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Tarabichi S, Lizcano JD, Abe EA, Goh GS, Baker CM, Parvizi J. Finding the Optimal Screening Test for Periprosthetic Joint Infection: A Prospective Study. J Arthroplasty 2024:S0883-5403(24)00129-3. [PMID: 38452860 DOI: 10.1016/j.arth.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND No single test has demonstrated absolute accuracy in the diagnosis of periprosthetic joint infection (PJI). Serological markers are often used as screening tools to avoid unnecessary joint aspiration in cases with a low probability of infection. This study aimed to determine the utility of standard-of-care serological tests as a screening tool for PJI in patients undergoing revision arthroplasty. METHODS This prospective study enrolled 502 patients undergoing revision hip or knee arthroplasty between May 2017 and August 2021. A PJI was defined using a modified definition of the 2018 International Consensus Meeting criteria. Plasma D-dimer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen were measured preoperatively. There were 82 patients undergoing reimplantation who were excluded. Additionally, 8 patients who had an inconclusive International Consensus Meeting score were also excluded. Of the 412 included patients, 317 (76.9%) underwent revision for aseptic failure, and 95 (23.1%) had PJI. Receiver operating characteristic curves were used to assess the diagnostic utility of each serological test. A pairwise comparison with Bonferroni correction was performed to determine whether the differences in areas under the curve (AUCs) between the tests were significant. Additional analyses were performed to find the threshold for each test that offered 100% sensitivity, allowing it to be the optimal screening test. RESULTS All 4 serological markers, D-dimer (AUC 0.860, sensitivity 81.3%, specificity 81.7%), CRP (AUC 0.862, sensitivity 90.4%, specificity 70.0%), ESR (AUC 0.833, sensitivity 73.9%, specificity 85.2%), and fibrinogen (AUC 0.798, sensitivity 74.7%, specificity 75.4%), demonstrated comparable accuracy for the diagnosis of PJI (all P > .05). When maximizing sensitivity to 100%, D-dimer demonstrated the highest specificity (AUC 0.860, specificity 40.2%), outperforming ESR (AUC 0.833, specificity 3.3%), fibrinogen (AUC 0.798, specificity 2.3%), and CRP (AUC 0.862, specificity 0%). A plasma D-dimer level of ≥ 244 ng/mL was identified as the optimal cutoff for use as a screening test. CONCLUSIONS Although plasma D-dimer demonstrated similar diagnostic accuracy as CRP, ESR, and fibrinogen, it outperformed all 3 aforementioned serological markers when used as a screening test for PJI. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Saad Tarabichi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Juan D Lizcano
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elizabeth A Abe
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Graham S Goh
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Colin M Baker
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Cleveland Clinic South Pointe, Cleveland, Ohio
| | - Javad Parvizi
- International Joint Center, Acibadem University Hospital, Istanbul, Turkey
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2
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Malhotra G, Hansford BG, Felcher C, Wuerfel KA, Yablon CM. Fluoroscopic-guided procedures of the lower extremity. Skeletal Radiol 2023; 52:855-874. [PMID: 35930079 PMCID: PMC9362560 DOI: 10.1007/s00256-022-04139-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
This article reviews the literature and the authors' experiences regarding the performance of lower extremity fluoroscopically guided procedures from the hip to the toes. An overview of injections and aspirations, their indications, risks, and complications are provided, focusing on anesthetics, corticosteroids, and contrast agents. A variety of approaches to each joint and the associated pearls and pitfalls of each approach will be discussed.
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Affiliation(s)
- Gunjan Malhotra
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Barry G. Hansford
- grid.5288.70000 0000 9758 5690Department of Radiology, Oregon Health & Science University, 3181 SW Jackson Park Rd., Portland, OR 97239 USA
| | - Cindy Felcher
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Kristie A. Wuerfel
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Corrie M. Yablon
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
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3
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Labmayr V, Eckhart FJ, Smolle M, Klim S, Fischerauer SF, Bernhardt G, Seibert FJ. [Sterile puncture of large joints]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:65-80. [PMID: 36648491 PMCID: PMC9894986 DOI: 10.1007/s00064-022-00786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Puncture of large joints is performed for diagnostic purposes on the one hand and for the treatment of joint pathologies on the other. Puncture can be used for rapid pain relief by relieving effusions or intra-articular hematomas. The obtained puncture specimen allows immediate visual assessment and subsequent microscopic-cytological and microbiological evaluation in the laboratory. INDICATIONS The indication for puncture of a large joint is for diagnosis and/or therapy of inflammatory, traumatic or postoperative joint problems. Diagnostic punctures are used to obtain punctate, to differentiate the location of pain or (rarely) to apply contrast medium for magnetic resonance arthrography. Therapeutic punctures allow the injection of drugs or platelet-rich plasma (PRP) as well as the relief or drainage of effusions. CONTRAINDICATIONS If there are inflammatory skin alterations-especially purulent inflammation-joint punctures through these lesions are absolutely contraindicated. Special attention is necessary if the patients are on anticoagulants. SURGICAL TECHNIQUE Absolute sterile handling is mandatory. Unnecessary pain can be avoided by a sterile skin wheal of local anesthesia, safe puncture points, and careful handling of the cannulas. POSTOPERATIVE MANAGEMENT Joint aspiration material has to be handled according to the local, intrahospital rules in a timely manner. Puncture sites are covered with sterile dressings, and if intra-articular medication is administered, the joints have to be passively moved through the range of motion to distribute the medication. Thereafter, compression therapy from distally to proximally while also covering the puncture site avoids recurrence of swelling or hematoma. FACTS If sterile conditions are guaranteed, infections rarely occur (0.04-0.08%, 4-8/10,000 cases). The risk of false-positive detection of microorganisms is extremely low.
