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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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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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Min JJ, Ryu YJ, Sung KH, Lee J, Kim JY, Park MS. Anatomic consideration of the radial nerve in relation to humeral length for unilateral external fixation: a retrospective study using magnetic resonance imaging findings in korean. BMC Musculoskelet Disord 2023; 24:380. [PMID: 37189124 DOI: 10.1186/s12891-023-06474-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND This study aimed to present a safe zone for distal pin insertion for external fixation using magnetic resonance imaging (MRI) images. METHODS All patients who took at least one upper arm MRI from June 2003 to July 2021 were searched via a clinical data warehouse. For measuring the humerus length, proximal and distal landmarks were set as the highest protruding point of the humeral head and lowermost margin of ossified bone of the lateral condyle, respectively. For children or adolescents with incomplete ossification, the uppermost and lowermost ossified margin of the ossification centers were set as proximal and distal landmarks respectively. The anterior exit point (AEP) was defined as the location of the radial nerve exiting the lateral intermuscular septum to the anterior humerus and distance between the distal margin of the humerus and AEP was measured. The proportions between the AEP and full humeral length were calculated. RESULTS A total of 132 patients were enrolled for final analysis. The mean humerus length was 29.4 cm (range 12.9-34.6 cm). The mean distance between the ossified lateral condyle and AEP was 6.6 cm (range 3.0-10.6 cm). The mean ratio of the anterior exit point and humeral length was 22.5% (range 15.1-30.8%). The minimum ratio was 15.1%. CONCLUSION A percutaneous distal pin insertion for humeral lengthening with an external fixator may be safely done within 15% length of the distal humerus. If pin insertion is required more proximal than distal 15% of the humeral shaft, an open procedure or preoperative radiographic assessment is advised to prevent iatrogenic radial nerve injury.
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Affiliation(s)
- Jae Jung Min
- Department of Orthopaedic surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jisoo Lee
- Department of Orthopaedic surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea.
| | - Moon Seok Park
- Department of Orthopaedic surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
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Lyra da Silva CC, Cardoso JR, Rodrigues da Silva WP, Pinheiro LA, Ferreira LR, Nunes GO, Borges NC. Morphological and radiological study of the shoulder and elbow joints of the giant anteater (Myrmecophaga tridactyla). J Morphol 2023; 284:e21526. [PMID: 36271893 DOI: 10.1002/jmor.21526] [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: 04/15/2022] [Revised: 10/04/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
The giant anteater (Myrmecophaga tridactyla) has specialized thoracic limbs to forage by breaking the walls of anthills and termite mounds. They also play critical roles in defense posture and locomotion. This study aimed to provide a morphological and radiographic description of the shoulder joint and elbow joint of the giant anteater. Both joints of 13 tamanduas were assessed by morphological dissections and histological evaluation and radiographies without and with positive contrast. The radiographic projections selected to this study were the mediolateral and craniocaudal projections. The radiographic and anatomical findings were compared with the following results: the shoulder joint had a continuous joint capsule with the tendon sheaths of the short head and long head of the biceps brachii muscle, which could be visualized with an injection of 3 ml of intra-articular contrast. The shoulder joint arthrography was performed with the needle positioned cranially to the joint for contrast injection. The elbow joint presented three articular compartments, and the insertion of the joint capsule was proximal to the radial fossa and distal to the radial tuberosity in the radial notch of the ulna, which were possible to identify with 2 ml of intra-articular contrast. The elbow joint arthrography was performed with the needle positioned laterally to the joint for contrast injection. Moreover, the joint capsule presented a caudomedial distention and fat pads. The powerful muscles of the forelimb play a fundamental role in maintaining the shoulder joint and elbow joint stability due to bony adaptations and the absence of usual ligaments. The morphological and radiological study provided relevant information on the soft-tissue characteristics of shoulder and elbow joints, which may aid clinical-surgical and diagnostic imaging procedures.
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Affiliation(s)
- Carolina Castro Lyra da Silva
- Department of Veterinary Medicine, School of Veterinary and Animal Science, Federal University of Goiás, Goiânia, Brazil
| | - Júlio Roquete Cardoso
- Department of Morphology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | | | - Lizandra Araújo Pinheiro
- Department of Veterinary Medicine, School of Veterinary and Animal Science, Federal University of Goiás, Goiânia, Brazil
| | - Lucas Rodrigues Ferreira
- Department of Veterinary Medicine, School of Veterinary and Animal Science, Federal University of Goiás, Goiânia, Brazil
| | - Gabriel Oliveira Nunes
- Department of Veterinary Medicine, Federal Institute of Education, Science and Technology of Goiás, Urutaí, Brazil
| | - Naida Cristina Borges
- Department of Veterinary Medicine, School of Veterinary and Animal Science, Federal University of Goiás, Goiânia, Brazil
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Duan XY, Xu B, Ma JX, Gong KT, Yuan Y, Gao JM, Ma XL. Morphological Changes of Medial Epicondyle-Olecranon Ligament and Ulnar Nerve in the Cubital Tunnel Syndrome: An Ultrasonic Study. Orthop Surg 2022; 14:2682-2691. [PMID: 36076356 PMCID: PMC9531097 DOI: 10.1111/os.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Few studies have performed detailed ultrasound measurements of medial epicondyle‐olecranon (MEO) ligament that cause the entrapment of ulnar nerve. This study aims to comprehensively evaluate dynamic ultrasonographic characteristics of MEO ligament and ulnar nerve for clinical diagnosis and accurate treatment of cubital tunnel syndrome (CuTS). Methods Thirty CuTS patients (CuTS group) and sixteen healthy volunteers (control group) who underwent ultrasound scanning from October 2016 to October 2020 were retrospectively collected, with 30 elbows in each group. Primary outcomes were thickness at six points, length and width of MEO ligament. Secondary outcomes were thickness of ulnar nerve under MEO ligament at seven parts and the cross‐sectional area (CSA) of ulnar nerve at proximal end of MEO ligament (P0 mm). The thickness of MEO ligament and ulnar nerve in different points of each group was compared by one‐way ANOVA analysis with Bonferroni post hoc test, other outcomes were compared between two elbow positions or two groups using independent‐samples t test. Results Thickness of MEO ligament in CuTS group at epicondyle end, midpoint in transverse view, olecranon end, proximal end, midpoint in axial view, and distal end was 0.67 ± 0.31, 0.37 ± 0.18, 0.89 ± 0.35, 0.39 ± 0.21, 0.51 ± 0.38, 0.36 ± 0.25 at elbow extension, 0.68 ± 0.34, 0.38 ± 0.27, 0.77 ± 0.39, 0.32 ± 0.20, 0.48 ± 0.22, 0.32 ± 0.12 (mm) at elbow flexion, respectively. Compared with control group, they were significantly thickened except for proximal end at elbow flexion. MEO ligament thickness at epicondyle end and olecranon end was significantly larger than midpoint in two groups. No significant difference was found in length and width of MEO ligament among different comparisons. Ulnar nerve thickness at 5 mm proximal to MEO ligament (P5 mm, 3.25 ± 0.66 mm) was significantly increased than midpoint of MEO ligament (Mid), distal end of MEO ligament (D0 mm), 5 mm (D5 mm), 10 mm (D10 mm) distal to MEO ligament at extension in CuTS group. Compared with control group, ulnar nerve thickness at P5 mm in CuTS group was significantly increased at extension position, at D5 mm and D10 mm was significantly decreased at flexion position. CSA of ulnar nerve at extension position (14.44 ± 4.65 mm2) was significantly larger than flexion position (11.83 ± 3.66 mm2) in CuTS group, and CuTS group was significantly larger than control group at two positions. Conclusions MEO ligament in CuTS patients was thickened, which compressed ulnar nerve and caused its proximal end swelling. Ultrasonic image of MEO ligament thickness was a significant indicator for CuTS and can guide surgeons in selecting the appropriate treatment.
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Affiliation(s)
- Xiao-Yuan Duan
- Tianjin Hospital, Tianjin University, Tianjin, China.,Tianjin Medical University, Tianjin, China
| | - Bin Xu
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jian-Xiong Ma
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Ke-Tong Gong
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Yu Yuan
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jin-Mei Gao
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xin-Long Ma
- Tianjin Hospital, Tianjin University, Tianjin, China
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Mardani-Kivi M, Alizadeh A, Asadi K, Izadi A, Leili EK, arzpeyma SF. Can indirect magnetic resonance arthrography be a good alternative to magnetic resonance imaging in diagnosing glenoid labrum lesions?: a prospective study. Clin Shoulder Elb 2022; 25:182-187. [PMID: 35791684 PMCID: PMC9471823 DOI: 10.5397/cise.2021.00598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study was designed to evaluate and compare the diagnostic value of magnetic resonance imaging (MRI) and indirect magnetic resonance arthrography (I-MRA) imaging with those of arthroscopy and each other. Methods This descriptive-analytical study was conducted in 2020. All patients who tested positive for labrum lesions during that year were included in the study. The patients underwent conservative treatment for 6 weeks. In the event of no response to conservative treatment, MRI and I-MRA imaging were conducted, and the patients underwent arthroscopy to determine their ultimate diagnosis and treatment plan. Imaging results were assessed at a 1-week interval by an experienced musculoskeletal radiologist. Image interpretation results and arthroscopy were recorded in the data collection form. Results Overall, 35 patients comprised the study. Based on the kappa coefficient, the results indicate that the results of both imaging methods are in agreement with the arthroscopic findings, but the I-MRA consensus rate is higher than that of MRI (0.612±0.157 and 0.749±0.101 vs. 0.449±0.160 and 0.603±0.113). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI in detecting labrum tears were77.77%, 75.00%, 91.30%, 50.00%, and 77.14%, respectively, and those of I-MRA were 88.88%, 75.00%, 92.30%, 66.66%, and 85.71%. Conclusions Here, I-MRA showed higher diagnostic value than MRI for labral tears. Therefore, it is recommended that I-MRA be used instead of MRI if there is an indication for potential labrum lesions.
