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Zielinska N, LaPrade RF, Olewnik Ł. Morphological variations of the calcaneal tendon: clinical significance. J Orthop Surg Res 2023; 18:275. [PMID: 37016428 PMCID: PMC10074894 DOI: 10.1186/s13018-023-03748-y] [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: 01/14/2023] [Accepted: 03/24/2023] [Indexed: 04/06/2023] Open
Abstract
The calcaneal tendon, the largest and strongest in the human body, is created by the common junction of tendons of the gastrocnemius and soleus muscles. It is not a homogenous structure, being represented by layers in various arrangements. Morphological variability can be seen in the connection between the aponeurosis of the gastrocnemius muscle and the soleus muscle. Some types of plantaris tendon can be associated with a higher possibility of Achilles tendinopathy. Moreover, the presence of accessory structures, such as an accessory soleus muscle or additional gastrocnemius muscle heads may result in symptomatic pathologies. The main aim of this review is to summarize the current state of knowledge regarding the calcaneal tendon. Another aim is to present morphological variations of the calcaneal tendon and their clinical significance. Such information may be useful for clinicians, especially orthopedists, and surgeons. This review also provides an overview of embryological development and morphological variation among fetuses. Materials and methods: review was conducted according to PRISMA guidelines. An electronic search was conducted in five databases. Top quality tools were used to assess the quality of evidence in the studies reviewed. Research papers that made up the database of this review were analyzed, selected and assessed by two independently working researchers.
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Affiliation(s)
- Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | | | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
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Abd Ellah M, Taljanovic M, Klauser A. Musculoskeletal elastography. TISSUE ELASTICITY IMAGING 2020:197-224. [DOI: 10.1016/b978-0-12-809662-8.00009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Ultrasonographic assessment of patellar tendon thickness at 16 clinically relevant measurement sites - A study of intra- and interrater reliability. J Bodyw Mov Ther 2019; 23:344-351. [PMID: 31103118 DOI: 10.1016/j.jbmt.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/02/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine intra- and interrater reliability of ultrasonographic imaging (USI) measurements of patellar tendon (PT) thickness using 16 measurement sites covering the entire tendon. DESIGN Reliability study. SETTING Physiotherapy outpatient clinic. PARTICIPANTS Twenty healthy and physically active volunteers (9 women). Mean age: 24 years (SD ± 2.73). Mean body mass: 75.8 kg (SD ± 11.8). MAIN OUTCOME MEASURES Intraclass correlation coefficient (ICC) and 95% limits of agreement (LOA) in cm and in percentage relative to the mean PT thickness. RESULTS Intrarater reliability ranged from 0.59 to 0.87 and 0.59 to 0.93 for examiners I and II, respectively. Interrater reliability ranged from 0.37 to 0.89. Measurement precision for examiner I ranged from 0.05 to 0.09 cm (17.5%-26.7%) while ranging from 0.04 to 0.13 cm (13.3%-38.7%) for examiner II. Interrater measurement precision ranged from 0.07 to 0.15 cm (19.1%-42.5%). CONCLUSION In an attempt to replicate daily clinical USI practice, this was the first study extensively assessing reliability throughout the full range of the patellar tendon - revealing a considerable variation in intra- and interrater reliability as well as measurement precision throughout the 16 individual PT sites. In a clinical context, the low interrater reliability and precision found at the proximal tendon insertion site may have implications for USI of the symptomatic PT, as this is the site mainly associated with underlying pathologic changes. Further reliability studies are needed to clarify the region-specific reliability of the full length PT.
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Hayes A, Easton K, Devanaboyina PT, Wu JP, Kirk TB, Lloyd D. A review of methods to measure tendon dimensions. J Orthop Surg Res 2019; 14:18. [PMID: 30636623 PMCID: PMC6330756 DOI: 10.1186/s13018-018-1056-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/27/2018] [Indexed: 12/16/2022] Open
Abstract
Tendons are soft tissues of the musculoskeletal system that are designed to facilitate joint movement. Tendons exhibit a wide range of mechanical properties matched to their functions and, as a result, have been of interest to researchers for many decades. Dimensions are an important aspect of tendon properties. Change in the dimensions of tissues is often seen as a sign of injury and degeneration, as it may suggest inflammation or general disorder of the tissue. Dimensions are also important for determining the mechanical properties and behaviours of materials, particularly the stress, strain, and elastic modulus. This makes the dimensions significant in the context of a mechanical study of degenerated tendons. Additionally, tendon dimensions are useful in planning harvesting for tendon transfer and joint reconstruction purposes. Historically, many methods have been used in an attempt to accurately measure the dimensions of soft tissue, since improper measurement can lead to large errors in the calculated properties. These methods can be categorised as destructive (by approximation), contact, and non-contact and can be considered in terms of in vivo and ex vivo.