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Affiliation(s)
- Viktor Labmayr
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | | | - Maria Smolle
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Sebastian Klim
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Stefan Franz Fischerauer
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Gerwin Bernhardt
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Franz Josef Seibert
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
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4
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Pierce JL, Perry MT, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Banks J, Caracciolo JT, DeGeorge KC, Demertzis JL, Garner HW, Scott JA, Sharma A, Beaman FD. ACR Appropriateness Criteria® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot): 2022 Update. J Am Coll Radiol 2022; 19:S473-S487. [PMID: 36436971 DOI: 10.1016/j.jacr.2022.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Musculoskeletal infections involve bones, joints, and soft tissues. These infections are a common clinical scenario in both outpatient and emergent settings. Although radiography provides baseline findings, a multimodality approach is often implemented to provide more detailed information on the extent of infection involvement and complications. MRI with intravenous contrast is excellent for the evaluation of musculoskeletal infections and is the most sensitive for diagnosing osteomyelitis. MRI, CT, and ultrasound can be useful for joint and soft tissue infections. When MRI or CT is contraindicated, bone scans and the appropriate utilization of other nuclear medicine scans can be implemented for aiding in the diagnostic imaging of infection, especially with metal hardware and arthroplasty artifacts on MRI and CT. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Jennifer L Pierce
- University of Virginia, Charlottesville, Virginia; Associate Division Chair, Musculoskeletal Radiology, University of Virginia; Radiology Residency Global Health Leadership Track Program Director, University of Virginia.
| | - Michael T Perry
- Research Author, University of Virginia Health Center, Charlottesville, Virginia
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- The Johns Hopkins University School of Medicine, Baltimore, Maryland; member
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri; MSK Imaging and Interventions Fellowship Director, Mallinckrodt Institute of Radiology
| | - James Banks
- Aventura Hospital, Aventura, Florida; Student Radiology Rotation Clerkship Director for HCA Florida Aventura and Kendall Hospitals; Nova Southeastern University, Fort Lauderdale, Florida
| | - Jamie T Caracciolo
- Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; MSK-RADS (Bone) Committee; Section Head, MSK Imaging, Moffitt Cancer Center; Chairman, ACR MSK-RADS Committee
| | - Katharine C DeGeorge
- University of Virginia, Charlottesville, Virginia; Primary care physician; Deputy Editor, DynaMed; and Advisory Board, Flo Health Medical
| | - Jennifer L Demertzis
- Diagnostic Imaging Associates, Chesterfield, Missouri; Partner, ProSight Radiology
| | - Hillary W Garner
- Mayo Clinic Florida, Jacksonville, Florida; Committee Chair, Society of Skeletal Radiology and International Skeletal Society
| | - Jinel A Scott
- SUNY Downstate Health Sciences University, Brooklyn, New York; Chief Quality Officer
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging; Chair, Research Committee, Radiology, Mayo Clinic Florida; PET-MRI workgroup, Mayo Clinic Florida
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Fritz J, Meshram P, Stern SE, Fritz B, Srikumaran U, McFarland EG. Diagnostic Performance of Advanced Metal Artifact Reduction MRI for Periprosthetic Shoulder Infection. J Bone Joint Surg Am 2022; 104:1352-1361. [PMID: 35730745 DOI: 10.2106/jbjs.21.00912] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The diagnosis of periprosthetic shoulder infection (PSI) in patients with a painful arthroplasty is challenging. Magnetic resonance imaging (MRI) may be helpful, but shoulder implant-induced metal artifacts degrade conventional MRI. Advanced metal artifact reduction (MARS) improves the visibility of periprosthetic bone and soft tissues. The purpose of our study was to determine the reliability, repeatability, and diagnostic performance of advanced MARS-MRI findings for diagnosing PSI. METHODS Between January 2015 and December 2019, we enrolled consecutive patients suspected of having PSI at our academic hospital. All 89 participants had at least 1-year clinical follow-up and underwent standardized clinical, radiographic, and laboratory evaluations and advanced MARS-MRI. Two fellowship-trained musculoskeletal radiologists retrospectively evaluated the advanced MARS-MRI studies for findings associated with PSI in a blinded and independent fashion. Both readers repeated their evaluations after a 2-month interval. Interreader reliability and intrareader repeatability were assessed with κ coefficients. The diagnostic performance of advanced MARS-MRI for PSI was quantified using sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). When applying the International Consensus Meeting (ICM) 2018 criteria, of the 89 participants, 22 (25%) were deemed as being infected and 67 (75%) were classified as being not infected (unlikely to have PSA and not requiring a surgical procedure during 1-year follow-up). RESULTS The interreader reliability and intrareader repeatability of advanced MARS-MRI findings, including lymphadenopathy, joint effusion, synovitis, extra-articular fluid collection, a sinus tract, rotator cuff muscle edema, and periprosthetic bone resorption, were good (κ = 0.61 to 0.80) to excellent (κ > 0.80). Lymphadenopathy, complex joint effusion, and edematous synovitis had sensitivities of >85%, specificities of >90%, odds ratios of >3.6, and AUC values of >0.90 for diagnosing PSI. The presence of all 3 findings together yielded a PSI probability of >99%, per logistic regression analysis. CONCLUSIONS Our study shows the clinical utility of advanced MARS-MRI for diagnosing PSI when using the ICM 2018 criteria as the reference standard. Although the reliability and diagnostic accuracy were high, these conclusions are based on our specific advanced MARS-MRI protocol interpreted by experienced musculoskeletal radiologists. Investigations with larger sample sizes are needed to confirm these results. LEVEL OF EVIDENCE Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jan Fritz
