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Santos HT, Silva-Albuquerque VM, Salvatori R, Melo EV, Oliveira-Santos AA, Oliveira CRP, Campos VC, Barros-Oliveira CS, Menezes NV, Santos EG, Pereira FA, Santana NO, Batista VO, Villar-Gouy KR, Oliveira-Neto LA, Aguiar-Oliveira MH. Function and form of the shoulder in congenital and untreated growth hormone deficiency. Endocrine 2023; 81:547-554. [PMID: 37198380 DOI: 10.1007/s12020-023-03391-x] [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: 01/10/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVES The shoulder is the most mobile joint in the entire human body. During arm elevation, it requires the integrity of a set of muscles, bones, and tendons. Individuals with short stature often need to raise their arms above the shoulder girdle and may have functional restriction or shoulder injuries. The impact of isolated GH deficiency (IGHD) on joints remains not well defined. The purpose of this work is to evaluate the function and structure of the shoulder in short-statured adult individuals with untreated IGHD due to the same homozygous mutation in the GHRH receptor gene. METHODS A cross-sectional study (evidence 3) was carried out in 20 GH-naive IGHD subjects and 20 age-matched controls. They completed the disabilities of the arm, shoulder, and hand (DASH) questionnaire and shoulder ultrasound (US). Thickness of the anterior, medial, and posterior portions of the supraspinatus tendon and of subacromial space was measured, and the number of individuals with tendinosis or tearing of the supraspinatus tendon was registered. RESULTS DASH score was similar between IGHD and controls, but IGHD subjects complained less of symptoms (p = 0.002). The number of individual with tears was higher in the controls (p = 0.02). As expected, the absolute US measurements were lower in IGHD, but the magnitude of the reduction was most pronounced in the thickness of the anterior portion of the supraspinatus tendon. CONCLUSION Adults with lifetime IGHD do not have functional shoulder restrictions, complain less of problems in performing upper extremity activities, and have fewer tendinous injuries than controls.
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Affiliation(s)
- Hertz T Santos
- Division of Orthopedics, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Victor M Silva-Albuquerque
- Ultrasound Division, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine Baltimore, Baltimore, Maryland, 21287, USA
| | - Enaldo V Melo
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Alécia A Oliveira-Santos
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Carla R P Oliveira
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Viviane C Campos
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Cynthia S Barros-Oliveira
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Nelmo V Menezes
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Elenilde G Santos
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Francisco A Pereira
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Nathalie O Santana
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Vanderlan O Batista
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Keila R Villar-Gouy
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil
| | - Luiz A Oliveira-Neto
- Postgraduate Program in Dentistry, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Manuel H Aguiar-Oliveira
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, 49060-100, Aracaju, Sergipe, Brazil.
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Pirri C, Pirri N, Stecco C, Macchi V, Porzionato A, De Caro R, Özçakar L. Hearing and Seeing Nerve/Tendon Snapping: A Systematic Review on Dynamic Ultrasound Examination. SENSORS (BASEL, SWITZERLAND) 2023; 23:6732. [PMID: 37571516 PMCID: PMC10422582 DOI: 10.3390/s23156732] [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: 06/25/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
Nerve/tendon snapping can occur due to their sudden displacement during the movement of an adjacent joint, and the clinical condition can really be painful. It can actually be challenging to determine the specific anatomic structure causing the snapping in various body regions. In this sense, ultrasound examination, with all its advantages (especially providing dynamic imaging), appears to be quite promising. To date, there are no comprehensive reviews reporting on the use of dynamic ultrasound examination in the diagnosis of nerve/tendon snapping. Accordingly, this article aims to provide a substantial discussion as to how US examination would contribute to 'seeing' and 'hearing' these pathologies' different maneuvers/movements.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Nina Pirri
- Department of Medicine—DIMED, School of Radiology, Radiology Institute, University of Padua, 35122 Padova, Italy;
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey;
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Rajpar I, Tomlinson RE. Function of peripheral nerves in the development and healing of tendon and bone. Semin Cell Dev Biol 2022; 123:48-56. [PMID: 33994302 PMCID: PMC8589913 DOI: 10.1016/j.semcdb.2021.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 01/03/2023]
Abstract
Although the functions of the peripheral nervous system in whole body homeostasis and sensation have been understood for many years, recent investigation has uncovered new roles for innervation in the musculoskeletal system. This review centers on advances regarding the function of nerves in the development and repair of two connected tissues: tendon and bone. Innervation in healthy tendons is generally confined to the tendon sheaths, and tendon-bone attachment units are typically aneural. In contrast to tendon, bone is an innervated and vascularized structure. Historically, the function of abundant peripheral nerves in bone has been limited to pain and some non-painful sensory perception in disease and injury. Indeed, much of our understanding of peripheral nerves in tendons, bones, and entheses is limited to the source and type of innervation in healthy and injured tissues. However, more recent studies have made important observations regarding the appearance, type, and innervation patterns of nerves during embryonic and postnatal development and in response to injury, which suggest a more expansive role for peripheral nerves in the formation of musculoskeletal tissues. Indeed, tendons and bones develop in a close spatiotemporal relationship in the embryonic mesoderm. Models of limb denervation have shed light on the importance of sensory innervation in bone and to a lesser extent, tendon development, and more recent work has unraveled key nerve signaling pathways. Furthermore, loss of sensory innervation also impairs healing of bone fractures and may contribute to chronic tendinopathy. However, more study is required to translate our knowledge of peripheral nerves to therapeutic strategies to combat bone and tendon diseases.
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Affiliation(s)
- Ibtesam Rajpar
- Department of Orthopedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan E Tomlinson
- Department of Orthopedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
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4
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Strakowski JA, Chiou-Tan FY. Musculoskeletal ultrasound for traumatic and torsional alterations. Muscle Nerve 2020; 62:654-663. [PMID: 32696511 DOI: 10.1002/mus.27025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/10/2020] [Accepted: 07/19/2020] [Indexed: 12/20/2022]
Abstract
The sonographic appearance of soft tissue can be altered by trauma and positional change with torsional stress. This creates challenges for ultrasonographic interpretation, because most descriptive literature and standard instructional references are displayed in anatomically neutral or other conventional positions. Knowledge of anatomic alteration and changes in sonographic appearance with torsional stress is essential for accurately assessing soft tissue abnormalities in conditions of spasticity, traumatic and post-surgical changes, and other conditions that distort musculoskeletal relationships. A systematic scanning approach to these alterations is needed for accurate diagnostic interpretation, optimizing electrode placement for electrodiagnostic techniques, effective needle placement for therapeutic ultrasound-guided procedures, and even planning for restorative surgery. This review describes expected positional changes of normal structures with torsional alteration, as well as sonographic recognition of scars, burns, hematomas, fat layer fracture, Morel-Lavallee lesions, abscesses, foreign bodies, myotendinous lesions, muscle injury and denervation, and traumatic peripheral nerve injury.