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Swan ER, Lynch TB, Sheean AJ, Schmitz MR, Dickens JF, Patzkowski JC. High Incidence of Combined and Posterior Labral Tears in Military Patients With Operative Shoulder Instability. Am J Sports Med 2022; 50:1529-1533. [PMID: 35315289 DOI: 10.1177/03635465221078609] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior shoulder instability is the pattern most commonly reported in the civilian population, but military servicemembers may represent a unique population. At 1.7 per 1000 person-years, servicemembers not only have a higher incidence of instability events compared with civilians (reported rate of 0.2-0.8), but the distribution of labral tears in the military may differ significantly as well. HYPOTHESIS The incidence of combined and posterior labral tears in the military population will be greater than numbers previously reported. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The Wounded, Ill, and Injured Registry, a Department of Defense patient reported outcomes data collection platform that includes all military branches, was queried retrospectively for all patients who had undergone a primary arthroscopic or open shoulder stabilization procedure (Current Procedural Terminology codes 29806, 23455, 23462) between October 2016 and January 2019. Demographic information was obtained through intake forms completed by patients at the time of enrollment into the Military Orthopaedics Tracking Injuries and Outcomes Network. Tear location was determined arthroscopically and labeled as anterior, inferior, posterior, superior, or any combination thereof. Chi-square analysis was used to compare the percentage of patients with isolated anterior, isolated posterior, isolated inferior, or combined labral tears in the current study cohort with those in a previously reported cohort of patients with operative shoulder instability at a single military treatment facility. RESULTS A total of 311 patients were included who had undergone primary shoulder stabilization during the study period. Of these patients, 94 (30.2%) had isolated anterior tears, 76 (24.4%) had isolated posterior tears, and 136 (43.7%) had combined tears. We observed a higher percentage of combined tears in our data set than in a data set from a single military treatment facility (χ2(2) = 48.2; P < .00001). Chi-square analysis demonstrated that significantly more female patients had an isolated anterior labral tear (51.2%) compared with male patients (27.1%; χ2(2) = 9.4; P = .009). CONCLUSION The incidence of combined and posterior labral tears in the military population is greater than numbers previously reported in both military and civilian populations.
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Affiliation(s)
- Erin R Swan
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Thomas B Lynch
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Andrew J Sheean
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | | | - Jon F Dickens
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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The importance of surgeon judgment in obtaining early magnetic resonance imaging to prevent delays in care for acute subacromial injury. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Preoperative Evaluation and Surgical Simulation for Osteochondritis Dissecans of the Elbow Using Three-Dimensional MRI-CT Image Fusion Images. Diagnostics (Basel) 2021; 11:diagnostics11122337. [PMID: 34943574 PMCID: PMC8700753 DOI: 10.3390/diagnostics11122337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
We used our novel three-dimensional magnetic resonance imaging-computed tomography fusion images (3D MRI-CT fusion images; MCFIs) for detailed preoperative lesion evaluation and surgical simulation in osteochondritis dissecans (OCD) of the elbow. Herein, we introduce our procedure and report the findings of the assessment of its utility. We enrolled 16 men (mean age: 14.0 years) and performed preoperative MRI using 7 kg axial traction with a 3-Tesla imager and CT. Three-dimensional-MRI models of the humerus and articular cartilage and a 3D-CT model of the humerus were constructed. We created MCFIs using both models. We validated the findings obtained from the MCFIs and intraoperative findings using the following items: articular cartilage fissures and defects, articular surface deformities, vertical and horizontal lesion diameters, the International Cartilage Repair Society (ICRS) classification, and surgical procedures. The MCFIs accurately reproduced the lesions and correctly matched the ICRS classification in 93.5% of cases. Surgery was performed as simulated in all cases. Preoperatively measured lesion diameters exhibited no significant differences compared to the intraoperative measurements. MCFIs were useful in the evaluation of OCD lesions and detailed preoperative surgical simulation through accurate reproduction of 3D structural details of the lesions.
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Shin YE, Kim SJ, Kim JS, Kwak KY, Kim JH, Kim JP. Efficiency of magnetic resonance imaging for diagnosing unstable ligament injuries around the thumb metacarpophalangeal joint: A comparison to arthroscopy. J Orthop Surg (Hong Kong) 2021; 28:2309499020978308. [PMID: 33345693 DOI: 10.1177/2309499020978308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study aimed to assess the accuracy of MRI in identifying ulnar collateral ligament (UCL), radial collateral ligament (RCL), and volar plate (VP) injuries of the metacarpophalangeal joint (MCPJ) of the thumb by comparing with diagnostic arthroscopy. METHODS A total of 56 consecutive patients (56 thumbs) who underwent arthroscopy of MCPJ of thumb were enrolled. MRI findings reviewed by consensus reading of two blinded radiologists were compared with arthroscopic examination. Statistical data, including sensitivity, specificity, accuracy, were analyzed. Additionally, the performance characteristics between 3.0-tesla (39 thumbs) and 1.5-tesla (17 thumbs) MRI and acute (≤4 weeks after injury) and chronic (>4 weeks) injuries were compared. RESULTS Of the 56 thumbs, 38 thumbs (67.9%) showed complete correspondence between MRI and arthroscopic findings. The sensitivity, specificity and accuracy of MRI for detecting UCL injuries were 78.8%, 87.0%, and 82.1%, respectively. The sensitivity, specificity and accuracy of MRI for detecting RCL injuries were 85.7%, 91.4%, and 85.7%, respectively. The sensitivity, specificity, and accuracy of MRI for detecting VP injuries were 89.5%, 89.2%, and 81.0%, respectively. 3.0-tesla MRI showed higher correspondence with arthroscopic observation (76.9%) than 1.5-tesla MRI (47.1%) (p = 0.028). For acute injuries, 78.4% showed complete correspondence between MRI and arthroscopic findings, whereas 47.4% with chronic injuries revealed complete agreement (p = 0.019). CONCLUSION Overall, MRI is moderately effective in evaluating ligamentous lesions around MCPJ of thumb, but MRI is more sensitive in diagnosing acute injuries. Furthermore, 3.0-tesla MRI can provide results with better accuracy for diagnosing ligamentous lesions around MCPJ of thumb. However, the sensitivity and the specificity are not applicable to all ligament injuries, but only the severe one which would agree for surgical options.
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Affiliation(s)
- Yong-Eun Shin
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Sung-Joon Kim
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Jeong-Sang Kim
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Kwon-Young Kwak
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Ji-Hyo Kim
- Department of Teaching Education, College of Liberal Arts, Dankook University, Cheonan, Republic of Korea
| | - Jong-Pil Kim
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Republic of Korea
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11
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Characteristic MRI findings of shoulder, elbow, and wrist joints in wheelchair user. Skeletal Radiol 2021; 50:171-178. [PMID: 32699953 DOI: 10.1007/s00256-020-03545-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Wheelchair users frequently utilize their upper extremities for moving around in their daily life. Therefore, it is likely they may develop conditions of overuse in their joints, which could affect their activity and daily life. The purpose of this study is to clarify the actual conditions of the joints of wheelchair users using MRI. MATERIAL AND METHODS Twenty-five wheelchair users and twenty able-bodied control volunteers participated in this study. We scanned MRI images of their right and left shoulders, elbows, and wrists. Two radiologists interpreted the images and made diagnoses for each of the joints. The number of diseases for each joint was compared between wheelchair users and able-bodied volunteers. RESULTS The number of supraspinatus tendon tears was higher in wheelchair users than controls in the right (Rt.) (P < 0.05), left (Lt.) (P < 0.05), and bilateral (Bil.) (P < 0.05) shoulders. The number of elbow LP lesions (Rt. (P < 0.01), Lt. (P < 0.01), and Bil. (P < 0.05)) and the number of elbow lateral epicondylitis cases (Rt. [P < 0.05] and Lt. [P < 0.05]) were also higher in wheelchair users than that of control volunteers. Additionally, the number of wrist TFCC injuries in wheelchair users (Rt. [P < 0.01], Lt. [P < 0.01], and Bil. [P < 0.01]) was more than that of control volunteers. CONCLUSION Our results suggest that there are several types of overuse injury in each joint. However, we hypothesize that these are not induced by driving wheelchairs, but instead by the "push up" movement characteristic for wheelchair users, according to the situations caused by each injury.
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Dixit A, Dandu N, Hadley CJ, Nazarian LN, Cohen SB, Ciccotti M. Ultrasonographic Technique, Appearance, and Diagnostic Accuracy for Common Elbow Sports Injuries. JBJS Rev 2020; 8:e19.00219. [PMID: 33186208 DOI: 10.2106/jbjs.rvw.19.00219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Ultrasonography is a valuable diagnostic imaging tool because of its availability, tolerability, low cost, and utility in real-time dynamic evaluation. Its use in diagnosing elbow injuries has expanded recently and continues to do so. In particular, stress ultrasonography represents a unique imaging technique that directly visualizes the ulnar collateral ligament (UCL) and allows the assessment of ligament laxity, offering an advantage over magnetic resonance imaging and magnetic resonance arthrography in this patient population. Furthermore, ultrasonography has shown particular usefulness in instances where invasive techniques might be less desirable. This is particularly important in athletes since more invasive procedures potentially result in lost time from their sport. Ultrasonography is an important imaging tool that complements a thorough history and physical examination in the evaluation of elbow injuries in athletes. The use of ultrasonography in orthopaedic sports medicine has been investigated previously; however, to our knowledge, there has been no comprehensive review regarding the utility of ultrasonography for common elbow injuries in athletes. The current study provides a comprehensive, detailed review of the utility and indications for the use of ultrasonography for common elbow injuries in athletes.
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Affiliation(s)
- Anant Dixit
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Pasadena, California
| | - Navya Dandu
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Christopher J Hadley
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Levon N Nazarian
- Thomas Jefferson University Hospital at Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Steven B Cohen
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Ciccotti
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Kohyama S, Tanaka T, Shimasaki K, Kobayashi S, Ikumi A, Yanai T, Ochiai N. Effect of elbow MRI with axial traction on articular cartilage visibility-a feasibility study. Skeletal Radiol 2020; 49:1555-1566. [PMID: 32367208 DOI: 10.1007/s00256-020-03455-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Accurate evaluation of the articular cartilage of the elbow using MRI is sometimes challenging because of its anatomical complexity and relatively small size. Moreover, the articular cartilage of the humerus is in close contact with the opposing cartilage surfaces. Magnetic resonance arthrography with traction was reported to resolve this issue; however, less invasive methods are desirable. This study aimed to assess the effect of MRI with axial traction (without arthrography) on joint space widening and cartilage outline visibility of the elbow. MATERIALS AND METHODS We enrolled 10 volunteers (female = 1; mean age, 36.7 ± 8.6; range 28-56) and performed MRI with and without axial traction on the elbow. Joint space widths were measured, and the humeral articular cartilage outline visibility was evaluated at the radiocapitellar joint and lateral one-third and medial one-third of the ulnohumeral joints. Measurements were compared using the Wilcoxon signed-rank test. Significance was set at p < 0.05. Volunteers scored pain and discomfort during MRI with traction using the visual analog scale in a questionnaire format. RESULTS Traction significantly increased joint space width at the radiocapitellar joint. Humeral articular cartilage outline visibility also significantly improved at the radiocapitellar joint. Pain and discomfort scores during traction MRI were low. CONCLUSION MRI of the elbow with traction widens joint space and enables better articular cartilage visibility at the radiocapitellar joint. Anatomical features of the elbow might have affected these results. Therefore, it would be safe and useful for evaluating elbow injuries involving articular cartilage lesions.