- New York University Grossman School of Medicine, New York University, New York, NY
| | | | - Steven E Stern
- Centre for Data Analytics, Bond University, Gold Coast, Queensland, Australia
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Uma Srikumaran
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Edward G McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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6
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Roberts CC, Metter DF, Fox MG, Appel M, Jawetz ST, Morrison WB, Nacey N, Said N, Stensby JD, Subhas N, Tynus KM, Walker EA, Yu JS, Kransdorf MJ. ACR Appropriateness Criteria® Imaging After Shoulder Arthroplasty: 2021 Update. J Am Coll Radiol 2022; 19:S53-S66. [PMID: 35550805 DOI: 10.1016/j.jacr.2022.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 11/19/2022]
Abstract
Shoulder arthroplasty is a common orthopedic procedure with a complication rate reported to be as high as 39.8% and revision rates as high as 11%. Symptoms related to postoperative difficulties include activity-related pain, decreased range of motion, and apprehension. Some patients report immediate and persistent dissatisfaction, although others report a symptom-free postoperative period followed by increasing pain and decreasing shoulder function and mobility. Imaging plays an important role in diagnosing postoperative complications of shoulder arthroplasties. The imaging algorithm should always begin with radiographs. The selection of the next imaging modality depends on several factors, including findings on the initial imaging study, clinical suspicion of an osseous versus soft-tissue injury, and clinical suspicion of infection.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Michael G Fox
- Panel Chair, Musculoskeletal Division Chair and Diagnostic Radiology Program Director, Mayo Clinic Arizona, Phoenix, Arizona
| | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons; and liaison with AOOS
| | - Shari T Jawetz
- Director, Radiology Quality Assurance; Director, Radiology Resident and Medical Student Education; and Chief, Division of Body CT, Hospital for Special Surgery, New York, New York
| | - William B Morrison
- Director, Division of Musculoskeletal Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; ACR education center faculty; ACR AIRP faculty; ACR CPI author
| | - Nicholas Nacey
- Fellowship Director, Imaging Center Medical Director, University of Virginia Health System, Charlottesville, Virginia
| | - Nicholas Said
- Medical Director of MRI Duke University Health System, Access Champion Department of Radiology, Director of Musculoskeletal Intervention, Duke University Medical Center, Durham, North Carolina
| | - James D Stensby
- MSK Imaging Fellowship Director, University of Missouri Health Care, Columbia, Missouri
| | - Naveen Subhas
- Vice Chair of Clinical Effectiveness and Efficiency, Imaging Institute Program Director, Musculoskeletal Radiology; and Director, Bone Mineral Densitometry, Cleveland Clinic, Cleveland, Ohio
| | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland; Past President of the Penn State College of Medicine Faculty Organization, ACR local chapter PRS President Elect
| | - Joseph S Yu
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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7
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Bretagne V, Delapierre A, Cerasuolo D, Bellot A, Marcelli C, Guillois B. Randomized Controlled Study of a Training Program for Knee and Shoulder Arthrocentesis on Procedural Simulators with Assessment on Cadavers. ACR Open Rheumatol 2022; 4:312-321. [PMID: 34989181 PMCID: PMC8992473 DOI: 10.1002/acr2.11400] [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: 06/26/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022] Open
Abstract
Objective The study objective was to assess the efficacy of simulators in improving the competence of students in performing a knee and shoulder arthrocentesis on cadavers and to determine the minimum number of simulator training procedures needed to achieve competence in arthrocentesis. Methods Two groups of 15 medical students were each trained to perform a single joint arthrocentesis (“knee group” and “shoulder group”) on a simulator to serve as a control for the other. The two groups received the same theoretical training (anatomy, arthrocentesis techniques, ultrasound, and hybrid simulation). Each student punctured the two joints on a cadaver. A student was considered “competent on the cadaver” if they succeeded at two or more arthrocentesis procedures out of the three tests on the joint on which they were trained. The minimum threshold value to be competent was calculated by a receiver operating characteristic curve and the Youden index. An assessment of theoretical knowledge and confidence level in joint arthrocentesis was carried out at the start and end of the study. Results Twenty‐two out of 29 students (75.8%) achieved competence in arthrocentesis at the joint for which they were trained. Of the students in the knee group, 79% were competent on the cadaver’s knee versus 60% of the students in the shoulder group (P = 0.43). Of students in the shoulder group, 74% were competent on the cadaver’s shoulder versus 57% of students in the knee group (P = 0.45). Four training punctures on a simulator are necessary to achieve competence on a cadaver. The students’ confidence level in arthrocentesis increased significantly during the study, as did the students’ theoretical knowledge. Conclusion Knee and shoulder arthrocentesis success rates were not statistically different between the two training groups. A minimum number of 4.0 training arthrocentesis on a simulator is needed to achieve competency on a cadaver.
