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Böl M, Leichsenring K, Kohn S, Ehret AE. The anisotropic and region-dependent mechanical response of wrap-around tendons under tensile, compressive and combined multiaxial loads. Acta Biomater 2024:S1742-7061(24)00301-5. [PMID: 38838908 DOI: 10.1016/j.actbio.2024.05.053] [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: 12/01/2023] [Revised: 05/20/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024]
Abstract
The present work reports on the multiaxial region and orientation-dependent mechanical properties of two porcine wrap-around tendons under tensile, compressive and combined loads based on an extensive study with n=175 samples. The results provide a detailed dataset of the anisotropic tensile and compressive longitudinal properties and document a pronounced tension-compression asymmetry. Motivated by the physiological loading conditions of these tendons, which include transversal compression at bony abutments in addition to longitudinal tension, we systematically investigated the change in axial tension when the tendon is compressed transversally along one or both perpendicular directions. The results reveal that the transversal compression can increase axial tension (proximal-distal direction) in both cases to orders of 30%, yet by a larger amount in the first case (transversal compression in anterior-posterior direction), which seems to be more relevant for wrap-around tendons in-vivo. These quantitative measurements are in line with earlier findings on auxetic properties of tendon tissue, but show for the first time the influence of this property on the stress response of the tendon, and may thus reveal an important functional principle within these essential elements of force transmission in the body. STATEMENT OF SIGNIFICANCE: The work reports for the first time on multiaxial region and orientation-dependent mechanical properties of wrap-around tendons under various loads. The results indicate that differences in the mechanical properties exist between zones that are predominantly in a uniaxial tensile state and those that experience complex load states. The observed counterintuitive increase of the axial tension upon lateral compression points at auxetic properties of the tendon tissue which may be pivotal for the function of the tendon as an element of the musculoskeletal system. It suggests that the tendon's performance in transmitting forces is not diminished but enhanced when the action line is deflected by a bony pulley around which the tendon wraps, representing an important functional principle of tendon tissue.
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Affiliation(s)
- Markus Böl
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany.
| | - Kay Leichsenring
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Stephan Kohn
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Alexander E Ehret
- Empa, Swiss Federal Laboratories for Materials Science and Technology, CH-8600 Dübendorf, Switzerland; Institute for Mechanical Systems, ETH Zurich, Zürich, CH-8092, Switzerland
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2
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Rohan, Sundarapandian R, Pillai A. A Rare Case of Hallux Saltans Treated using Ultrasound-guided Intralesional Steroid Injection: A Case Report. J Orthop Case Rep 2024; 14:52-55. [PMID: 38910998 PMCID: PMC11189074 DOI: 10.13107/jocr.2024.v14.i06.4500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/24/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Stenosing tenosynovitis is a condition characterized by the inflammation and constriction of the tendons within a fibro-osseous tunnel. Case Report We present a case of a 38-year-old man who presented with hallux saltans, a rare manifestation of this condition which was successfully treated with intralesional steroid injection. The patient experienced significant relief from pain and improved function following the procedure. Conclusion This case highlights the importance of considering stenosing tenosynovitis as a potential cause of hallux saltans and the efficacy of non-surgical interventions in its management.
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Affiliation(s)
- Rohan
- Department of Trauma and Orthopaedics, Wythenshawe Hospital (Manchester University NHS Foundation Trust) Southmoor Road, Manchester, M23 9LT, United Kingdom
| | - Rajkumar Sundarapandian
- Department of Trauma and Orthopaedics, Wythenshawe Hospital (Manchester University NHS Foundation Trust) Southmoor Road, Manchester, M23 9LT, United Kingdom
| | - Anand Pillai
- Department of Trauma and Orthopaedics, Wythenshawe Hospital (Manchester University NHS Foundation Trust) Southmoor Road, Manchester, M23 9LT, United Kingdom
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3
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Marais JV, Jansen van Rensburg A, Schwellnus MP, Jordaan E, Boer P. Risk factors associated with a history of iliotibial band syndrome (hITBS) in distance runners: a cross-sectional study in 76 654 race entrants - a SAFER XXXIII study. PHYSICIAN SPORTSMED 2024:1-11. [PMID: 38618688 DOI: 10.1080/00913847.2024.2341607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Despite the numerous health benefits of distance running, it is also associated with the development of 'gradual onset running-related injuries' (GORRIs) one of which is Iliotibial Band Syndrome (ITBS). Novel risk factors associated with a history of ITBS (hITBS) have not been described in a large cohort of distance runners. OBJECTIVE To identify risk factors associated with hITBS in distance runners. DESIGN Descriptive cross-sectional study. SETTING 21.1 km and 56 km Two Oceans Marathon races (2012-2015). PARTICIPANTS 106 743 race entrants completed the online pre-race medical screening questionnaire. A total of 1 314 runners confirmed an accurate hITBS diagnosis. METHODS Selected risk factors associated with hITBS explored included: demographics (race distance, sex, age groups), training/running variables, history of existing chronic diseases (including a composite chronic disease score) and history of any allergy. Prevalence (%) and prevalence ratios (PR; 95% CI) are reported (uni- & multiple regression analyzes). RESULTS 1.63% entrants reported hITBS in a 12-month period. There was a higher (p < 0.0001) prevalence of hITBS in the longer race distance entrants (56 km), females, younger entrants, fewer years of recreational running (PR = 1.07; p = 0.0009) and faster average running speed (PR = 1.02; p = 0.0066). When adjusted for race distance, sex, age groups, a higher chronic disease composite score (PR = 2.38 times increased risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001) were independent risk factors associated with hITBS. CONCLUSION Apart from female sex, younger age, fewer years of running and slower running speed, two novel independent risk factors associated with hITBS in distance runners are an increased number of chronic diseases and a history of allergies. Identifying athletes at higher risk for ITBS can guide healthcare professionals in their prevention and rehabilitation efforts.