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Affiliation(s)
- Jeffry A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Faye Y Chiou-Tan
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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Dickson DM, Fawole HO, Hendry GJ, Smith SL. Intermachine Variation of Ultrasound Strain Elastographic Measures of the Quadriceps and Patellar Tendons in Healthy Participants: Implications for Clinical Practice. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1343-1353. [PMID: 31981428 DOI: 10.1002/jum.15228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate intermachine variation and compare intraoperator and interoperator agreement and repeatability characteristics of 2 ultrasound (US) systems for measurements of quadriceps and patellar tendons by strain elastography (SE). METHODS Forty tendons from 20 healthy participants were investigated by operators with different experience (operator 1, 12 years of US experience and >50 SE examinations; operator 2, no US experience and 1 day of SE training). Repeated measures were performed on GE Healthcare (Waukesha, WI) and Esaote (Genoa, Italy) US systems. The percentage of agreement, Cohen κ, intraclass correlation coefficient, and correlation tests assessed agreement, repeatability, and associations of SE measures. A paired t test and Wilcoxon signed rank test assessed differences in SE measures. RESULTS The study participants included 5 male and 15 female volunteers (mean [range] age, 29.3 [21-39] years). Better agreement and repeatability characteristics were observed for the patellar compared to the quadriceps tendon and the color score (CS) method over the elasticity ratio (ER). Intraoperator agreement was better for the experienced operator. Intraoperator repeatability was achieved in 55% of ER (intraclass correlation coefficient, 0.40-0.91; P < .05) and 77% to 85% (κ = -0.25-1) of CS measures. Interoperator repeatability was achieved in 35% (t/z, -2.93-7.94; P < .001-.048) of all ER measures. No significant differences in proximal (z, -0.13- -0.78) and distal patellar (z, -1.52-2.26; P > .5) patellar ER measures were observed. Seventy-four percent to 75% mean agreement (κ = 0-0.5) for CS measures comparable across both US systems was observed. Intermachine ER associations were poor (r = -0.39-0.13; P > .05), whereas greater than 70% agreement (κ = -0.87-0.53) for the CS was achieved. CONCLUSIONS The reproducibility of knee tendon SE measurements is influenced by the operator experience, US system, and tendon site.
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Affiliation(s)
- Diane M Dickson
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
| | - Henrietta O Fawole
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
- Physiotherapy Department, University of Benin, School of Basic Medical Sciences, Benin City, Nigeria
| | - Gordon J Hendry
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
| | - Stephanie L Smith
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
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6
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Dickson DM, Fawole HO, Newcombe L, Smith SL, Hendry GJ. Reliability of ultrasound strain elastography in the assessment of the quadriceps and patellar tendon in healthy adults. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2019; 27:252-261. [PMID: 31762782 DOI: 10.1177/1742271x19859380] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/31/2019] [Indexed: 11/16/2022]
Abstract
Objective To report the intra- and inter-operator reliability of ultrasound strain elastography measures in the assessment of quadriceps and patellar tendons. Materials and methods Forty tendons were investigated of 20 healthy volunteers. Five anatomical sites were examined and analysed by three operators of differing levels of experience. Ultrasound was performed over two measures, employing three sonoelastography measurement techniques using a GE S8 with linear probe (L6-15 MHz). The percentage of exact agreement, Cohen's kappa and ICC2,1 were performed to assess intra- and inter-operator reliability. Results The patellar tendon is more reliably measured across all techniques compared to the quadriceps tendon, particularly the distal region. Colour scoring was the most reliable method of sonoelastography. Colour scoring intra- and inter-operator reliability was better for patella tendon sites across all operators (60-95% agreement range), and greatest for experienced operators. Elasticity index intra-operator reliability was greatest for the most experienced operator compared with the least (ICC range 0.35-0.72 and ICC 0.17-0.60). Elasticity ratio intra-operator reliability of the patella tendon was fair-excellent for the experienced operator (ICC range 0.43-0.91), excluding the mid patellar region (ICC 0.13). Poor-fair inter-operator reliability was observed for elasticity ratio (ICC range 0.0-0.54) and elasticity index (ICC range 0.0-0.57). Conclusions Strain elastography of the patellar tendon is more reliable than the quadriceps tendon. Intra- and inter-operator reliability was better when undertaken by more experienced operators. Colour scoring was more reliable than elasticity ratio and index methods. Poor-fair intra- and inter-operator reliability of the elasticity ratio and elasticity index was observed.
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Affiliation(s)
- Diane M Dickson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Henrietta O Fawole
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Physiotherapy Department, School of Basic Medical Sciences, University of Benin, Benin-City, Nigeria
| | - Lisa Newcombe
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Stephanie L Smith
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Gordon J Hendry
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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7
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Strakowski JA, Visco CJ. Diagnostic and therapeutic musculoskeletal ultrasound applications of the shoulder. Muscle Nerve 2019; 60:1-6. [PMID: 31054148 DOI: 10.1002/mus.26505] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/28/2019] [Indexed: 11/10/2022]
Abstract
High frequency ultrasound is a valuable tool for assessing soft tissue injuries about the shoulder. It has advantages over other imaging modalities including relatively low cost, portability, and dynamic real-time visualization. It has a high sensitivity for identifying tendon degeneration, bursitis, and rotator cuff tears. Ultrasound is also an excellent modality for diagnostic and therapeutic needle-guided procedures. A detailed knowledge of shoulder anatomy and transducer positioning is required for obtaining adequate diagnostic value from ultrasound. This Monograph is designed to help develop scanning protocols for optimizing image acquisition for musculoskeletal assessment of the shoulder. Muscle Nerve, 2019.
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Affiliation(s)
- Jeffrey A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA.,OhioHealth Riverside Methodist Hospital, 3555 Olentangy River Road, Columbus, 43214, Ohio, USA.,The McConnell Spine, Sport, and Joint Center, Columbus, Ohio, USA
| | - Christopher J Visco
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
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8
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Abstract
Although the diagnosis of arthritis and spondyloarthritis is based on clinical criteria, today the imaging methods are an indispensable aid to the rheumatologist. Imaging has not only the task of helping early diagnosis, but it has also a fundamental role in disease grading and therapeutic monitoring. In this scenario where many publications emphasize the importance of identifying synovitis and erosions at an early stage, it is essential to know the possible pitfalls which can determine both false positives and false negatives. The high variability of the musculoskeletal system anatomy makes it necessary to have a correct knowledge of all anatomical complexes, in order not to confuse them with the pathology. Moreover, the correct and standardized method of the execution and interpretation of the exams, such as ultrasound, is crucial to identifying and correctly monitoring the pathological hallmarks of the arthritis. This paper aims to provide an instrument to radiologists, highlighting the main imaging pitfalls in ultrasound and magnetic resonance which may be encountered in daily practice.
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9
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Visalli C, Cavallaro M, Concerto A, La Torre D, Di Salvo R, Mazziotti S, Salamone I. Ultrasonography of traumatic injuries to limb peripheral nerves: technical aspects and spectrum of features. Jpn J Radiol 2018; 36:592-602. [DOI: 10.1007/s11604-018-0765-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022]
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10
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Ultrasound classification of traumatic distal biceps brachii tendon injuries. Skeletal Radiol 2018; 47:519-532. [PMID: 29177701 PMCID: PMC5814508 DOI: 10.1007/s00256-017-2816-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The present work is aimed at analysing ultrasound findings in patients with distal biceps brachii tendon (DBBT) injuries to assess the sensitivity of ultrasound in detecting the different forms of injury, and to compare ultrasound results with magnetic resonance imaging (MRI) and surgical results. MATERIALS AND METHODS A total of 120 patients with traumatic DBBT injuries examined between 2011 and 2015 were analysed. We compared ultrasound results with MRI results when surgery was not indicated and with MRI and surgical results when surgery was indicated. RESULTS For major DBBT injuries (complete tears and high-grade partial tears), the concordance study between exploration methods and surgical results found that ultrasound presented a slight statistically significant advantage over MRI (ultrasound: κ = 0.95-very good-95% CI 0.88 to 1.01, MRI: κ = 0.63-good-95% CI 0.42 to 0.84, kappa difference p < 0.01). Minor injuries, in which most tendon fibres remain intact (tendinopathies, elongations and low-grade partial tears), are the most difficult to interpret, as ultrasound and MRI reports disagreed in 12 out of 39 cases and no surgical confirmation could be obtained. CONCLUSIONS Based on present results and previous MRI classifications, we establish a traumatic DBBT injury ultrasound classification. The sensitivity and ultrasound-surgery correlation results in the diagnosis of major DBBT injuries obtained in the present study support the recommendation that ultrasound can be used as a first-line imaging modality to evaluate DBBT injuries.