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8
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Dünkel J, Tamborrini G. [CME-Sonography 105: Ultrasound in Sports Injuries]. PRAXIS 2022; 111:397-420. [PMID: 35611482 DOI: 10.1024/1661-8157/a003882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CME-Sonography 105: Ultrasound in Sports Injuries Abstract. Muscle injuries are frequent in athletes and in the general population. For therapy and prognosis, it is important to understand the total extent of the injury and to be aware of possible complications. In most cases ultrasound is a useful tool for diagnostics of muscle injuries. However, muscle ultrasound is not as common as joint ultrasound; this article discusses the possibilities of high-resolution dynamic ultrasound in diagnostics and its limitations.
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Affiliation(s)
| | - Giorgio Tamborrini
- UZR® - Schweizer Ultraschallzentrum und Institut für Rheumatologie, Basel, Schweiz
- Klinik für Rheumatologie, Universitätsspital Basel, Basel, Schweiz
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9
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Papalexis N, Ponti F, Rinaldi R, Peta G, Bruno R, Miceli M, Battaglia M, Marinelli A, Spinnato P. Ultrasound-Guided Treatments for the Painful Shoulder. Curr Med Imaging 2021; 18:693-700. [PMID: 34872482 DOI: 10.2174/1573405617666211206112752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/30/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022]
Abstract
Shoulder pain is an extremely common condition. The painful shoulder may be the result of a wide spectrum of underlying pathological conditions, including calcific tendinopathy of the rotator cuff, subacromial-subdeltoid bursitis, acromioclavicular or glenohumeral arthritis, tenosynovitis of the long biceps tendon, rotator cuff lesions, and many other less common conditions. Ultrasound imaging is an effective tool for the diagnosis and also for the image guidance of treatment of the majority of these conditions. Several ultrasound-guided procedures are effective for pain relief, such as percutaneous irrigation, intra-bursal or intra-articular drugs injection, fluid aspiration, neural block. This review article aims to summarize and discuss the most common treatment possibilities with ultrasound guidance for the painful shoulder.
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Affiliation(s)
- Nicolas Papalexis
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Raffaella Rinaldi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Giuliano Peta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Riccardo Bruno
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Milva Battaglia
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | | | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
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10
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Sahoo RK, Galluccio F, Chang KV, Perez MF. Indications and Future Perspectives of a Minimally Invasive Ultrasound-guided Double-needle Joint Lavage. J Med Ultrasound 2021; 29:291-293. [PMID: 35127412 PMCID: PMC8772468 DOI: 10.4103/jmu.jmu_120_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/29/2020] [Accepted: 12/04/2020] [Indexed: 11/04/2022] Open
Abstract
Arthroscopic joint lavage was proposed as a treatment option for different joint conditions such as septic or inflammatory arthritis. Ultrasound (US) is today considered a fundamental tool in musculoskeletal diseases as for diagnostic and guide for interventional procedures such as synovial fluid sampling and drug injections. To enable faster recovery and to have an alternative to surgery, to reduce risks and costs, we performed an US-guided double-needle lavage of the shoulder joint. Here, we present two different clinical cases, the first with septic arthritis and the second with recalcitrant gouty arthritis, successfully treated with this technique.