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Affiliation(s)
- Sho Kohyama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. .,Department of Orthopaedic Surgery, Kikkoman General Hospital, 100 Miyazaki, Noda, Chiba, 278-0005, Japan.
| | - Toshikazu Tanaka
- Department of Orthopaedic Surgery, Kikkoman General Hospital, 100 Miyazaki, Noda, Chiba, 278-0005, Japan
| | - Koshiro Shimasaki
- Department of Orthopaedic Surgery, Kikkoman General Hospital, 100 Miyazaki, Noda, Chiba, 278-0005, Japan
| | - Sayaka Kobayashi
- Department of Orthopaedic Surgery, Kikkoman General Hospital, 100 Miyazaki, Noda, Chiba, 278-0005, Japan
| | - Akira Ikumi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takaji Yanai
- Department of Orthopaedic Surgery, Kikkoman General Hospital, 100 Miyazaki, Noda, Chiba, 278-0005, Japan
| | - Naoyuki Ochiai
- Department of Orthopaedic Surgery, Kikkoman General Hospital, 100 Miyazaki, Noda, Chiba, 278-0005, Japan
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14
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The Impact of Adherence to Clinical Practice Guidelines on Medical Costs. J Occup Environ Med 2020; 62:712-717. [PMID: 32890209 DOI: 10.1097/jom.0000000000001938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the association between non-adherence to clinical practice guidelines (CPGs) and medical and indemnity spending among back and shoulder injury patients. METHODS Workers compensation claims data was used from a large, US insurer (1999 to 2010). Least square regression models were created to examine the association between spending and guideline-discordant care. RESULTS Non-adherence to CPGs was associated with higher medical and indemnity spending for 11 of the 28 CPG indicators. Failure to adhere to the other CPGs did not increase medical or total spending. After covariate adjustment, non-adherence to these 11 CPGs was associated with spending increases that ranged from $16,000 for physical therapy (PT) to $114,000 for surgery. CONCLUSIONS Our results demonstrate that failure to adhere to a subset of CPG indicators significantly predicts increased medical and indemnity spending for two important occupational injuries.
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Tennent D, Green G. Partial articular supraspinatus tendon avulsion: Should we repair? A systematic review of the evidence. Shoulder Elbow 2020; 12:253-264. [PMID: 32788930 PMCID: PMC7400714 DOI: 10.1177/1758573219864101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Partial articular sided rotator cuff tears are described as being a common cause of shoulder pain and to have a significant impact of patient quality of life. The natural history of partial articular supraspinatus tendon avulsion lesions is not clearly defined and there is limited evidence to determine optimal management. AIMS To perform a systematic review of the literature regarding the evidence for partial articular supraspinatus tendon avulsion repair and to determine whether there is any difference between operative and non-operatively managed patients. METHODS Conventional and grey literature were searched with defined terms to identify studies in human adults concerning management of partial articular sided supraspinatus avulsions. RESULTS Out of 86 papers identified by the search terms, 28 were deemed eligible for review including 1966 shoulders. 4/28 papers were of level I-II evidence but all were comparing techniques. 4/28 papers were biomechanical cadaveric studies, assessing strength of repair and effect on stability. The remaining 20 studies were level IV-V evidence and consisted of case series and technical notes identifying varying techniques of repair and their outcomes. CONCLUSION Current literature suggests that all techniques used to repair partial articular supraspinatus tendon avulsion lesions give increased functional scores and reduced pain. However, this represents a heterogeneous group of patients with variable degrees of tear and is not reproducible. There are limited controlled studies to determine whether partial articular supraspinatus tendon avulsion lesions require repair. Current classification systems represent a single plane and are open to user variation. No evidence exists to determine which tears are stable and which may progress.
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Affiliation(s)
- Duncan Tennent
- Duncan Tennent, St George's Hospital, Blackshaw Rd, London SW17 0QT, UK.
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16
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Ibounig T, Simons T, Launonen A, Paavola M. Glenohumeral Osteoarthritis: An Overview of Etiology and Diagnostics. Scand J Surg 2020; 110:441-451. [PMID: 32662351 DOI: 10.1177/1457496920935018] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Osteoarthritis (OA) is the world's most common joint disease and there is currently no cure. Glenohumeral osteoarthritis (GHOA) accounts for an estimated 5% -17% of patients with shoulder complaints. The etiology of GHOA is multifactorial, and we review the various non-specific and specific risk factors and further sub-classify them into local and systemic factors. MATERIALS AND METHODS Data for this review article were identified by searches of MEDLINE, PubMed, and references from relevant articles using search terms such as "glenohumeral," "osteoarthritis," "epidemiology," "etiology," "imaging," and "pathophysiology." Only articles published in English, German, and Finnish between 1957 and 2017 were included. RESULTS The prevalence of radiological shoulder OA has been estimated to be as high as 16% -20% in the middle-aged and elderly population, but the concordance between structural findings and symptoms seems to be weak, as many of these individuals are asymptomatic. The vast majority of GHOA is related to non-specific factors, namely advancing age, while specific risk factors are commonly found in young patients. Diagnosis of GHOA is made when typical clinical features and defined radiological findings overlap in an individual. CONCLUSION Ultimately the determinants of shoulder pain in GHOA remain incompletely understood. Improved understanding of the etiology and diagnosis of GHOA will enable clinicians to better determine which patients will benefit from different treatment modalities, as well as provide new avenues to potential treatments.
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Affiliation(s)
- T Ibounig
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Finnish Center of Evidence based Orthopaedics (FICEBO), University of Helsinki, Helsinki, Finland
| | - T Simons
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - M Paavola
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Liu F, Cheng X, Dong J, Zhou D, Han S, Yang Y. Comparison of MRI and MRA for the diagnosis of rotator cuff tears: A meta-analysis. Medicine (Baltimore) 2020; 99:e19579. [PMID: 32195972 PMCID: PMC7220562 DOI: 10.1097/md.0000000000019579] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Numerous quantitatively based studies measuring the accuracy of MRI and MRA for the diagnosis of rotator cuff tears remain inconclusive. In order to compare the accuracy of MRI with MRA in detection of rotator cuff tears a meta-analysis was performed systematically. METHODS PubMed/Medline and Embase were utilized to retrieve articles comparing the diagnostic performance of MRI and MRA for use in detecting rotator cuff tears. After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis the pooled evaluation indexes including sensitivity and specificity as well as hierarchical summary receiver operating characteristic (HSROC) curves with 95% confidence interval (CI) were calculated. RESULTS Screening determined that 12 studies involving a total of 1030 patients and 1032 shoulders were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that MRA has a higher sensitivity and specificity than MRI for the detection of any tear; similar results were observed in the detection of full-thickness tears. However, for the detection of partial-thickness tear, MRI has similar performance with MRA. CONCLUSION MRI is recommended to be a first-choice imaging modality for the detection of rotator cuff tears. Although MRA have a higher sensitivity and specificity, it cannot replace MRI after the comprehensive consideration of accuracy and practicality.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong
| | - Xiangyun Cheng
- Department of Orthopaedics, The 2nd Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong
| | - Shumei Han
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong, China
| | - Yongliang Yang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong
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18
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Pappa E, Tomlinson A, Ferreira A, Pettitt R, Mortier J. Ultrasonographic and CT arthrography findings in two dogs with biceps brachii tendon avulsion. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-000989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Eirini Pappa
- Small Animal Teaching HospitalUniversity of LiverpoolNestonUK
| | - Andy Tomlinson
- Small Animal Teaching HospitalUniversity of LiverpoolNestonUK
| | - Amy Ferreira
- Small Animal Teaching HospitalUniversity of LiverpoolNestonUK
| | - Rob Pettitt
- Small Animal Teaching HospitalUniversity of LiverpoolNestonUK
| | - Jeremy Mortier
- Small Animal Teaching HospitalUniversity of LiverpoolNestonUK
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Liu F, Cheng X, Dong J, Zhou D, Sun Q, Bai X, Wang D. Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:487. [PMID: 31656171 PMCID: PMC6815459 DOI: 10.1186/s12891-019-2876-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/09/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multiple published studies quantitatively analysing the diagnostic value of MRI, MR arthrography (MRA) and CT arthrography (CTA) for labral lesions of the shoulder have had inconsistent results. The aim of this meta-analysis was to systematically compare the diagnostic performance of MRI, MRA, CTA and CT. METHODS Two databases, PubMed and EMBASE, were used to retrieve studies targeting the accuracy of MRI, MRA, CTA and CT in detecting labral lesions of the shoulder. After carefully screening and excluding studies, the studies that met the inclusion criteria were used for a pooled analysis, including calculation of sensitivity and specificity with 95% confidence intervals (CIs) and the area under the hierarchical summary receiver operating characteristic (HSROC) curves. RESULTS The retrieval process identified 2633 studies, out of which two reviewers screened out all but 14 studies, involving a total of 1216 patients who were deemed eligible for inclusion in the meta-analysis. The results assessing the diagnostic performance of MRI vs. MRA for detecting labral lesions showed a pooled sensitivity of 0.77 (95% CI 0.70-0.84) vs. 0.92 (95% CI 0.84-0.96), a specificity of 0.95 (95% CI 0.85-0.98) vs. 0.98 (95% CI 0.91-0.99), and an area under the HSROC curve of 3.78 (95% CI 2.73-4.83) vs. 6.01 (95% CI 4.30-7.73), respectively. CONCLUSION MRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality. MRI is by far the first choice recommendation for the detection of acute labral lesions. CT should be a necessary supplemental imaging technique when there is highly suspected glenoid bone damage.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xiangyun Cheng
- Department of Orthopaedics, The 2nd Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Qian Sun
- Department of General and Paediatric Surgery, Yantai Yuhuangding Hospital affiliated Qingdao University, Yuhuangding eastern road 20, Yantai, China
| | - Xiaohui Bai
- Department of Clinical Laboratory, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road 324, Jinan, 250021, Shandong, China.