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11
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Krogh TP, Fredberg U, Ammitzbøl C, Ellingsen T. Ultrasonographic Characteristics of the Common Extensor Tendon of the Elbow in Asymptomatic Individuals: Thickness, Color Doppler Activity, and Bony Spurs. Orthop J Sports Med 2017; 5:2325967117704186. [PMID: 28540316 PMCID: PMC5431425 DOI: 10.1177/2325967117704186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Ultrasonography (US) of the common extensor tendon (CET) of the elbow is often part of the assessment of patients with lateral epicondylitis. This US assessment is currently based on general tendinopathy references and not well-defined US entities. Purpose: To describe CET thickness, color Doppler activity, and bony spurs on US in asymptomatic volunteers and to investigate the influence of sex, age, height, body mass index (BMI), weight, and elbow dominance on the measurements. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Tendon thickness, color Doppler activity, and bony spurs of the CET were measured sonographically in 264 adults (50% women) aged 20 to 96 years. Two different tendon-thickness measuring techniques were applied, labeled the “plateau measure” and the “1-cm measure.” Color Doppler activity was based on a 0 to 4 rating scale (negative, grades 0 and 1; positive, grades 2-4). A bony spur was defined as a bony outgrowth (≥0.3 mm) arising at the insertional site of the CET. Results: With both tendon-thickness measuring techniques, the CET in the dominant elbow was thicker than that in the nondominant elbow, and male tendons were thicker than female tendons (all P ≤ .03). In regression analysis, tendon thickness correlated with weight, color Doppler activity, and arm dominance for both measuring techniques in multiple regression analysis. In addition, the plateau measure correlated with height and the presence of bony spurs. No correlations were observed regarding BMI, sex, or age. Positive color Doppler activity was found in 9% of examined elbows, with no difference between the sexes regarding dominant versus nondominant elbows (all P ≥.20). Bony spurs were found to increase with age, from 23% for people in their 20s to 74% in people older than 70 years. Bony spurs were more common in the dominant elbow (P ≤ .01). Women had a higher prevalence of bony spurs than men, but only in the dominant elbow (P = .03). Conclusion: This study presents the US characteristics and normal values of the CET. In 264 asymptomatic participants, the CET was found to be thicker in men and in the dominant elbow. No difference in tendon thickness could be demonstrated with regard to different age groups. Color Doppler activity was found to be positive in nearly 1 of 10 asymptomatic subjects. Bony spurs were a common finding; they increased in prevalence with every decade in age and were considered part of the aging process. Normal variations in CET morphologic characteristics should therefore be considered when implementing US in trials and clinical practice.
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Affiliation(s)
- Thøger P Krogh
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | - Torkell Ellingsen
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
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12
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A case of lateral calcaneal neuropathy: Lateral heel pain. Muscle Nerve 2016; 54:801-4. [DOI: 10.1002/mus.25188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/07/2022]
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13
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A Novel Adhesion Index for Verifying the Extent of Adhesion for the Extensor Digitorum Communis in Patients with Metacarpal Fractures. Sci Rep 2016; 6:31102. [PMID: 27492808 PMCID: PMC4974625 DOI: 10.1038/srep31102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/13/2016] [Indexed: 11/21/2022] Open
Abstract
This study aims to determine if the relative displacement between the extensor digitorum communis (EDC) tendon and its surrounding tissues can be used as an adhesion index (AI) for assessing adhesion in metacarpal fractures by comparing two clinical measures, namely single-digit-force and extensor lag (i.e., the difference between passive extension and full active extension). The Fisher–Tippett block-matching method and a Kalman-filter algorithm were used to determine the relative displacements in 39 healthy subjects and 8 patients with metacarpal fractures. A goniometer was used to measure the extensor lag, and a force sensor was used to measure the single-digit-force. Measurements were obtained twice for each patient to evaluate the performance of the AI in assessing the progress of rehabilitation. The Pearson correlation coefficient was calculated to quantify the various correlations between the AI, extensor lag, and single-digit-force. The results showed strong correlations between the AI and the extensor lag, the AI and the single-digit-force, and the extensor lag and the single-digit-force (r = 0.718, −0.849, and −0.741; P = 0.002, P < 0.001, and P = 0.001, respectively). The AI in the patients gradually decreased after continuous rehabilitation, but remained higher than that of healthy participants.
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14
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Primack SJ. Past, Present, and Future Considerations for Musculoskeletal Ultrasound. Phys Med Rehabil Clin N Am 2016; 27:749-52. [PMID: 27468676 DOI: 10.1016/j.pmr.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Musculoskeletal ultrasound has a rich history originally rooted in nautical technology. In recent years, it has proliferated significantly for both diagnostic and interventional purposes in the point-of-care clinical setting by nonradiologist musculoskeletal clinicians. This article outlines the history of musculoskeletal ultrasound, examines present developments, and discusses its future outlook.
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Affiliation(s)
- Scott J Primack
- Colorado Rehabilitation and Occupational Medicine, 1390 South Potomac Street, Suite 100, Aurora, CO 80012, USA.
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15
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Bisi-Balogun A, Cassel M, Mayer F. Reliability of Various Measurement Stations for Determining Plantar Fascia Thickness and Echogenicity. Diagnostics (Basel) 2016; 6:diagnostics6020015. [PMID: 27089369 PMCID: PMC4931410 DOI: 10.3390/diagnostics6020015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 11/16/2022] Open
Abstract
This study aimed to determine the relative and absolute reliability of ultrasound (US) measurements of the thickness and echogenicity of the plantar fascia (PF) at different measurement stations along its length using a standardized protocol. Twelve healthy subjects (24 feet) were enrolled. The PF was imaged in the longitudinal plane. Subjects were assessed twice to evaluate the intra-rater reliability. A quantitative evaluation of the thickness and echogenicity of the plantar fascia was performed using Image J, a digital image analysis and viewer software. A sonography evaluation of the thickness and echogenicity of the PF showed a high relative reliability with an Intra class correlation coefficient of ≥0.88 at all measurement stations. However, the measurement stations for both the PF thickness and echogenicity which showed the highest intraclass correlation coefficient (ICCs) did not have the highest absolute reliability. Compared to other measurement stations, measuring the PF thickness at 3 cm distal and the echogenicity at a region of interest 1 cm to 2 cm distal from its insertion at the medial calcaneal tubercle showed the highest absolute reliability with the least systematic bias and random error. Also, the reliability was higher using a mean of three measurements compared to one measurement. To reduce discrepancies in the interpretation of the thickness and echogenicity measurements of the PF, the absolute reliability of the different measurement stations should be considered in clinical practice and research rather than the relative reliability with the ICC.