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Affiliation(s)
- Jandre V Marais
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Martin P Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Emeritus Professor of Sport and Exercise Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
| | - Esme Jordaan
- Biostatistics Research Unit, Medical Research Council, Cape Town, South Africa
- Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
| | - Pieter Boer
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Human Movement Science, Cape Peninsula University of Technology, Wellington, South Africa
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4
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Seror P. Conduction blocks of the median nerve at the wrist in pregnancy and postpartum carpal tunnel syndromes. Muscle Nerve 2023; 68:380-387. [PMID: 37449670 DOI: 10.1002/mus.27929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION/AIMS The aim in this study is to describe the clinical and electrophysiological patterns of pregnancy-related carpal tunnel syndrome (PRCTS) occurring during pregnancy or after delivery. METHODS Clinical, epidemiological, and electrodiagnostic (EDx) data were studied in 130 women with PRCTS onset during pregnancy (n = 80) or after delivery (n = 50). Twenty-six women with PRCTS underwent EDx analysis during pregnancy and 104 after delivery (83 within 6 months of delivery and 21 up to 24 months after pregnancy onset). PRCTS was compared with idiopathic CTS in a control group consisting of 57 age-matched women with 98 cases of CTS. Twenty-four women with PRCTS had clinical and electrophysiological follow-up after corticosteroid injection (CSI) at the wrist. RESULTS Clinical analysis showed a higher rate of bilateral and diurnal/permanent paraesthesia and more severe symptoms in PRCTS compared with idiopathic CTS. EDx analysis showed more severe abnormalities in classical tests and a higher rate of conduction block (CB) in PRCTS. Statistical analysis showed a strong negative correlation between the incidence and importance of CB and the time interval at which PRCTS women underwent EDx examination, between pregnancy onset and 24 months later. CSI resulted in significant clinical and EDx improvement in 22 of 24 PRCTS women, with disappearance of all motor and most sensory CBs. DISCUSSION The EDx pattern of PRCTS is an acute/subacute median nerve lesion at the wrist identified by many CBs. This occurs concurrently with hormonal changes, is responsible for more severe clinical symptoms and EDx data, and it explains why CSI is so effective.
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Affiliation(s)
- Paul Seror
- Laboratoire d'Electroneuromyographie, Paris, France
- Laboratoire d'Electroneuromyographie, Hôpital de l'Est Parisien, Ramsay GS, Aulnay/s Bois, France
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5
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Boer PH, Schwellnus MP, Jordaan E. Chronic diseases and allergies are risk factors predictive of a history of Medial Tibial Stress Syndrome (MTSS) in distance runners: SAFER study XXIV. PHYSICIAN SPORTSMED 2023; 51:166-174. [PMID: 35073241 DOI: 10.1080/00913847.2021.2021597] [Citation(s) in RCA: 1] [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 Medial Tibial Stress Syndrome (MTSS) is one of the most common causes of exercise-associated lower leg pain in distance runners. AIM To identify risk factors predictive of a history of MTSS in distance runners entering the Two Oceans Marathon races (21.1 km and 56 km). DESIGN Cross-sectional study. SETTING 2012 to 2015 Two Oceans Marathon races (21.1 km and 56 km). PARTICIPANTS Consenting race entrants. METHODS 106,743 race entrants completed an online pre-race medical screening questionnaire. 76,654 consenting runners (71.8%) were studied. 558 verified MTSS injuries were reported in the previous 12 months. Risk factors predictive of a history of MTSS were explored using uni - & multivariate analyses: demographics (race distance, sex, and age groups), training/racing history, history of chronic diseases, allergies, and medication use. RESULTS Independent risk factors predictive of a history of MTSS (adjusted for sex, age group, and race distance) were a higher chronic disease composite score (PR = 3.1 times increase risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001). Chronic diseases (PR > 2) predictive of a history of MTSS were: symptoms of CVD (PR = 4.2; p < 0.0001); GIT disease (PR = 3.3; p < 0.0001); kidney/bladder disease (PR = 3.3; p < 0.0001); nervous system/psychiatric disease (PR = 3.2; p < 0.0001); respiratory disease (PR = 2.9; p < 0.0001) a history of CVD (PR = 2.9; p < 0.0001); and risk factors of CVD (PR = 2.4; p < 0.0001) (univariate analysis). Average running speed was associated with higher risk of MTSS. CONCLUSION Novel independent risk factors predictive of a history of MTSS in distance runners (56 km, 21.1 km) were multiple chronic diseases and a history of allergies. Identifying athletes at higher risk for MTSS can guide healthcare professionals in their prevention and rehabilitation efforts.