| | - Dawei Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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20
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Klaan B, Wuennemann F, Kintzelé L, Gersing AS, Weber MA. [MR and CT arthrography in cartilage imaging : Indications and implementation]. Radiologe 2019; 59:710-721. [PMID: 31286150 DOI: 10.1007/s00117-019-0564-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The imaging of chondral pathologies is an essential part in the work-up of acute and chronic joint diseases. Besides conventional MR imaging, CT and MR arthrography are well-established methods in evaluating articular cartilage. The application of these techniques requires knowledge of indications and safe injection procedures by the performing radiologist. PURPOSE Our goal is to describe the techniques of cross-sectional arthrographies of different joints, give an overview of general and joint-specific considerations for practical application as well as provide typical indications for cartilage imaging. MATERIALS AND METHODS A selective PubMed literature search concerning "arthrography", "CT arthrography", "MR arthrography", "arthrography cartilage", "arthrography wrist", "arthrography elbow", "arthrography shoulder", "arthrography hip", "arthrography knee", "arthrography ankle", "arthrography complications", "arthrography imaging guidance" "osteochondral lesion", "cartilage imaging" and "cartilage lesion" was performed. RESULTS AND CONCLUSION CT and MR arthrography are valuable and safe tools in cartilage imaging. They are useful to verify and specify chondral pathologies, usually after conventional MR imaging, and have an important role in evaluating the stability and therefore in therapeutic decision making of osteochondral lesions. CT arthrography is not only a substitute technique in case of MR contraindications, it can be advantageous in small joints (wrist, elbow, ankle) compared to MR arthrography due to its higher image resolution. Fluoroscopic guided joint puncture is still the most commonly used image guidance method, but the role of ultrasound is steadily increasing. Joint traction in MR arthrography is a promising technique to improve cartilage visualization, though it is not yet used in clinical routine imaging.
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Affiliation(s)
- B Klaan
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland.
| | - F Wuennemann
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - L Kintzelé
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A S Gersing
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - M-A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland
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21
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Kim HS, Yoon YC, Choi BO, Jin W, Cha JG. Muscle fat quantification using magnetic resonance imaging: case-control study of Charcot-Marie-Tooth disease patients and volunteers. J Cachexia Sarcopenia Muscle 2019; 10:574-585. [PMID: 30873759 PMCID: PMC6596397 DOI: 10.1002/jcsm.12415] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/27/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the potential value of 3D multiple gradient echo Dixon-based magnetic resonance imaging (MRI) sequence as a tool for thigh intramuscular fat quantification in Charcot-Marie-Tooth disease (CMT) patients. METHODS A prospective comparison study comprising 18 CMT patients and 18 age/sex-matched volunteers was performed. MRI including 3D multiple gradient echo Dixon-based imaging was performed for each subject. Region of interest analyses were performed at the upper and lower third of both thighs. The two-sample t-test or Wilcoxon rank sum test was used for intergroup comparison of the mean muscle fat fraction. Intraclass correlation coefficients were used to evaluate the interobserver agreement and test-retest reproducibility. Semiquantitive analysis using the Goutallier classification (Grades 0-4) was performed on T1-weighted images in upper thigh muscles. For Goutallier Grade 0 muscles, comparison of the mean intramuscular fat fraction between volunteers and CMT patients was performed. RESULTS The interobserver agreements were excellent for all measurements (intraclass correlation coefficients > 0.8). Mean muscle fat fractions were significantly higher in all the measured muscles of CMT patients (P < 0.05) except in the adductor magnus in the upper thigh (P = 0.109). Goutallier Grade 0 muscles of the CMT patients showed a significantly higher mean fat fraction compared with that of the volunteers (P < 0.05). CONCLUSIONS 3D multiple gradient echo Dixon-based MRI is a reproducible and sensitive technique which can reveal a significant difference in the fat fraction of thigh muscle, including comparison between Goutallier Grade 0 muscles, between CMT patients and volunteers.
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Affiliation(s)
- Hyun Su Kim
- Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Byung-Ok Choi
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
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22
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Bastawy EM, Gad Allah NA, El Nasser OA, Tawfik EA. Neuromuscular ultrasound in ulnar neuropathy at the elbow: correlation with electrodiagnostic studies. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2019. [DOI: 10.4103/err.err_21_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Créteur V, Madani A, Sattari A, El Kazzi W, Bianchi S. Ultrasonography of Complications in Surgical Repair of the Distal Biceps Brachii Tendon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:499-512. [PMID: 30027585 DOI: 10.1002/jum.14707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/05/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Viviane Créteur
- Department of Radiology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, Belgium
| | - Afarine Madani
- Department of Radiology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, Belgium
| | - Azadeh Sattari
- Department of Radiology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, Belgium
| | - Wissam El Kazzi
- Department of Orthopedics and Traumatology, Hospital Erasme, Université Libre of Brussels, University Clinic of Brussels, Brussels, Belgium
| | - Stefano Bianchi
- Department of Cabinet Imagerie Médicale SA, Geneva, Switzerland
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Teng A, Liu F, Zhou D, He T, Chevalier Y, Klar RM. Effectiveness of 3-dimensional shoulder ultrasound in the diagnosis of rotator cuff tears: A meta-analysis. Medicine (Baltimore) 2018; 97:e12405. [PMID: 30213014 PMCID: PMC6156036 DOI: 10.1097/md.0000000000012405] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/24/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Numerous quantitatively based studies measuring the accuracy of 3D shoulder ultrasound (US) for the diagnosis of rotator cuff tears remain inconclusive. In order to determine how effective 3D shoulder US is for detecting rotator cuff tears, a meta-analysis was performed systematically. METHODS Six electronic databases, PubMed/Medline, Embase, Cochrane Library, CNKI, VIP data, and Wanfang data, were utilized to retrieve articles praising the diagnostic value of 3D shoulder US for use in detecting rotator cuff tears. After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis, the pooled evaluation indexes including sensitivity, specificity, and diagnostic odds ratio (DOR) as well as the summary receiver operating characteristic curve (SROC) were calculated utilizing Meta-Disc v.1.4. RESULTS Screening determined that out of 4220, 7 studies involving a total of 282 patients were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that the sensitivity and specificity were at 94% and 83%, respectively, with a DOR of 60.06, Q* index of 0.9058 and the area under SROC of 0.9609. Additionally, a satisfactory accuracy of 3D shoulder US was observed in detecting full- and partial-thickness rotator cuff tears. CONCLUSION This meta-analysis suggests that 3D shoulder US is very effective and highly accurate to detect full-thickness rotator cuff tears, but may lack accuracy in the diagnosis of partial tears.
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Affiliation(s)
- Aiping Teng
- Department of Ultrasonography, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Fanxiao Liu
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Tao He
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Roland M. Klar
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
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Abstract
INTRODUCTION Plain radiographs of the shoulder are routinely obtained for patients presenting with atraumatic shoulder pain. The diagnostic utility of these radiographs is debatable. METHODS Patients presenting for the first time to a shoulder clinic with atraumatic shoulder pain received a plain radiographic series. After considering their medical history and physical examination, we made a preliminary diagnosis and formulated a tentative treatment plan. We then reviewed the radiographs and determined whether the addition of these radiographs altered the diagnosis and/or treatment. RESULTS A total of 343 patients met the inclusion criteria. Age >50 years (odds ratio, 3.3; 95% confidence interval, 1.9 to 5.8; P < 0.00001) and weakness in forward elevation (odds ratio, 2.9; 95% confidence interval, 1.6 to 5.4; P = 0.0003) were associated with the presence of radiographic findings. Plain radiographs altered the proposed diagnosis in only 14.9% (51/343) of cases. However, clinical management was changed in only 1.7% of cases. Plain radiographs had no effect on clinical management in 97.4% of patients younger than 50 years. DISCUSSION Plain radiographs rarely alter the diagnosis or affect management in the setting of atraumatic shoulder pain, particularly in patients younger than 50 years. Patients may be exposed to unnecessary radiation, and the healthcare system as a whole may be burdened with the increased cost of this imaging modality. LEVEL OF EVIDENCE Level II (diagnostic).
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Rhee SM, Chung NY, Jeong HJ, Oh JH. Subacromial Local Anesthetics Do Not Interfere With Rotator Cuff Healing After Arthroscopic Repair. Am J Sports Med 2018; 46:1097-1105. [PMID: 29470095 DOI: 10.1177/0363546517753827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Subacromial pain pumps are used for analgesia after arthroscopic rotator cuff surgery. However, there is controversy about myotoxic or tendinotoxic effects of local anesthetics. HYPOTHESIS Ropivacaine administered via a subacromial pain pump would have no adverse effect on rotator cuff tendon healing, fatty degeneration, strength, or functional outcomes after arthroscopic repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study continues follow-up of patients enrolled in the authors' 3 published prospective studies regarding pain control after arthroscopic rotator cuff repair. In total, 118 patients who underwent rotator cuff repair and returned for evaluation at least 1 year postoperatively were divided into 3 groups: patients who received continuous subacromial ropivacaine infusion (group 1, n = 33), those who received patient-controlled subacromial ropivacaine infusion (group 2, n = 30), and those who received other pain control modalities (intravenous patient-controlled analgesia and/or interscalene block; group 3, n = 55). At least 1 year postoperatively, tendon healing and changes in global fatty degeneration index (GFDI) were estimated through computed tomographic arthrography, magnetic resonance imaging, or ultrasonography. Changes in isokinetic muscle performance test (IMPT) were calculated and functional outcomes evaluated, including visual analog scales (VASs) for pain and satisfaction, American Shoulder and Elbow Surgeons score, and Constant score. RESULTS At final follow-up, there were no differences in pain VAS (group 1, 1.1 ± 2.3; group 2, 1.3 ± 1.9; group 3, 0.9 ± 1.7; P = .88), satisfaction VAS (group 1, 8.3 ± 2.4; group 2, 8.7 ± 1.5; group 3, 8.0 ± 2.1; P = .64), American Shoulder and Elbow Surgeons score (group 1, 79.5 ± 10.5; group 2, 81.1 ± 6.9; group 3, 75.7 ± 7.6; P = .34), or Constant score (group 1, 81.8 ± 8.7; group 2, 77.6 ± 9.3; group 3, 78.2 ± 8.4; P = .31). Among the 3 groups, there were no significant differences in healing rates (group 1, 72.7%; group 2, 73.3%; group 3, 70.9%; P = .83) and no differences in changes of GFDI (group 1, 0.45; group 2, 0.62; group 3, 0.41; P = .79), and IMPT (abduction: group 1, 113.0%; group 2, 121.5%; group 3, 120.1%; P = .73; external rotation: group 1, 112.1%; group 2, 121.6%; group 3, 111.7%; P = .71; internal rotation: group 1, 118.2%; group 2, 118.0%; group 3, 118.1%; P = .95). When data were reanalyzed with 2 groups (group 1 + 2 vs group 3), there were no significant differences in functional scores, healing rates, or changes in GFDI and IMPT ( P > .05). CONCLUSION Current data suggest that myotoxicity of subacromial ropivacaine administered via pain pump may be reversible or may not be so severe as to interfere with tendon healing and cause muscle degeneration and thus may not affect postoperative function.