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Affiliation(s)
- Adebisi Bisi-Balogun
- Clinical Exercise Science, University of Potsdam, Am Neues Palais, Potsdam, Brandenburg 14467, Germany.
- Sports and Health Sciences, University Outpatient Clinic, Am Neues Palais, Potsdam, Brandenburg 14467, Germany.
| | - Michael Cassel
- Sports and Health Sciences, University Outpatient Clinic, Am Neues Palais, Potsdam, Brandenburg 14467, Germany
| | - Frank Mayer
- Sports and Health Sciences, University Outpatient Clinic, Am Neues Palais, Potsdam, Brandenburg 14467, Germany
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Lai TY, Chen HI, Shih CC, Kuo LC, Hsu HY, Huang CC. Application of a novel Kalman filter based block matching method to ultrasound images for hand tendon displacement estimation. Med Phys 2016; 43:148. [PMID: 26745907 DOI: 10.1118/1.4937932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Information about tendon displacement is important for allowing clinicians to not only quantify preoperative tendon injuries but also to identify any adhesive scaring between tendon and adjacent tissue. The Fisher-Tippett (FT) similarity measure has recently been shown to be more accurate than the Laplacian sum of absolute differences (SAD) and Gaussian sum of squared differences (SSD) similarity measures for tracking tendon displacement in ultrasound B-mode images. However, all of these similarity measures can easily be influenced by the quality of the ultrasound image, particularly its signal-to-noise ratio. Ultrasound images of injured hands are unfortunately often of poor quality due to the presence of adhesive scars. The present study investigated a novel Kalman-filter scheme for overcoming this problem. METHODS Three state-of-the-art tracking methods (FT, SAD, and SSD) were used to track the displacements of phantom and cadaver tendons, while FT was used to track human tendons. These three tracking methods were combined individually with the proposed Kalman-filter (K1) scheme and another Kalman-filter scheme used in a previous study to optimize the displacement trajectories of the phantom and cadaver tendons. The motion of the human extensor digitorum communis tendon was measured in the present study using the FT-K1 scheme. RESULTS The experimental results indicated that SSD exhibited better accuracy in the phantom experiments, whereas FT exhibited better performance for tracking real tendon motion in the cadaver experiments. All three tracking methods were influenced by the signal-to-noise ratio of the images. On the other hand, the K1 scheme was able to optimize the tracking trajectory of displacement in all experiments, even from a location with a poor image quality. The human experimental data indicated that the normal tendons were displaced more than the injured tendons, and that the motion ability of the injured tendon was restored after appropriate rehabilitation sessions. CONCLUSIONS The obtained results show the potential for applying the proposed FT-K1 method in clinical applications for evaluating the tendon injury level after metacarpal fractures and assessing the recovery of an injured tendon during rehabilitation.
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Affiliation(s)
- Ting-Yu Lai
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan
| | - Hsiao-I Chen
- Department of Occupational Therapy, National Cheng Kung University, Tainan 701, Taiwan
| | - Cho-Chiang Shih
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan and Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, National Cheng Kung University, Tainan 701, Taiwan
| | - Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan
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Lee SJ, Kim OH, Choo HJ, Park JH, Park YM, Jeong HW, Lee SM, Cho KH, Choi JA, Jacobson JA. Ultrasonographic findings of the various diseases presenting as calf pain. Clin Imaging 2015; 40:1-12. [PMID: 26490092 DOI: 10.1016/j.clinimag.2015.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/24/2015] [Accepted: 09/15/2015] [Indexed: 12/30/2022]
Abstract
There are various causes of calf pain. The differential diagnoses affecting the lower leg include cystic lesions, trauma-related lesions, infection or inflammation, vascular lesions, neoplasms, and miscellaneous entities. Ultrasound (US) provide detailed anatomical information of the calf structures, and it offers the ability to confirm, other calf abnormalities, particularly when deep vein thrombosis (DVT) is ruled out. The purpose of this article is to review the causes of a painful calf presenting as DVT and incidental findings found as part of the work-up of DVT, and to provide a broad overview of US findings and clinical features of these pathologies.
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Affiliation(s)
- Sun Joo Lee
- Department of Radiology, College of Medicine, Inje University, Pusan Paik Hospital, Busan, South Korea.
| | - Ok Hwa Kim
- Department of Radiology, College of Medicine, Inje University, Haeundae Paik Hospital, Busan, South Korea
| | - Hye Jung Choo
- Department of Radiology, College of Medicine, Inje University, Pusan Paik Hospital, Busan, South Korea
| | - Jun Ho Park
- Department of Radiology, College of Medicine, Inje University, Pusan Paik Hospital, Busan, South Korea
| | - Yeong-Mi Park
- Department of Radiology, College of Medicine, Inje University, Pusan Paik Hospital, Busan, South Korea
| | - Hae Woong Jeong
- Department of Radiology, College of Medicine, Inje University, Pusan Paik Hospital, Busan, South Korea
| | - Sung Moon Lee
- Department of Radiology, College of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Kil Ho Cho
- Department of Radiology, College of Medicine, Yeungnam University Medical Center, Daegu, South Korea
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Jon A Jacobson
- Department of Radiology, University of Michigan Medical Center, MI, US
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Teggeler M, Schmitz M, Fink A, Jansen JACG, Pisters MF. Reliability and agreement of ultrasonographic thickness measurements of the common lateral extensors of the elbow. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1592-1598. [PMID: 25748525 DOI: 10.1016/j.ultrasmedbio.2015.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/10/2015] [Accepted: 01/21/2015] [Indexed: 06/04/2023]
Abstract
In individuals with lateral elbow tendinopathy, the thickness of the common lateral extensors tendon can be evaluated by musculoskeletal ultrasonography (MSU) for diagnostic and evaluative purposes. The reproducibility of these thickness measurements should be established before integrating it into daily practice. A test-retest design was used to determine the reproducibility of these measurements in the longitudinal and transverse planes. Seventy-three healthy participants were measured two times by two raters. Intra-class correlation coefficient values for inter-rater reliability for the longitudinal and transverse planes were 0.67 and 0.49. Intra-class correlation coefficient values for intra-rater reliability varied between 0.73 and 0.92. The smallest detectable change ranged from 0.50 to 0.78 mm and comprised 9.8%-16.3% of the mean thickness. MSU thickness measurement of the common lateral extensors tendon of the elbow has fair to excellent intra- and inter-rater reliability. Additionally, agreement is acceptable, which makes MSU a valuable tool for the evaluation of tendon thickness over time.
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Affiliation(s)
- Marlijn Teggeler
- Physical Therapy Science, Program in Clinical Health Sciences and Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Physical Therapy Practice Emmastraat, Enschede, The Netherlands.
| | - Marc Schmitz
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Alexandra Fink
- Physical Therapy Science, Program in Clinical Health Sciences and Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Hand Therapy Center, Enschede, The Netherlands
| | - Jaap A C G Jansen
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Martijn F Pisters
- Physical Therapy Science, Program in Clinical Health Sciences and Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands
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Oca Pernas R, Prada González R, Santos Armentia E, Hormaza Aguirre N, Tardáguila de la Fuente G, Trinidad López C, Delgado Sánchez-Gracián C. Benign soft-tissue lesions of the fingers: radiopathological correlation and clinical considerations. Skeletal Radiol 2015; 44:477-90. [PMID: 25367671 DOI: 10.1007/s00256-014-2040-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/13/2014] [Accepted: 10/15/2014] [Indexed: 02/02/2023]
Abstract
Soft-tissue lesions of the fingers are commonly found in daily clinical practice. A wide range of tumors and pseudotumors have been described in this location, and the majority of them are benign. Ganglion cysts are the most common entity, and the localized type of tenosynovial giant cell tumors are the most frequent solid condition. Both may be easily recognized owing to their typical clinical and radiological characteristics. However, categorization of the spectrum of soft-tissue lesions of the fingers remains limited, despite imaging development, and many patients undergo surgery before radiological or histological diagnosis. Clinical history, radiographic features, and ultrasound and magnetic resonance patterns may help in obtaining the correct diagnosis or reducing the list of differential diagnoses. Radiologists should be familiar with imaging findings so that they can determine the size, extension, and affected neighboring anatomical structures, and provide information that allows adequate presurgical counseling.
