1
|
Singh M, Soo Hoo J. A Sports Medicine Clinician's Guide to the Diagnosis and Management of Distal Clavicular Osteolysis. Curr Sports Med Rep 2023; 22:230-237. [PMID: 37294199 DOI: 10.1249/jsr.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ABSTRACT Weightlifting associated shoulder injuries have seen a dramatic rise in the last 20 years. Distal clavicular osteolysis, coined weightlifter's shoulder, is one such condition caused by repetitive microtrauma to the distal clavicle with subsequent, painful development of bony erosions and resorption of the distal clavicle. Diagnosis, treatment, and prevention of this condition can be challenging. In this article, we highlight evidence-based clinical recommendations for the diagnosis and management of distal clavicular osteolysis, including specific considerations for atraumatic and posttraumatic etiologies, to help clinicians better care for their patients. Activity modification and rehabilitation are the mainstays of the initial treatment. Adjuvant treatments, such as injections or surgery, may be required in refractory cases or in certain patient populations. Early recognition and treatment of weightlifter's shoulder is essential to prevent progression to acromioclavicular joint pathology or instability and to allow for continued participation in sport-specific activities.
Collapse
Affiliation(s)
| | - Jennifer Soo Hoo
- Department of Rehabilitation, Weill Cornell Medical Center, NewYork-Presbyterian, New York, NY
| |
Collapse
|
2
|
Kelley N, Tuttle M, Sylvia SM, Dragoo JL, Khodaee M. Acromioclavicular Joint Injuries in Sport. Curr Sports Med Rep 2023; 22:91-99. [PMID: 36866952 DOI: 10.1249/jsr.0000000000001046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT Sport-related shoulder injuries, including disruptions to the acromioclavicular joint (ACJ), are common. An ACJ injury is classified by the degree and direction of the clavicle displacement. Although the diagnosis can be made clinically, standard radiographic views are important to determine the severity of the ACJ disruption and assess for concurrent injuries. The majority of ACJ injuries can be managed nonoperatively; however, surgical treatment is indicated in some cases. Long-term outcomes are generally favorable for most ACJ injuries, and athletes generally return to sport without functional limitations. This article provides an in-depth discussion regarding all aspects of ACJ injuries, including clinically relevant anatomy, biomechanics, evaluation, treatment, and complications.
Collapse
Affiliation(s)
- Naomi Kelley
- University of Colorado School of Medicine, Aurora, CO
| | - Matthew Tuttle
- Head of Soccer Medicine and Performance, New York Red Bulls, Harrison, NJ
| | - Stephen M Sylvia
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Jason L Dragoo
- University of Colorado School of Medicine, Department of Orthopedics, Division of Sports Medicine, Englewood, CO
| | - Morteza Khodaee
- University of Colorado School of Medicine, Department of Family Medicine and Orthopedics, Division of Sports Medicine, Denver, CO
| |
Collapse
|
3
|
Yu P, Zhang Y, Ye T, Liu J, Zhuang C, Wang L. Clinical and radiological outcomes of acute Rookwood type IIIB acromioclavicular joint dislocation: Mini-open tightrope technique versus hook plate. Injury 2022; 54 Suppl 2:S63-S69. [PMID: 35180996 DOI: 10.1016/j.injury.2022.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/13/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Treatment of acute Rookwood type III AC joint dislocation is still controversially discussed. ISAKOS suggested to subdivide type III AC joint injuries into type IIIA (stable) and type IIIB (unstable). The aim of this study was to compare clinical and radiographic outcomes between hook plate fixation and mini-open tightrope for the treatment of acute Rookwood type IIIB acromioclavicular joint dislocation. METHODS We conducted a retrospective clinical study of 112 patients with acute Rookwood type IIIB acromioclavicular joint dislocation who were treated surgically using either mini-open TightRope or hook plate from 2013 to 2019. All patients were followed up for 12 months. Clinical outcomes were evaluated using Visual Analogue Scale (VAS) and the Constant-Murley Score (CMS). Radiological