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Affiliation(s)
- Sung-Min Rhee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | | | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Stem Cells for Cartilage Repair: Preclinical Studies and Insights in Translational Animal Models and Outcome Measures. Stem Cells Int 2018. [PMID: 29535784 PMCID: PMC5832141 DOI: 10.1155/2018/9079538] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Due to the restricted intrinsic capacity of resident chondrocytes to regenerate the lost cartilage postinjury, stem cell-based therapies have been proposed as a novel therapeutic approach for cartilage repair. Moreover, stem cell-based therapies using mesenchymal stem cells (MSCs) or induced pluripotent stem cells (iPSCs) have been used successfully in preclinical and clinical settings. Despite these promising reports, the exact mechanisms underlying stem cell-mediated cartilage repair remain uncertain. Stem cells can contribute to cartilage repair via chondrogenic differentiation, via immunomodulation, or by the production of paracrine factors and extracellular vesicles. But before novel cell-based therapies for cartilage repair can be introduced into the clinic, rigorous testing in preclinical animal models is required. Preclinical models used in regenerative cartilage studies include murine, lapine, caprine, ovine, porcine, canine, and equine models, each associated with its specific advantages and limitations. This review presents a summary of recent in vitro data and from in vivo preclinical studies justifying the use of MSCs and iPSCs in cartilage tissue engineering. Moreover, the advantages and disadvantages of utilizing small and large animals will be discussed, while also describing suitable outcome measures for evaluating cartilage repair.
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Erosion of the medial compartment of the canine elbow: occurrence, diagnosis and currently available treatment options. Vet Comp Orthop Traumatol 2017; 28:9-18. [DOI: 10.3415/vcot-13-12-0147] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 10/23/2014] [Indexed: 11/17/2022]
Abstract
SummaryErosion of the medial compartment of the elbow joint refers to full thickness cartilage loss with exposure of the subchondral bone (modified Outerbridge grades 4–5) of the medial part of the humeral condyle (MHC) and the corresponding ulnar contact area. This finding may appear in the absence of an osteochondral fragment or a cartilage flap, or in combination with fragmentation of the medial coronoid process (MCP) or osteochondritis dissecans (OCD) of the MHC. With regard to the prognosis, it is important to diagnose these severe erosions. Imaging of cartilage lesions by means of radiography, ultrasonography, computed tomography or magnetic resonance imaging is challenging in dogs. In contrast, direct arthroscopic inspection provides detailed information about the cartilage.The treatment of these severe erosions is difficult because of the limited regenerative capacity of cartilage and presumed mechanical or physical triggering factors. Several conservative and surgical treatment methods have been proposed to treat elbows with severe cartilage defects. However, due to irreversible loss of cartilage, the prognosis in these cases remains guarded.
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Kvalvaag E, Anvar M, Karlberg AC, Brox JI, Engebretsen KB, Soberg HL, Juel NG, Bautz-Holter E, Sandvik L, Roe C. Shoulder MRI features with clinical correlations in subacromial pain syndrome: a cross-sectional and prognostic study. BMC Musculoskelet Disord 2017; 18:469. [PMID: 29157224 PMCID: PMC5696760 DOI: 10.1186/s12891-017-1827-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 11/10/2017] [Indexed: 12/11/2022] Open
Abstract
Background Previous studies on shoulder patients have suggested that the prevalence of rotator cuff or bursa abnormalities are weakly related to symptoms and that similar findings are often found in asymptomatic persons. In addition, it is largely unknown whether structural changes identified by magnetic resonance imaging (MRI) affect outcome after treatment for shoulder pain. The purpose of this study was therefore to evaluate the presence of structural changes on MRI in patients with subacromial pain syndrome and to determine to what extent these changes are associated with symptoms and predict outcome after treatment (evaluated by the Shoulder Pain and Disability Index (SPADI)). Methods A prospective, observational assessment of a subset of shoulder patients who were included in a randomized study was performed. All participants had an MRI of the shoulder. An MRI total score for findings at the AC joint, subacromial bursa and rotator cuff was calculated. Multiple linear regression analysis was applied to examine the relationship between the MRI total score and the outcome measure at baseline and to examine to what extent the MRI total score was associated with the change in the SPADI score from baseline to the one year follow-up. Results There was a weak, inverse association between the SPADI score at baseline and the MRI total score (β = −3.1, with 95% CI −5.9 to −0.34; p = 0.03), i.e. the SPADI score was higher for patients with a lower MRI total score. There was an association between the change in the SPADI score from baseline to the one year follow-up and the MRI total score (β = 8.1, 95% CI -12.3 to −3.8; p < 0.001), with a poorer outcome for patients with a higher MRI total score. Both tendinosis (p = 0.01) and bursitis (p = 0.04) were associated with a poorer outcome after one year. Conclusions In this study, MRI findings were significantly associated with the change in the SPADI score from baseline and to one year follow-up, with a poorer outcome after treatment for the patients with higher MRI total score, tendinosis and bursitis on MRI. Trial registration Clinicaltrials.gov no NCT01441830. September 28, 2011.
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Affiliation(s)
- Elisabeth Kvalvaag
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Ullevaal, Postboks 4956 Nydalen, 0424, Oslo, Norway. .,University of Oslo, Medical Faculty, Boks 1072 Blindern, 0316, Oslo, Norway.
| | - Masoud Anvar
- Department of Radiology, Oslo University Hospital HF, Ullevaal, Postboks 4956 Nydalen, 0424, Oslo, Norway
| | - Anna Cecilia Karlberg
- Department of Radiology, Oslo University Hospital HF, Ullevaal, Postboks 4956 Nydalen, 0424, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Ullevaal, Postboks 4956 Nydalen, 0424, Oslo, Norway
| | - Kaia Beck Engebretsen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Ullevaal, Postboks 4956 Nydalen, 0424, Oslo, Norway
| | - Helene Lundgaard Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Ullevaal, Postboks 4956 Nydalen, 0424, Oslo, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Ullevaal, Postboks 4956 Nydalen, 0424, Oslo, Norway
| | - Erik Bautz-Holter
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Ullevaal, Postboks 4956 Nydalen, 0424, Oslo, Norway
| | - Leiv Sandvik
- University of Oslo, Faculty of Dentistry, Boks 1072 Blindern, 0316, Oslo, Norway
| | - Cecilie Roe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Ullevaal, Postboks 4956 Nydalen, 0424, Oslo, Norway.,University of Oslo, Medical Faculty, Boks 1072 Blindern, 0316, Oslo, Norway
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Konschake M, Stofferin H, Moriggl B. Ultrasound visualization of an underestimated structure: the bicipital aponeurosis. Surg Radiol Anat 2017; 39:1317-1322. [PMID: 28597034 PMCID: PMC5681602 DOI: 10.1007/s00276-017-1885-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/31/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE We established a detailed sonographic approach to the bicipital aponeurosis (BA), because different pathologies of this, sometimes underestimated, structure are associated with vascular, neural and muscular lesions; emphasizing its further implementation in routine clinical examinations. METHODS The BA of 100 volunteers, in sitting position with the elbow lying on a suitable table, was investigated. Patients were aged between 18 and 28 with no history of distal biceps injury. Examination was performed using an 18-6 MHz linear transducer (LA435; system MyLab25 by Esaote, Genoa, Italy) utilizing the highest frequency, scanned in two planes (longitudinal and transverse view). In each proband, scanning was done with and without isometric contraction of the biceps brachii muscle. RESULTS The BA was characterized by two clearly distinguishable white lines enveloping a hypoechoic band. In all longitudinal images (plane 1), the lacertus fibrosus was clearly seen arising from the biceps muscle belly, the biceps tendon or the myotendinous junction, respectively. In transverse images (plane 2) the BA spanned the brachial artery and the median nerve in all subjects. In almost all probands (97/100), the BA was best distinguishable during isometric contraction of the biceps muscle. CONCLUSION With the described sonographic approach, it should be feasible to detect alterations and unusual ruptures of the BA. Therefore, we suggest additional BA scanning during clinical examinations of several pathologies, not only for BA augmentation procedures in distal biceps tendon tears.