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Affiliation(s)
- Alex Hayes
- Department of Mechanical Engineering, Curtin University of Technology, Perth, Western Australia, Australia. .,Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia, Australia.
| | | | - Pavan Teja Devanaboyina
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Jian-Ping Wu
- Academy of Advanced Interdisciplinary Studies and the Department of Biomedical Engineering of Southern University of Science and Technology, No 1088, Xueyaun Rd, Xili, Nanshan District, Shenzhen City, 518055, Guangdong Province, China
| | - Thomas Brett Kirk
- Department of Mechanical Engineering, Curtin University of Technology, Perth, Western Australia, Australia.,Faculty of Science and Engineering, Curtin University of Technology, Perth, Western Australia, Australia
| | - David Lloyd
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Kim SH, Cho WS, Joung HY, Choi YE, Jung M. Perfusion of the Rotator Cuff Tendon According to the Repair Configuration Using an Indocyanine Green Fluorescence Arthroscope: A Preliminary Report. Am J Sports Med 2017; 45:659-665. [PMID: 28272929 DOI: 10.1177/0363546516669778] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The disturbance of rotator cuff tendon perfusion has been connected with the suture-bridge configuration repair (SBCR) technique; however, in vivo assessments of the tendon blood supply have been problematic with other modalities. An evaluation of tissue perfusion by an indocyanine green (ICG) fluorescence arthroscope has been developed to counteract this difficulty. PURPOSE To verify the hindrance of perfusion in SBCR, we used an ICG fluorescence camera to compare parallel-type transosseous repair (PTR) and SBCR in rabbits immediately and at 3 days after rotator cuff repair. STUDY DESIGN Controlled laboratory study. METHODS Acute rotator cuff repair was performed on the shoulders of 10 rabbits. Both shoulders were repaired using either PTR or SBCR. For PTR, simple repair was performed through 2 parallel transosseous tunnels created using a microdrill. For SBCR, 2 additional crisscross transosseous tunnels were added to mimic arthroscopic SBCR. Immediately after repair, ICG was injected through the ear vein, and images were recorded using an ICG fluorescence camera. Tendon perfusion was compared by measuring fluorescence intensity using ImageJ software in both methods. At 3 days after rotator cuff repair, a reassessment of ICG fluorescence was performed. In addition, as a subsidiary study, a comparison of each repair method and a healthy tendon was performed (PTR vs healthy tendon and SBCR vs healthy tendon). Six rabbits (3 for each comparison) were included. RESULTS Immediately after rotator cuff repair, the mean (±SD) grayscale intensity of ICG fluorescence was weaker in SBCR than PTR in 10 specimens (65.9 ± 47.6 vs 84.3 ± 53.4 per pixel, respectively; P = .003). At 3 days after repair, 8 specimens were included in the analysis because suture strands failed in 2 specimens in SBCR. The mean intensity of fluorescence was still weaker in SBCR compared with PTR (52.5 ± 13.7 vs 60.2 ± 22.7 per pixel, respectively; P = .077). The mean fluorescence intensity compared with a healthy tendon was 83.2% ± 9.5% in PTR and 63.2% ± 13.2% in SBCR. CONCLUSION Our ICG fluorescence camera system was able to detect ICG fluorescence in an acute rabbit rotator cuff repair model. SBCR showed inferior tendon perfusion immediately after repair. At 3 days after repair, SBCR still showed inferior fluorescence intensity, although it did not reach statistical significance. CLINICAL RELEVANCE In this study, SBCR hindered perfusion at the tendon in the compressed area. This finding may affect rotator cuff tendon healing and failure mode.
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Affiliation(s)
- Sae Hoon Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho-Yun Joung
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Eun Choi
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Minwoong Jung
- Russia Science Seoul Center, Korea Electrotechnology Research Institute, Seoul, Korea
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McAuliffe S, McCreesh K, Culloty F, Purtill H, O'Sullivan K. Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis. Br J Sports Med 2016; 50:1516-1523. [DOI: 10.1136/bjsports-2016-096288] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 12/22/2022]
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Abstract
Synopsis Tendinopathy is frequently associated with structural disorganization within the tendon. As such, the clinical use of ultrasound and magnetic resonance imaging for tendinopathy has been the focus of numerous academic studies and clinical discussions. However, similar to other musculoskeletal conditions (osteoarthritis and intervertebral disc degeneration), there is no direct link between tendon structural disorganization and clinical symptoms, with findings on imaging potentially creating a confusing clinical picture. While imaging shows the presence and extent of structural changes within the tendon, the clinical interpretation of the images requires context in regard to the features of pain and the aggravating loads. This review will critically evaluate studies that have investigated the accuracy and sensitivity of imaging in the detection of clinical tendinopathy and the methodological issues associated with these studies (subject selection, lack of a robust gold standard, reliance on subjective measures). The advent of new imaging modalities allowing for the quantification of tendon structure or mechanical properties has allowed new critical insight into tendon pathology. A strength of these novel modalities is the ability to quantify properties of the tendon. Research utilizing ultrasound tissue characterization and sonoelastography will be discussed. This narrative review will also attempt to synthesize current research on whether imaging can predict the onset of pain or clinical outcome, the role of monitoring tendon structure during rehabilitation (ie, does tendon structure need to improve to get a positive clinical outcome?), and future directions for research, and to propose the clinical role of imaging in tendinopathy. J Orthop Sports Phys Ther 2015;45(11):842-852. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5880.