results were assessed with the coracoclavicular distance (CCD), the change in clavicular elevation (ΔCE) and horizontal translation. RESULTS The length of incision was significantly shorter in the mini-open TightRope group than that in hook plate group (6.62±0.60 vs. 2.58±0.43 p <0.001). Duration of surgery was significantly shorter in the mini-open TightRope group than that in hook plate group (30.12±6.65 vs. 53.33±12.03; p < 0.001). Total blood loss volume was significantly less in the mini-open TightRope group than in the hook plate group. (23.85±7.88 vs. 70.67±24.62, p < 0.001). VAS and CMS in mini-open TightRope group were better than that in hook plate group at 2 weeks after surgery (VAS: 2.19±0.92 vs. 3.30±1.51, p = 0.002 and CMS 69.80±5.61 vs. 57.53±9.24, p<0.001) and 3 month after surgery (VAS: 1.19±0.48 vs. 3.07±1.36, p<0.001 and CMS 89.30±4.47 vs. 83.20±12.11, p = 0.205). There was no statistically significant difference between two groups at 12 months follow-up including VAS, CMS, the CC distance,ΔCE and the degree of dynamic horizontal translation. There were 2 complications in the hook plate group including 1cut out and 1 superficial wound infection. CONCLUSION The mini-open tightrope has better function and relieves pain in the early postoperative period compared to hook plate, and at the last follow up two groups have similar clinical and radiological outcomes. Mini-open TightRope fixation is a good option for the treatment of acute Rockwood types ⅢB AC joint dislocation.
Collapse
Affiliation(s)
- Pei Yu
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Yin Zhang
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Tingjun Ye
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Jingfeng Liu
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Chengyu Zhuang
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China.
| | - Lei Wang
- Department of orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China.
| |
Collapse
|
4
|
Abdelkader N, deGraauw C. Detailed management of post-traumatic distal clavicle osteolysis in a 24-year-old female: a case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2021; 65:360-367. [PMID: 35197651 PMCID: PMC8791541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Distal clavicular osteolysis (DCO) is a musculoskeletal pathology characterized by shoulder pain. Given the high prevalence of shoulder pain due to rotator cuff and subacromial injuries, DCO is often overlooked. Conservative therapy is indicated prior to surgical intervention. However, no literature has described conservative management of DCO in detail. This report will outline conservative management details for DCO to guide future research and clinicians. CASE PRESENTATION A 24-year-old female hockey player presented with trauma-induced injury, where she was diagnosed with type II acromio-clavicular joint separation. She presented 5-months later with residual pain and limitations in ranges of motion (ROM). Radiographic images revealed DCO. MANAGEMENT AND OUTCOME Management entailed strict rest from overhead activities followed by rehabilitation and manual therapy. 6-months later the patient reported resolution of symptoms, improved ROMs, and activities of daily living. SUMMARY DCO can be difficult to diagnose given its limited etiological understanding, low incidence, and poor radiographic sensitivity. DCO diagnosis should be considered in cases with unresolving shoulder pain.
Collapse
Affiliation(s)
- Nader Abdelkader
- Division of Graduate Studies, Sports Sciences, Canadian Memorial Chiropractic College
| | - Chris deGraauw
- Associate Professor, Canadian Memorial Chiropractic College
| |
Collapse
|
5
|
Mantripragada S, Bhagwani S, Peh WC, Lim YW. Acromioclavicular joint injuries: Imaging and management. J Med Imaging Radiat Oncol 2020; 64:803-813. [PMID: 32794363 DOI: 10.1111/1754-9485.13094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
Acromioclavicular joint injuries are commonly encountered in the setting of shoulder trauma. Knowledge of the anatomy and biomechanics of the joint, grading of joint injuries, and understanding the capabilities and limitations of different radiological modalities will help in selecting the best management option and outcomes for affected patients.