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Affiliation(s)
- Roque Oca Pernas
- Radiology Department, Povisa Hospital, Salamanca S/N, 36211, Vigo, Spain,
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Ayad M, Whisenhunt A, Hong E, Heller J, Salvatore D, Abai B, DiMuzio PJ. Posterior tibial vein aneurysm presenting as tarsal tunnel syndrome. Vascular 2014; 23:322-6. [DOI: 10.1177/1708538114548715] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve within the tarsal tunnel. Its etiology varies, including space occupying lesions, trauma, inflammation, anatomic deformity, iatrogenic injury, and idiopathic and systemic causes. Herein, we describe a 46-year-old man who presented with left foot pain. Work up revealed a venous aneurysm impinging on the posterior tibial nerve. Following resection of the aneurysm and lysis of the nerve, his symptoms were alleviated. Review of the literature reveals an association between venous disease and tarsal tunnel syndrome; however, this report represents the first case of venous aneurysm causing symptomatic compression of the nerve.
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Affiliation(s)
- Micheal Ayad
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anumeha Whisenhunt
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - EnYaw Hong
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Josh Heller
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dawn Salvatore
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Babak Abai
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul J DiMuzio
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Han M, Larson PEZ, Liu J, Krug R. Depiction of achilles tendon microstructure in vivo using high-resolution 3-dimensional ultrashort echo-time magnetic resonance imaging at 7 T. Invest Radiol 2014; 49:339-45. [PMID: 24500089 PMCID: PMC4143127 DOI: 10.1097/rli.0000000000000025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The objective of this study was to demonstrate the feasibility of depicting the internal structure of the Achilles tendon in vivo using high-resolution 3-dimensional ultrashort echo-time (UTE) magnetic resonance imaging at 7 T. MATERIALS AND METHODS For our UTE imaging, a minimum-phase radiofrequency pulse and an anisotropic field-of-view 3-dimensional radial acquisition were used to minimize the echo time and scan time. A fat saturation pulse was applied every 8 spoke acquisitions to reduce blurring and chemical shift artifacts from fat and to improve the dynamic range of the tendon signal. Five healthy volunteers and 1 patient were scanned with an isotropic spatial resolution of up to 0.6 mm. Fat-suppressed UTE images were qualitatively evaluated and compared with non-fat-suppressed UTE images and longer echo-time images. RESULTS High-resolution UTE imaging was able to visualize the microstructure of the Achilles tendon. Fat suppression substantially improved the depiction of the internal structure. The UTE images revealed a fascicular pattern in the Achilles tendon and fibrocartilage at the tendon insertion. In a patient who had tendon elongation surgery after birth, there was a clear depiction of disrupted tendon structure. CONCLUSIONS High-resolution fat-suppressed 3-dimensional UTE imaging at 7 T allows for the evaluation of the Achilles tendon microstructure in vivo.
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Affiliation(s)
- Misung Han
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Peder E. Z. Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Jing Liu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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Delle Sedie A, Riente L, Bombardieri S. Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases. Mod Rheumatol 2014. [DOI: 10.3109/s10165-008-0046-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Evans KD, Volz KR, Roll SC, Hutmire CM, Pargeon RL, Buford JA, Sommerich CM. Establishing an Imaging Protocol for Detection of Vascularity within the Median Nerve Using Contrast-Enhanced Ultrasound. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013; 29:10.1177/8756479313503211. [PMID: 24236299 PMCID: PMC3825188 DOI: 10.1177/8756479313503211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This preclinical study was conducted to develop discrete sonographic instrumentation settings and also safe contrast dosing that would consistently demonstrate perineural vascularity along the median nerve. This set of imaging studies was conducted with a convenience cohort of young adult female monkeys (Macaca fascicularis). Sonographic equipment settings and dosing were refined throughout the imaging series to ensure consistent contrast-enhanced ultrasound imaging. A mechanical index of 0.13 was consistently used for imaging. Perineural vessels were imaged with a suspension solution of 0.04 mL Definity/0.96 mL saline introduced over 5 minutes for a total dose of 0.8 mL of contrast solution. Blinded studies of high and low dose contrast, along with saline injections, were correctly identified by two experienced sonographers. This preclinical study established adequate equipment settings and dosing that allowed for a valid demonstration of vascularity surrounding the median nerve.
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Affiliation(s)
- Kevin D. Evans
- School of Health and Rehabilitation Sciences, The Ohio
State University, Columbus, OH, USA
| | - Kevin R. Volz
- School of Health and Rehabilitation Sciences, The Ohio
State University, Columbus, OH, USA
| | - Shawn C. Roll
- Division of Occupational Science and Occupational Therapy,
University of Southern California, Los Angeles, CA, USA
| | - Cristina M. Hutmire
- School of Health and Rehabilitation Sciences, The Ohio
State University, Columbus, OH, USA
| | - Rachel L. Pargeon
- School of Health and Rehabilitation Sciences, The Ohio
State University, Columbus, OH, USA
| | - John A. Buford
- School of Health and Rehabilitation Sciences, The Ohio
State University, Columbus, OH, USA
| | - Carolyn M. Sommerich
- School of Health and Rehabilitation Sciences, The Ohio
State University, Columbus, OH, USA
- Department of Integrated Systems Engineering, The Ohio
State University, Columbus, OH, USA
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Skou ST, Aalkjaer JM. Ultrasonographic measurement of patellar tendon thickness—a study of intra- and interobserver reliability. Clin Imaging 2013; 37:934-7. [DOI: 10.1016/j.clinimag.2013.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/30/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
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Giant cell tumors of the tendon sheaths in the hand: review of 96 patients with an average follow-up of 12 years. Orthop Traumatol Surg Res 2013; 99:S251-4. [PMID: 23623439 DOI: 10.1016/j.otsr.2013.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Giant cell tumors (GCT) of the hand are relatively common and have a good prognosis, but the risk of recurrence is high. The goal of this study was to evaluate the long-term clinical results of a consecutive series of patients and to determine the risk factors for recurrence. MATERIAL AND METHODS This was a retrospective study of 96 patients (57 women, 39 men) operated between February 1982 and October 2005 for GCT of the tendon sheaths in the hand. The average age at the time of the procedure was 47.7±14.5 years (range 13-75). All the patients were reviewed by an independent surgeon. The following were recorded: clinical result (QuickDASH, satisfaction), recurrence, histological appearance of tumor, location of tumor, excision margins and extension into the neighboring anatomical structures (tendon, joint). The tumor was located in the index finger in 29 cases, middle finger in 23 cases, thumb in 21 cases, ring finger in 11 cases, little finger in 11 cases, hypothenar area in two cases and thenar area in one case. In all cases, the lesion was isolated. The swelling was palmar in 27 cases, dorsal in 20 cases and medial or lateral in 59 cases. The most common joint location was the DIP joint (35% of cases). The swollen area was sensitive in 12 cases. The time from the appearance of the tumor to physician consultation ranged between 1 month and 7 years. Before the surgery, standard X-rays were taken in all patients; ultrasonography was also performed in eight patients and MRI in one patient. The tumor had an average diameter of 15.8±2.6mm (range 5-30). Histological analysis revealed a multilobed lesion with multinucleated giant cells, with or without encapsulation. RESULTS The average follow-up at the time of review was 12.1±3.8 years (range 5-29). There were eight recurrences in seven patients (8.3%). The average time to recurrence was 2.75±2 years (range 1-6.5). In every case of recurrence, there had been intra-articular tumor development and/or tendon destruction (P<0.01). There was one functional complication: one DIP joint fusion secondary to one of the recurrences. The average QuickDASH was 2.3/100 (range 0-31). CONCLUSION Giant cell tumors of the synovial sheaths in the hand are benign lesions where recurrence is the primary risk. The recurrence typically occurred within 36 months of the excision. Intra-articular tumor development, marginal resection and tendon involvement seem to contribute to recurrence. There was no correlation found between the histological type of tumor (encapsulated or not) and recurrence. LEVEL OF PROOF IV.
