1
|
Patricios J, Rossiter M, Cunningham C, Fitzpatrick J, Hirschmueller A, Mweli T, Roos B, Thornton JS. From da Vinci to definitive diagnosis: how training in sports ultrasound harnesses sound, science and skill. Br J Sports Med 2021; 56:118-119. [PMID: 34193472 DOI: 10.1136/bjsports-2021-104667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Jon Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael Rossiter
- Faculty of Sport & Exercise Medicine, Edinburgh, UK.,Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK
| | - Corey Cunningham
- Medical, NSW Institute of Sport, Sydney, New South Wales, Australia.,Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
| | - Jane Fitzpatrick
- Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia.,Centre for Health and Exercise Sports Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Anja Hirschmueller
- ALTIUS Swiss Sportmed Center AG, Rheinfelden, Switzerland.,Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Thamsanqa Mweli
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Dr Sulman and Partners, Netcare Rosebank Hospital, Johannesburg, South Africa
| | - Beverly Roos
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane S Thornton
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| |
Collapse
|
2
|
Abstract
Achilles tendinopathy is a common cause of disability. Despite the economic and social relevance of the problem, the causes and mechanisms of Achilles tendinopathy remain unclear. Tendon vascularity, gastrocnemius-soleus dysfunction, age, sex, body weight and height, pes cavus, and lateral ankle instability are considered common intrinsic factors. The essence of Achilles tendinopathy is a failed healing response, with haphazard proliferation of tenocytes, some evidence of degeneration in tendon cells and disruption of collagen fibers, and subsequent increase in noncollagenous matrix. Tendinopathic tendons have an increased rate of matrix remodeling, leading to a mechanically less stable tendon which is more susceptible to damage. The diagnosis of Achilles tendinopathy is mainly based on a careful history and detailed clinical examination. The latter remains the best diagnostic tool. Over the past few years, various new therapeutic options have been proposed for the management of Achilles tendinopathy. Despite the morbidity associated with Achilles tendinopathy, many of the therapeutic options described and in common use are far from scientifically based. New minimally invasive techniques of stripping of neovessels from the Kager's triangle of the tendo Achillis have been described, and seem to allow faster recovery and accelerated return to sports, rather than open surgery. A genetic component has been implicated in tendinopathies of the Achilles tendon, but these studies are still at their infancy.
Collapse
|
3
|
Chen HH. The Third Eye of the Rheumatologist: Applications of Musculoskeletal Ultrasound in Rheumatic Diseases. J Med Ultrasound 2017; 25:4-8. [PMID: 30065447 PMCID: PMC6029281 DOI: 10.1016/j.jmu.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/24/2017] [Indexed: 11/23/2022] Open
Abstract
Rheumatologists manage patients with rheumatic diseases, which are of a wide range of musculoskeletal pathologies. Without clarification of the exact location of pathologies and the degree of inflammation, rheumatologists may have an incorrect assessment, leading to inappropriate management. In everyday practice, physical examination is limited by its sensitivity and power of assessment. Musculoskeletal ultrasonography (MSUS) is inexpensive, readily available, and allows side-by-side image comparisons. Thus, during the past 10 years, MSUS has become the “third eye” of the rheumatologist, in that it allows more detailed examination of muscles, bones, and joints, just as the stethoscope provides further details about the respiratory and circulatory systems. We briefly introduce how rheumatologists in Taiwan use MSUS for the diagnosis and treatment for rheumatic diseases.