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Klauser AS, Miyamoto H, Bellmann-Weiler R, Feuchtner GM, Wick MC, Jaschke WR. Sonoelastography: musculoskeletal applications. Radiology 2014; 272:622-33. [PMID: 25153273 DOI: 10.1148/radiol.14121765] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
All participants for image samplings provided written informed consent. Conventional B-mode ultrasonography (US) has been widely utilized for musculoskeletal problems as a first-line approach because of the advantages of real-time access and the relatively low cost. The biomechanical properties of soft tissues reflect to some degree the pathophysiology of the musculoskeletal disorder. Sonoelastography is an in situ method that can be used to assess the mechanical properties of soft tissue qualitatively and quantitatively through US imaging techniques. Sonoelastography has demonstrated feasibility in the diagnosis of cancers of the breast and liver, and in some preliminary work, in several musculoskeletal disorders. The main types of sonoelastography are compression elastography, shear-wave elastography, and transient elastography. In this article, the current knowledge of sonoelastographic techniques and their use in musculoskeletal imaging will be reviewed.
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Affiliation(s)
- Andrea S Klauser
- From the Department of Diagnostic Radiology (A.S.K., G.M.F., M.C.W., W.R.J.) and Department of Internal Medicine I, Division of Clinical Immunology and Infectious Diseases (R.B.W.), Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; and Department of Orthopaedic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (H.M.)
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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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Klauser AS, Miyamoto H, Tamegger M, Faschingbauer R, Moriggl B, Klima G, Feuchtner GM, Kastlunger M, Jaschke WR. Achilles Tendon Assessed with Sonoelastography: Histologic Agreement. Radiology 2013; 267:837-842. [DOI: 10.1148/radiol.13121936] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Helfenstein M, Ferreira MS, Assad Maia AB, Fávaro Siena CA, Techy A. Ultrassonografia no diagnóstico da tendinite e eletroneuromiografia no diagnóstico da neuropatia periférica e da radiculopatia do membro superior – visão do reumatologista. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000300006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kavaguchi De Grandis A, Boulocher C, Viguier E, Roger T, Sawaya S. Ultrasonograph and clinical quantitative characterization of tendinopathy by modified splitting in a goat model. ScientificWorldJournal 2012; 2012:472023. [PMID: 22997496 PMCID: PMC3444857 DOI: 10.1100/2012/472023] [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: 05/21/2012] [Accepted: 07/16/2012] [Indexed: 12/03/2022] Open
Abstract
A tendinopathy is a clinical condition characterized by activity-related pain, focal tendons tenderness, and intratendinous imaging changes. This study characterizes a surgically induced tendinopathy in a goat model with a noninvasive in vivo longitudinal followup based on physical examination and US. Cross-sectional area (CSA) is the most objective feature for the evaluation of tendinopathy in correlation with clinical findings. The deep digital flexor tendon (DDFT) of the left hind limb of six goats was isolated and scarified by a modified splitting. Pain and lameness at walk and trot were evaluated. External width and thickness of tendon region were measured by calipers. CSA and the ratio lesion/tendon CSA were obtained at days 0, 7, 21, 42, and 84 by US. The highest value of global functional score was obtained at day 7, then decreased until day 40 and was not significantly different from day 0 at the end of the study. The external width recovered a normal value at the end of the study, but the external thickness was still significantly increased (P < 0.05). Peritendinous oedema was observed at day 7, but intratendinous lesions were visible only at day 21 as a focal hypo to anechoic area. At day 84, two tendons still presented visible lesions. US examination was reproducible, specific, and provided complementary information to the global functional score. A standardized focal tendinopathy was induced in goats. This experimental model of focal tendinopathy could be used to study the effect of different treatments.
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Affiliation(s)
- A Kavaguchi De Grandis
- Université de Lyon et VetAgro Sup, Campus Vétérinaire de Lyon, UPSP ICE, 69280 Marcy l'Etoile, France.