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Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med 2013; 41:625-35. [PMID: 23328738 DOI: 10.1177/0363546512472975] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral epicondylitis (LE) is a common musculoskeletal disorder for which an effective treatment strategy remains unknown. PURPOSE To examine whether a single injection of platelet-rich plasma (PRP) is more effective than placebo (saline) or glucocorticoid in reducing pain in adults with LE after 3 months. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 60 patients with chronic LE were randomized (1:1:1) to receive either a blinded injection of PRP, saline, or glucocorticoid. The primary end point was a change in pain using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at 3 months. Secondary outcomes were ultrasonographic changes in tendon thickness and color Doppler activity. RESULTS Pain reduction at 3 months (primary end point) was observed in all 3 groups, with no statistically significant difference between the groups; mean differences were the following: glucocorticoid versus saline: -3.8 (95% CI, -9.9 to 2.4); PRP versus saline: -2.7 (95% CI, -8.8 to 3.5); and glucocorticoid versus PRP: -1.1 (95% CI, -7.2 to 5.0). At 1 month, however, glucocorticoid reduced pain more effectively than did both saline and PRP; mean differences were the following: glucocorticoid versus saline: -8.1 (95% CI, -14.3 to -1.9); and glucocorticoid versus PRP: -9.3 (95% CI, -15.4 to -3.2). Among the secondary outcomes, at 3 months, glucocorticoid was more effective than PRP and saline in reducing color Doppler activity and tendon thickness. For color Doppler activity, mean differences were the following: glucocorticoid versus PRP: -2.6 (95% CI, -3.1 to -2.2); and glucocorticoid versus saline: -2.0 (95% CI, -2.5 to -1.6). For tendon thickness, mean differences were the following: glucocorticoid versus PRP: -0.5 (95% CI, -0.8 to -0.2); and glucocorticoid versus saline: -0.8 (95% CI, -1.2 to -0.5). CONCLUSION Neither injection of PRP nor glucocorticoid was superior to saline with regard to pain reduction in LE at the primary end point at 3 months. However, injection of glucocorticoid had a short-term pain-reducing effect at 1 month in contrast to the other therapies. Injection of glucocorticoid in LE reduces both color Doppler activity and tendon thickness compared with PRP and saline.
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Achilles tendon and plantar fascia in recently diagnosed type II diabetes: role of body mass index. Clin Rheumatol 2012; 31:1109-13. [DOI: 10.1007/s10067-012-1955-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 01/28/2012] [Accepted: 01/31/2012] [Indexed: 12/16/2022]
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Chalian M, Soldatos T, Faridian-Aragh N, Williams EH, Rosson GD, Eng J, Carrino JA, Chhabra A. 3T magnetic resonance neurography of tibial nerve pathologies. J Neuroimaging 2012; 23:296-310. [PMID: 22243916 DOI: 10.1111/j.1552-6569.2011.00676.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Diagnosis of tibial neuropathy has been traditionally based on clinical examination and electrodiagnostic studies; however, cross-sectional imaging modalities have been used to increase the diagnostic accuracy and provide anatomic mapping of the abnormalities. In this context, magnetic resonance neurography (MRN) offers high-resolution imaging of the tibial nerve (TN), its branches and the adjacent soft tissues, and provides an objective assessment of the neuromuscular anatomy, abnormality, and the surrounding pathology. This review describes the pathologies affecting the TN and illustrates their respective 3 Tesla (T) MRN appearances with relevant case examples.
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Affiliation(s)
- Majid Chalian
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Abstract
Ultrasound has added a feather in the cap of the anesthesiologists as real-time nerve localization and drug deposition around the nerve structure under real-time guidance is now a reality, as the saying “seeing is believing” has been proven true with the advent of ultrasound in anesthesia. Pediatric patients are a unique group regarding their anatomical and physiological features in comparison with adults; regional blocks in adults with the anatomical landmark and surface marking are almost uniform across the adult population. The landmark technique in pediatric patients is not reliable in all patients due to the variability in the age and size; the advent of ultrasound in assisting nerve localization has changed the way regional blocks are achieved in children and the range of blocks performed on adults can now be performed on pediatric patients; with advances in the technology and dexterity of ultrasound equipment, the chances of success of blocks has increased with a smaller dose of the local anesthetic in comparison to the traditional methods. Anesthesiologists are now able to perform blocks with more accuracy and avoid complications like intravascular injection and injury to the pleura and peritoneum during routine practice with the assistance of high-frequency transducers and top of the range portable ultrasound machines; catheters can be inserted to provide a continuous analgesia in the postoperative period. This review article describes the common peripheral blocks in pediatric patients; the readers are encouraged to gain experience by attending workshops, hands-on practice under supervision, and conduct random controlled trials pertaining to ultrasound-guided blocks in the pediatric age group. The recent literature is encouraging and further research is promising; a wide range of blocks being described in detail by many prominent experts from all over the world.
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Affiliation(s)
- Mohamed Bilal Delvi
- Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Salini V, Abate M. Percutaneous steroidal treatment in relapses of chronic tendinopathies: a pilot study. Int J Immunopathol Pharmacol 2011; 24:211-6. [PMID: 21496380 DOI: 10.1177/039463201102400125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Relapses are frequently observed in subjects with chronic tendinopathies. Corticosteroid injections are usually performed with positive results, but are uncomfortable for the patient and not free from side effects. The aim of this pilot study is to evaluate the short-term efficacy and tolerability of an occlusive Betamethasone Valerate medicated Plaster (BMVP). Fifteen subjects with relapses of chronic tendinopathies (clinical and ultrasound diagnosis) were enrolled, and treated according to RICE (Rest - Ice - Compression - Elevation) protocol. An BMVP plaster was also applied on the affected tendon. Clinical examination, at baseline and after 7, 14, 21 and 28 days, included pain (VAS at rest and during activities) and functional evaluation. Local side effects on the area and drop-outs were also recorded. Pain, both at rest and during activities, significantly decreased at 28 days (from 3.7 ± 2.7 to 1.1 ± 1.7 p < 0.01, and from 7.3 ± 1.7 to 3.3 ± 1.4 p < 0.0000, respectively). Moreover, the patients reported a significant improvement in the functional limitation. Five subjects dropped out of the study. No side effects were reported. The release of the steroid in pharmacologically-active concentrations over 12 - 24 hours and the good penetration of the drug in subcutaneous tissues explain the positive results. BMVP application may be considered a reliable first therapeutic approach in relapses of chronic tendinopathies.