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Affiliation(s)
- Rajendra Kumar Sahoo
- Department of Anesthesiology and Pain Management, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.,Morphological Madrid Research Center, Madrid, Spain
| | - Felice Galluccio
- Morphological Madrid Research Center, Madrid, Spain.,Medical-Geriatric Department, Division of Rheumatology, University Hospital AOU Careggi, Florence, Italy
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Mario Fajardo Perez
- Morphological Madrid Research Center, Madrid, Spain.,Department of Anesthesia and Reanimation, Hospital Universitario Mostoles, Madrid, Spain
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11
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Septic Arthritis: An Evidence-Based Review of Diagnosis and Image-Guided Aspiration. AJR Am J Roentgenol 2020; 215:568-581. [PMID: 32783556 DOI: 10.2214/ajr.20.22773] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. The purpose of this evidence-based review is to equip radiologists to discuss and interpret findings obtained with various imaging modalities, guide patient selection for percutaneous aspiration, and safely perform arthrocentesis to assess for infection in both native and prosthetic joints. CONCLUSION. Septic arthritis is an emergency that can lead to rapidly progressive, irreversible joint damage. Despite the urgency associated with this diagnosis, there remains a lack of consensus regarding many aspects of the management of native and periprosthetic joint infections.
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12
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Yausep OE, Madhi I, Trigkilidas D. Platelet rich plasma for treatment of osteochondral lesions of the talus: A systematic review of clinical trials. J Orthop 2020; 18:218-225. [PMID: 32071508 PMCID: PMC7013135 DOI: 10.1016/j.jor.2020.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The ankle is the second most frequent site, following the knee, that requires cartilage repair. Osteochondral lesion of the talus (OLT) is common among athletes and is a result of talar cartilage detachment with or without subchondral bone fragmentation after a traumatic event. Treatment strategies for OLT can be classified as reparative or replacement interventions, with the former taking precedence. Recent studies show that the growth factors and bioactive components in platelet rich plasma (PRP) could improve cartilage regeneration. The prospect of using autologous blood to obtain a product that could enhance regeneration in damaged cartilage has been regarded as innovative, as it could circumvent the need for a replacement, and potentially join the ranks of first line reparative interventions against cartilage diseases. METHODS Literature searches were performed across seven search engines for randomized controlled trials using PRP to treat patients with OLT. Outcomes extracted included ankle function and pain measures. Level of evidence and methodological quality were evaluated using relevant guidelines. RESULTS Four studies met the eligibility criteria and were systematically appraised. Two studies scored Level 1 and 2 scored Level 2 based on the LOE assessment. MQOE evaluation revealed one study with excellent quality, and three with good quality. Overall results showed that PRP, as an adjunct to microfracture surgery, significantly improved function and reduced pain compared to microfracture surgery alone. Intra-articular PRP injection also demonstrated significantly enhanced recovery of function, and decreased pain scores compared to HA. CONCLUSION PRP improves joint function, and reduces pain in patients with OLT regardless of the method of implementation. In addition, inter-study comparison demonstrated that patients that received surgery along with PRP injections improved more than those that received PRP only. The studies that corroborate this conclusion have high levels of evidence with satisfactory methodological quality. LEVEL OF EVIDENCE Level 2, systematic review of Level 1 and 2 studies.
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Affiliation(s)
| | - Imad Madhi
- Orthopedic Division, South Tyneside District Hospital, South Shields, United Kingdom
| | - Dionysios Trigkilidas
- Orthopedic Division, South Tyneside District Hospital, South Shields, United Kingdom
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Pearls and pitfalls of fluoroscopic-guided foot and ankle injections: what the radiologist needs to know. Skeletal Radiol 2019; 48:1661-1674. [PMID: 31062056 DOI: 10.1007/s00256-019-03226-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/11/2019] [Accepted: 04/17/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This article provides a comprehensive, joint-by-joint review of fluoroscopic-guided foot and ankle injections and emphasizes pre-procedural planning, relevant anatomy, appropriate technique, troubleshooting the difficult procedure, and the importance of communicating unexpected findings with the referring clinician. The interrogation of pain generators including variant ossicles, fractures, and post-surgical/traumatic findings is also described. CONCLUSIONS Even the most challenging foot and ankle injections may be successfully completed with a solid anatomical understanding and thoughtful approach.
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Porrino J, Richardson ML, Flaherty E, Albahhar M, Ha AS, Mulcahy H, Chew FS. Septic Arthritis and Joint Aspiration: The Radiologist's Role in Image-Guided Aspiration for Suspected Septic Arthritis. Semin Roentgenol 2019; 54:177-189. [PMID: 31128740 DOI: 10.1053/j.ro.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jack Porrino
- Yale School of Medicine Radiology and Biomedical Imaging, 20 York Street, New Haven, CT 06510.
| | | | - Erin Flaherty
- Kaiser Permanente Washington Medical Group, Tacoma, WA
| | - Mahmood Albahhar
- Niagara Health-St Catharines Hospital, McMaster university, St Catharines, ON, Canada
| | - Alice S Ha
- Department of Radiology, University of Washington, Seattle, WA
| | | | - Felix S Chew
- Department of Radiology, University of Washington, Seattle, WA
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15
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Interventional therapeutic procedures to treat degenerative and inflammatory musculoskeletal conditions: state of the art. Radiol Med 2019; 124:1112-1120. [PMID: 30828775 DOI: 10.1007/s11547-019-01018-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
Imaging-guided interventional procedures have become increasingly popular in the treatment of several pathologic conditions in the musculoskeletal system. Besides oncological treatments, musculoskeletal procedures can be performed to treat different degenerative or inflammatory conditions. This paper is aimed to review clinical indications and technical aspects of these kinds of procedures. In particular, we revise the general aspects common to most procedures and the different imaging-guided interventions which can be performed around joints, soft tissues, and spine.