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Affiliation(s)
- Pieter-Henk Boer
- Department of Human Movement Science, Cape Peninsula University of Technology, Wellington, South Africa
| | - Martin P Schwellnus
- Sport Exercise Medicine and Lifestyle Institute (Semli), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, South Africa
- Emeritus Professor, Faculty of Health Sciences, University of Cape Town Rondebosch South Africa
| | - Esmè Jordaan
- Biostatistics Unit, South African Medical Research Council, South Africa
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6
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Filippini C, Saran S, Chari B. Musculoskeletal steroid injections in pregnancy: a review. Skeletal Radiol 2023:10.1007/s00256-023-04320-9. [PMID: 36917270 DOI: 10.1007/s00256-023-04320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Pregnant women experience a wide range of musculoskeletal pain disorders, which include general ailments occurring during pregnancy, exacerbation of pre-existing conditions, or pregnancy-specific pain/inflammatory conditions. There are significant concerns and knowledge gaps surrounding the safety, dosage, and potential long-term effects of several drugs used during pregnancy. Our article reviews the use of focal steroid injections during pregnancy. A mixture of case studies, meta-analyses, and randomised controlled trials have shown at least there is no adverse side effect to the mother or baby from maternal use of non-systemic injection during pregnancy and a significant improvement in symptoms of pain or paraesthesia can be achieved in patients that do not respond to more conservative measures. As with all patients, the use of steroid injection should be judged on a case-by-case basis to ensure that it is the most appropriate treatment choice. However, being pregnant should not be considered a contraindication to a single dose of non-systemic steroid administration, as these women can achieve significant symptomatic relief that reduces reliance on systemic medication and can significantly improve their quality of life.
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Affiliation(s)
- Claire Filippini
- Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK
| | - Sonal Saran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Basavaraj Chari
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.
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7
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Hall MM, Allen GM, Allison S, Craig J, DeAngelis JP, Delzell PB, Finnoff JT, Frank RM, Gupta A, Hoffman DF, Jacobson JA, Narouze S, Nazarian LN, Onishi K, Ray JW, Sconfienza LM, Smith J, Tagliafico A. Recommended Musculoskeletal and Sports Ultrasound Terminology: A Delphi-Based Consensus Statement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2395-2412. [PMID: 35103998 DOI: 10.1002/jum.15947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The current lack of agreement regarding standardized terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice, and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. METHODS A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus which was defined as group level agreement >80%. RESULTS Content was organized into seven general topics including: 1) General Definitions, 2) Equipment and Transducer Manipulation, 3) Anatomic and Descriptive Terminology, 4) Pathology, 5) Procedural Terminology, 6) Image Labeling, and 7) Documentation. Terms and definitions which reached consensus agreement are presented herein. CONCLUSIONS The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients, and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.
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Affiliation(s)
- Mederic M Hall
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | | | - Sandra Allison
- Department of Radiology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Joseph Craig
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joseph P DeAngelis
- Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Atul Gupta
- Department of Radiology, Rochester General Hospital, Rochester, New York, USA
| | - Douglas F Hoffman
- Departments of Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Jon A Jacobson
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samer Narouze
- Department of Surgery and Anesthesiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Levon N Nazarian
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeremiah W Ray
- Departments of Emergency Medicine and Physical Medicine and Rehabilitation, University of California, Davis, Davis, California, USA
| | - Luca M Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Alberto Tagliafico
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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8
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Makuku R, Werthel JD, Zanjani LO, Nabian MH, Tantuoyir MM. New frontiers of tendon augmentation technology in tissue engineering and regenerative medicine: a concise literature review. J Int Med Res 2022; 50:3000605221117212. [PMID: 35983666 PMCID: PMC9393707 DOI: 10.1177/03000605221117212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Tissue banking programs fail to meet the demand for human organs and tissues for
transplantation into patients with congenital defects, injuries, chronic
diseases, and end-stage organ failure. Tendons and ligaments are among the most
frequently ruptured and/or worn-out body tissues owing to their frequent use,
especially in athletes and the elderly population. Surgical repair has remained
the mainstay management approach, regardless of scarring and adhesion formation
during healing, which then compromises the gliding motion of the joint and
reduces the quality of life for patients. Tissue engineering and regenerative
medicine approaches, such as tendon augmentation, are promising as they may
provide superior outcomes by inducing host-tissue ingrowth and tendon
regeneration during degradation, thereby decreasing failure rates and morbidity.
However, to date, tendon tissue engineering and regeneration research has been
limited and lacks the much-needed human clinical evidence to translate most
laboratory augmentation approaches to therapeutics. This narrative review
summarizes the current treatment options for various tendon pathologies, future
of tendon augmentation, cell therapy, gene therapy, 3D/4D bioprinting,
scaffolding, and cell signals.
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Affiliation(s)
- Rangarirai Makuku
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France
| | - Jean-David Werthel
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Oryadi Zanjani
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France
| | - Mohammad Hossein Nabian
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France
| | - Marcarious M Tantuoyir
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France.,Biomedical Engineering Unit, University of Ghana Medical Centre, Accra, Ghana
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9
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Hall MM, Allen GM, Allison S, Craig J, DeAngelis JP, Delzell PB, Finnoff JT, Frank RM, Gupta A, Hoffman D, Jacobson JA, Narouze S, Nazarian L, Onishi K, Ray JW, Sconfienza LM, Smith J, Tagliafico A. Recommended musculoskeletal and sports ultrasound terminology: a Delphi-based consensus statement. Br J Sports Med 2022; 56:310-319. [PMID: 35110328 DOI: 10.1136/bjsports-2021-105114] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 12/26/2022]
Abstract
The current lack of agreement regarding standardised terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus, which was defined as group level agreement of >80%. Content was organised into seven general topics including: (1) general definitions, (2) equipment and transducer manipulation, (3) anatomical and descriptive terminology, (4) pathology, (5) procedural terminology, (6) image labelling and (7) documentation. Terms and definitions which reached consensus agreement are presented herein. The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.