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Affiliation(s)
- V Salini
- Department of Human Movement Science, University of Chieti-Pescara, Chieti, Italy
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Abstract
Neuropathies can be a cause of chronic foot and ankle pain. The diagnosis can be elusive given the sometimes nonspecific clinical presentation. Although electrodiagnostic studies are primarily relied on for the diagnosis of nerve impairment, imaging is sometimes helpful in helping define the exact site of the entrapment and whether any masses are present. It is critical for the imager to understand the complex anatomy of these nerves and their adjacent structures, to know the most common locations for their entrapments or injury, and to select the proper imaging modality to improve detection of these difficult-to-diagnose clinical conditions.
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Rathleff MS, Moelgaard C, Lykkegaard Olesen J. Intra- and interobserver reliability of quantitative ultrasound measurement of the plantar fascia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:128-134. [PMID: 21387326 DOI: 10.1002/jcu.20787] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 10/25/2010] [Indexed: 05/30/2023]
Abstract
PURPOSE To determine intra- and interobserver reliability and measurement precision of sonographic assessment of plantar fascia thickness when using one, the mean of two, or the mean of three measurements. METHODS Two experienced observers scanned 20 healthy subjects twice with 60 minutes between test and retest. A GE LOGIQe ultrasound scanner was used in the study. The built-in software in the scanner was used to measure the thickness of the plantar fascia (PF). Reliability was calculated using intraclass correlation coefficient (ICC) and limits of agreement (LOA). RESULTS Intraobserver reliability (ICC) using one measurement was 0.50 for one observer and 0.52 for the other, and using the mean of three measurements intraobserver reliability increased up to 0.77 and 0.67, respectively. Interobserver reliability (ICC) when using one measurement was 0.62 and increased to 0.82 when using the average of three measurements. LOA showed that when using the average of three measurements, LOA decreased to 0.6 mm, corresponding to 17.5% of the mean thickness of the PF. CONCLUSIONS The results showed that reliability increases when using the mean of three measurements compared with one. Limits of agreement based on intratester reliability shows that changes in thickness that are larger than 0.6 mm can be considered actual changes in thickness and not a result of measurement error.
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Affiliation(s)
- Michael Skovdal Rathleff
- Orthopaedic Division, North Denmark Region, Aalborg Hospital-Aarhus University Hospital, Aalborg, Denmark.
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Macfarlane AJR, Sites BD, Sites VR, Naraghi AM, Chan VWS, Singh M, Antonakakis JG, Brull R. Musculoskeletal sonopathology and ultrasound-guided regional anesthesia. HSS J 2011; 7:64-71. [PMID: 22294960 PMCID: PMC3026115 DOI: 10.1007/s11420-010-9174-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 06/11/2010] [Indexed: 02/07/2023]
Abstract
The use of real-time ultrasound guidance has revolutionized the practice of regional anesthesia. Ultrasound is rapidly becoming the technique of choice for nerve blockade due to increased success rates, faster onset, and potentially improved safety. In the course of ultrasound-guided regional anesthesia, unexpected pathology may be encountered. Such anomalous or pathological findings may alter the choice of nerve block and occasionally affect surgical management. This case series presents a variety of musculoskeletal conditions that may be encountered during ultrasound-guided regional anesthesia practice.
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Affiliation(s)
| | - Brian D. Sites
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | | | - Ali M. Naraghi
- Joint Department of Medical Imaging of University Health Network and Mount Sinai Hospital, Toronto Western Hospital, Toronto, ON Canada
| | - Vincent W. S. Chan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8 Canada
| | - Mandeep Singh
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8 Canada
| | - John G. Antonakakis
- Department of Anesthesiology, University of Virginia, Charlottesville, VA USA
| | - Richard Brull
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8 Canada
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Clinical sonopathology for the regional anesthesiologist: part 1: vascular and neural. Reg Anesth Pain Med 2011; 35:272-80. [PMID: 20921839 DOI: 10.1097/aap.0b013e3181ddd1f8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The use of ultrasound to facilitate regional anesthesia is an evolving area of clinical, education, and research interests. As our community's experience grows, it has become evident that anesthesiologists performing "routine" ultrasound-guided blocks may very well be confronted with atypical or even pathologic anatomy. As an educational resource for anesthesiologists, the following articles present examples of common sonopathology that may be encountered during ultrasound-guided regional anesthesia. This present article describes sonopathology related to blood vessels and nerves.
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Park JY, Park H, Park NJ, Park JS, Sung HJ, Lee SS. Use of Calretinin, CD56, and CD34 for Differential Diagnosis of Schwannoma and Neurofibroma. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.1.30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ji Young Park
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - Hoon Park
- Department of Otolaryngology, Korea Cancer Center Hospital, Seoul, Korea
| | - Nam Jo Park
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - June Sik Park
- Department of Otolaryngology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun-Jung Sung
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sang Sook Lee
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
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Lento PH, Strakowski JA. The Use of Ultrasound in Guiding Musculoskeletal Interventional Procedures. Phys Med Rehabil Clin N Am 2010; 21:559-83. [DOI: 10.1016/j.pmr.2010.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Donovan A, Rosenberg ZS, Cavalcanti CF. MR Imaging of Entrapment Neuropathies of the Lower Extremity. Radiographics 2010; 30:1001-19. [PMID: 20631365 DOI: 10.1148/rg.304095188] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrea Donovan
- Department of Radiology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada.
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Wan JMC, Magarelli N, Peh WCG, Guglielmi G, Shek TWH. Imaging of giant cell tumour of the tendon sheath. Radiol Med 2010; 115:141-51. [PMID: 20077044 DOI: 10.1007/s11547-010-0515-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 02/27/2009] [Indexed: 12/25/2022]
Abstract
Giant cell tumours of the tendon sheath (GCTTS) and pigmented villonodular synovitis (PVNS) are part of a spectrum of benign proliferative lesions of synovial origin that may affect the joints, bursae and tendon sheaths. This review article describes the clinicopathological features and imaging findings in patients with GCTTS. GCTTS usually presents as a soft tissue mass with pressure erosion of the underlying bone. Magnetic resonance (MR) imaging of GCTTS typically shows low to intermediate signal on T1- and T2-weighted spin-echo sequences due to the presence of haemosiderin, which exerts a paramagnetic effect. On gradient-echo sequences, the paramagnetic effect of haemosiderin is further exaggerated, resulting in areas of very low signal due to the blooming artefact. Ultrasonography shows a soft mass related to the tendon sheath that is hypervascular on colour or power Doppler imaging.