Collapse
Affiliation(s)
- Hsin-Hua Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan, ROC
| |
Collapse
|
4
|
Benazzo F, Marullo M, Indino C, Zanon G. Achilles Tendinopathies. ARTHROSCOPY AND SPORT INJURIES 2016:69-76. [DOI: 10.1007/978-3-319-14815-1_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
5
|
Dones VC, Grimmer K, Thoirs K, Suarez CG, Luker J. The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review. BMC Med Imaging 2014; 14:10. [PMID: 24589069 PMCID: PMC4015882 DOI: 10.1186/1471-2342-14-10] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 02/17/2014] [Indexed: 11/17/2022] Open
Abstract
Background Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral epicondylalgia. Despite the number of diagnostic studies for Lateral Epicondylalgia, there is no consensus in the current literature on the best abnormal ultrasound findings that confirm lateral epicondylalgia. Methods Eligible studies identified by searching electronic databases, scanning reference lists of articles and chapters on ultrasound in reference books, and consultation of experts in sonography. Three reviewers (VCDIII, KP, KW) independently searched the databases using the agreed search strategy, and independently conducted all stages of article selection. Two reviewers (VCDIII, KP) then screened titles and abstracts to remove obvious irrelevance. Potentially relevant full text publications which met the inclusion criteria were reviewed by the primary investigator (VCDIII) and another reviewer (CGS). Results Among the 15 included diagnostic studies in this review, seven were Level II diagnostic accuracy studies for chronic lateral epicondylalgia based on the National Health and Medical Research Council Hierarchy of Evidence. Based from the pooled sensitivity of abnormal ultrasound findings with homogenous results (p > 0.05), the hypoechogenicity of the common extensor origin has the best combination of diagnostic sensitivity and specificity. It is moderately sensitive [Sensitivity: 0.64 (0.56-0.72)] and highly specific [Specificity: 0.82 (0.72-0.90)] in determining elbows with lateral epicondylalgia. Additionally, bone changes on the lateral epicondyle [Sensitivity: 0.56 (0.50-0.62)] were moderately sensitive to chronic LE. Conversely, neovascularity [Specificity: 1.00 (0.97-1.00)], calcifications [Specificity: 0.97 (0.94-0.99)] and cortical irregularities [Specificity: 0.96 (0.88-0.99)] have strong specificity for chronic lateral epicondylalgia. There is insufficient evidence supporting the use of Power Doppler Ultrasonogrophy, Real-time Sonoelastography and sonographic probe-induced tenderness in diagnosing LE. Conclusions The use of Gray-scale Ultrasonography is recommended in objectively diagnosing lateral epicondylalgia. The presence of hypoechogenicity and bone changes indicates presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia. In addition to diagnosis, detection of these abnormal ultrasound findings allows localization of pathologies to tendon or bone that would assist in designing an appropriate treatment suited to patient’s condition.
Collapse
Affiliation(s)
- Valentin C Dones
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia.
| | | | | | | | | |
Collapse
|
6
|
Yu TY, Tsai WC, Cheng JW, Yang YM, Liang FC, Chen CH. The effects of aging on quantitative sonographic features of rotator cuff tendons. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:471-478. [PMID: 22508403 DOI: 10.1002/jcu.21919] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 02/24/2012] [Indexed: 05/31/2023]
Abstract
PURPOSE Grayscale analysis is a practical, objective, and easy way to quantify echogenicity during ultrasonography. The purpose of the current study was to measure the changes in thickness and echogenicity that result from aging of the rotator cuff and long head of the biceps tendons. METHODS The study comprised 45 volunteers, aged between 20 and 84 years and without history of shoulder pain. Participants were divided into three groups: young, middle-aged, and old. All subjects underwent standard ultrasonography of both shoulders. Tendon thickness and tear were recorded, and images in both transverse and longitudinal scans were taken for grayscale analysis. To reduce the attenuation effect from skin and subcutaneous fat, we used the ratio of echogenicity of the tendon to that of the reference muscle and compared the tendon echogenicity among the different age groups. Sonographic findings were also correlated with age. RESULTS The supraspinatus tendon was significantly thicker in elderly participants and this was positively correlated with age. Moreover, the echogenicity ratio of the supraspinatus tendon decreased in the elderly group and showed a negative correlation with age. There was a higher prevalence of supraspinatus tendon tears in the older participants. CONCLUSIONS Our results indicate that supraspinatus tendons became thickened, hypoechogenic, and more likely to tear with age. The study presents a simple and useful method to investigate the echogenicity of the rotator cuff quantitatively.
