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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Stevens KJ, Chaudhari AS, Kuhn KJ. Differences in Anatomic Adaptation and Injury Patterns Related to Valgus Extension Overload in Overhead Throwing Athletes. Diagnostics (Basel) 2024; 14:217. [PMID: 38275464 PMCID: PMC10814069 DOI: 10.3390/diagnostics14020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
The purpose of our study was to determine differences in adaptative and injury patterns in the elbow related to valgus extension overload (VEO) in overhead throwing athletes by age. A total of 86 overhead throwing athletes and 23 controls underwent MRI or MR arthrography (MRA) of the elbow. Throwing athletes were divided by age into three groups: ≤16 years (26 subjects), 17-19 years (25 subjects), and ≥20 years (35 subjects). Consensus interpretation of each MRI was performed, with measurements of ulnar collateral ligament (UCL) thickness and subchondral sclerosis at the radial head, humeral trochlea, and olecranon process. A higher frequency of apophyseal and stress injuries was seen in adolescent athletes and increased incidence of soft tissue injuries was observed in older athletes. Early adaptive and degenerative changes were observed with high frequency independent of age. Significant differences were observed between athletes and controls for UCL thickness (p < 0.001) and subchondral sclerosis at the radial head (p < 0.001), humeral trochlea (p < 0.001), and olecranon process (p < 0.001). Significant differences based on athlete age were observed for UCL thickness (p < 0.001) and subchondral sclerosis at the olecranon process (p = 0.002). Our study highlights differences in anatomic adaptations related to VEO at the elbow between overhead throwing athletes and control subjects, as well as across age in throwing athletes.
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Affiliation(s)
- Kathryn J. Stevens
- Department of Radiology, Stanford University Medical Center, Palo Alto, CA 94304, USA;
| | - Akshay S. Chaudhari
- Department of Radiology, Stanford University Medical Center, Palo Alto, CA 94304, USA;
| | - Karin J. Kuhn
- MAPMG: Mid-Atlantic Permanente Medical Group, Rockville, MD 20852, USA;
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Goes PK, Flores DV, Damer A, Huang BK. Shoulder and Elbow Injuries in Adult Overhead Throwers: Imaging Review. Radiographics 2023; 43:e230094. [PMID: 37917538 DOI: 10.1148/rg.230094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Overhead throwing, particularly in baseball, subjects the shoulder and elbow to various unique injuries. Capsular contracture following repetitive external rotation shifts the humeral head posterosuperiorly, predisposing to glenohumeral internal rotation deficit (GIRD), Bennett, posterosuperior internal impingement (PSI), and superior labrum anterior-posterior (SLAP) lesions. GIRD represents loss of internal rotation at the expense of external rotation. Bennett lesion represents ossification of the posteroinferior glenohumeral ligament due to repetitive traction. PSI manifests with humeral head cysts and "kissing" tears of the posterosuperior cuff and labrum. Scapular dysfunction contributes to symptoms of PSI and predisposes to labral or rotator cuff disease. "Peel-back" or SLAP lesions occur when torsional forces detach the biceps-labral anchor from the glenoid. Finally, disorders of the anterior capsule, latissimus dorsi, teres major, and subscapularis are well recognized in overhead throwers. At the elbow, injuries typically involve the medial-sided structures. The ulnar collateral ligament (UCL) is the primary static restraint to valgus stress and can be thickened, attenuated, ossified, and/or partially or completely torn. Medial epicondylitis can occur with tendinosis, partial tear, or complete rupture of the flexor-pronator mass and can accompany UCL tears and ulnar neuropathy. Posteromedial impingement (PMI) and valgus extension overload syndrome are related entities that follow abundant valgus forces during late cocking or acceleration, and deceleration. These valgus stresses wedge the olecranon into the olecranon fossa, leading to PMI, osteophytes, and intra-articular bodies. Other osseous manifestations include olecranon stress fracture and cortical thickening of the humeral shaft. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Paola Kuenzer Goes
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Dyan V Flores
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Alameen Damer
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Brady K Huang
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
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Arora S, Popkin CA, Wong TT. Trends in MR Arthrogram Utilization at a Tertiary Care Academic Center. Curr Probl Diagn Radiol 2023; 52:346-352. [PMID: 36842885 DOI: 10.1067/j.cpradiol.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
The purpose is to evaluate the trends in MR arthrogram utilization at a tertiary care academic institution and to determine if there are factors that can be implicated in the utilization trends. Number of MR arthrograms of the shoulder, hip, and elbow from 2013-2020 at our institution were identified (n = 1882). Patient demographics including age, sex, sports participation, history of prior surgery, and physician referral were obtained. Descriptive statistics were performed to determine the prevalence of MR arthrograms. Linear regression analyses were performed to determine the relationship of time with prevalence of arthrograms. Chi-square tests and posthoc analyses with Bonferroni correction were used to assess if categorical variables were different between the years. There was overall decrease in the prevalence of MR arthrograms of the shoulder, hip, and elbow despite an increase in the overall MR volume during the study period. Linear regression models significantly predicated decrease in arthrogram prevalence with each passing year (P < 0.001). The percentage of orthopedic referrals for arthrograms in the hip (P = 0.002) and shoulder (P = < 0.001) decreased significantly towards the end of the study period. None of the other variables assessed were significant. At our tertiary care academic institution, arthrogram utilization has been drastically decreasing over the past 8 years. The percentage of orthopedic referrals for shoulder and hip arthrograms significantly decreased at the end of the study period.