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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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Buck FM, Gheno R, Nico MAC, Haghighi P, Trudell DJ, Resnick D. Chiasma crurale: intersection of the tibialis posterior and flexor digitorum longus tendons above the ankle. Magnetic resonance imaging-anatomic correlation in cadavers. Skeletal Radiol 2010; 39:565-73. [PMID: 19876626 PMCID: PMC2856856 DOI: 10.1007/s00256-009-0817-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 10/02/2009] [Accepted: 10/05/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the precise anatomy and magnetic resonance (MR) imaging appearance of the chiasma crurale in cadavers, paying special attention to degenerative changes MATERIAL AND METHODS Twelve fresh human ankles were harvested from 11 nonembalmed cadavers (mean age at death 77 years) and used according to institutional guidelines. MR imaging and MR tenography were used to investigate the anatomy of the chiasma crurale using proton density-weighted sequences. The gross anatomy of the chiasma crurale was evaluated and compared to the MR imaging findings. Histology was used to elucidate further the structure of the chiasma crurale. RESULTS Above the chiasma, five specimens had a small amount of fat tissue between the tibialis posterior and flexor digitorum longus tendon. In all specimens both tendons had a sheath below the chiasma but not above it. At the central portion of the chiasma there was no soft tissue between the tendons, except in two specimens that showed an anatomic variant consisting of a thick septum connecting the tibial periosteum and the deep transverse fascia of the leg. In MR images, eight specimens showed what were believed to be degenerative changes in the tendons at the level of the chiasma. However, during gross inspection and histologic analysis of the specimens, there was no tendon degeneration visible. CONCLUSION At the central portion of the chiasma, there is no tissue between the tibialis posterior and flexor digitorum longus tendons unless there is an anatomic variant. At the chiasma crurale, areas with irregular tendon surfaces are normal findings and are not associated with tendon degeneration (fraying).
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Affiliation(s)
- Florian M. Buck
- Department of Radiology, VA San Diego Medical Center, San Diego, CA USA ,Present Address: Institut für Diagnostische Radiologie, Uniklinik Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Ramon Gheno
- Department of Radiology, VA San Diego Medical Center, San Diego, CA USA
| | | | - Parviz Haghighi
- Department of Pathology, VA San Diego Medical Center, San Diego, CA USA
| | - Debra J. Trudell
- Department of Radiology, VA San Diego Medical Center, San Diego, CA USA
| | - Donald Resnick
- Department of Radiology, VA San Diego Medical Center, San Diego, CA USA
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Joensen J, Couppe C, Bjordal JM. Increased palpation tenderness and muscle strength deficit in the prediction of tendon hypertrophy in symptomatic unilateral shoulder tendinopathy: an ultrasonographic study. Physiotherapy 2009; 95:83-93. [DOI: 10.1016/j.physio.2008.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 09/15/2008] [Indexed: 11/27/2022]
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Finnoff JT, Willick S, Akau CK, Harrast MA, Storm SA. Sports and Performing Arts Medicine: 6. Tendinopathy. PM R 2009; 1:S83-7. [DOI: 10.1016/j.pmrj.2009.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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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Robert Śmigielski. Management of Partial Tears of the Gastro-Soleus Complex. Clin Sports Med 2008; 27:219-29, x. [DOI: 10.1016/j.csm.2007.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Overuse syndromes due to lifestyle problems or sporting activities commonly lead to foot abnormalities. The tendons of the long flexor and extensor muscles are specifically prone to degeneration. The various disorders may be classified by a grading system that includes peritendinous inflammation, degenerative tendon disease, and ruptures. Bone marrow edema is another typical manifestation of overuse. It may be differentiated from inflammatory or traumatic forms of edema by its anatomic distribution. Systematic pattern recognition is based on the concept of musculotendinous and osseous kinetic chains.
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Affiliation(s)
- F Kainberger
- Klinik für Radiodiagnostik, AKH, Medizinische Universität Wien, Währinger Gürtel 18-20, A-1090 Wien.
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Harish S, Jan E, Finlay K, Petrisor B, Popowich T, Friedman L, Wainman B, Jurriaans E. Sonography of the superomedial part of the spring ligament complex of the foot: a study of cadavers and asymptomatic volunteers. Skeletal Radiol 2007; 36:221-8. [PMID: 17136559 DOI: 10.1007/s00256-006-0229-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 09/23/2006] [Accepted: 09/26/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the ability of high-resolution sonography for assessing the thickness and echogenicity of the superomedial part of the normal spring ligament in the foot in cadavers and asymptomatic volunteers. MATERIALS AND METHODS The superomedial part of the normal spring ligament of four cadaveric feet was imaged with a high-resolution linear array transducer. Upon localization, the ligament was injected with 0.1% methylene blue with sonographic guidance. A posteromedial approach was used to dissect the feet immediately following injection to confirm accurate identification of the ligament. The bilateral ligaments in 40 asymptomatic adult volunteers were subsequently imaged. RESULTS Surgical dissection confirmed the accurate injection of methylene blue into all four cadaveric ligaments. The superomedial part of the normal spring ligament was identified bilaterally in all of the 40 asymptomatic volunteers, with a mean thickness of 3 mm in longitudinal short axes. The ligament was echogenic relative to surrounding fat, and it was thinner in women. Differences in ligament measurements with respect to age, sex, side (left vs. right) and foot dominance were not significant. The volunteers' height, weight and body mass index had a weakly positive correlation with ligament thickness. CONCLUSION High-resolution ultrasound can be used to identify and measure the thickness of the superomedial part of the normal spring ligament. The provided baseline measurements for the normal ligament could prove valuable when assessing the abnormal ligament.