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Affiliation(s)
- Mederic M Hall
- Orthopedics and Rehabilitation, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | - Joseph Craig
- Radiology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | | | - Jonathan T Finnoff
- Department of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA.,Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel M Frank
- Orthopedic Surgery, University of Colorado, Denver, Colorado, USA
| | - Atul Gupta
- Radiology, Rochester General Hospital, Rochester, New York, USA
| | - Douglas Hoffman
- Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Jon A Jacobson
- Radiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samer Narouze
- Surgery and Anesthesiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Levon Nazarian
- Radiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Kentaro Onishi
- Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeremiah Wayne Ray
- Emergency Medicine, University of California Davis, Davis, California, USA
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Biomedical Sciences for Health, University of Milan, Milano, Italy
| | - Jay Smith
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.,Institute of Advanced Ultrasound Guided Procedures, Sonex Health, Inc, Eagan, Minnesota, USA
| | - Alberto Tagliafico
- Health Sciences, University of Genoa, Genova, Italy.,Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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10
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McCool L, Tonkin B, Guo D, Guo D, Senk A. Ultrasound Measurements of the First Extensor Compartment: Determining the Transection Limits for Ultra-minimally Invasive Release of De Quervain Tenosynovitis. Hand (N Y) 2021; 16:644-649. [PMID: 31540554 PMCID: PMC8461189 DOI: 10.1177/1558944719873435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: De Quervain syndrome is the second most common compressive tendinopathy. Although the length of the first extensor compartment (FEC) has been studied previously, there is no documented reported comparison study of short-axis and long-axis sonographic measurements. The thread technique, or Guo Technique, has been applied to carpal tunnel syndrome, trigger finger, and superficial peroneal compressive neuropathy. To perform this procedure, it is critically important to accurately identify the boundaries for transection. Methods: Twenty-one fresh frozen cadaver upper extremities were examined under ultrasound to determine the length of the extensor retinaculum (ER) over the FEC. Using the sonographic landmarks, the ERs were measured in short axis and long axis over their proximal to distal margins and from the distal margins to the distal edges of the radial styloids. These sonographic measurements were then compared with gross anatomical measurements. Results: The short-axis sonographic measurement of the ER on average was 22.53 mm (95% confidence interval [CI] = 20.79-24.05 mm). The long-axis sonographic measurement of the ER on average was 15.65 mm (95% CI = 13.70-17.78 mm). The average length of the ER by gross anatomical dissection was 22.40 mm (95% CI = 21.15-23.51 mm). Conclusions: The short axis is not significantly different from the gross anatomical measurement; however, the long axis is significantly lower than the gross anatomical measurement. The results support the idea that the short axis is more accurate than the long axis.
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Affiliation(s)
| | - Brionn Tonkin
- Minneapolis Veterans Affairs Medical Center, MN, USA
| | | | | | - Alexander Senk
- Minneapolis Veterans Affairs Medical Center, MN, USA,Alexander Senk, Department of Physical Medicine & Rehabilitation, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.
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11
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Landstrӧm JT. Volar radial wrist–forearm primary and recurrent ganglia of the flexor carpi radialis tendon secondary to pathology isolated to the trapezial fibro-osseous synovial sheath tunnel: A case series report. SAGE Open Med Case Rep 2020; 8:2050313X20977389. [PMID: 35154773 PMCID: PMC8826100 DOI: 10.1177/2050313x20977389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022] Open
Abstract
Surgical treatment of primary and recurrent volar radial wrist–forearm ganglia has yielded higher recurrence rates of ganglia when compared to surgical treatment of dorsal wrist ganglia. The published surgical literature hypothesizes that the variability in etiology of volar radial wrist–forearm ganglia may account for the higher surgical recurrence rates of these ganglia. Currently, the literature states that volar radial wrist–forearm ganglia may be secondary to arthritic intercarpal joints, carpal interosseous ganglia, or by mechanical stress within tendon sheaths, joint capsules, and ligaments. The literature has not reported pathology isolated to the flexor carpi radialis tendon and its tendon sheath at the volar trapezial fibro-osseous synovial sheath tunnel as a cause of volar radial wrist–forearm ganglia. This case series reports findings of pathology isolated to the flexor carpi radialis tendon at the trapezial fibro-osseous synovial sheath tunnel that caused primary and recurrent volar radial wrist–forearm ganglia. The pathology identified in this case series hypothesizes an additional etiologic factor in development of volar radial wrist–forearm ganglia. Surgeon awareness of potential pathology of the flexor carpi radialis tendon at the trapezial fibro-osseous synovial sheath tunnel may reduce recurrence rates of volar radial wrist–forearm ganglia treated by surgical intervention.