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Affiliation(s)
- Silvia Arora
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY 10032
| | - Charles A Popkin
- Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032
| | - Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY 10032.
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5
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Edelmuth DGL, Helito PVP, Correa MFDP, Bordalo-Rodrigues M. Acute Ligament Injuries of the Elbow. Semin Musculoskelet Radiol 2021; 25:580-588. [PMID: 34706388 DOI: 10.1055/s-0041-1729959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ulnar collateral, radial collateral, lateral ulnar collateral, and annular ligaments can be injured in an acute trauma, such as valgus stress in athletes and elbow dislocation. Recognizing normal anatomy in magnetic resonance imaging and ultrasonography studies is important to identify ligamentous abnormalities in these imaging modalities.
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Affiliation(s)
- Diogo Guilherme Leão Edelmuth
- Radiology Department - Hospital Sirio Libanes, São Paulo, Brazil.,Radiology Department - Orthopedic Institute - Clinics Hospital - University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo Victor Partezani Helito
- Radiology Department - Hospital Sirio Libanes, São Paulo, Brazil.,Radiology Department - Orthopedic Institute - Clinics Hospital - University of São Paulo Medical School, São Paulo, Brazil
| | | | - Marcelo Bordalo-Rodrigues
- Radiology Department - Hospital Sirio Libanes, São Paulo, Brazil.,Radiology Department - Orthopedic Institute - Clinics Hospital - University of São Paulo Medical School, São Paulo, Brazil
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6
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Kholinne E, Nanda A, Liu H, Kwak JM, Kim H, Koh KH, Jeon IH. The elbow plica: a systematic review of terminology and characteristics. J Shoulder Elbow Surg 2021; 30:e185-e198. [PMID: 33038495 DOI: 10.1016/j.jse.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND There has been a lack of evidence regarding the structure of the elbow plica, or synovial fold. Inconsistency remains regarding the correct terminology, prevalence, and investigation used to understand this anatomic structure. METHODS For this systematic review, we searched the PubMed, Ovid-MEDLINE, Cochrane, Google Scholar, and Embase databases using keywords as well as medical subject headings for English-language studies. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS We included 27 articles in this review. "Plica" was the most commonly used terminology (33%). The prevalence of plicae in asymptomatic and symptomatic patients was 77% and 97%, respectively. Provocative factors were sporting activities (57%), including those performed by professional athletes, and heavy labor (43%). Lateral elbow pain represented the most common symptom (49%). Magnetic resonance imaging was the most commonly used diagnostic modality (64%). On the magnetic resonance imaging scans of symptomatic patients, the most common location of the plica was the posterolateral region (54%) and its thickness was a minimum of 3 mm. In 2 studies that included symptomatic patients, the plica was found to cover more than one-third of the radial head. CONCLUSION Plicae are prevalent in both asymptomatic and symptomatic patients. Consideration of the pathologies associated with an elbow plica helped identify the following: (1) its thickness is >3 mm and (2) its location is in the posterolateral aspect and/or it covers more than one-third of the radial head quadrant.
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Affiliation(s)
- Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia; Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Akriti Nanda
- Medical Sciences Division, John Radcliffe Hospital, Oxford, UK
| | - Hua Liu
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong University, Nantong, China
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Hyojune Kim
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea.