Collapse
Affiliation(s)
| | - Sanjeev Bhagwani
- Department of Diagnostic Radiology, Farrer Park Hospital, Singapore City, Singapore
| | - Wilfred Cg Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore City, Singapore
| | - Yeow Wai Lim
- Raffles Orthopaedic Centre, Raffles Hospital, Singapore City, Singapore
| |
Collapse
|
6
|
Bickelhaupt B, Oyama S, Benfield J, Burau K, Lee S, Trbovich M. Effect of Wheelchair Stroke Pattern on Upper Extremity Muscle Fatigue. PM R 2018; 10:1004-1011. [PMID: 29627608 DOI: 10.1016/j.pmrj.2018.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/12/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Shoulder dysfunction is common in persons with spinal cord injury (SCI) with an incidence of up to 63%. Dysfunction is a result of muscle imbalances, specifically denervated rotator cuff muscles that are repetitively used during manual wheelchair propulsion. OBJECTIVE To determine which arm stroke technique, pump (P) or semicircular (SC), is most energy efficient for long periods of propulsion. DESIGN A randomized study with repeated measures observations. SETTING The study was performed at an institutional gait analysis laboratory. PARTICIPANTS 18 able-bodied (AB) male participants were studied and randomized into one of 2 conditions, SC or P. METHODS Shoulder muscle fatigue was measured by changes in Borg CR10 Rate of Perceived Exertion (Borg RPE) and upper extremity strength via a handheld dynamometer. Participants were studied and assigned into one of 2 conditions of wheelchair arm propulsion patterns, SC or P group, and propelled on a wheelchair treadmill for 10 minutes. MAIN OUTCOME MEASURES The primary outcomes included recordings of Borg RPE scale during continuous wheelchair propulsion and pre- and post-test dynamometer testing means for bilateral elbow and shoulder extension. Analysis of covariance, t-tests, and Kruskal-Wallis tests were used in analyzing data. RESULTS Although not significant (P = .23), the Borg RPE scores for the SC condition were consistently higher than the scores for the P condition. In addition, the dynamometer pre- and post-test readings demonstrated a larger decrease for the SC condition participants than for the P condition participants, but were not statistically significant. CONCLUSIONS These data demonstrate that the SC wheelchair propulsion pattern appears to be more fatiguing to shoulder muscles than the P propulsion pattern. However, more data would need to be collected to find a significant difference. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Brittany Bickelhaupt
- Department of Rehabilitation Medicine, University of Texas Health Science Center of San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229
| | - Sakiko Oyama
- Department of Kinesiology, Health, and Nutrition, University of Texas at San Antonio, San Antonio, TX
| | - Jonathan Benfield
- Department of Rehabilitation Medicine, University of Texas Health Science Center of San Antonio, San Antonio, TX
| | - Keith Burau
- Department of Rehabilitation Medicine, University of Texas Health Science Center of San Antonio, San Antonio, TX; and Spinal Cord Injury Center, Audie L. Murphy Memorial Hospital, San Antonio, TX
| | - Shuko Lee
- Research and Development, Audie L. Murphy Memorial Hospital, San Antonio, TX
| | - Michelle Trbovich
- University of Texas Health Science Center of San Antonio, San Antonio, TX; Spinal Cord Injury Center, Audie L. Murphy Memorial Hospital, San Antonio, TX
| |
Collapse
|
7
|
Tang G, Zhang Y, Liu Y, Qin X, Hu J, Li X. Comparison of surgical and conservative treatment of Rockwood type-III acromioclavicular dislocation: A meta-analysis. Medicine (Baltimore) 2018; 97:e9690. [PMID: 29369191 PMCID: PMC5794375 DOI: 10.1097/md.0000000000009690] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There is no consensus on the effects of surgical versus conservative treatment on Rockwood type-III dislocation of the acromioclavicular joint in general orthopedic practice. The objective of this meta-analysis was to compare the clinical outcomes of patients managed surgically and conservatively following type-III acromioclavicular (AC) dislocation. METHODS The Cochrane Library, EMBASE, MEDLINE via Ovid SP, and PubMed databases were searched for randomized controlled trials and observational