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Affiliation(s)
- Srinivasan Harish
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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Mello RAFD, Marchiori E, Santos AASD, Torres Neto G. Avaliação morfométrica do tendão de Aquiles por ultra-sonografia. Radiol Bras 2006. [DOI: 10.1590/s0100-39842006000300003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Determinar os valores normais dos diâmetros ântero-posterior e transversal do tendão de Aquiles na nossa população e correlacioná-los com sexo, faixa etária, cor da pele, grupo sanguíneo ABO e índice de massa corporal. MATERIAIS E MÉTODOS: Foi feita análise ultra-sonográfica de 100 tendões de Aquiles de 50 voluntários sadios, visando à mensuração dos diâmetros ântero-posterior e transversal desses tendões. Todos os exames foram realizados pelo mesmo examinador, em aparelho de ultra-sonografia com transdutor linear com freqüência de 10 MHz. RESULTADOS: Dos 50 voluntários estudados, 25 eram do sexo masculino e 25, do sexo feminino, com a faixa etária variando de 20 a 52 anos (média de 33,9 anos). O valor médio do diâmetro transversal do tendão de Aquiles foi de 13,3 ± 1,0 mm para o sexo feminino e 14,4 ± 1,4 mm para o sexo masculino; em relação ao diâmetro ântero-posterior, foi de 5,4 ± 0,5 mm para o sexo feminino e 5,6 ± 0,6 mm para o sexo masculino. Os diâmetros do tendão de Aquiles foram significativamente menores no sexo feminino (p < 0,05). Não houve diferença estatisticamente significativa entre os diâmetros ântero-posterior e transversal em relação a faixa etária, grupo sanguíneo e cor da pele. O grupo com índice de massa corporal de sobrepeso apresentou diâmetro transversal do tendão de Aquiles significativamente maior que do grupo com índice de massa corporal normal. CONCLUSÃO: Os valores médios encontrados na nossa casuística foram discordantes em relação à maioria dos estudos da literatura, demonstrando ser de grande importância a padronização e o emprego de tabelas próprias da nossa população na prática clínica diária.
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Affiliation(s)
| | - Edson Marchiori
- Universidade Federal Fluminense; Universidade Federal do Rio de Janeiro
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Knobloch K, Kraemer R, Lichtenberg A, Jagodzinski M, Gossling T, Richter M, Zeichen J, Hufner T, Krettek C. Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes. Am J Sports Med 2006; 34:92-7. [PMID: 16219947 DOI: 10.1177/0363546505278705] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neovascularisation can be detected qualitatively by Power Doppler in Achilles tendinopathy. Quantitative data regarding tendon microcirculation have not been established and may be substantial. PURPOSE To assess the microcirculation of the Achilles tendon and the paratendon in healthy volunteers as well as in athletes with either midportion or insertional tendinopathy. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS In 66 physically active volunteers, parameters of Achilles tendon and paratendon microcirculation, such as tissue oxygen saturation, relative postcapillary venous filling pressures, and microcirculatory blood flow, were determined at rest at 2-mm and 8-mm tissue depths. Forty-one patients never had Achilles pain (25 men, 27 +/- 8 years), 14 patients had insertional pain (7 men, 29 +/- 8 years), and 11 patients had midportion tendinopathy (7 men, 38 +/- 13 years, not significant). RESULTS Achilles tendon diameter 2 cm and 6 cm proximal to the insertion was increased in symptomatic tendons. Compared with the uninvolved opposite tendon, deep microcirculatory blood flow was significantly elevated at insertional (160 +/- 79 vs 132 +/- 42, P < .05) as well as in midportion tendinopathy (150 +/- 74 vs 119 +/- 34, P < .05). The microcirculation in the uninvolved opposite tendon and the normal athlete controls were not significantly different from each other (132 +/- 42 insertional asymptomatic vs 119 +/- 34 mid-portion vs 120 +/- 48 healthy tendon). Insertional paratendon deep microcirculatory flow was elevated in all groups, whereas tissue oxygen saturation and relative postcapillary venous filling pressures were not significantly different. CONCLUSION Microcirculatory blood flow is significantly elevated at the point of pain in insertional and midportion tendinopathy. Postcapillary venous filling pressures are increased at both the midportion Achilles tendon and the midportion paratendon, whereas tissue oxygen saturation is not different among the studied groups. We found no evidence of an abnormal microcirculation of the asymptomatic limb in Achilles tendinopathy.
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Affiliation(s)
- Karsten Knobloch
- Trauma Surgery, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Abstract
In the recent years there has been an increase in the number of tendon tears (TT) seen in routine daily outpatient practice secondary to the increasing popularity of sport activities. Tears require early diagnosis to ensure proper treatment and reduce functional impairment. Since local pain, edema and reflex muscle contraction can significantly limit the usefulness of clinical examination, imaging is usually required to confirm the clinical diagnosis, differentiate between partial and complete tear, and localize the retracted tendon stump. Several imaging modalities can be used in the evaluation of TT. Ultrasound is an efficient, dynamic, low cost and non invasive modality that is being increasingly utilized in the evaluation of the musculoskeletal system. It is well accepted by the acutely injured patient. The aim of this review article is to describe the ultrasound findings of the most common tendon tears.