Collapse
Affiliation(s)
- Tung-Yang Yu
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | | | | | | | | | | |
Collapse
|
7
|
|
8
|
Bowen CJ, Dewbury K, Sampson M, Sawyer S, Burridge J, Edwards CJ, Arden NK. Musculoskeletal ultrasound imaging of the plantar forefoot in patients with rheumatoid arthritis: inter-observer agreement between a podiatrist and a radiologist. J Foot Ankle Res 2008; 1:5. [PMID: 18822149 PMCID: PMC2553775 DOI: 10.1186/1757-1146-1-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 07/28/2008] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The use of musculoskeletal ultrasound (MSUS) in the diagnosis and management of foot and ankle musculoskeletal pathology is increasing. Due to the wide use of MSUS and the depth and breadth of training required new proposals advocate tailored learning of the technique to discrete fields of practice. The aims of the study were to evaluate the inter-observer agreement between a MSUS radiologist and a podiatrist, who had completed basic skills training in MSUS, in the MSUS assessment of the forefoot of patients with Rheumatoid Arthritis. METHODS A consecutive sample of thirty-two patients with rheumatoid arthritis was assessed for presence of synovitis, erosions and bursitis within the forefoot using MSUS. All MSUS assessments were performed independently on the same day by a podiatrist and one of two Consultant Radiologists experienced in MSUS. RESULTS Moderate agreement on image acquisition and interpretation was achieved for bursitis (kappa 0.522; p < 0.01) and erosions (kappa 0.636; p < 0.01) and fair agreement for synovitis (kappa 0.216; p < 0.05) during the primary assessments. Following a further training session, substantial agreement (kappa 0.702) between the two investigators was recorded. The sensitivity of the podiatrist using MSUS was 82.4% for detection of bursitis, 83.0% for detection of erosion and 84.0% for detection of synovitis. Specificity of the podiatrist using MSUS was 88.9% for detection of bursitis, 80.7% for detection of erosion and 35.9% for detection of synovitis. CONCLUSION This study demonstrated good inter-observer agreement between a podiatrist and radiologist on MSUS assessment of the forefoot, particularly for bursitis and erosions, in patients with rheumatoid arthritis. There is scope to further evaluate and consider the role of podiatrists in the MSUS imaging of the foot following appropriate training and also in the development of reliable protocols for MSUS assessment of the foot.
Collapse
Affiliation(s)
- Catherine J Bowen
- School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton, UK.
| | | | | | | | | | | | | |
Collapse
|
9
|
Alfredo Chávez-López M, Naredo E, Carlos Acebes-Cachafeiro J, de Miguel E, Cabero F, Sánchez-Pernaute O, Jiménez-Palop M, Javier Aceves-Ávila F. Agudeza diagnóstica del examen físico de rodilla en la artritis reumatoide: estudio clínico y sonogr‡fico del derrame articular y quiste de Baker. ACTA ACUST UNITED AC 2007; 3:98-100. [DOI: 10.1016/s1699-258x(07)73675-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 03/01/2007] [Indexed: 11/16/2022]
|
10
|
Abstract
Although Achilles tendinopathy has been extensively studied, there is a clear lack of properly conducted scientific research to clarify its etiology, pathology and optimal management. Emerging non-operative management and heavy load eccentric strengthening protocols based on these theories have yielded encouraging early results. Operative management traditionally produced good to excellent results, but randomized controlled studies comparing different surgical procedures and prospective evaluation of patient outcomes are necessary to truly establish the efficacy of these procedures. As the biology of tendinopathy is being clarified, more effective management regimens may come to light, improving the success rate of both conservative and operative management.
Collapse
Affiliation(s)
- Anand M Vora
- Lake Forest Orthopaedic Associates, Illinois Bone and Joint Institute Ltd., 720 Florsheim Drive, Libertyville, IL 60048, USA
| | | | | | | |
Collapse
|
11
|
Luukkainen R, Sanila MT, Saltyshev M, Huhtala H, Koski JM. Relationship between clinically detected joint swelling and effusion diagnosed by ultrasonography in elbow joints in patients with rheumatoid arthritis. Clin Rheumatol 2004; 24:228-31. [PMID: 15940556 DOI: 10.1007/s10067-004-1010-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 07/28/2004] [Indexed: 11/29/2022]
Abstract
The aim of this study was to compare the relationship between clinically detected swelling and effusion diagnosed by ultrasonography (US) in elbow joints in patients with rheumatoid arthritis (RA). Fifty consecutive patients with RA entered the study and 20 healthy persons formed a control group. Altogether 100 elbow joints of the RA patients and 40 of the controls were studied. All the clinical assessments were performed by one doctor and the US investigations by the other and they were blinded to each others results. In 77 elbow joints of the RA patients the clinical assessment and the US gave similar results, whereas they differed in the remaining 23 joints. The kappa coefficient between these investigations was 0.371. In the control group no elbow joint showed either swelling in the clinical assessment or effusion in the US investigation. The results of this study indicate that clinical assessment of swelling and evaluation of effusion by US in elbow joints in patients with RA show only fair agreement. Thus, US may improve the accuracy of diagnosis of synovitis in many cases in these patients.