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12
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El-Deek AMF, Hassan Dawood EMAEH. Role of ultrasonography in evaluation of tendons abnormalities in hand and fingers. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0110-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bianchi S, Gitto S, Draghi F. Ultrasound Features of Trigger Finger: Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3141-3154. [PMID: 31106876 DOI: 10.1002/jum.15025] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/25/2019] [Accepted: 04/19/2019] [Indexed: 06/09/2023]
Abstract
Trigger finger is a common pathologic condition of the digital pulleys and flexor tendons in the hand. The key clinical finding is a transient blockage of the digit when it is flexed with subsequent painful snapping when it is extended. Imaging is a helpful guide for establishing the severity of the disease, identifying the underlying cause, and deciding the appropriate management. This narrative review aims to recall the anatomic and pathologic bases and describe the ultrasound features of trigger finger, also including common ultrasound findings and complications after therapy. Ultrasound enables an accurate static and dynamic evaluation of trigger finger as well as a comparison with the adjacent normal digits and thus should be considered the radiologic modality of first choice for its diagnosis.
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Affiliation(s)
| | - Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
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14
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Bianchi S, Becciolini M. Ultrasound Features of Ankle Retinacula: Normal Appearance and Pathologic Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3321-3334. [PMID: 31119773 DOI: 10.1002/jum.15026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/28/2019] [Indexed: 06/09/2023]
Abstract
Disorders of retinacula are frequent in acute and repetitive microtrauma of the ankle. Ultrasound (US), thanks to its spatial resolution and dynamic capabilities, is routinely used in the evaluation of the posttraumatic ankle for accurate delineation of ligaments and tendons. In addition, US can provide a depiction of normal retinacula and a detailed assessment of their pathologic changes. An accurate US assessment of ankle retinacula is helpful in choosing the proper treatment. In this pictorial essay, we briefly review the normal anatomy of ankle retinacula, describe their normal US appearance, and present a wide range of US pathologic abnormalities.
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Sugiura S, Matsuura Y, Suzuki T, Nishikawa S, Kuniyoshi K, Ohtori S. Histological assessment of a septum in the first dorsal compartment: a fresh cadaver study. J Hand Surg Eur Vol 2019; 44:805-809. [PMID: 30917737 DOI: 10.1177/1753193419838204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Resistance of de Quervain's disease to conservative treatment has been associated with an intertendinous septum in the first compartment; little is known about the histological features of such a septum. This study aimed to examine the intertendinous septum histologically and note its variations. After dissecting the first extensor compartment of 24 hands from 12 fresh frozen cadavers, the presence of any intertendinous septa was determined. The length of the extensor retinaculum and intertendinous septum was measured; histological findings of the first compartment with or without septa were studied and compared with those of the third/fourth compartment. Intertendinous septa were observed in 12 of 24 wrists. Histological assessment of the intertendinous septum revealed tissue similar in composition to the retinaculum observed between the third and fourth compartments.
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Affiliation(s)
- Shiro Sugiura
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan.,Nishikawa Orthopaedic Clinic, Chiba, Japan
| | - Yusuke Matsuura
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Chiba University, Chiba, Japan
| | | | - Kazuki Kuniyoshi
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
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Abstract
BACKGROUND: Stenosing peroneal tenosynovitis (SPT) is an uncommon entity that is equally difficult to diagnose. We evaluated our outcomes with a local anesthetic diagnostic injection followed by surgical release of the sheath and calcaneal exostectomy. METHODS: Eleven patients diagnosed with SPT underwent surgery between 2006 and 2014. Upon initial presentation, all patients reported a persistent history of pain along the ankle. Ultrasound-guided injections of anesthetics were administered into the peroneal tendon sheath to confirm the diagnosis. In patients with a confirmed diagnosis of SPT, we proceeded with surgical intervention with release of the peroneal tendon sheath and debridement of the calcaneal exostosis. Retrospective chart review was performed, and functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS). FAOS results were collected pre- and postoperatively and were successfully obtained at 1 year or greater. RESULTS: Of these patients, all showed significant improvements ( P < .05) in 4 of 5 categories of the FAOS (pain, daily activities, sports activities, and quality of life). CONCLUSION: We present a case series in which the peroneal tendon sheath was diagnostically injected with anesthetic to confirm a diagnosis of SPT. In each of these cases, symptomatic improvement was obtained following the injection. With the fact that many of these patients had advanced imaging denoting no significant tears, we believe that this diagnostic injection is paramount for the success of surgical outcome. LEVEL OF EVIDENCE: Level IV, retrospective case series.
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Affiliation(s)
- Geoffrey I Watson
- 1 Department of Orthopedic Surgery, Bone and Joint Institute of Tennessee, Franklin, TN, USA
| | | | - David S Levine
- 3 Department of Orthopedic Surgery, Foot and Ankle, Hospital for Special Surgery, New York, NY, USA
| | - Mark C Drakos
- 3 Department of Orthopedic Surgery, Foot and Ankle, Hospital for Special Surgery, New York, NY, USA
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17
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Lui TH, Lau AYC. Endoscopic Ganglionectomy and Release of the Sixth Extensor Compartment. Arthrosc Tech 2019; 8:e111-e115. [PMID: 30899661 PMCID: PMC6410419 DOI: 10.1016/j.eats.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023] Open
Abstract
Stenosing tenosynovitis of the extensor carpi ulnaris is one of the causes of dorsoulnar wrist pain. Conservative treatment is usually effective to alleviate the pain. Surgical release of the retinaculum of the sixth extensor compartment is indicated if conservative treatment cannot alleviate the pain. The purpose of this Technical Note is to describe the technical details of endoscopic release of the sixth extensor compartment via a 2-portal approach. Endoscopic resection of a ganglion over the sixth compartment can also be performed via the same approach.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(H.K.), F.R.C.S.(Edin.), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Rd, Sheung Shui, NT, Hong Kong SAR, China.