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Affiliation(s)
- M Konschake
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstr. 59, 6020, Innsbruck, Austria.
| | - H Stofferin
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstr. 59, 6020, Innsbruck, Austria
| | - B Moriggl
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstr. 59, 6020, Innsbruck, Austria
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Wali AR, Gabel B, Mitwalli M, Tubbs RS, Brown JM. Clarification of Eponymous Anatomical Terminology: Structures Named After Dr Geoffrey V. Osborne That Compress the Ulnar Nerve at the Elbow. Hand (N Y) 2017; 13:1558944717708030. [PMID: 28503939 PMCID: PMC5987985 DOI: 10.1177/1558944717708030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In 1957, Dr Geoffrey Osborne described a structure between the medial epicondyle and the olecranon that placed excessive pressure on the ulnar nerve. Three terms associated with such structures have emerged: Osborne's band, Osborne's ligament, and Osborne's fascia. As anatomical language moves away from eponymous terminology for descriptive, consistent nomenclature, we find discrepancies in the use of anatomic terms. This review clarifies the definitions of the above 3 terms. METHODS We conducted an extensive electronic search via PubMed and Google Scholar to identify key anatomical and surgical texts that describe ulnar nerve compression at the elbow. We searched the following terms separately and in combination: "Osborne's band," "Osborne's ligament," and "Osborne's fascia." A total of 36 papers were included from 1957 to 2016. RESULTS Osborne's band, Osborne's ligament, and Osborne's fascia were found to inconsistently describe the etiology of ulnar neuritis, referring either to the connective tissue between the 2 heads of the flexor carpi ulnaris muscle as described by Dr Osborne or to the anatomically distinct fibrous tissue between the olecranon process of the ulna and the medial epicondyle of the humerus. CONCLUSIONS The use of eponymous terms to describe ulnar pathology of the elbow remains common, and although these terms allude to the rich history of surgical anatomy, these nonspecific descriptions lead to inconsistencies. As Osborne's band, Osborne's ligament, and Osborne's fascia are not used consistently across the literature, this research demonstrates the need for improved terminology to provide reliable interpretation of these terms among surgeons.
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Hontoir F, Clegg P, Simon V, Kirschvink N, Nisolle JF, Vandeweerd JM. Accuracy of computed tomographic arthrography for assessment of articular cartilage defects in the ovine stifle. Vet Radiol Ultrasound 2017; 58:512-523. [PMID: 28429403 DOI: 10.1111/vru.12504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/30/2016] [Accepted: 01/16/2017] [Indexed: 01/30/2023] Open
Abstract
Articular cartilage defects are one of the features of osteoarthritis in animals and humans. Early detection of cartilage defects is a challenge in clinical veterinary practice and also in translational research studies. An accurate, diagnostic imaging method would be desirable for detecting and following up lesions in specific anatomical regions of the articular surface. The current prospective experimental study aimed to describe the accuracy of computed tomographic arthrography (CTA) for detecting cartilage defects in a common animal model used for osteoarthritis research, the ovine stifle (knee, femoropatellar/femorotibial) joint. Joints in cadaver limbs (n = 42) and in living animals under anesthesia (n = 13) were injected with a contrast medium and imaged using a standardized CT protocol. Gross anatomy and histological assessment of specific anatomic regions were used as a gold standard for the evaluation of sensitivity, specificity, negative predictive value, and positive predictive value for CTA identification of articular cartilage defects in those regions. Pooled estimated sensitivity and specificity were 90.32% and 97.30%, respectively, in cadaver limbs, and 81.82% and 95.24%, respectively, in living animals. Pooled estimated positive predictive value and negative predictive values were 98.25% and 85.71%, respectively, in cadaver limbs, and 81.82% and 95.24%, respectively, in living animals. The delineation of cartilage surface was good for anatomical regions most frequently affected by cartilage defects in the ovine stifle: medial femoral condyle, medial tibial condyle, and patella. This study supported the use of CTA as an imaging technique for detecting and monitoring articular cartilage defects in the ovine stifle joint.
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Affiliation(s)
- Fanny Hontoir
- Department of Veterinary Medicine, Integrated Veterinary Research Unit-Namur Research Institute for Life Science (IVRU-NARILIS), Faculty of Sciences, University of Namur, 5000, Namur, Belgium
| | - Peter Clegg
- Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - Vincent Simon
- Department of Veterinary Medicine, Integrated Veterinary Research Unit-Namur Research Institute for Life Science (IVRU-NARILIS), Faculty of Sciences, University of Namur, 5000, Namur, Belgium
| | - Nathalie Kirschvink
- Department of Veterinary Medicine, Integrated Veterinary Research Unit-Namur Research Institute for Life Science (IVRU-NARILIS), Faculty of Sciences, University of Namur, 5000, Namur, Belgium
| | | | - Jean-Michel Vandeweerd
- Department of Veterinary Medicine, Integrated Veterinary Research Unit-Namur Research Institute for Life Science (IVRU-NARILIS), Faculty of Sciences, University of Namur, 5000, Namur, Belgium
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Chang RF, Lee CC, Lo CM. Computer-Aided Diagnosis of Different Rotator Cuff Lesions Using Shoulder Musculoskeletal Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2315-2322. [PMID: 27381057 DOI: 10.1016/j.ultrasmedbio.2016.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/18/2016] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
The lifetime prevalence of shoulder pain approaches 70%, which is mostly attributable to rotator cuff lesions such as inflammation, calcific tendinitis and tears. On clinical examination, shoulder ultrasound is recommended for the detection of lesions. However, there exists inter-operator variability in diagnostic accuracy because of differences in the experience and expertise of operators. In this study, a computer-aided diagnosis (CAD) system was developed to assist ultrasound operators in diagnosing rotator cuff lesions and to improve the practicality of ultrasound examination. The collected cases included 43 cases of inflammation, 30 cases of calcific tendinitis and 26 tears. For each case, the lesion area and texture features were extracted from the entire lesions and combined in a multinomial logistic regression classifier for lesion classification. The proposed CAD achieved an accuracy of 87.9%. The individual accuracy of this CAD system was 88.4% for inflammation, 83.3% for calcific tendinitis and 92.3% for tears. Cohen's k was 0.798. On the basis of its diagnostic performance, clinical use of this CAD technique has promise.
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Affiliation(s)
- Ruey-Feng Chang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan; Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Chung-Chien Lee
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan; Department of Orthopedic Surgery, New Taipei City Hospital, New Taipei City, Taiwan; Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chung-Ming Lo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
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Lee RKL, Griffith JF, Yuen BTY, Ng AWH, Yeung DKW. Elbow MR arthrography with traction. Br J Radiol 2016; 89:20160378. [PMID: 27327406 DOI: 10.1259/bjr.20160378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the effect of axial traction during MR arthrography (MRA) of the elbow joint on joint space widening, contrast dispersion between opposing cartilage surfaces and cartilage surface visibility. METHODS 11 patients with elbow MRA with and without axial traction were prospectively studied. Two radiologists independently measured the elbow joint space width and semi-quantitatively graded contrast material dispersion between the opposing cartilage surfaces as well as the articular cartilage surface visibility before and after traction. The detection and visibility of articular cartilage defects were also compared before and after traction. Patients were instructed to report on pain or any other symptoms during elbow traction. RESULTS No patient reported discomfort, pain or any other symptoms related to traction on immediate and intermediate-term follow-up. Joint space width increased, more at the radiocapitellar joint space (Δ = 0.63 mm, p = 0.005) than at the ulnotrochlear joint space (Δ = 0.17 mm, p = 0.012), with contrast dispersion into the radiocapitellar joint and cartilage visibility of the radiocapitellar joint space significantly improving after traction (all p < 0.05). All of these parameters also improved at the ulnotrochlear joint, although this did not reach statistical significance. Traction improved the visibility of cartilage defects. CONCLUSION This is the first study to evaluate the effect of traction on MRA of the elbow joint. This technique is safe and technically feasible. Traction MRA improves the cartilage surface visibility and cartilage defect visibility. ADVANCES IN KNOWLEDGE This technique is safe and technically feasible. Traction MRA improves cartilage surface visibility and cartilage defect visibility.
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Affiliation(s)
- Ryan K L Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Brian T Y Yuen
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alex W H Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - David K W Yeung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Abstract
Purpose of review Healthcare costs have exploded in the past 30 years and they are a major concern for governments worldwide. Care management of musculoskeletal disorders and advanced imaging account for a large part of this socioeconomic burden. Recent findings Musculoskeletal ultrasound is now performed primarily by nonradiologists. Both musculoskeletal ultrasound and MRI total utilization rates continue to increase. Despite the existence of evidence-based diagnostic recommendations and the potential cost-savings of using musculoskeletal ultrasound instead of MRI in certain clinical situations, ensuring appropriate use of imaging among health professionals remains difficult for various reasons. Summary In the context of healthcare budgets restraints, use of imaging must be shown scientifically, to improve patient outcomes and be cost-effective. Current evidence recommends musculoskeletal ultrasound as the primary imaging modality in the investigation of rotator cuff disease. Policies aiming at ensuring the application of imaging guidelines among physicians are needed.
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Affiliation(s)
- Nathalie J Bureau
- Department of Radiology, Centre hospitalier de l'Université de Montréal, 1058 St-Denis street, Montreal, QC H2X 3J4 Canada ; Research center, Centre Hospitalier de l'Université de Montréal, Montreal, QC Canada
| | - Daniela Ziegler
- Library, Centre Hospitalier de l'Université de Montréal, Montreal, QC Canada
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Mook WR, Petri M, Greenspoon JA, Horan MP, Dornan GJ, Millett PJ. Clinical and Anatomic Predictors of Outcomes After the Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Combined Glenoid and Humeral Bone Defects. Am J Sports Med 2016; 44:1407-16. [PMID: 27217523 DOI: 10.1177/0363546516634089] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Latarjet procedure for the treatment of recurrent anterior shoulder instability is highly successful, but reasons for failure are often unclear. Measurements of the "glenoid track" have not previously been evaluated as potential predictors of postoperative stability. HYPOTHESIS There are clinical and anatomic characteristics, including the glenoid track, that are predictive of outcomes after the Latarjet procedure. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent the Latarjet procedure for anterior shoulder instability with glenoid bone loss before October 2012 were assessed for eligibility. Patient-reported subjective data that were prospectively collected and retrospectively reviewed included demographic information, patient satisfaction, pain measured on a visual analog scale (VAS), questions regarding instability, Single Assessment Numeric Evaluation (SANE) scores, American Shoulder and Elbow Surgeons (ASES) scores, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, and Short Form-12 Physical Component Summary (SF-12 PCS) scores. Anatomic measurements were performed of the coracoid size (surface area and width), width of the conjoined tendon and subscapularis tendon, estimated glenoid defect surface area, Hill-Sachs interval (HSI), and projected postoperative glenoid track engagement. Failure was defined as the necessity for revision stabilization or continued instability (dislocation or subjective subluxation) at a minimum of 2 years postoperatively. RESULTS A total of 38 shoulders in 38 patients (33 men, 5 women) with a mean age of 26 years (range, 16-43 years) were included. The mean follow-up for 35 of 38 patients (92%) was 3.2 years (range, 2.0-7.9 years); 25 of 38 had undergone prior stabilization surgery, and 6 had workers' compensation claims. All mean subjective outcome scores significantly improved (P < .05), with a high median satisfaction score of 9 of 10. Eight patients had failures because of continued instability. Patients with moderate or higher preoperative pain scores (VAS ≥3) had a negative correlation with postoperative SF-12 PCS scores (ρ = 0.474, P = .022). Patients with outside-and-engaged (Out-E) or "off-track" lesions were 4.0 times more likely to experience postoperative instability (relative risk, 4.0; 95% CI, 1.32-12.2; P = .33). The width of patients' coracoid processes was also directly associated with postoperative stability (P = .014). Moreover, 50% (4/8) of failures demonstrated Out-E glenoid tracks (off-track lesions) versus 16% (4/25) of those without recurrent instability (P = .033). Five of 8 failures were considered as such because of subjective subluxation events, not frank dislocations. Four of the 6 patients with workers' compensation claims had failed results (P = .016). CONCLUSION Workers' compensation claims were associated with continued instability, and patients with higher preoperative pain levels demonstrated lower SF-12 PCS scores postoperatively. The concept of the glenoid track may be predictive of stability after the Latarjet procedure and may be helpful in surgical decision making regarding the treatment of Hill-Sachs lesions at risk for persistent engagement. Although stability and patient satisfaction are high after the Latarjet procedure, subjective complaints of subluxation may be more common than previously estimated.