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Affiliation(s)
- S Bianchi
- Fondation et Clinique des Grangettes, 7, chemin des Grangettes, 1224 Chêne-Bougeries, Suisse.
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25
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Bianchi S, Martinoli C, Abdelwahab IF. Ultrasound of tendon tears. Part 1: general considerations and upper extremity. Skeletal Radiol 2005; 34:500-12. [PMID: 15999281 DOI: 10.1007/s00256-005-0956-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 03/11/2005] [Accepted: 06/01/2005] [Indexed: 02/02/2023]
Abstract
The role of ultrasound (US) in assessing musculoskeletal disorders is persistently increasing because of its low cost, readiness, noninvasiveness, and possibility of allowing a dynamic examination. Secondary to increased sport practice, tendon tears are more frequently observed in daily medical practice. They deserve early diagnosis to allow proper treatment that can limit functional impairment. The aim of this review article is twofold: to illustrate the US appearance of normal tendons and to describe the US findings of the most common tendon tears.
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Affiliation(s)
- Stefano Bianchi
- Fondation des Grangettes Chene-Bougeries, Institut de Radiologie, Clinique des Grangettes Chene-Bougeries, Geneva, Switzerland.
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26
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Nallamshetty L, Nazarian LN, Schweitzer ME, Morrison WB, Parellada JA, Articolo GA, Rawool NM, Abidi NA. Evaluation of posterior tibial pathology: comparison of sonography and MR imaging. Skeletal Radiol 2005; 34:375-80. [PMID: 15895226 DOI: 10.1007/s00256-005-0903-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Revised: 01/13/2005] [Accepted: 01/25/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the results of sonographic (US) and magnetic resonance (MR) imaging in detecting pathology of the posterior tibial tendon (PTT) in patients with PTT dysfunction. DESIGN Twenty-two ankles that were clinically suspected by the orthopedic surgeon to have PTT dysfunction were evaluated with US (10 MHz linear-array transducer) and 1.5 T MR examinations within the same day. The US and MR studies were conducted and interpreted by two sonologists and two musculoskeletal radiologists who were masked to the results of the other study. Four patients had bilateral studies. Classic clinical findings were utilized as a standard reference in staging PTT dysfunction. PATIENTS Eighteen women (mean age 61 years, age range 39-86 years). RESULTS Based on a commonly accepted staging system for PTT dysfunction, 6 ankles were classified as stage I, 11 ankles as stage II, and 5 ankles as stage III. All stage I ankles were interpreted as having an intact PTT by both MR imaging and US. In the stage II and III tendons, MR imaging demonstrated PTT tears in 12 of 22 examinations, including 11 partial tears and 1 complete tear. US demonstrated PTT tears in 8 of 22 examinations, including 8 partial tears and no complete tears. The findings of US and MR imaging were consistent in 17 of 22 cases (77%). The five inconsistencies were as follows: in 4 cases, US reported tendinosis when MR imaging interpreted partial tears (no change in management); in one case, US diagnosed a partial tear when MR reported a complete tear of the PTT (no change in management because the clinical findings were more consistent with a partial tear). CONCLUSIONS In this study, US and MR imaging of the PTT were concordant in the majority of cases. US was slightly less sensitive than MR imaging for PTT pathology, but these discrepancies did not affect clinical management.
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Affiliation(s)
- Leelakrishna Nallamshetty
- Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, Philadelphia, PA 19107, USA.
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27
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Abstract
The Achilles tendon is the most commonly injured tendon in the foot and ankle; injuries commonly are related to sports/athletic activities. Imaging modalities that are used most commonly in the diagnostic assessment of the Achilles tendon include conventional radiography, ultrasonography, and MRI. This article reviews the normal and pathologic imaging features of the Achilles tendon, and highlights the potential usefulness and limitations of various imaging techniques in the noninvasive assessment of the tendon and the potential impact of imaging findings on clinical patient care.
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Affiliation(s)
- Robert R Bleakney
- Joint Department of Medical Imaging, University Health Network, and Mount Sinai Hospitals, 5th Floor, University of Toronto, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
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O'Connor PJ, Grainger AJ, Morgan SR, Smith KL, Waterton JC, Nash AFP. Ultrasound assessment of tendons in asymptomatic volunteers: a study of reproducibility. Eur Radiol 2004; 14:1968-73. [PMID: 15309497 DOI: 10.1007/s00330-004-2448-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Revised: 06/28/2004] [Accepted: 07/01/2004] [Indexed: 12/28/2022]
Abstract
The purpose was to evaluate the inter-visit, inter-observer and intra-observer variation of quantitative and qualitative tendon examinations in vivo for a cohort of asymptomatic volunteers. Eleven healthy male subjects were recruited. The following tendons were assessed by ultrasonography: Achilles tendon, patellar tendon, triceps tendon, extensor pollicis longus, flexor carpi radialis and supraspinatus. For each tendon a quantitative measurement of tendon size was made at a predefined anatomical location. Two experienced sonologists, blind to one another's findings, evaluated each of the tendons independently. Each tendon was evaluated on two occasions 1 week apart. No difference was found to be attributed to variation in tendon size between visits. Inter-observer variation was a source of error with intra-subject, inter-visit measurements proving more reproducible. There was some significant variation between observers. This variation was more marked with some tendon measures than others. Inter-observer variation for triceps, flexor carpi radialis and supraspinatus was most marked. Minimum detectable change in tendons varied from 13 to 57% depending on the plane of scanning and the tendon being examined. Good reproducibility of quantitative tendon measurements can be achieved within a study using two observers by following a defined scanning protocol. However, it is recommended that the same observer perform serial assessments. The data allow minimal detectable changes in tendon size to be calculated.