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18
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Gitto S, Draghi AG, Draghi F. Sonography of Non-neoplastic Disorders of the Hand and Wrist Tendons. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:51-68. [PMID: 28708327 DOI: 10.1002/jum.14313] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 06/07/2023]
Abstract
Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis.
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Affiliation(s)
- Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Anna Guja Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
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Allam AES, Al-Ashkar DS, Negm AA, Eltawab BA, Wu WT, Chang KV. Ultrasound-guided methotrexate injection for De Quervain disease of the wrist: what lies beyond the horizon? J Pain Res 2017; 10:2299-2302. [PMID: 29026332 PMCID: PMC5627726 DOI: 10.2147/jpr.s143256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
De Quervain disease (DQVD) is one of the most common causes of lateral wrist pain and can lead to significant disability. The current case involves a right-handed, middle-aged, female patient with severe lateral wrist pain due to DQVD. Her pain was not responsive to oral non-steroidal anti-inflammatory drugs, rehabilitation, and repeated corticosteroid injections. Because she refused surgical intervention, we performed ultrasound-guided methotrexate injections (four times). After the injections, dramatic pain relief, functional improvement, and reduction of the thickness of the retinaculum and tendons in the first dorsal extensor compartment of the wrist were noted. This case report highlights the potential usefulness of ultrasound-guided methotrexate injection for recalcitrant DQVD of the wrist.
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Affiliation(s)
- Abdallah El-Sayed Allam
- Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Doaa Shawky Al-Ashkar
- Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed A Negm
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
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Abstract
OBJECTIVE This article reviews the normal anatomy of the extensor tendons of the wrist as well as the clinical presentation and MRI appearances of common tendon abnormalities, such as tears, tenosynovitis, intersection syndromes, and associated or predisposing osseous findings. Treatment options are also discussed. CONCLUSION We review the anatomy and normal MRI appearance of the clinically important dorsal extensor tendons of the wrist, in addition to the spectrum of abnormalities associated with these tendons.
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21
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Sugiura S, Matsuura Y, Kuniyoshi K, Nishikawa S, Toyooka T, Mori C, Suzuki T. Anatomic study of the first extensor compartment and the relationship between the extensor tendon width and its distal insertion. Surg Radiol Anat 2017; 39:1223-1226. [PMID: 28484860 DOI: 10.1007/s00276-017-1867-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The extensor pollicis brevis (EPB) tendon normally inserts into the base of the proximal phalanx of the thumb. However, a distal insertion of the EPB tendon into the thumb interphalangeal joint has been reported in refractory cases of de Quervain's disease. We hypothesized that the EPB tendon is wider beyond the thumb metacarpophalangeal joint in patients with extended EPB. This study aimed to evaluate the relationship between the extensor tendon width and the point of distal insertion of the EPB tendon. MATERIALS AND METHODS In 45 hands from 18 male and 27 female adult cadavers, the first extensor compartment was dissected and the existence of the intertendinous septum was assessed. The extensor tendon width was measured at the midpoint of the proximal phalanx, and relationships between extended EPB tendon, existence rate of the intertendinous septum, sex, and extensor tendon width were examined. RESULTS Of 45 cases, intertendinous septum and extended EPB tendon were observed in 37 (82.2%) and 23 (51.1%), respectively. There was no significant difference between the existence rates of both these factors and sex. The mean extensor tendon width in the extended EPB group was significantly greater than in the normal EPB group. The cut-off value of extensor tendon width in the extended EPB group was 7.12 mm. CONCLUSIONS The extensor tendon width was wider in the extended EPB group than in the normal EPB group, suggesting that the differences in the EPB tendon width can be used to identify various anatomical variations in extended EPB.