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Affiliation(s)
- William R Mook
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | - Maximilian Petri
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | | | | | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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Tsikopoulos K, Tsikopoulos I, Simeonidis E, Papathanasiou E, Haidich AB, Anastasopoulos N, Natsis K. The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: A meta-analysis. Phys Ther Sport 2016; 17:87-94. [DOI: 10.1016/j.ptsp.2015.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/14/2015] [Accepted: 06/09/2015] [Indexed: 12/19/2022]
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Hasan NMA, Alam-Eldean MH, Mousa SS. Stiff elbow in adult: MR imaging findings. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lueders DR, Pourcho AM, Sellon JL, Dahm DL, Smith J. Optimal Elbow Angle for Sonographic Visualization of the Ulnar Collateral Ligament. PM R 2015; 7:970-977. [PMID: 25819667 DOI: 10.1016/j.pmrj.2015.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/11/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To formally examine the sonographic appearance of the elbow ulnar collateral ligament (UCL) at 30° versus 70° of elbow flexion in asymptomatic baseball pitchers. DESIGN A prospective, cross-sectional design. SETTING Sports medicine clinic in a tertiary academic medical center. PARTICIPANTS Thirty asymptomatic adolescent baseball pitchers 13-18 years of age (mean 15.8 years), with at least 3 years of continuous pitching experience and no significant history of elbow pain or injury. METHODS Static sonographic images of the bilateral UCLs were obtained at 30° and 70° of elbow flexion by a single experienced examiner. Images were anonymized and randomized into a slide set. Three clinicians with different levels of ultrasound experience reviewed the static 30° and 70° images for each elbow and chose their preferred image based on UCL conspicuity. The clinicians reviewed a re-randomized slide set 1 week later. A different study co-investigator measured UCL cross-sectional area (CSA) on all images using ultrasound machine electronic calipers. MAIN OUTCOME MEASURES Preference for the sonographic conspicuity of the UCL at 30° versus 70° of elbow flexion, and UCL CSA at 30° versus 70° of flexion. RESULTS Each clinician demonstrated a significant preference for UCL images obtained at 70° of flexion when compared to those obtained at 30° (80.3% overall preference for 70°, P < .001). There was no statistically significant effect of clinician experience or arm dominance on image preference. The sonographically determined CSA of the UCLs were on average 1.4 mm(2) greater at 70° than at 30° of flexion (P < .001) when combining dominant and nondominant arms. CONCLUSIONS Static sonographic evaluation of the UCL at 70° of elbow flexion should be integrated into UCL imaging protocols. Furthermore, when performing sonographically guided procedures targeting the UCL, clinicians should consider positioning the elbow at >30° of flexion to optimize UCL conspicuity and CSA.
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Affiliation(s)
- Daniel R Lueders
- Department of Physical Medicine & Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN
| | - Adam M Pourcho
- Swedish Spine, Sports, & Musculoskeletal Medicine, Swedish Medical Group, Seattle, WA
| | - Jacob L Sellon
- Department of Physical Medicine & Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN
| | - Diane L Dahm
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Jay Smith
- Departments of Physical Medicine & Rehabilitation, Radiology and Anatomy, Mayo Clinic College of Medicine, W14 Mayo Building, 200 1st St, SW, Rochester, MN 55905
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De Rycke LM, Gielen IM, Dingemanse W, Kromhout K, van Bree H. Computed Tomographic and Low-Field Magnetic Resonance Arthrography: A Comparison of Techniques For Observing Intra-articular Structures of the Normal Canine Shoulder. Vet Surg 2015; 44:704-12. [DOI: 10.1111/vsu.12321] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lieve M. De Rycke
- Department of Medical Imaging of Domestic Animals and Orthopaedics of Small Animals; Ghent University; Merelbeke Belgium
| | - Ingrid M. Gielen
- Department of Medical Imaging of Domestic Animals and Orthopaedics of Small Animals; Ghent University; Merelbeke Belgium
| | - Walter Dingemanse
- Department of Medical Imaging of Domestic Animals and Orthopaedics of Small Animals; Ghent University; Merelbeke Belgium
| | - Kaatje Kromhout
- Department of Medical Imaging of Domestic Animals and Orthopaedics of Small Animals; Ghent University; Merelbeke Belgium
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Do subacromial ultrasonography findings predict efficacy of intra-bursal injection? Prospective study in 39 patients. Orthop Traumatol Surg Res 2014; 100:S361-4. [PMID: 25454329 DOI: 10.1016/j.otsr.2014.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ultrasonography has become an investigation of choice in the management of shoulder pain. The objective of this study was to determine whether the efficacy of subacromial-subdeltoid bursa injection correlated with the ultrasound findings. MATERIAL AND METHODS We prospectively recruited patients who were seen between November 2012 and November 2013 for subacromial pain and whose rotator cuff was either intact or showed a full-thickness tear less than 1cm in length. A standardised physical examination of the shoulder was followed immediately by static and dynamic ultrasonography, intra-bursal injection of lidocaine, and a repetition of the same physical examination. Recorded ultrasonography features were the appearance of the bursa, shape of the coraco-acromial ligament, and bursal deformation induced by passage under the coraco-acromial ligament during dynamic imaging. A response to the injection was defined as greater than 75% improvements in at least three of the physical examination parameters. RESULTS We included 39 patients with a mean age of 56.7 years. Ultrasonography showed abnormalities of the bursa in 30 patients, including 1 with an intra-bursal effusion, 10 with thickening, and 19 with both. Deformation of the bursa under the coraco-acromial ligament was noted in 26 patients. The proportions of patients with bursal effusion and with bursal thickening were similar in the 20 responders and 19 non-responders. Neither were any significant differences found for coraco-acromial ligament shape or bursal deformation under the ligament. CONCLUSIONS No correlation was found between ultrasonography findings and the efficacy of a local anaesthetic injection into the subacromial bursa. These findings suggest that ultrasound abnormalities may constitute mere physiological changes, in keeping with earlier studies in asymptomatic individuals. Thus, subacromial impingement may be currently overdiagnosed.
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Gendler A, Keuler NS, Schaefer SL. COMPUTED TOMOGRAPHIC ARTHROGRAPHY OF THE NORMAL CANINE ELBOW. Vet Radiol Ultrasound 2014; 56:144-52. [DOI: 10.1111/vru.12195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 05/07/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Andrew Gendler
- WestVet Emergency and Specialty Center; Garden City ID 83714
| | - Nicholas S. Keuler
- Department of Statistics; University of Wisconsin-Madison; Madison WI 53706
| | - Susan L. Schaefer
- Department of Surgical Sciences, School of Veterinary Medicine; University of Wisconsin-Madison; Madison WI 53706
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Women performing repetitive work: is there a difference in the prevalence of shoulder pain and pathology in supermarket cashiers compared to the general female population? Int J Occup Med Environ Health 2014; 27:722-35. [PMID: 25142682 DOI: 10.2478/s13382-014-0292-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 05/16/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Shoulder disorders in the occupational environment have been widely studied, but the quality of research and methodology applied vary. Little has been done to ascertain whether shoulder pain in female repetitive workers is due to any verifiable pathology, or to compare findings with the general population. Therefore, we decided to evaluate the prevalence of self-reported shoulder pain in a group of female supermarket cashiers and in the general female population using a standardized questionnaire. Shoulder pain prevalence was then compared to imaging findings in order to assess specific and non-specific pain prevalence. MATERIAL AND METHODS 196 cashiers and 302 controls filled in a standardized shoulder questionnaire and underwent an imaging examination of a shoulder. RESULTS The prevalence of shoulder pain was significantly higher in the group of cashiers (46.4%) than in the general population (25.5%) (OR = 1.821; 95% CI: 1.426-2.325). Specific pain prevalence was higher among the controls (19.5%) than among the cashiers (13.2%). CONCLUSIONS The more frequent reports of shoulder pain in the supermarket cashiers are not correlated with a higher prevalence of imaging abnormalities. The causes of these more frequent complaints should be probably sought in the psycho-social and occupational environment.