Collapse
Affiliation(s)
- R Luukkainen
- Department of Rheumatology, Rauma Regional Hospital, Steniuksenkatu 2, 26100, Rauma, Finland.
| | | | | | | | | |
Collapse
|
12
|
Grassi W, Filippucci E, Carotti M, Salaffi F. Imaging modalities for identifying the origin of regional musculoskeletal pain. Best Pract Res Clin Rheumatol 2003; 17:17-32. [PMID: 12659819 DOI: 10.1016/s1521-6942(02)00099-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Regional musculoskeletal pain is one of the most common complaints in daily rheumatological practice. Conventional radiology remains the cornerstone of diagnostic imaging in these patients despite the advent of new, fascinating imaging techniques. Ultrasonography may have a relevant impact on final diagnosis or therapeutic choices. It is highly sensitive to the identification of fine, soft-tissue changes and it should be considered as an integral part of the clinical examination in most patients. Scintigraphy is indicated when multifocal processes have to be excluded and when high sensitivity is required. Computed tomography is an excellent tool for the assessment of osseous based abnormalities. Magnetic resonance has several characteristics of the ideal diagnostic tool. However, its appropriateness in the evaluation of many regional musculoskeletal conditions is a matter for discussion. An appropriate diagnostic programme for patients with regional musculoskeletal pain has to be focused on the strengths and weaknesses of various imaging techniques.
Collapse
Affiliation(s)
- Walter Grassi
- Clinica Reumatologica, Università degli Studi di Ancona, Ospedale A. Murri, Via dei Colli, 52. 60035 Jesi (Ancona), Italy.
| | | | | | | |
Collapse
|
13
|
Kader D, Saxena A, Movin T, Maffulli N. Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med 2002; 36:239-49. [PMID: 12145112 PMCID: PMC1724537 DOI: 10.1136/bjsm.36.4.239] [Citation(s) in RCA: 254] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Achilles tendinopathy is prevalent and potentially incapacitating in athletes involved in running sports. It is a degenerative, not an inflammatory, condition. Most patients respond to conservative measures if the condition is recognised early. Surgery usually involves removal of adhesions and degenerated areas and decompression of the tendon by tenotomy or measures that influence the local circulation.
Collapse
Affiliation(s)
- D Kader
- Department of Orthopaedic Surgery, University of Aberdeen Medical School, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | | | | | | |
Collapse
|
14
|
Abstract
PURPOSE The purpose of the present research was to test the diagnostic value of ultrasonography (US) to detect chondrocalcinosis in the hyalin cartilage (HC). METHOD This was tested on both knees of 21 selected patients with a history of unilateral HC and 19 controls. In Group, I (US), evaluation was performed on selected knees. The selection was based on the evidence of HC on previous radiographs. In Group II, US examination of the contralateral side of the same cohort was performed first and radiographic picture was done as a second step. RESULTS Ultrasonically, detectable calcification was present in 17 of 21 in Groups I and II, respectively. The US findings of the latter were confirmed on radiographs in 15. The sensitivity and specificity of Groups I and II were 80-100% and 89-91%, respectively. The overall sensitivity and specificity of US in calcification verification in HC proved to be 89% and 90%. Popliteal cyst was detected in 10 cases of which 8 showed evidence of calcification in the bursal fluid. Typical calcium pyrophosphate dihydrate (CPPD) crystals could be demonstrated in five of those. CONCLUSION US is a valuable, sensitive and specific method in the evaluation of patients with chondrocalcinosis and crystal deposition disease.
Collapse
Affiliation(s)
- Karoly Foldes
- Institute of Pulmonology, Megyei Tudogyogyintezet, Nogradgardony, 2661, Balassagyarmat Pf. 23, Hungary
| |
Collapse
|
15
|
Grassi W, Farina A, Filippucci E, Cervini C. Sonographically guided procedures in rheumatology. Semin Arthritis Rheum 2001; 30:347-53. [PMID: 11303307 DOI: 10.1053/sarh.2001.19822] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide some representative examples of sonographically guided arthrocentesis and intralesional injection therapy. METHODS Sonographic evaluation was performed with high-frequency linear (13 MHz) and mechanical sector (20 MHz) transducers. The images were obtained in representative patients with rheumatoid arthritis and posttraumatic subacromial bursitis. RESULTS Sonographically guided intralesional injection is a rapid and reliable procedure, especially in patients with arthritis, tenosynovitis, and bursitis. After target localization, needle placement can be performed under continuous sonographic monitoring. Sonographic guidance is particularly useful when fluid collections are small (less than 5 mm) and deep or when the inflammatory process is adjacent to anatomic structures that could be seriously damaged by the injection. CONCLUSIONS Over the last few years, the rapid technologic advancements in ultrasonography have dramatically increased the potential applications of sonographically guided procedures. The simplicity and reliability of the technique might warrant rheumatologists to undergo sonographic training.
