scanning performance are described and its value as diagnostic and therapeutic control tools are discussed. Our results suggest that real time ultrasonography is a useful method to confirm the diagnosis and could be indispensable to follow and control the therapeutic results in Painful Shoulders.

[Radiology of the cervical spine]

The author describes some particularities seen in the abnormal or pathological image of the cervical spine: the osteolysis of the cortical bone in the spinous processes, the "Y" shaped course of the corporeal veins, the notch in interspinous bursitis, and the main forms of constitutional stenosis of the cervical canal.

Radiographic measurement from the lateromedial projection of the equine foot with navicular disease

Radiographic measurements from the lateromedial projection of the equine foot were compared in three groups of horses. Group 1 consisted of 143 normal horses, group 2 were 60 horses with clinical navicular disease and group 3 were 161 horses with clinical and radiographic navicular disease. Several measurements tended to be larger in group 3 than group 1. An enlargement of the navicular bone was observed in proximodistal and dorsopalmar directions. Partial enlargement of the pedal bone was observed in groups 2 and 3. Few differences were observed between age classes. All horses aged four years and over had an increased length of the hoof in the dorosopalmar direction and a decrease of the cranial angle of the hoof. Enlargement of the navicular bone fits well into the concept of osteoarthrosis. The pedal bone was partly engaged. These findings may be an expression of a regional acceleratory phenomenon.

The varied clinical manifestations of iliopsoas bursitis

Iliopsoas bursitis is often overlooked as the cause of symptoms involving the inguinal area and lower extremity. We report 8 patients with iliopsoas bursitis. All had either osteoarthritis or rheumatoid arthritis of the hip but only 3 had significant hip pain. Patients presented with an inguinal mass and hip pain (2); unilateral leg swelling (2); inguinal mass and unilateral leg swelling (1); hip pain (1); pelvic mass with bladder compression (1); and no symptoms (1). The diagnosis was entertained initially in only 2 patients. Computed tomography was useful in establishing the diagnosis.

Cubital bursitis

We describe two cases of bursitis at the insertion of the biceps tendon. They presented as swellings in the cubital fossa with symptoms of median nerve irritation. The aetiology was probably mechanical trauma; both patients were cured by operation.