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Anakwenze OA, Iyengar JJ, Ahmad CS. Treatment of Medial Collateral Ligament Injuries of the Elbow with Use of the "Tommy John" Operation: Indications and Results. JBJS Rev 2014; 2:01874474-201406000-00003. [PMID: 27500715 DOI: 10.2106/jbjs.rvw.m.00057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Oke A Anakwenze
- The San Diego Shoulder and Elbow Service at the Garfield Specialty Center, Kaiser Permanente, 5893 Copley Drive, San Diego, CA 92111
| | - Jaicharan J Iyengar
- Alpine Orthopaedic Medical Group, 2488 North California Street, Stockton, CA 95204
| | - Christopher S Ahmad
- Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University, 622 West 168th Street, PH-11, New York, NY 10032
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Gancarczyk SM, Ahmad CS. Medial Collateral Ligament Tears in the Overhead Athlete: Surgical Indications and Reconstruction Technique. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2014.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lohman CM, Smith MP, Dedrick GS, Brismée JM. Validity of musculoskeletal ultrasound for identification of humeroradial joint chondral lesions: a preliminary investigation. J Athl Train 2014; 49:7-14. [PMID: 24377960 DOI: 10.4085/1062-6050-49.1.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Epicondylalgia is a common condition involving pain-generating structures such as tendon, neural, and chondral tissue. The current noninvasive reference standard for identifying chondral lesions is magnetic resonance imaging. Musculoskeletal ultrasound (MUS) may be an inexpensive and effective alternative. OBJECTIVE To determine the intrarater reliability and validity of MUS for identifying humeroradial joint (HRJ) chondral lesions. DESIGN Cross-sectional study. SETTING Clinical anatomy research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-eight embalmed cadavers (14 women, 14 men; mean age = 79.5 ± 8.5 years). MAIN OUTCOME MEASURE(S) An athletic trainer performed MUS evaluation of each anterior and distal-posterior capitellum and radial head to identify chondral lesions. The reference standard was identification of chondral lesions by gross macroscopic examination. Intrarater reliability for reproducing an image was calculated using the intraclass correlation coefficient (3,k) for measurements of the articular surface using 2 images. Intrarater reliability to evaluate a single image was calculated using the Cohen κ for agreement as to the presence of chondral lesions. Validity was calculated using the agreement of MUS images and gross macroscopic examination. RESULTS Intrarater reliability was 0.88 (95% confidence interval = 0.77, 0.94) for reproducing an image and 0.93 (95% confidence interval = 0.80, 1.06) for evaluating a single image. Identifying chondral lesions on all HRJ surfaces with MUS demonstrated sensitivity = 0.93, specificity = 0.28, positive predictive value = 0.58, negative predictive value = 0.77, positive likelihood ratio = 1.28, and negative likelihood ratio = 0.27. CONCLUSIONS Musculoskeletal ultrasound is a reliable and sensitive tool for a clinician with relatively little experience and training to rule out HRJ chondral lesions. These results may assist with clinical assessment and decision making in patients with lateral epicondylalgia to rule out HRJ chondral lesions.
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Affiliation(s)
- Chelsea M Lohman
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock
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The rising incidence of rotator cuff repairs. J Shoulder Elbow Surg 2013; 22:1628-32. [PMID: 23466172 DOI: 10.1016/j.jse.2013.01.006] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/13/2012] [Accepted: 01/07/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff repairs (RCRs) have become increasingly common. Several studies have shown variation in the indications for this procedure. We chose to track the incidence of RCRs in New York State (NYS) from 1995 to 2009. We hypothesized that after the introduction of the Current Procedural Terminology (CPT) code 29827 for arthroscopic RCR, there would be a significant increase in the rate of RCRs performed in NYS. MATERIALS AND METHODS The NYS Department of Health's Statewide Planning and Research Cooperative System (SPARCS) database was queried for reported RCRs between the years 1995 and 2009. Using the International Classification of Diseases, Ninth Revision, Clinical Modification procedural code 83.63 and CPT codes 23410, 23412, 23420, and 29827, we collected and analyzed data on RCR procedures. RESULTS A total of 168,780 RCRs were performed in NYS from 1995 to 2009. In 1995, the population incidence of RCRs was 23.5 per 100,000. In comparison, in 2009, the population incidence was 83.1 per 100,000, an increase of 238% (P < .0001). The percentage of individuals aged between 45 and 65 years undergoing RCR increased from 53.0% to 64.2% during this same period. CONCLUSIONS There has been a notable increase in the volume of RCRs performed in NYS. In addition, after the introduction of CPT code 29827 in 2003, the increase in the incidence of RCRs became significantly more pronounced. LEVEL OF EVIDENCE Level III, cross-sectional design, epidemiology study.
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A comparison of 3-T magnetic resonance imaging and computed tomography arthrography to identify structural cartilage defects of the fetlock joint in the horse. Vet J 2013; 199:115-22. [PMID: 24321368 DOI: 10.1016/j.tvjl.2013.10.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 10/14/2013] [Accepted: 10/18/2013] [Indexed: 11/23/2022]
Abstract
Articular cartilage defects are prevalent in metacarpo/metatarsophalangeal (MCP/MTP) joints of horses. The aim of this study was to determine and compare the sensitivity and specificity of 3-Tesla magnetic resonance imaging (3-T MRI) and computed tomography arthrography (CTA) to identify structural cartilage defects in the equine MCP/MTP joint. Forty distal cadaver limbs were imaged by CTA (after injection of contrast medium) and by 3-T MRI using specific sequences, namely, dual-echo in the steady-state (DESS), and sampling perfection with application-optimised contrast using different flip-angle evolutions (SPACE). Gross anatomy was used as the gold standard to evaluate sensitivity and specificity of both imaging techniques. CTA sensitivity and specificity were 0.82 and 0.96, respectively, and were significantly higher than those of MRI (0.41 and 0.93, respectively) in detecting overall cartilage defects (no defect vs. defect). The intra and inter-rater agreements were 0.96 and 0.92, respectively, and 0.82 and 0.88, respectively, for CT and MRI. The positive predictive value for MRI was low (0.57). CTA was considered a valuable tool for assessing cartilage defects in the MCP/MTP joint due to its short acquisition time, its specificity and sensitivity, and it was also more accurate than MRI. However, MRI permits assessment of soft tissues and subchondral bone and is a useful technique for joint evaluation, although clinicians should be aware of the limitations of this diagnostic technique, including reduced accuracy.
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Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NCA, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev 2013; 2013:CD009020. [PMID: 24065456 PMCID: PMC6464715 DOI: 10.1002/14651858.cd009020.pub2] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Shoulder pain is a very common symptom. Disorders of the rotator cuff tendons due to wear or tear are among the most common causes of shoulder pain and disability. Magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and ultrasound (US) are increasingly being used to assess the presence and size of rotator cuff tears to assist in planning surgical treatment. It is not known whether one imaging method is superior to any of the others. OBJECTIVES To compare the diagnostic test accuracy of MRI, MRA and US for detecting any rotator cuff tears (i.e. partial or full thickness) in people with suspected rotator cuff tears for whom surgery is being considered. SEARCH METHODS We searched the Cochrane Register of Diagnostic Test Accuracy Studies, MEDLINE, EMBASE, and LILACS from inception to February 2011. We also searched trial registers, conference proceedings and reference lists of articles to identify additional studies. No language or publication restrictions were applied. SELECTION CRITERIA We included all prospective diagnostic accuracy studies that assessed MRI, MRA or US against arthroscopy or open surgery as the reference standard, in people suspected of having a partial or full thickness rotator cuff tear. We excluded studies that selected a healthy control group, or participants who had been previously diagnosed with other specific causes of shoulder pain such as osteoarthritis or rheumatoid arthritis. Studies with an excessively long period (a year or longer) between the index and reference tests were also excluded. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data on study characteristics and results of included studies, and performed quality assessment according to QUADAS criteria. Our unit of analysis was the shoulder. For each test, estimates of sensitivity and specificity from each study were plotted in ROC space and forest plots were constructed for visual examination of variation in test accuracy. Meta-analyses were performed using the bivariate model to produce summary estimates of sensitivity and specificity. We were unable to formally investigate potential sources of heterogeneity because of the small number of studies. MAIN RESULTS We included 20 studies of people with suspected rotator cuff tears (1147 shoulders), of which six evaluated MRI and US (252 shoulders), or MRA and US (127 shoulders) in the same people. Many studies had design flaws, with the potential for bias, thus limiting the reliability of their findings. Overall, the methodological quality of the studies was judged to be low or unclear. For each test, we observed considerable heterogeneity in study results, especially between studies that evaluated US for the detection of full thickness tears and studies that evaluated MRA for the detection of partial thickness tears. The criteria for a positive diagnostic test (index tests and reference standard) varied between studies.Meta-analyses were not possible for studies that assessed MRA for detection of any rotator cuff tears or partial thickness tears. We found no statistically significant differences in sensitivity or specificity between MRI and US for detecting any rotator cuff tears (P = 0.13), or for detecting partial thickness tears (P = 1.0). Similarly, for the comparison between MRI, MRA and US for detecting full thickness tears, there was no statistically significant difference in diagnostic performance (P = 0.7). For any rotator cuff tears, the summary sensitivity and specificity were 98% (95% CI 92% to 99%) and 79% (95% CI 68% to 87%) respectively for MRI (6 studies, 347 shoulders), and 91% (95% CI 83% to 95%) and 85% (95% CI 74% to 92%) respectively for US (13 studies, 854 shoulders). For full thickness tears, the summary sensitivity and specificity were 94% (95% CI 85% to 98%) and 93% (95% CI 83% to 97%) respectively for MRI (7 studies, 368 shoulders); 94% (95% CI 80% to 98%) and 92% (95% CI 83% to 97%) respectively for MRA (3 studies, 183 shoulders); and 92% (95% CI 82% to 96%) and 93% (95% CI 81% to 97%) respectively for US (10 studies, 729 shoulders).Because few studies were direct head-to-head comparisons, we could not perform meta-analyses restricted to these studies. The test comparisons for each of the three classifications of the target condition were therefore based on indirect comparisons which may be prone to bias due to confounding. AUTHORS' CONCLUSIONS MRI, MRA and US have good diagnostic accuracy and any of these tests could equally be used for detection of full thickness tears in people with shoulder pain for whom surgery is being considered. The diagnostic performance of MRI and US may be similar for detection of any rotator cuff tears. However, both MRI and US may have poor sensitivity for detecting partial thickness tears, and the sensitivity of US may be much lower than that of MRI. The strength of evidence for all test comparisons is limited because most studies were small, heterogeneous and methodologically flawed, and there were few comparative studies. Well designed studies that directly compare MRI, MRA and US for detection of rotator cuff tears are needed.
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Affiliation(s)
- Mário Lenza
- Hospital Israelita Albert EinsteinOrthopaedic and Trauma DepartmentAv. Albert Einstein, 627/701São PauloSao PauloBrazilCEP 05651‐901
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Yemisi Takwoingi
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamUKB15 2TT
| | - Renea V Johnston
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Nigel CA Hanchard
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughTees ValleyUKTS1 3BA
| | - Flávio Faloppa
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783‐5th FloorSão PauloSão PauloBrazil
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