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7
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Fritz B, Parkar AP, Cerezal L, Storgaard M, Boesen M, Åström G, Fritz J. Sports Imaging of Team Handball Injuries. Semin Musculoskelet Radiol 2020; 24:227-245. [PMID: 32987422 DOI: 10.1055/s-0040-1710064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Team handball is a fast high-scoring indoor contact sport with > 20 million registered players who are organized in > 150 federations worldwide. The combination of complex and unique biomechanics of handball throwing, permitted body tackles and blocks, and illegal fouls contribute to team handball ranging among the four athletic sports that carry the highest risks of injury. The categories include a broad range of acute and overuse injuries that most commonly occur in the shoulder, knee, and ankle. In concert with sports medicine, physicians, surgeons, physical therapists, and radiologists consult in the care of handball players through the appropriate use and expert interpretations of radiography, ultrasonography, CT, and MRI studies to facilitate diagnosis, characterization, and healing of a broad spectrum of acute, complex, concomitant, chronic, and overuse injuries. This article is based on published data and the author team's cumulative experience in playing and caring for handball players in Denmark, Sweden, Norway, Germany, Switzerland, and Spain. The article reviews and illustrates the spectrum of common handball injuries and highlights the contributions of sports imaging for diagnosis and management.
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Affiliation(s)
- Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, Zurich, and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Anagha P Parkar
- Department of Radiology, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Luis Cerezal
- Department of Radiology, Diagnostico Médico Cantabria, Santander, Spain
| | - Morten Storgaard
- Institute of Sports Medicine Copenhagen, Copenhagen Area, Denmark
| | - Mikael Boesen
- Department of Radiology Copenhagen university hospital, Bispebjerg and Frederiksberg, Copenhagen NV, Denmark.,Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
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8
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Abstract
Elbow pain can cause disability, especially in athletes, and is a common clinical complaint for both the general practitioner and the orthopaedic surgeon. Magnetic resonance imaging (MRI) is an excellent tool for the evaluation of joint pathology due to its high sensitivity as a result of high contrast resolution for soft tissues. This article aims to describe the normal imaging anatomy and biomechanics of the elbow, the most commonly used MRI protocols and techniques, and common MRI findings related to tendinopathy, ligamentous and osteochondral injuries, and instability of the elbow.
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Porrino J, Wang A, Taljanovic M, Stevens KJ. Comprehensive Update of Elbow Magnetic Resonance Imaging. Curr Probl Diagn Radiol 2020; 50:211-228. [PMID: 32561154 DOI: 10.1067/j.cpradiol.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022]
Abstract
We present a comprehensive update of elbow magnetic resonance imaging, detailing the complex anatomy and pathology of the elbow. A variety of pathologies may affect the elbow joint, and many of the symptoms overlap. As such, magnetic resonance imaging of the elbow serves as an invaluable clinical tool for the clinician in the diagnosis and management of patients presenting with elbow pain.
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Affiliation(s)
- Jack Porrino
- Yale University, Radiology and Biomedical Imaging, New Haven, CT.
| | - Annie Wang
- Yale University, Radiology and Biomedical Imaging, New Haven, CT
| | - Mihra Taljanovic
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, AZ
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Nakagomi M, Kajiwara M, Matsuzaki J, Tanabe K, Hoshiai S, Okamoto Y, Terada Y. Development of a small car-mounted magnetic resonance imaging system for human elbows using a 0.2 T permanent magnet. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2019; 304:1-6. [PMID: 31063952 DOI: 10.1016/j.jmr.2019.04.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/08/2019] [Accepted: 04/27/2019] [Indexed: 05/05/2023]
Abstract
Portable magnetic resonance imaging (MRI) scanners can provide opportunities for mobile operation in many environments including disease screening and primary care suites. Here, we develop a new, compact transportable MRI system for imaging small joints of the extremities using a 0.2 T, 200 kg permanent magnet. The whole system, including the magnet, gradient coils, RF probes, and MRI consoles (80 kg in weight) was installed in a standard-size minivan-style vehicle. The use of the open-geometry magnet enables easy patient positioning within the limited space of the vehicle. We show that our portable MRI system provides clinically relevant images of screening for elbow injuries induced by overuse of overhand throwing. This transportable system is deployable during sport events or in environments with poor access to MRI systems, and could be applicable for mass screening, early diagnosis, and case finding.