studies. Patient data were pooled using standard meta-analytic approaches. For continuous variables, the weighted mean difference was used. For dichotomous data, the odds ratio was calculated. RESULTS The current analysis included 10 trials on this topic, and the results demonstrated that there were no significant differences between surgical and conservative treatment in terms of pain, weakness, tenderness, post-traumatic arthritis, restriction of strength, unsatisfactory function, and scores (Constant, UCLA, Imatani, SST, DASH, Larsen). Analyses of ossification of the coracoclavicular ligament (OR = 1.62, 95% CI = 1.01-2.61) and osteolysis of the lateral clavicle (OR = 2.87, 95% CI = 1.27-6.52) suggested better function with conservative treatment versus surgical treatment, but the latter was superior to conservative treatment with regard to loss of anatomic reduction. Only 1 study showed a higher acromioclavicular joint instability score for surgical management compared with conservative management (P < .00001). CONCLUSION In the management of Rockwood type-III AC dislocation, conservative treatment is superior to surgical treatment. Nonoperative treatment results in a lower incidence of ossification of the coracoclavicular ligament and osteolysis of the lateral clavicle compared with operative treatment. However, there was no statistical difference between operative and nonoperative treatment in terms of clinical outcomes.
Collapse
Affiliation(s)
| | | | - Yuan Liu
- Department of Infectious Diseases, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | - Jun Hu
- Department of Orthopedics
| | | |
Collapse
|
8
|
Flint JH, Wade AM, Giuliani J, Rue JP. Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med 2014; 42:235-41. [PMID: 23749341 DOI: 10.1177/0363546513490656] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although many authors report on acute injuries and chronic injuries in the orthopaedic literature, the actual terms are seldom explicitly defined. HYPOTHESIS Much of the literature pertaining to sports injuries that are acute or chronic does not define these terms. It is believed that definitions will provide clarity and specificity in future literature. STUDY DESIGN Systematic review. METHODS A systematic review of 116 articles was conducted to determine whether and how the terms acute and chronic were defined as they pertain to several commonly treated conditions: Achilles tendon rupture, distal biceps tendon rupture, pectoralis major tendon rupture, anterior cruciate ligament (ACL) tear, anterior shoulder instability, and acromioclavicular (AC) joint dislocation. Articles were isolated from various databases and search engines by use of keywords to identify relevant literature. RESULTS This study determined that the terms acute and chronic for each injury are defined, respectively, as follows: Achilles tendon rupture: <1 week, >4 weeks; distal biceps tendon rupture: <6 weeks, >12 weeks; pectoralis major tendon rupture: <6 weeks, >6 weeks; ACL tear: <6 weeks, >6 months; anterior shoulder instability: <2 weeks, >6 months; AC joint dislocation, <3 weeks, >6 weeks. CONCLUSION The current literature varies greatly in defining the terms acute and chronic in common sports injuries. The vast majority of authors imply these terms, based on the method of their studies, rather than define them explicitly. Injuries involving tendons showed greater consistency among authors, thus making a definition based on consensus easier to derive. The literature on ACL and shoulder instability in particular showed great variability in defining these terms, likely representing the more complex nature of these injuries and the fact that timing of surgery in the majority of patients does not particularly affect the complexity of the surgical approach and treatment. CLINICAL RELEVANCE Defining injuries as acute or chronic is clinically relevant in many cases, particularly concerning tendon injuries, where these terms have implications regarding the anatomic pathologic changes and tissue quality, which may necessitate augmentation and alter the initial surgical plan. In cases where these terms are less pertinent to operative treatment considerations, they bring clarity to the discussion of the acuity of the injury (as it pertains to time from insult).