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Affiliation(s)
- J M C Wan
- Department of Diagnostic Radiology, Alexandra Hospital, Singapore, Republic of Singapore
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Ultrasound-anatomic correlation of the peripheral nerves of the upper limb. Surg Radiol Anat 2009; 32:305-14. [PMID: 19890595 DOI: 10.1007/s00276-009-0583-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 10/14/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sonography allows good visualization of the peripheral nerves and the vascular and muscular structures that surround them. Our goals are to provide an easy-to-use atlas that gives accurate information about the locations and relations among the nerves in the different parts of the arm and to correlate it with the probe position and the ultrasound images. MATERIALS AND METHODS A cadaver right arm was used for the present study. The arterial and venous vessels were injected with red and blue-colored latex to obtain a better correlation with ultrasound slices from two healthy volunteers. The specimen was frozen and then cut into slices with an average thickness of 2 cm, starting from the lower part of the axilla. RESULTS Close correlation was present between the ultrasound and anatomic slices identifying the main muscular, vascular and nervous structures. In the arm, median, ulnar and radial nerves were easily seen because of the proximity to vascular landmark and their size. In the forearm, the ulnar nerve was also easy to identify because of the factors previously mentioned; the median nerve was easy to locate between the flexor digitorum superficialis and profundus muscles. The superficial branch of the radial arm was seen in most cases, although some skill was required. CONCLUSION Ultrasound is a useful tool to identify the main nerves of the upper arm. This atlas indicates the locations and relations among the nerves, correlating with the ultrasound appearance.
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Hashefi M. Ultrasound in the Diagnosis of Noninflammatory Musculoskeletal Conditions. Ann N Y Acad Sci 2009; 1154:171-203. [DOI: 10.1111/j.1749-6632.2009.04391.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Smith J, Finnoff JT. Diagnostic and Interventional Musculoskeletal Ultrasound: Part 2. Clinical Applications. PM R 2009; 1:162-77. [DOI: 10.1016/j.pmrj.2008.09.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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Jeyapalan K, Bisson MA, Dias JJ, Griffin Y, Bhatt R. The role of ultrasound in the management of flexor tendon injuries. J Hand Surg Eur Vol 2008; 33:430-4. [PMID: 18687829 DOI: 10.1177/1753193408090097] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The use of ultrasound scanning to establish tendon pathologies was assessed retrospectively in 17 patients in 18 digits. The ultrasound scan demonstrated four patterns: (1) normal intact tendons in four, (2) ruptured tendons in three, (3) tendons in continuity but attenuated in five and (4) tendons in continuity but thickened with fibrosis and decreased movement representing adhesions in five patients. Surgery was undertaken in only three cases, confirming the ultrasound diagnosis in two. Surgery was offered to all three patients with ruptures but was declined by two. Ultrasound imaging helped to avoid surgery in 14 cases by excluding flexor tendon re-ruptures. This allowed on-going mobilisation, leading to recovery of function.
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Affiliation(s)
- K Jeyapalan
- Department of Radiology, University Hospitals of Leicester, Leicester, UK
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Percutaneous chemical nerve block with ultrasound-guided intraneural injection. Eur Radiol 2008; 18:1506-12. [DOI: 10.1007/s00330-008-0909-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 12/06/2007] [Accepted: 01/05/2008] [Indexed: 10/22/2022]
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da Costa RC, Parent JM, Dobson H, Ruotsalo K, Holmberg D, Duque MC, Poma R. Ultrasound-guided fine needle aspiration in the diagnosis of peripheral nerve sheath tumors in 4 dogs. CANADIAN JOURNAL OF ANIMAL SCIENCE 2008; 49:77-81. [PMID: 18320983 DOI: 10.4141/cjas69-011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ultrasound-guided fine needle aspiration was used in establishing the diagnosis in 4 cases of malignant peripheral nerve sheath tumor. Sonographic and cytologic characteristics are discussed. Because of its availability and ease of use, axillary ultrasonography with fine needle aspiration can be an initial diagnostic step for suspected brachial plexus tumors.
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Affiliation(s)
- Ronaldo C da Costa
- Veterinary Teaching Hospital, Ontario Veterinary College, University of Guelph, Guelph, Ontario.
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45
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Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases. Mod Rheumatol 2008; 18:125-31. [PMID: 18306005 DOI: 10.1007/s10165-008-0046-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 01/04/2008] [Indexed: 10/22/2022]
Abstract
Musculoskeletal sonography (MSUS) has played a growing role in the diagnosis and management of rheumatic diseases, enabling the imaging of synovitis, bone erosion, and cartilage damage in the early phase of arthritis. "Dynamic" evaluation of tendons and help in guiding needle positioning in interventional manoeuvres are some of the other reasons for its success. MSUS, particularly when coupled with power Doppler (PD) examination, has recently been shown to be an efficient tool for monitoring disease activity and progression in rheumatoid arthritis, spondyloarthritis, crystal-related arthropathy, and osteoarthritis, with general consensus on its interesting results. More specifically, the PD signal has proved to be a simple and promising tool for short-term monitoring of synovial vascularity changes induced by steroids or biological agents in RA patients. MSUS has some limits, because of the physical properties of US and the quality of the equipment; it is, moreover, an operator-related imaging technique, with few standardized protocols. Future goals should be standardization of the examining approach in grey scale and Doppler ultrasound (US), including use of new equipment (3D US), extensive use in other fields (i.e. connective tissue diseases and vasculitis), and possible new applications (e.g. thoracic US).
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Granata G, Martinoli C, Pazzaglia C, Caliandro P, Padua L, Ferraro D. Letter to Editor: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: the risk of misdiagnosis and mismanagement. World J Surg Oncol 2008; 6:22. [PMID: 18284709 PMCID: PMC2278133 DOI: 10.1186/1477-7819-6-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 02/20/2008] [Indexed: 11/10/2022] Open
Abstract
A response to Chalidis et al: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement. World J Surg Oncol 2007, 5:92.
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Tsai WC, Chiou HJ, Chou YH, Wang HK, Chiou SY, Chang CY. Differentiation between schwannomas and neurofibromas in the extremities and superficial body: the role of high-resolution and color Doppler ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:161-169. [PMID: 18204006 DOI: 10.7863/jum.2008.27.2.161] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this study was to verify whether high-resolution and color Doppler ultrasonography could distinguish schwannomas from neurofibromas. METHODS Seventy-six tumors in 71 patients were included in this study. There were 46 patients (50 tumors) with schwannomas and 25 patients (26 tumors) with nondiffuse neurofibromas in the extremities or superficial parts of the body. Ultrasonographic examinations were performed in all patients. The tumor size, shape, location, internal echogenicity, posterior acoustic phenomenon (eg, shadowing or enhancement), capsule, relationship with the adjacent nerve, and presence of cystic components were documented. Color Doppler studies (75 lesions) and spectral Doppler studies (44 lesions) were performed. All data were analyzed with statistical software to check the significance. RESULTS Both tumors presented as well-defined hypoechoic nodules on ultrasonography. They were oval or lobulated, showed posterior acoustic enhancement, and were hypervascular on color Doppler ultrasonography. There was no significant difference with respect to ultrasonographic morphologic characteristics. The rates of centric, eccentric, and undetermined associations with nerves were 40%, 20%, and 40% in the schwannomas and 46.2%, 0%, and 53.8% in the neurofibromas, respectively, showing a significant difference (P = .032). There was no significant difference in the chance of cystic changes between the schwannomas (30%) and neurofibromas (23%). CONCLUSIONS No ultrasonographic finding (gray scale, color Doppler, or spectral analysis) allows differentiation between neurofibromas and schwannomas of the extremities. A nerve eccentrically entering a mass was seen only in schwannomas, and that may allow differentiation between neurofibromas and schwannomas.
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Affiliation(s)
- Wan-Chen Tsai
- Department of Radiology, Taipei Veterans General Hospital, Taiwan
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