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Affiliation(s)
- Mayu Nakagomi
- Institute of Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Michiru Kajiwara
- Institute of Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Jumpei Matsuzaki
- Institute of Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Katsumasa Tanabe
- Institute of Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Sodai Hoshiai
- Institute of Clinical Medicine, Department of Diagnostic and Interventional Radiology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshikazu Okamoto
- Institute of Clinical Medicine, Department of Diagnostic and Interventional Radiology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yasuhiko Terada
- Institute of Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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Ulnar Collateral Ligament Insertional Injuries in Pediatric Overhead Athletes: Are MRI Findings Predictive of Symptoms or Need for Surgery? AJR Am J Roentgenol 2019; 212:867-873. [DOI: 10.2214/ajr.18.20474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Frangiamore SJ, Bigart K, Nagle T, Colbrunn R, Millis A, Schickendantz MS. Biomechanical analysis of elbow medial ulnar collateral ligament tear location and its effect on rotational stability. J Shoulder Elbow Surg 2018; 27:2068-2076. [PMID: 30076036 DOI: 10.1016/j.jse.2018.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent anatomic and clinical studies have shown that the location of the injury to the elbow ulnar collateral ligament (UCL) is an important variable in deciding on surgical intervention; however, no studies have evaluated these findings biomechanically. METHODS This study tested 16 intact elbow specimens. Valgus torques of 2.5 and 5 Nm were applied to the elbow at various flexion angles, and the resulting valgus angles were measured. The valgus angles were applied to the elbows in their intact states and again after partial and complete cuts were made on the proximal and distal insertions of the UCL. Resulting valgus torques were measured, and stiffness was calculated for each elbow flexion angle. Unpaired t tests were used to evaluate the effects of cut location and flexion angle on joint rotational stability and stiffness. RESULTS The posterior-distal insertion contributed the most to stability. At valgus angles generated from 2.5 Nm intact torques, the posterior-distal insertions contributed to 51% ± 26% (P < .03) intact rotational stability, and at valgus angles generated from 5 Nm intact torques, the posterior-distal insertions contributed to 41% ± 17% (P < .02) intact rotational stability. For overall stiffness, the posterior-distal insertions contributed to 31% ± 12% (P < .045) intact stiffness. CONCLUSION Overall, the posterior distal insertion of the UCL contributed most to rotational stability and stiffness of the medial elbow when subjected to valgus stress at 90° and 120° of elbow flexion. At higher elbow flexion angles, the posterior insertions contributed more to stability, whereas the anterior insertions had a greater effect at lower flexion angles.
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Affiliation(s)
- Salvatore J Frangiamore
- Department of Orthopedic Surgery and Sports Medicine, Summa Health Medical Group, Akron, OH, USA
| | - Kevin Bigart
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Tara Nagle
- Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robb Colbrunn
- Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrew Millis
- Orthopedics and Sports Medicine, Winona Health, Winona, MN, USA
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13
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Pathologies of the shoulder and elbow affecting the overhead throwing athlete. Skeletal Radiol 2017; 46:873-888. [PMID: 28299434 DOI: 10.1007/s00256-017-2627-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 02/08/2023]
Abstract
The overhead-throwing athlete is susceptible to a variety of predictable disease entities affecting the shoulder and elbow. While the pathophysiology and nomenclature of these diseases are ubiquitous throughout the clinical literature, this information is sparse within the radiology domain. We provide a comprehensive review of these unique injuries with accompanying imaging features in an effort to enhance the role of the radiologist during the management of the overhead thrower. When appropriately recognized and described, the imaging features aid in establishing a diagnosis and ultimately the implementation of appropriate clinical management.
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14
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Frangiamore SJ, Lynch TS, Vaughn MD, Soloff L, Forney M, Styron JF, Schickendantz MS. Magnetic Resonance Imaging Predictors of Failure in the Nonoperative Management of Ulnar Collateral Ligament Injuries in Professional Baseball Pitchers. Am J Sports Med 2017; 45:1783-1789. [PMID: 28398820 DOI: 10.1177/0363546517699832] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A medial ulnar collateral ligament (UCL) injury of the elbow is an increasingly common injury in professional baseball pitchers. Predictors of success and failure are not well defined for the nonoperative management of these injuries. PURPOSE To evaluate the efficacy of objective measures to predict failure of the nonoperative management of UCL injuries. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Thirty-two professional pitchers (82%) met inclusion criteria and underwent an initial trial of nonoperative treatment for UCL tears based on clinical and radiological findings. Age, preseason physical examination results, magnetic resonance imaging (MRI) characteristics, and performance metrics were analyzed for these pitchers. Successful nonoperative management was defined as a return to the same level of play or higher for >1 year. Failure was defined as recurrent pain or weakness requiring a surgical intervention after a minimum of 3 months' rest when attempting a return to a throwing rehabilitation program. RESULTS Thirty-two pitchers (mean age, 22.3 years) who underwent initial nonoperative treatment of UCL injuries were evaluated. Thirty-four percent (11/32) failed and required subsequent ligament reconstruction. Sixty-six percent (21/32) successfully returned to the same level of play for 1 year without a surgical intervention. There was no significant difference seen in physical examination findings or performance metrics between these patients. When comparing MRI findings between the groups, 82% (9/11) ( P < .001) who failed nonoperative management had distal tears, and 81% (17/21) who did not fail had proximal tears ( P < .001). When adjusting for age, location, and evidence of chronic changes on MRI, the likelihood of failing nonoperative management was 12.40 times greater ( P = .020) with a distal tear. No other variable alone or in combination reached significance. When combining the parameters of a high-grade tear and distal location, 88% (7/8) failed nonoperative management. CONCLUSION In professional pitchers, distal UCL tears showed significantly higher odds of failure with nonoperative management compared with proximal tears. Thus, tear location should be considered when deciding between operative and nonoperative management.