Collapse
Affiliation(s)
- James H Flint
- James H. Flint, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600.
| | | | | | | |
Collapse
|
9
|
Abstract
OBJECTIVE The purpose of this review is to describe the upper extremity injuries that frequently accompany aging, the typical clinical presentations, and the differential diagnoses with an emphasis on the injury most likely encountered with each presentation. CONCLUSION Expectation of continued participation in exercise and sports activities by the baby boomer population has presented new challenges to the medical field. The concepts behind factors that predispose older athletes to certain pathologic conditions that affect the muscles, tendons, and bones of the upper extremity must be understood.
Collapse
|
10
|
Post-traumatic osteolysis of the distal clavicle. Pediatr Radiol 2010; 40:784. [PMID: 19777224 DOI: 10.1007/s00247-009-1403-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 08/04/2009] [Accepted: 08/24/2009] [Indexed: 10/20/2022]
|
11
|
Abstract
Magnetic resonance imaging has become an important diagnostic adjunct in the evaluation of shoulder conditions, and the technology continues to evolve. Direct magnetic resonance arthrography can improve detection of labral and rotator cuff pathology, especially partial thickness tears of the rotator cuff. Special positioning, such as abducted-externally rotated views, improves visualization of the rotator cuff and posterior superior labrum in throwing athletes. Diagnosis-specific sequencing such as fat suppression, spin-echo and proton-density techniques, and higher power magnets (3.0 T) allow for an unprecedented level of soft tissue detail. Clinical expertize is required to differentiate between normal anatomic variants, incidental findings, and true pathology. Although magnetic resonance imaging findings may be diagnostic in some cases, clinical correlation with history and physical examination findings is critical.
Collapse
|
12
|
Alyas F, Curtis M, Speed C, Saifuddin A, Connell D. MR imaging appearances of acromioclavicular joint dislocation. Radiographics 2008; 28:463-79; quiz 619. [PMID: 18349451 DOI: 10.1148/rg.282075714] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The key structures involved in dislocation of the acromioclavicular joint (ACJ) are the joint itself and the strong accessory coracoclavicular ligament. ACJ dislocations are classified with the Rockwood system, which comprises six grades of injury. Treatment planning requires accurate grading of the ACJ disruption, but correct classification can be difficult with clinical assessment. Magnetic resonance (MR) imaging has a well-established role in evaluation of ACJ pain. MR imaging performed in the coronal oblique plane parallel to the distal clavicle allows assessment of the acromioclavicular and coracoclavicular ligaments owing to its in-plane orientation in relation to these structures. This technique enables distinction between grade 2 and grade 3 injuries, which can be difficult with conventional clinical and radiographic evaluation. In addition, diagnosis of grade 1 injuries is possible by demonstration of a ruptured superiodorsal acromioclavicular ligament. Resultant thickening of the acromioclavicular or coracoclavicular ligament allows identification of chronic ACJ injuries.
Collapse
Affiliation(s)
- Faisal Alyas
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, England.
| | | | | | | | | |
Collapse
|
13
|
|
14
|
Kassarjian A, Llopis E, Palmer WE. Distal clavicular osteolysis: MR evidence for subchondral fracture. Skeletal Radiol 2007; 36:17-22. [PMID: 17021902 DOI: 10.1007/s00256-006-0209-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 08/09/2006] [Accepted: 08/15/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the association between distal clavicular osteolysis and subchondral fractures of the distal clavicle at MRI. MATERIALS AND METHODS This study was approved by the hospital human research committee, which waived the need for informed consent. Three radiologists retrospectively analyzed 36 shoulder MR examinations in 36 patients with imaging findings of distal clavicular osteolysis. The presence of a subchondral fracture of the distal clavicle, abnormalities of the acromioclavicular joint, rotator cuff tears and labral tears were assessed by MRI. These cases were then compared with 36 age-matched controls. RESULTS At MRI, 31 of 36 patients (86%) had a subchondral line within the distal clavicular edema, consistent with a subchondral fracture. Of the 36 patients, 32 (89%) had fluid in the acromioclavicular joint, while 27 of 36 patients (75%) had cysts or erosions in the distal clavicle. There were 13 patients (36%) with associated labral tears, while eight patients (22%) had partial-thickness rotator cuff tears. In the control group one of 36 (3%) had a subchondral line (P<0.05), while ten of 36 (28%) had rotator cuff tears and 13 of 36 (36%) had labral tears. These latter two were not statistically significant between the groups. CONCLUSION A distal clavicular subchondral fracture is a common finding in patients with imaging evidence of distal clavicular osteolysis. These subchondral fractures may be responsible for the propensity of findings occurring on the clavicular side of the acromioclavicular joint.