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Affiliation(s)
- Philip J O'Connor
- Department of Clinical Radiology, Leeds Teaching Hospitals Trust, The General Infirmary, Great George Street, LS1 3EX, Leeds, UK
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Klauser A, Stadlbauer KH, Frauscher F, Herold M, Klima G, Schirmer M, zur Nedden D. Value of transducer positions in the measurement of finger flexor tendon thickness by sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:331-337. [PMID: 15055779 DOI: 10.7863/jum.2004.23.3.331] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the value of 2 transducer positions for measurement of finger flexor tendon thickness by sonography. METHODS Flexor tendon thickness of the third finger was measured sonographically by 2 independent investigators in 20 healthy volunteers (n = 40 fingers) and in 4 cadaveric specimens (n = 4 fingers). Flexor tendon thickness was measured at histologic examination in the cadaveric specimens. We defined the area of the A1 annular pulley as position I and the area of the A2 annular pulley as position II. Sonographic measurements were performed in transverse (dorsovolar and radioulnar) and longitudinal planes. Interobserver and intraobserver variabilities were evaluated by each investigator performing 3 measurements at each position. RESULTS In position I, volunteers had flexor tendon thickness of 2.7 to 4.0 mm (mean +/- SD, 3.28 +/- 0.26 mm) longitudinally; transversally the thickness was 2.5 to 4.0 mm (mean, 3.34 +/- 0.29 mm) dorsovolar and 5.5 to 8.9 mm (mean, 7.34 +/- 0.71) radioulnar in position I. Position II revealed thickness of 3.2 to 4.2 mm (mean, 3.6 +/- 0.23 mm) longitudinally; transversally the thickness was 2.7 to 4.1 mm (mean, 3.4 +/- 0.27) dorsovolar and 4.3 to 6.8 mm (mean, 5.27 +/- 0.65) radioulnar. Interobserver and intraobserver variability for position I was better than for position II (P < .01 versus P < .05). Sonographic findings correlated excellently with histologic findings (r2 = 0.94). CONCLUSIONS Standardized transducer positions for sonographic measurements of finger flexor tendon thickness showed good interobserver and intraobserver variability. Position I was found to be more reliable than position II.
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Affiliation(s)
- Andrea Klauser
- Department of Radiology II, University Hospital Innsbruck, Innsbruck, Austria.
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30
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Abstract
Scope of this article is to give practical hints for the most common, typical and important topics of trauma radiology in children to those radiologists who are not exclusively occupied with paediatric imaging. Due to the increased radiation sensitivity of children compared with adults balancing radiation protection and necessary image quality is of utmost importance. Outlines for this optimisation process are given. Especially in imaging of the extremities perhaps the greatest difficulties are posed by the dynamically changing face of the immature, growing, only partially ossified skeleton. Lack of experience must be compensated by meticulous comparison with the normal skeletal development as shown in standard textbooks, and by knowledge of the radiological image of the developmental variants. Besides general remarks about paediatric trauma radiology, some important topics are discussed into more detail. Especially the elbow joint poses a challenge for those less experienced with its radiological appearance in children. More than in adults, ultrasound should remain the primary imaging modality of choice especially in the assessment of abdominal trauma, and CT be tailored to radiological and clinical findings. Imaging and diagnosis of non-accidental injury (NAI) may be a less common task for the general radiologist, however, the severe social implications of physical child abuse mandate a basic knowledge about the radiological symptoms and the imaging management of this problem for all physicians occupied with paediatric radiology.
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Affiliation(s)
- Gerald Pärtan
- Radiology Department and Ludwig Boltzmann Institute for Digital Radiography and Interventional Radiology, Danube Hospital, Langobardenstrasse 122, A-1220 Vienna, Austria.