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Affiliation(s)
- Shiro Sugiura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan.,Nishikawa Orthopaedic Clinic, Chiba, Japan
| | - Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Kazuki Kuniyoshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | | | | | - Chisato Mori
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
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22
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Cockenpot E, Lefebvre G, Demondion X, Chantelot C, Cotten A. Imaging of Sports-related Hand and Wrist Injuries: Sports Imaging Series. Radiology 2016; 279:674-92. [PMID: 27183404 DOI: 10.1148/radiol.2016150995] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hand and wrist injuries are common occurrences in amateur and professional sports and many of them are sport-specific. These can be divided into two categories: traumatic injuries and overuse injuries. The aim of this article is to review the most common hand and wrist sports-related lesions. Acute wrist injuries are predominantly bone fractures, such as those of the scaphoid, hamate hook, and ulnar styloid. Ligament lesions are more challenging for radiologists and may lead to carpal instability if undiagnosed. Overuse wrist injuries are mainly represented by tendinous disorders, with De Quervain syndrome and extensor carpi ulnaris tendon disorders being the most common among them; however, there are other possible disorders such as impaction syndromes, stress fractures, and neurovascular lesions. Finally, finger lesions, including closed-tendon injuries (mallet and boutonniere injuries, jersey finger, and boxer's knuckle), flexor pulley injuries, and skier's thumb, should also be detected. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Eric Cockenpot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Guillaume Lefebvre
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Xavier Demondion
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Christophe Chantelot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Anne Cotten
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
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Ultrasonography-guided de Quervain Injection: Accuracy and Anatomic Considerations in a Cadaver Model. J Am Acad Orthop Surg 2016; 24:399-404. [PMID: 27128027 DOI: 10.5435/jaaos-d-15-00753] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Confirmation of pertinent anatomy and accurate needle placement for de Quervain injection may improve outcomes and limit complications. We evaluated the accuracy of the first extensor compartment in regard to the following: (1) anatomic assessment, (2) needle placement without imaging guidance, and (3) ultrasonography-guided injection with priority for the extensor pollicis brevis subcompartment. METHODS Anatomic assessment and ultrasonography-guided first extensor compartment injection was completed in 50 cadaver specimens. Initial needle placement was done without the guidance of ultrasonography; its final position was evaluated with ultrasonography. Then, using ultrasonography, 1 mL of India ink was injected into the extensor pollicis brevis compartment. Open evaluation confirmed pertinent anatomy and injection accuracy. RESULTS A subcompartment of the first extensor compartment was identified in 27 of 50 wrists; 18 of 27 compartments were complete and 9 of 27 were incomplete, with ultrasonographic evaluation having an accuracy rate of 94%. Accurate needle placement occurred in 26 of 50 wrists (52%) when ultrasonography was not used, but only 2 of 27 needles (7%) were located within the extensor pollicis brevis subcompartment. Ultrasonography-guided injection was 100% accurate (50 out of 50) and extensor pollicis brevis injection was 96% accurate (26 of 27) when two compartments were present. Minimal extravasation was identified in 6 of 50 wrists (12%). DISCUSSION Ultrasonography-guided de Quervain injection improves injection accuracy through the visualization of compartmental anatomy and needle placement and may improve clinical outcomes by minimizing complications associated with extra-compartmental injection.
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De Keating-Hart E, Touchais S, Kerjean Y, Ardouin L, Le Goff B. Presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound-guided steroid injection in de Quervain's syndrome. J Hand Surg Eur Vol 2016; 41:212-9. [PMID: 26497593 DOI: 10.1177/1753193415611414] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/14/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study was to find clinical or ultrasound characteristics that might predict the failure of conservative treatment in de Quervain's syndrome. A total of 42 ultrasound-guided injections have been performed in 41 patients after clinical and ultrasound examination. Patients were immobilized for 3 weeks with a spica splint cast, and clinically evaluated at 3 and 6 weeks and by phone call at the end of the study. Ultrasound showed a septum between the tendons of the first comportment in 34% of the wrists. At last follow-up (mean 15.6 months after the injection) ten patients (24%) had undergone surgery. When comparing ultrasound and clinical characteristics of the operated and non-operated wrists, we found that patients with a high baseline visual analogue scale, with all positive clinical tests and with a persistent intracompartmental septum, had a significantly higher risk of failure following conservative treatment. LEVEL OF EVIDENCE III.
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Affiliation(s)
- E De Keating-Hart
- Orthopaedic Surgery Department, University Hospital Hôtel Dieu, Nantes, France
| | - S Touchais
- Orthopaedic Surgery Department, University Hospital Hôtel Dieu, Nantes, France
| | - Y Kerjean
- Hand Surgery Unit, Jeanne d'Arc, Nantes, France
| | - L Ardouin
- Hand Surgery Unit, Jeanne d'Arc, Nantes, France
| | - B Le Goff
- Rheumatology Department, University Hospital Hôtel Dieu, Nantes, France
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26
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Tanaka Y, Gotani H, Yano K, Sasaki K, Miyashita M, Hamada Y. Sonographic evaluation of effects of the volar plate on trigger finger. J Orthop Sci 2015. [PMID: 26197960 DOI: 10.1007/s00776-015-0752-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We evaluated trigger fingers ultrasonographically and clarified differences between fingers with and without continuous locking or snapping symptoms according to the thicknesses of the A1 pulley, flexor tendon and volar plate. METHODS We evaluated 26 trigger fingers, divided into two groups: Group 1, 14 fingers with locking or snapping; and Group 2, 12 fingers without such symptoms. We also evaluated 26 contralateral fingers as controls (Control 1 and 2 groups). We compared each group to the respective control group according to thickness of the A1 pulley and volar plate, and cross-sectional area of the flexor tendon. In addition, nine fingers with locking or snapping and treated using corticosteroid injection were evaluated according to symptoms and sonographic findings 3-4 weeks after treatment. RESULTS Thickness of the A1 pulley and cross-sectional area of the flexor tendon were greater in both Groups 1 and 2 than in controls. Thickness of the volar plate was greater in Group 1 than in Control 1, although no significant difference was seen between Group 2 and Control 2. In Group 1, eight of the nine fingers showed an alleviation of locking or snapping symptoms with corticosteroid injection, and sonographic findings showed that thickness of the volar plate was significantly decreased with corticosteroid injection, in addition to reduced thickness of the A1 pulley. CONCLUSION In addition to thickening of the A1 pulley, thickening of the volar plate may represent an important contributor to continuous snapping or locking symptoms.
