Unsuspected sonographic findings in patients with posttraumatic shoulder complaints

INFORMATIVE VALUE OF RADIOLOGICAL METHODS FOR DIAGNOSING SUBACROMIAL IMPINGEMENT SYNDROME

Up to 30% of the adult population suffers from impingement syndrome with severe pain. Detection of the disease in the early stages is difficult. Early diagnosis of the initial signs of degenerative changes in the subacromial space saves the patient from surgery and additional risk of postoperative complications. The aim of the study is to evaluate the informative value of radiation methods for diagnosing subacromial impingement syndrome based on the analysis of papers published by domestic and foreign authors, depending on etiopathogenetic factors and anatomical structure of the shoulder joint. Materials and methods. The authors analyzed Russian and foreign publications on anatomical, etiological, pathogenetic, clinical, diagnostic features of subacromial conflict syndrome from databases: e-library (https://www.elibrary.ru), Oxford Medicine Online (https://academic.oup.com /), PubMed (https://pubmed.ncbi.nlm.nih.gov/) and others. The applied research methods were analysis and synthesis, axiomatic method and abstraction. Results. The development of subacromial impingement syndrome was revealed to be due to the structural features of the shoulder joint, which differs from other joints in anatomical and functional complexity. At this, changes in the rotator cuff of the shoulder joint develop under the influence of various etiopathogenetic factors, which can be both external (a decrease in subacromial space, an increase in the volume of the coracoacromial arch, instability, overload of the shoulder joint) and internal (changes in vascularization, pathology of collagen fibers' microstructure, degeneration of the tendons in the rotator cuff, etc.) Currently there is no unified approach to the algorithm of radiation diagnosing the early signs of impingement syndrome and injuries to the rotator cuff of the shoulder joint. Although radiography is a simple and informative method to assess the condition of the shoulder joint, its sensitivity at an early stage of impingement syndrome is insufficient. Magnetic resonance imaging is highly informative and sensitive in the diagnosis of injuries to the rotator cuff of the shoulder joint, however, it has a number of limitations, such as the presence of some contraindications, its high cost, protracted examination time, etc. Ultrasound examination is currently considered the preferred method in the diagnosis of impingement syndrome due to its high informative value, speed of execution and the possibility of its repeatability. Conclusions. The analysis of the informative value of radiation diagnostics methods showed that in identifying the early signs of subacromial impingement syndrome, taking into account etiopathogenetic factors and the anatomical structure of the shoulder joint, the ultrasound method is optimal and preferable; for more complex and controversial cases, according to certain indications, they are the methods of X-ray computer and magnetic resonance imaging. In the absence of the possibility of using high-tech diagnostic methods, classical radiography of the shoulder joint is performed.

A Review on Biological Effects of Ultrasounds: Key Messages for Clinicians

Ultrasound (US) is acoustic energy that interacts with human tissues, thus, producing bioeffects that may be hazardous, especially in sensitive organs (i.e., brain, eye, heart, lung, and digestive tract) and embryos/fetuses. Two basic mechanisms of US interaction with biological systems have been identified: thermal and non-thermal. As a result, thermal and mechanical indexes have been developed to provide a means of assessing the potential for biological effects from exposure to diagnostic US. The main aims of this paper were to describe the models and assumptions used to estimate the "safety" of acoustic outputs and indices and to summarize the current state of knowledge about US-induced effects on living systems deriving from in vitro models and in vivo experiments on animals. This review work has made it possible to highlight the limits associated with the use of the estimated safety values of thermal and mechanical indices relating above all to the use of new US technologies, such as contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) shear wave elastography (SWE). US for diagnostic and research purposes has been officially declared safe, and no harmful biological effects in humans have yet been demonstrated with new imaging modalities; however, physicians should be adequately informed on the potential risks of biological effects. US exposure, according to the ALARA (As Low As Reasonably Achievable) principle, should be as low as reasonably possible.

Ultrasound and bone: a pictorial review

The assessment of bone mainly relies on standard radiographs, CT, MRI, and bone scintigraphy depending on the anatomic region complexity and clinical scenario. Ultrasound (US), due to different acoustic impedance between soft tissues and the bone cortex, only allows the evaluation of the bone surfaces. Nevertheless, US can be useful in the evaluation of several bone disorders affecting the limbs as a result of its tomographic capabilities and high definition. This pictorial review article summarises our clinical experience in adults and reviews the literature on US bone examination. We first present the US appearance of normal bone and the main congenital anatomic variations, after which we illustrate the US findings of a variety of bone disorders. Although US has limits in bone assessment, its analysis must be a part of every musculoskeletal US examination.

ACR Appropriateness Criteria® Shoulder Pain-Traumatic

Traumatic shoulder pain is pain directly attributed to a traumatic event, either acute or chronic. This pain may be the result of either fracture (the clavicle, scapula, or proximal humerus) or soft-tissue injury (most commonly of the rotator cuff, acromioclavicular ligaments, or labroligamentous complex). Imaging assessment of traumatic shoulder pain begins with conventional radiography and, depending on physical examination findings, will require MRI or MR arthrography for assessment of soft-tissue injuries and CT for delineation of fracture planes. Ultrasound excels in assessment of rotator cuff injuries but has limited usefulness for assessment of the deep soft-tissues. CT angiography and conventional arteriography are helpful for assessment of vascular injury, and bone scintigraphy can be used in assessment of complex regional pain syndrome after traumatic shoulder injury. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.