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31
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Bleakney RR, Tallon C, Wong JK, Lim KP, Maffulli N. Long-term ultrasonographic features of the Achilles tendon after rupture. Clin J Sport Med 2002; 12:273-8. [PMID: 12394198 DOI: 10.1097/00042752-200209000-00003] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the long-term ultrasonographic appearance of rupture of the Achilles tendon. SUBJECTS AND METHODS We examined 70 patients at an average of 63 months (range 10-120 months) after rupture of the Achilles tendon. We assessed the patient's contralateral tendon and also performed ultrasonography on the Achilles tendon of 70 age- and sex-matched controls. We recorded the maximum transverse anteroposterior diameter, the presence of intratendinous alterations, and the presence of intratendinous calcification. RESULTS The average maximum anteroposterior diameter of the ruptured tendon was 11.7 mm (SD = 2.10). The patients' normal tendons measured an average of 5.4 mm (SD = 0.9), and there was an average measure of 4.9 mm (SD = 0.5) (p = 0.0001) in the controls. There was no difference in the maximum anteroposterior diameter of the ruptured tendon depending on the method of treatment (conservative, open repair, percutaneous repair). Seventeen patients exhibited areas of hypoechogenicity in their ruptured tendon, two patients had areas of hypoechogenicity in their unruptured contralateral tendon, and 10 patients had calcification in their ruptured tendon. CONCLUSION The anteroposterior diameter of the ruptured tendon was significantly greater than the nonruptured contralateral. However, when compared with a group of individually age- and sex-matched controls, the patients' contralateral tendons had significantly greater maximum anteroposterior diameter and had a greater prevalence of intratendinous alterations. This difference may represent a background of subclinical tendinopathy that may predispose to rupture.
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Affiliation(s)
- Robert R Bleakney
- Department of Radiology, Aberdeen Royal Infirmary, Foresterhill, Scotland
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32
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Bikkina RS, Chaljub G, Singh H, Allen SD. Magnetic resonance imaging of simultaneous bilateral quadriceps tendon rupture in a weightlifter: case report. THE JOURNAL OF TRAUMA 2002; 52:582-4. [PMID: 11901344 DOI: 10.1097/00005373-200203000-00032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ravi S Bikkina
- Department of Radiology, University of Texas Medical Branch, Galveston, Texas 77555-0465, USA
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Abstract
With the rising popularity of recreational sports, radiologists are being asked to image tendons with increasing frequency. Recognition of the critical link tendons provide between muscle and bone has also led to a better understanding of the processes leading to tendon damage. While plain radiography and CT have only a limited role to play in the diagnosis of tendon abnormality, the improvements in ultrasound and MRI technology mean that tendons can now be demonstrated in exquisite detail and previously undetectable abnormalities are readily demonstrated. This article reviews the structure and pathological processes affecting tendons and discusses the role of imaging in their assessment with an emphasis on ultrasound and MRI.
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Affiliation(s)
- R S Campbell
- Department of Radiology, South Cleveland Hospital, Middlesborough, UK.
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34
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Affiliation(s)
- M E Schweitzer
- Both authors: Department of Radiology, Thomas Jefferson University Hospital, 111 S. 11th St., 3390 Gibbon, Philadelphia, PA 19107, USA
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35
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36
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Abstract
The refinement of high frequency transducers has improved the ability of ultrasound (US) to detect fine textural abnormalities of tendons and nerves and to identify a variety of pathologic conditions. Characteristic echotextural patterns, closely resembling the histologic ones, are typically depicted in these structures using high US frequencies. In tendon imaging, US can identify tendon dislocations, degenerative changes, differentiate partial from complete tears and determine whether the patient has to be treated surgically or conservatively. A spectrum of findings in inflammatory conditions, including paratendonitis and tenosynovitis, and tendon tumors also can be detected. In nerve imaging, US can support clinical and electrophysiologic testing for detection of compressing lesions caused by nerve entrapment in a variety of osteofibrous tunnels of the limbs and extremities. Nerve tears and tumors also can be diagnosed. Overall, US is an effective technique for imaging tendons and nerves.
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Affiliation(s)
- C Martinoli
- Department of Radiology R, University of Genova, Italy.
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37
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Rand T, Bindeus T, Alton K, Voegele T, Kukla C, Stanek C, Imhof H. Low-field magnetic resonance imaging (0.2 T) of tendons with sonographic and histologic correlation. Cadaveric study. Invest Radiol 1998; 33:433-8. [PMID: 9704281 DOI: 10.1097/00004424-199808000-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES The authors evaluate the role of low-field strength magnetic resonance imaging (MRI) compared with sonography in the evaluation of degenerative changes of tendons, with histologic correlation, based on investigations of horse cadavers. METHODS Low-field MRI and sonography was performed in 42 hours specimens for the evaluation of tendons and ligaments. Magnetic resonance imaging included sagittal and axial T1-weighted, T2-weighted, and gradient echo images. Sonography and MR images were evaluated for degenerative changes or tears and the findings were correlated with the histologic results. RESULTS Using histologic findings as a gold standard, the accuracy for the sonographic evaluation was 65.9%, sensitivity was 16.7%, and specificity was 100%. The corresponding data for low-field MR imaging were 70.5% accuracy, 44.4% sensitivity, and 88.5% specificity. CONCLUSIONS Low-field MRI investigation allows more accurate staging of tendinous changes than sonography. It is more reproducible and potentially includes the advantages of the combined evaluation of bones, ligaments, and soft tissue.
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Affiliation(s)
- T Rand
- Department of Radiology, University of Vienna, Austria
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