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Affiliation(s)
- Yoshitaka Tanaka
- Department of Orthopaedic Hand and Microsurgery Center, Osaka Ekisaikai Hospital, 2-1-10, Honden, Nishi-ku, Osaka, Osaka, 550-0022, Japan.
| | - Hiroyuki Gotani
- Department of Orthopaedic Hand and Microsurgery Center, Osaka Ekisaikai Hospital, 2-1-10, Honden, Nishi-ku, Osaka, Osaka, 550-0022, Japan
| | - Koichi Yano
- Department of Orthopaedic Hand and Microsurgery Center, Seikeikai Hospital, 4-2-10 Kouryounaka-machi, Sakai-ku, Sakai, Osaka, 590-0024, Japan
| | - Kosuke Sasaki
- Department of Orthopaedic Hand and Microsurgery Center, Osaka Ekisaikai Hospital, 2-1-10, Honden, Nishi-ku, Osaka, Osaka, 550-0022, Japan
| | - Masahiro Miyashita
- Department of Orthopaedic Hand and Microsurgery Center, Osaka Ekisaikai Hospital, 2-1-10, Honden, Nishi-ku, Osaka, Osaka, 550-0022, Japan
| | - Yoshitaka Hamada
- Department of Orthopaedic Hand and Microsurgery Center, Osaka Ekisaikai Hospital, 2-1-10, Honden, Nishi-ku, Osaka, Osaka, 550-0022, Japan
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Panwar J, Thomas BP, Sreekanth R. Sonographic findings of extensor digiti minimi triggering caused by thickened extensor retinaculum. J Ultrasound 2015; 18:79-82. [PMID: 25767644 DOI: 10.1007/s40477-014-0140-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 10/15/2014] [Indexed: 11/28/2022] Open
Abstract
Trigger finger is a common well recognized condition and involves the flexor tendons at the A1 pulley in the palm. Triggering of the extensor tendons is a very rare clinical entity. We report a rare case of extensor triggering of little finger caused by constriction of the extensor digiti minimi by a markedly thickened extensor retinaculum (ER) at the wrist, well delineated dynamically by real-time high-resolution ultrasound. The patient underwent release of thickened ER and was asymptomatic immediately.
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Affiliation(s)
- Jyoti Panwar
- Department of Radiology, Christian Medical College and Hospital, Vellore, 632004 Tamil Nadu India
| | - Binu P Thomas
- Department of Hand and Leprosy Reconstructive Surgery (HLRS), Christian Medical College and Hospital, Vellore, Tamil Nadu India
| | - Raveendran Sreekanth
- Department of Hand and Leprosy Reconstructive Surgery (HLRS), Christian Medical College and Hospital, Vellore, Tamil Nadu India
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28
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Drug-induced tendinopathy: From physiology to clinical applications. Joint Bone Spine 2014; 81:485-92. [DOI: 10.1016/j.jbspin.2014.03.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/22/2022]
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Uchihashi K, Tsuruta T, Mine H, Aoki S, Nishijima-Matsunobu A, Yamamoto M, Kuraoka A, Toda S. Histopathology of tenosynovium in trigger fingers. Pathol Int 2014; 64:276-82. [DOI: 10.1111/pin.12168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 04/14/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Kazuyoshi Uchihashi
- Department of Pathology and Microbiology; Faculty of Medicine, Saga University; Saga Japan
| | | | | | - Shigehisa Aoki
- Department of Pathology and Microbiology; Faculty of Medicine, Saga University; Saga Japan
| | | | - Mihoko Yamamoto
- Department of Pathology and Microbiology; Faculty of Medicine, Saga University; Saga Japan
| | - Akio Kuraoka
- Department of Anatomy and Physiology; Faculty of Medicine, Saga University; Saga Japan
| | - Shuji Toda
- Department of Pathology and Microbiology; Faculty of Medicine, Saga University; Saga Japan
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30
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Molini L, Bianchi S. US in peroneal tendon tear. J Ultrasound 2014; 17:125-34. [PMID: 24883136 DOI: 10.1007/s40477-014-0072-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/08/2013] [Indexed: 02/06/2023] Open
Abstract
Peroneal tendon injuries are common also due to the recent increase in sports participants involved in amateur activities. Clinical evaluation generally provides a diagnosis, but diagnostic imaging is often required to confirm a clinical suspicion and make correct management decisions. Ultrasound (US) imaging is the method of choice in the study of peroneal tendon injuries due to the high resolution of the images and the possibility of performing dynamic studies. US is furthermore non-invasive and inexpensive and provides the possibility of performing US-guided steroid infiltration of the tendon sheath or the surrounding tissues. The present paper will address the normal anatomy of the peroneal tendons and related structures, US imaging techniques and the various conditions and injuries which may affect this anatomic region. Also more expensive imaging techniques, such as computed tomography and magnetic resonance imaging, will be mentioned as well as their indications; however, they are required only in rare cases in which diagnosis remains uncertain or for pre-operative assessment.
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Affiliation(s)
- Lucio Molini
- Department of Radiodiagnostics, Galliera Hospital, Mura delle Cappuccine 14, Genoa, Italy
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