Arthrography of the shoulder

Arthrography of the shoulder is a simple, safe, and relatively painless diagnostic procedure that is used to demonstrate the integrity, shape, and capacity of the glenohumeral joint space.

Navicular disease in the horse. A microangiographic investigation

Microangiographical investigations of the navicular bone in horses with navicular disease show, compared to similar investigations of normal navicular bones, that, in general, the vascular pattern is preserved but the vessels are dilated with "pooling" of the contrast medium subchondrally under facies flexoria. Similar changes may be observed in cases of human arthrosis. The present investigation therefore supports the view that navicular disease is a disease which resembles arthrosis.

Olecranon bursitis related to calcium pyrophosphate dihydrate crystal deposition disease

A case of olecranon bursitis in an 81-year-old patient is presented. Analysis of the bursal fluid revealed positive birefringent crystals; radiographs showed calcifications in the distal triceps tendon. A bursectomy was performed. X-ray diffraction analyses demonstrated calcium pyrophosphate dihydrate patterns in a subcutaneous "tophus" and in a specimen of the tendon. On histologic examination, there was a bursitis with positive birefringent crystals on the bursa's inner surface; histologic images of "chondrocalcinosis" were observed in and around the tendon. It is concluded that bursitis may be part of the extraarticular manifestations of calcium pyrophosphate dihydrate crystal deposition disease.

The Haglund syndrome: initial and differential diagnosis

Haglund syndrome is a common cause of posterior heel pain, characterized clinically by a painful soft-tissue swelling at the level of the achilles tendon insertion. On the lateral heel radiograph the syndrome is characterized by a prominent calcaneal bursal projection, retrocalcaneal bursitis, thickening of the Achilles tendon, and a convexity of the superficial soft tissues at the level of the Achilles tendon insertion, a "pump-bump." An objective method for evaluating prominence of the bursal projection is measurement using the parallel pitch lines. This measurement helps to identify patients with Haglund syndrome and patients predisposed to develop this condition, and also to differentiate local causes of posterior heel pain from systemic causes. The parallel pitch line measurement was determined in 10 symptomatic feet and 78 control feet and the results were analyzed statistically.

Traumatic olecranon bursitis. Radiologic observations

The affected elbow of 28 patients with traumatic olecranon bursitis was radiographically compared with the homologous elbow of 28 matched controls. Olecranon spurs, amorphous calcium deposits, or both, were present in 16 patients and 4 controls (p less than 0.01). Air was injected in the bursa in 12 additional patients. Nodules in the bursal floor were noted in 10, and the bursa was partially septated in 8. Olecranon spurs, present in 6 patients, corresponded to the insertion of the triceps tendon. With elbow flexion the bursa flattened and lengthened while the olecranon process glided distally beneath the bursal floor.

The "hot" patella

Increased patellar uptake on bone scans is seen quite commonly but the possible or probable etiologies of this finding have not been previously well described. A review of 100 consecutive bone scans showed that the incidence of bilateral "hot" patellae is 15%. Identified etiologies include osteoarthritic degenerative disease (35%), fracture, possible metastatic disease, bursitis, Paget's disease, and osteomyelitis. The value of careful history, physical examination, and radiographs is stressed.

Iliopsoas bursitis in rheumatoid arthritis: an unusual cause of leg oedema

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Popliteal cysts (Baker's cysts) in adults. I. Clinical and roentgenological results of operative excision

Forty patients were re-examined between 6 months and 15 years (mean 4 years) after excision of a popliteal cyst. Forty-six operations had been performed, including one bilateral cyst and five recurrent cysts. The history was reviewed with respect to the preoperative symptoms, clinical and roentgenological signs, the operative and histopathological findings and the postoperative course. Fifteen operations were followed by wound healing complications or tense swelling of the calf simulating deep venous thrombosis. At clinical follow-up a reccurent cyst was found in 63 per cent of the knees. A simplified follow-up arthrography was performed in all knees, and revealed a cyst-like cavity in all but one knee. The majority of the recurrent cysts displayed irregularities of the wall that had not been seen in the preoperative arthrograms. Despite this high rate of recurrence most of the patients had fewer symptoms from the popliteal space at the time of follow-up than before the operation. as associated knee disorders were present in the majority of patients, popliteal cysts (Baker's cysts) should be regarded and, if possible, treated as secondary to the basic pathological condition of the joint. Only if the knee disorder is not curable and if the symptoms from the popliteal region are troublesome should excision of the cyst and tight closure of the communication with the joint be considered.