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16
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Monfaredi R, Iordachita I, Wilson E, Sze R, Sharma K, Krieger A, Fricke S, Cleary K. Development of a shoulder-mounted robot for MRI-guided needle placement: phantom study. Int J Comput Assist Radiol Surg 2018; 13:1829-1841. [PMID: 30099660 DOI: 10.1007/s11548-018-1839-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This paper presents new quantitative data on a signal-to-noise ratio (SNR) study, distortion study, and targeting accuracy phantom study for our patient-mounted robot (called Arthrobot). Arthrobot was developed as an MRI-guided needle placement device for diagnostic and interventional procedures such as arthrography. METHODS We present the robot design and inverse kinematics. Quantitative assessment results for SNR and distortion study are also reported. A respiratory motion study was conducted to evaluate the shoulder mounting method. A phantom study was conducted to investigate end-to-end targeting accuracy. Combined error considering targeting accuracy, respiratory motion, and structure deformation is also reported. RESULTS The SNR study showed that the SNR changes only 2% when the unpowered robot was placed on top of a standard water phantom. The distortion study showed that the maximum distortion from the ground truth was 2.57%. The average error associated with respiratory motion was 1.32 mm with standard deviation of 1.38 mm. Results of gel phantom targeting studies indicate average needle placement error of 1.64 mm, with a standard deviation of 0.90 mm. CONCLUSIONS Noise and distortion of the MR images were not significant, and image quality in the presence of the robot was satisfactory for MRI-guided targeting. Combined average total error, adding mounting stability errors and structure deformation errors to targeting error, is estimated to be 3.4 mm with a standard deviation of 1.65 mm. In clinical practice, needle placement accuracy under 5 mm is considered sufficient for successful joint injection during shoulder arthrography. Therefore, for the intended clinical procedure, these results indicate that Arthrobot has sufficient positioning accuracy.
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Affiliation(s)
- Reza Monfaredi
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA.
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Emmanuel Wilson
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Raymond Sze
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Karun Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Axel Krieger
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Stanley Fricke
- Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
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17
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Zhang M, Pessina MA, Higgs JB, Kissin EY. A Vascular Obstacle in Ultrasound-Guided Hip Joint Injection. J Med Ultrasound 2018; 26:77-80. [PMID: 30065523 PMCID: PMC6029204 DOI: 10.4103/jmu.jmu_8_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/05/2017] [Indexed: 11/05/2022] Open
Abstract
Background: We evaluated the risk of lateral circumflex femoral artery (LCFA) injury during ultrasound-guided intra-articular hip injections. Methods: This study was divided into three parts. (1) Four ultrasound-guided hip injections were performed on human cadavers. With needles in place, tissues were dissected to expose the LCFA. (2) Ultrasound-trained rheumatologists marked a planned needle trajectory from skin to hip joint on live human ultrasound images during an Observed Structured Clinical Examination (OSCE). Doppler was subsequently activated to locate the LCFA, and the distance between trajectory and arterial signal was recorded. (3) Rheumatologists certified in musculoskeletal ultrasound were surveyed about joint injection vascular complications. Results: (1) In one of the four cadaveric dissections, the needle made direct contact with the LCFA. (2) Of 27 OSCE participants, only two activated Doppler before marking simulated hip injection trajectories. Trajectories passed through LCFA Doppler signal in six (22%) cases. Mean minimal distance from trajectory to arterial signal was 4 mm (range, 0–11 mm). (3) Of 62 survey respondents, 24% stated that they did not use Doppler routinely. While none reported bleeding injuries with their patients, 16% knew of a hip injection-related vascular complication performed by another provider. Conclusion: There is a risk of LCFA injury during ultrasound-guided hip joint injection. Routine use of Doppler should be considered in standard hip injection protocols.
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Affiliation(s)
- MaryAnn Zhang
- Department of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Monica A Pessina
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jay B Higgs
- Brooke Army Medical Center, San Antonio, Texas, USA
| | - Eugene Y Kissin
- Department of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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18
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Ingber RB, Alhammoud A, Murray DP, Abraham R, Dixit A, Naziri Q, Ahmed G, Paulino CB, Urban WP, Craig C, Maheshwari AV, Diebo BG. A Systematic Review and Meta-Analysis of Procalcitonin as a Marker of Postoperative Orthopedic Infections. Orthopedics 2018; 41:e303-e309. [PMID: 29658977 DOI: 10.3928/01477447-20180409-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/31/2017] [Indexed: 02/03/2023]
Abstract
Procalcitonin is a serologic marker that increases in response to inflammatory stimuli, especially those of bacterial origin. Postoperative orthopedic periprosthetic infections are often difficult to diagnose. This study systematically reviewed the literature to evaluate the statistical measures of performance of procalcitonin as a marker of postoperative orthopedic infection. This study showed that procalcitonin has a weighted pooled sensitivity of 67.3%, specificity of 69.4%, positive likelihood ratio of 1.778, negative likelihood ratio of 0.423, and diagnostic odds ratio of 5.770. These results illustrate that procalcitonin is an effective serologic marker for postoperative bacterial infections. [Orthopedics. 2018; 41(3):e303-e309.].