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Affiliation(s)
| | - T Sean Lynch
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Michael D Vaughn
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Michael Forney
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joseph F Styron
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark S Schickendantz
- Sports Health Center, Department of Orthopaedic Surgery, Cleveland Clinic, Garfield Heights, Ohio, USA
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Tanaka K, Okamoto Y, Makihara T, Maehara K, Yoshizawa T, Minami M, Yamazaki M. Clinical interpretation of asymptomatic medial collateral ligament injury observed on magnetic resonance imaging in adolescent baseball players. Jpn J Radiol 2017; 35:319-326. [PMID: 28421395 DOI: 10.1007/s11604-017-0636-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/27/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) of medial collateral ligament (MCL) injury of the elbow was often observed in asymptomatic adolescent baseball players. We aimed to clarify the clinical interpretation of "asymptomatic MCL injury observed on MRI" by comparing MRI, ultrasonography (US), and physical findings. MATERIALS AND METHODS Sixty-four asymptomatic adolescent baseball players (mean 11.2 years) were enrolled. An open-type 0.2T MRI was used. MCL function was evaluated by measuring the opening of the ulnohumeral joint using US. Physical findings included MCL tenderness, the moving valgus test, and the Milking test. The correlation between MRI and US, and MRI and physical findings were analyzed. RESULTS Thirty-four subjects (53.1%) showed MCL injury by MRI. The mean laterality of the ulnohumeral joint opening showed no significant difference (P = 0.16) between the group with (0.29 ± 1.06 mm) and without (0.08 ± 0.96 mm) MCL injury on MRI. There was no correlation between MRI and physical findings except for a weak correlation between subjects with positive Milking test and MCL injury on MRI (φ coefficient = 0.3, P = 0.02). CONCLUSION 'Asymptomatic MCL injury on MRI' had little correlation to ligament dysfunction. It might represent the transition period to MCL thickening called "adaptation."
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Affiliation(s)
- Kenta Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8576, Japan
| | - Yoshikazu Okamoto
- Department of Radiology, Faculty of Medicine University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Takeshi Makihara
- Department of Orthopaedic Surgery, Faculty of Medicine University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kiyoshi Maehara
- Gradient School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomohiro Yoshizawa
- Department of Orthopaedic Surgery, Faculty of Medicine University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8576, Japan
| | - Manabu Minami
- Department of Radiology, Faculty of Medicine University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8576, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8576, Japan
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Abstract
OBJECTIVE The purpose of this article is to review common elbow injuries found in overhead athletes with focus on mechanism, clinical features, imaging appearance, and treatment options. CONCLUSION The overhead throwing motion subjects the elbow to a variety of complex forces, which places both osseous and soft-tissue structures at high risk for injury.
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Abstract
Elbow pain is a frequent presenting symptom in athletes, particularly athletes who throw. The elbow can be injured as a result of acute trauma, such as a direct blow or a fall onto an outstretched hand or from chronic microtrauma. In particular, valgus extension overload during the throwing motion can precipitate a cascade of chronic injuries that can be debilitating for both casual and high-performance athletes. Prompt imaging evaluation facilitates accurate diagnosis and appropriate targeted interventions.
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Affiliation(s)
- Matthew D Bucknor
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
| | - Kathryn J Stevens
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
| | - Lynne S Steinbach
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
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Incidence of elbow injuries in adolescent baseball players: screening by a low field magnetic resonance imaging system specialized for small joints. Jpn J Radiol 2016; 34:300-6. [DOI: 10.1007/s11604-016-0526-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
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