Collapse
Affiliation(s)
- Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Radiology, Yawkey Center, 6th floor Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | | | | |
Collapse
|
15
|
Kijowski R, De Smet AA. The role of ultrasound in the evaluation of sports medicine injuries of the upper extremity. Clin Sports Med 2006; 25:569-90, viii. [PMID: 16798143 DOI: 10.1016/j.csm.2006.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The two major imaging modalities used for assessment of soft tissue injuries are ultrasound and MRI. Although ultrasound of the extremities is used only to a limited extent in the United States, it is widely used in many other countries for evaluation of extremity injuries. This article first considers the advantages and disadvantages of MRI and ultrasound. Understanding these differences will help the reader understand the role of ultrasound as compared with MRI in evaluating upper extremity injuries. The uses of ultrasound for evaluating sports medicine injuries in specific regions of the upper extremity are then reviewed. Where the data are available, the reported accuracy of ultrasound is compared with MRI for each type of injury.
Collapse
Affiliation(s)
- Richard Kijowski
- Division of Musculoskeletal Radiology, Department of Radiology, University of Wisconsin Clinical Science Center, 600 Highland Avenue, E3/311 CSC, Madison, WI 53792-3252, USA.
| | | |
Collapse
|
16
|
Vahlensieck M, Schmittke I, Schmidt HM. [Distal clavicle edema]. Radiologe 2005; 46:579-83. [PMID: 15971040 DOI: 10.1007/s00117-005-1240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Distal clavicle marrow edema: frequency, MRI in the early stage and macroscopic correlation to the bone marrow distribution and to evaluate frequency and diagnostic criteria of a posttraumatic clavicula disorder with an edema pattern on MRI. An additional macroscopic study of the clavicle should elucidate anatomic peculiarities which could explain the reaction of the distal clavicle. MATERIAL AND METHODS 285 MRI of traumatized patients were analyzed for edema pattern of the distal clavicle. Pattern A edema within the clavicle and the acromion was distinguished from pattern B edema within the clavicle only. Dissection in 20 cadavers should reveal vascular peculiarities and the bone marrow distribution within clavicle and acromion or vascular peculiarities. RESULTS In 38 patients (13,3%) we found edema within the distal clavicle. Pattern A was found in 28 (9,8%) and pattern B in 10 patients (3,5%). Pattern A was usually associated with swelling of the AC joint (27 out of 28). Other injuries were not evident. 18 cadavers showed hematopoietic marrow within the distal clavicle and fatty marrow within the acromion. CONCLUSION The distal clavicle can frequently react with edema pattern after trauma without evidence for another injury. Distinguish in cases with and cases without synovitis of the AC joint could have impact on therapy. A peculiar vascular supply of the distal clavicle could not be found.
Collapse
|
17
|
Gordon BH, Chew FS. Isolated Acromioclavicular Joint Pathology in the Symptomatic Shoulder on Magnetic Resonance Imaging. J Comput Assist Tomogr 2004; 28:215-22. [PMID: 15091126 DOI: 10.1097/00004728-200403000-00011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The acromioclavicular (AC) joint is a synovial joint that is predisposed to painful syndromes because of mechanical stress or developmental variation. It is often overlooked in the evaluation of patients with shoulder pain, however. Isolated AC joint pathology was studied on magnetic resonance imaging scans of patients with symptoms suggesting rotator cuff pathology. The conditions identified included osteoarthritis, distal clavicle osteolysis, and os acromiale syndrome.