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19
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Porrino J, Carlson B, Kani KK, Mulcahy H, Wyatt A, Chew FS. Disappearing Acts: The Many Causes of Rapidly Destructive Arthritis. Curr Probl Diagn Radiol 2017; 46:63-73. [DOI: 10.1067/j.cpradiol.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/24/2016] [Indexed: 01/12/2023]
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20
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Gyftopoulos S, Rosenberg ZS, Roberts CC, Bencardino JT, Appel M, Baccei SJ, Cassidy RC, Chang EY, Fox MG, Greenspan BS, Hochman MG, Jacobson JA, Mintz DN, Newman JS, Shah NA, Small KM, Weissman BN. ACR Appropriateness Criteria Imaging After Shoulder Arthroplasty. J Am Coll Radiol 2016; 13:1324-1336. [PMID: 27814833 DOI: 10.1016/j.jacr.2016.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 10/20/2022]
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21
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Belair JA, Hegazi TM, Roedl JB, Zoga AC, Omar IM. Core Injuries Remote from the Pubic Symphysis. Radiol Clin North Am 2016; 54:893-911. [PMID: 27545427 DOI: 10.1016/j.rcl.2016.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The core, or central musculoskeletal system of the torso, is essential for participating in sports and other physical activities. Core injuries are commonly encountered in athletes and active individuals. The importance of the midline pubic plate and rectus abdominis-adductor aponeurosis for core stability and function is discussed in the literature. This review article examines other important core injuries remote from the pubic symphysis, relevant clinical features, and preferred approaches to imaging. Several specific syndromes encountered in the core are reviewed. By protocoling imaging studies and identifying pathology, radiologists can add value to the clinical decision-making process and help guide therapeutic options.
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Affiliation(s)
- Jeffrey A Belair
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA.
| | - Tarek M Hegazi
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA; Department of Radiology, University of Dammam, PO Box 2114, Dammam 31451, Saudi Arabia
| | - Johannes B Roedl
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA
| | - Adam C Zoga
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
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22
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Martel Villagrán J, Bueno Horcajadas Á, Agrela Rojas E. Intervencionismo en musculoesquelético. Ecografía y tac. RADIOLOGIA 2016; 58 Suppl 2:45-57. [DOI: 10.1016/j.rx.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/09/2016] [Accepted: 03/19/2016] [Indexed: 01/23/2023]
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Periprosthetic Joint Infection After Hip and Knee Arthroplasty: A Review for Emergency Care Providers. Ann Emerg Med 2016; 68:324-34. [PMID: 27083857 DOI: 10.1016/j.annemergmed.2016.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/18/2016] [Accepted: 02/29/2016] [Indexed: 01/27/2023]
Abstract
Periprosthetic joint infection is among the most common modes of failure of a total hip or knee arthroplasty and can be a common concern when patients present to the emergency department for care. The initial evaluation for periprosthetic joint infection includes a history and physical examination, followed by radiographs (to rule out other causes of pain or failure) and then serum erythrocyte sedimentation rate and C-reactive protein testing. If the erythrocyte sedimentation rate and C-reactive protein level are elevated or if the clinical suspicion for infection is high, the joint should be aspirated and the fluid sent for culture, as well as for a synovial WBC count and differential, with optimal threshold values of 3,000 WBC/μL and 80% polymorphonuclear cells, respectively. Recent work has shown that optimal cutoff values for patients presenting in the early postoperative period (within the first 6 weeks postoperatively) are different, with a C-reactive protein level greater than or near 100 mg/L (normal <10 mg/L), indicating the need for aspiration, with synovial fluid WBC thresholds of 10,000 WBC/μL and 90% polymorphonuclear cells. Antibiotics should not be administered before joint aspiration unless the patient has systemic signs of sepsis because even a single dose may cloud the interpretation of subsequent tests, including cultures taken from the joint. Furthermore, superficial cultures taken from wound drainage are discouraged because they can similarly cloud diagnosis and treatment. The rising prevalence of total joint arthroplasty makes proficiency in the assessment and early management of periprosthetic joint infection important for the emergency physician to optimize clinical outcomes.