Collapse
Affiliation(s)
- W Grassi
- Department of Rheumatology, University of Ancona, Italy.
| | | | | | | |
Collapse
|
16
|
Fraser A, Veale DJ. What practical skills do rheumatologists of the future need? Best Pract Res Clin Rheumatol 2000; 14:635-48. [PMID: 11092793 DOI: 10.1053/berh.2000.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this chapter, we consider future practical skills required for rheumatologists. While difficult to predict against a background of rapid technological advance and successive changes to health-care provision world wide, a number of questions are examined. The first question is what core skills are essential in the curriculum? This has been addressed in at least one joint European effort by UEMS. Great diversity in both clinical practice and training was found across Europe; clearly, the difference across continents may prove even more significant. Second, the role of arthroscopy is considered, the evidence for its therapeutic benefit in clinical rheumatology practice being inconclusive. Issues concerning diagnostic methods including electrophysiology and ultrasound (US) are also discussed in this chapter. There is evidence to support the use of electrophysiology in routine diagnosis for specific diseases. US has become popular as technology improves. It is cheap but highly operator dependent, and the feasibility of rheumatologists using US in the clinic remains to be proved. In conclusion, health care is changing rapidly, and training must adapt, and is adapting, to meet its challenges. A number of opportunities will present to the rheumatologist of the future, but the feasibility of these in routine clinical practice remains to be seen.
Collapse
Affiliation(s)
- A Fraser
- Rheumatology Rehabilitation Research Unit, Department of Rheumatology, Old Home, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | | |
Collapse
|
17
|
Grassi W, Filippucci E, Farina A, Cervini C. Sonographic imaging of the distal phalanx. Semin Arthritis Rheum 2000; 29:379-84. [PMID: 10924024 DOI: 10.1053/sarh.2000.7002] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the potential role of ultrasonography (US) with very high frequency transducers in assessing distal phalanx involvement in some rheumatic diseases. METHODS We performed sonographic evaluation with an Esaote AU-4 Idea (Esaote Biomedica, Genoa, Italy) equipped with a 13-MHz linear transducer. The images were obtained in asymptomatic healthy subjects and representative patients with psoriatic arthritis, osteoarthritis of the distal interphalangeal joint (Heberden's nodes), erosive osteoarthritis, gout, rheumatoid arthritis, systemic sclerosis, and posttraumatic synovial cyst. RESULTS US with very high frequency transducers allowed a careful identification of the following anatomic details: joint space, extensor and flexor tendons, bone margin, periarticular and peritendinous soft tissues, nail, and blood vessels. Several pathological changes were depicted in different rheumatic disorders. These included joint space widening, tendon sheath widening, dislocation of the joint surfaces, irregularity of the bone margin, and urate and calcium deposits within periarticular soft tissues. CONCLUSIONS Very high frequency US is able to depict the anatomic substrate of distal phalanx involvement in several rheumatic diseases, adding useful information to clinical examination of the hand.
Collapse
Affiliation(s)
- W Grassi
- Department of Rheumatology, University of Ancona, Italy
| | | | | | | |
Collapse
|
18
|
Abstract
This article presents a clinical approach to the role of ultrasound in the assessment of intra-articular and extra-articular knee pathology, including a comprehensive review of both acute and chronic conditions that may affect the tendons, ligaments, and bursae related to the knee joint. A brief review of the ultrasound findings in degenerative and inflammatory arthropathies and some of the more common tumors and masses that may be encountered around the symptomatic knee also has been included. Finally, the limited role of ultrasound in the assessment of the knee menisci and the symptomatic postarthroscopic patient is discussed.
Collapse
Affiliation(s)
- R Ptasznik
- Melbourne Diagnostic Imaging Group, Epworth Hospital, Australia
| |
Collapse
|
19
|
Abstract
To successfully examine the musculoskeletal system sonographically, one must understand the normal musculoskeletal anatomy and function and be aware of the abnormal processes that affect the musculoskeletal structures. The goal of this review article is to provide a systematic approach to sonographic examination of the musculoskeletal system. The general sonographic appearances of normal and abnormal muscles, tendons, ligaments, bursae, and nerves are reviewed. The article then applies this general information to specific clinical applications by reviewing the normal anatomy of and specific pathologic conditions that affect the shoulder, elbow, hand, wrist, hip, knee, ankle, and foot.
Collapse
Affiliation(s)
- B E Hashimoto
- Department of Radiology, Virginia Mason Medical Center, Seattle, Washington 98111, USA
| | | | | |
Collapse
|