[Cystic pseudotumors (baker cysts) of the popliteal fossa (author's transl)]

Report on 38 Baker cysts found in 300 knee arthrographies performed for clinically suspected meniscus lesions. In order not to miss these cysts, fluoroscopy and/or X-ray documentation immediately following the instillation of contrast material and air into the knee joint is mandatory, because these contrast agents tend to disappear fairly rapidly, leaving the lesion poorly visible towards the end of the examination. Furthermore, the clinical significance and the therapeutic aspects of Baker cysts are discussed.

[Baker cysts: an accompaniment of chronic diseases of the knee joint (author's transl)]

One hundred and twenty one Baker cysts demonstrated by arthrography have been analysed. Morphologically one must distinguish between distension cysts and dissection cysts. Distension cysts are more common with various diseases of the knee joint (68% of all cysts). Dissection cysts (32%) are found particularly with inflammatory-rheumatic diseases and are rarely of degenerative or post-traumatic origin. Acute rupture of the cyst was observed on ten occasions. Repeated rupture, which had only been suspected previously, was demonstrated by arthrography in four patients. It is pointed out that Baker cysts may imitate the features of acute thrombophlebitis.

Trochanteric bursitis: a common cause of pelvic girdle pain

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[Sesamoid pathology of the 1st metatarsal bone]

The sesamoid region constitutes an "anatomo-clinical entity" because the small sesamoid bones and the tendino-sero-cutaneous formations which surround them are in close association. Subjected to various microtraumatisms, (professional, sports or static), it expresses its pathology through a painful sesamoid point, a localized tumefaction that is more or less ifnlammatory (sometimes with a pseudo-gout aspect) or a painful corn that disturbs walking. The observation of radiologic alterations of the sesamoid bones results in the discussion of osteonecrosis (Renander's disease) or a fracture. This region may also be the site of a specific micro-cristalline inflammation (with deposit of various crystals) or a rheumatic (mainly rheumatoid, sometimes psioriatic or spondylarthritic) responsible for sesamoid alterations of variable intensity. I can also be involved in an infectious process that is either acute or chronic (fistulization). The sesamoid region has a rich pathology, that is often poorly understood since it is inadequately investigated.

Arthrography-assisted intra-articular injection of steroids in treatment of adhesive capsulitis

Following shoulder arthrography to establish the diagnosis of adhesive capsulitis, we injected steroids via the in situ arthrogram needle. Subsequent intraarticular steroids, if needed, were given at the outpatient clinic using landmarks established at the time of arthrography. Out of 18 patients treated, function sufficient to permit resumption of usual work and self-care activities returned to 16. In 11 patients, recovery was associated with painless total shoulder movement gather than a return to glenohumeral motion. This therapy appears perferable to other forms of intraarticular injection and is an alternative to surgery when physical therapy has failed.

Acute bursitis calcarea trochanterica in an infant, with perforation into the hip joint demonstrated by arthrogram

A case of bursitis calcarea trochanterica acuta is reported in a boy aged four months. The calcification was amorphous, and arthrography revealed extension into the hip joint. The lesion was treated surgically.

Skeletal aches and pains

This report by no means includes all nontraumatic conditions that may produce symptoms and signs that require emergency treatment. Rather, it indicates some of the more common problems that may present in this fashion. This report also serves to remind us that we, as radiologists, do have an important role in the diagnosis and proper treatment of emergency room patients, and that such a role requires our close cooperation with the referring physicians. As we survey radiographs taken on these patients, we must remember to ask ourselves important questions: Are the films adequate? Is the abnormality the cause of the patient's symptoms?

[Arthrography and ultrasound scanning for the detection of Baker cysts (author's transl)]

23 knee joints with clinical evidence of Baker's cysts have been studied in comparison by arthrography and ultrasound-scanning. In 20 knees, there was correlation between arthrographic and sonographic findings. In 3 cases, a positive sonogram was not confirmed by arthrography. Possible causes for faulty interpretation and differential diagnoses have been discussed. We prefer ultrasound scanning for the diagnosis in inflammatory and degenerative joint diseases because it is entirely harmless. In cases of traumatic Baker cysts the arthrogram may reveal an additional meniscal injury.

[Clinical and arthrographic aspects of the popliteal cysts]

Arthrography revealed extended meniscus lesions in 68 of 78 patients with popliteal cysts. In the remaining cases mechanical damage or inflammatory diseases of the knee were responsible for cyst genesis. Popliteal cysts should be removed only after causal diagnosis of the underlying chronic relapsing effusion leading to increased joint pressure and cystic dilatation of the often communication submembranous bursa.