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Orlandi D, Corazza A, Arcidiacono A, Messina C, Serafini G, Sconfienza LM, Silvestri E. Ultrasound-guided procedures to treat sport-related muscle injuries. Br J Radiol 2015; 89:20150484. [PMID: 26562097 DOI: 10.1259/bjr.20150484] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Ultrasound is well known as a low-cost, radiation-free and effective imaging technique to guide percutaneous procedures. The lower limb muscles represent a good target to perform such procedures under ultrasound guidance, thus allowing for clear and precise visualization of the needle during the whole procedure. The knowledge of guidelines and technical aspects is mandatory to act in the most safe and accurate way on target tissues that can be as small as a few millimetres. This review will focus above the local treatments of traumatic lower limb muscle injuries described in literature, focusing on new and promising approaches, such as platelet-rich plasma treatment of muscle tears in athletes. For each procedure, a brief how-to-do practical guide will be provided, emphasizing precautions and tricks based on day-by-day experience that may help to improve the outcome of percutaneous ultrasound-guided procedures around the lower limb muscles.
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Affiliation(s)
- Davide Orlandi
- 1 Department of Radiology, Genoa University, Genova, Italy
| | - Angelo Corazza
- 1 Department of Radiology, Genoa University, Genova, Italy
| | | | - Carmelo Messina
- 2 Department of Radiology, IRCCS Policlinico San Donato, Milano, Italy
| | - Giovanni Serafini
- 3 Department of Radiology, Ospedale Santa Corona, Pietra Ligure, Savona, Italy
| | - Luca M Sconfienza
- 2 Department of Radiology, IRCCS Policlinico San Donato, Milano, Italy.,4 Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy
| | - Enzo Silvestri
- 5 Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy
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Fluoroscopy-guided infiltration for pain reduction in patients with Baastrup's disease: clinical experience and results. Skeletal Radiol 2015; 44:1327-31. [PMID: 25930945 DOI: 10.1007/s00256-015-2154-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 03/29/2015] [Accepted: 04/13/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Baastrup disease refers to degenerative changes of adjacent spinous processes with resultant back pain. The purpose of this study is to assess the safety and efficacy of percutaneous, fluoroscopy-guided infiltrations in a consecutive series of patients suffering from Baastrup disease. MATERIALS AND METHODS From January 2009 until December 2013, 55 patients suffering from Baastrup disease (diagnosed clinically and by imaging findings) underwent percutaneous, fluoroscopy-guided infiltration. The position of the needle (22-gauge spinal needle) was fluoroscopically verified at the level of interspinous ligament. Then a mixture of long-acting corticosteroid with local anesthetic (1.5/1 cc) was injected. A questionnaire with NVS scale helped in assessing pain relief degree, life quality, and mobility improvement. RESULTS In the patients of our study, a total of 67 sessions was performed. In 12/55 patients (22%), a second infiltration was performed within 7-10 days apart from the first one. The end point was 1 year post-treatment. Patients were followed 1 week after the first injection for a subsequent treatment and then if asymptomatic re-controlled in 3-6 and 12 months. Comparing the pain scores prior (mean value, 8.18 ± 1.44 NVS units) and after (mean value, 0.62 ± 0.93 NVS units) there was a mean decrease of 7.56 ± 1.68 NVS units (p < 0.001) on terms of pain reduction, effect upon mobility and life quality. There were no clinically significant complications noted in our study. CONCLUSIONS Fluoroscopy-guided infiltrations seem to be a feasible, efficacious, and safe approach for pain reduction and mobility improvement in patients with Baastrup disease.
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Natali GL, Paolantonio G, Fruhwirth R, Alvaro G, Parapatt GK, Toma' P, Rollo M. Paediatric musculoskeletal interventional radiology. Br J Radiol 2015; 89:20150369. [PMID: 26235144 DOI: 10.1259/bjr.20150369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population.
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Affiliation(s)
- Gian L Natali
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | | | - Rodolfo Fruhwirth
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Giuseppe Alvaro
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - George K Parapatt
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Paolo Toma'
- 2 Imaging Department, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Massimo Rollo
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
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Risk of bleeding associated with interventional musculoskeletal radiology procedures. A comprehensive review of the literature. Skeletal Radiol 2015; 44:619-27. [PMID: 25433718 DOI: 10.1007/s00256-014-2065-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/11/2014] [Accepted: 11/11/2014] [Indexed: 02/07/2023]
Abstract
This review compiles the current literature on the bleeding risks in common musculoskeletal interventional procedures and attempts to provide guidance for practicing radiologists in making decisions regarding the periprocedural management of patients on antithrombotic therapy. The practitioner must weigh the risk of bleeding if therapy is continued against the possibility a thromboembolic occurring if anticoagulation therapy is withheld or reversed. Unfortunately, there is little empirical data to guide evidence-based decisions for many musculoskeletal interventions. However, a review of the literature shows that for low-risk procedures, such as arthrograms/arthrocenteses or muscle/tendon sheath injections, bleeding risks are sufficiently small that anticoagulants and antiplatelet therapies need not be withheld. Additionally, relatively higher-risk procedures, such as needle biopsies of bone and soft tissue, may be safely performed without holding antithrombotic therapy, provided pre-procedural INR is within therapeutic range. Thus, while a patient's particular clinical circumstances should dictate optimal individualized management, anticoagulation alone is not a general contraindication to most interventional musculoskeletal radiology procedures.
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