Collapse
Affiliation(s)
- Benjamin H Gordon
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1088, USA
| | | |
Collapse
|
18
|
|
19
|
Mouhsine E, Garofalo R, Crevoisier X, Farron A. Grade I and II acromioclavicular dislocations: results of conservative treatment. J Shoulder Elbow Surg 2003; 12:599-602. [PMID: 14671526 DOI: 10.1016/s1058-2746(03)00215-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to assess the results of acute grade I and II acromioclavicular (AC) joint sprains treated by conservative measures. Between 1993 and 1997, 37 consecutive patients were treated conservatively for AC joint sprains, grade I and II in the Tossy classification. Of these patients, 4 were excluded (three lost to follow-up and one sustained a further AC injury), leaving a series of 33 patients. Among them, in 9 (27%), chronic AC joint pathology that required subsequent surgery developed at a mean of 26 months after injury. The remaining 24 were reviewed clinically and radiologically at a mean of 6.3 years (range, 4-8 years) after injury. At the latest follow-up, 17 of the 33 patients (52%) remained asymptomatic. Of the 24 patients reviewed, 7 complained of activity-related pain. Eight patients presented with residual anteroposterior instability. Tenderness at the AC joint as well as a positive cross-body test was observed in 12 patients. The mean Constant score at follow-up was 82 points. The x-ray films showed degenerative changes in 13 patients, ossification of the coracoclavicular ligaments in 2, an association of degenerative changes with ossification of the coracoclavicular ligaments in 3, and distal clavicular osteolysis in 3. Only 4 cases had no radiographic changes after this kind of AC injury. On the basis of these results, we conclude that the severity of the consequences after grade I and II AC sprains is underestimated.
Collapse
Affiliation(s)
- Elyazid Mouhsine
- Orthopedic and Traumatology Department, University Hospital of Lausanne, Switzerland.
| | | | | | | |
Collapse
|
20
|
Ernberg LA, Potter HG. Radiographic evaluation of the acromioclavicular and sternoclavicular joints. Clin Sports Med 2003; 22:255-75. [PMID: 12825529 DOI: 10.1016/s0278-5919(03)00006-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Plain radiography is useful for the initial assessment of suspected disorders of the sternoclavicular and acromioclavicular joints. Other modalities are often required to further assess more complex pathologies involving these joints, however. Ultrasound has been described as a screening tool to assess possible sternoclavicular joint dislocation; however, it is usually used only if CT and MRI are not readily available. It has also been used to confirm intraoperative relocation. Ultrasound has a limited role in the evaluation of the AC joint, where it is most useful to exclude the presence of joint inflammation. If joint fluid is detected sonographically, it is considered a nonspecific finding, which could represent active inflammation or simply joint effusion due to degenerative arthrosis. CT allows for excellent visualization of the articular surfaces, osseous changes, subtle or complex fractures, and joint malalignment, with a rapid scan time, making it particularly helpful in the work up of trauma patients. With its multiplanar capabilities and superior soft-tissue resolution, MRI is a very effective modality for characterizing soft-tissue injuries, inclusive of ligamentous tears and cartilaginous injuries. In the specific case of posterior sternoclavicular dislocations, both CT and MR angiography can be very helpful in elucidating occult associated vascular injury.
Collapse
Affiliation(s)
- Lauren A Ernberg
- Hospital for Special Surgery, Department of Radiology and Imaging, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA
| | | |
Collapse
|
21
|
Martinoli C, Bianchi S, Prato N, Pugliese F, Zamorani MP, Valle M, Derchi LE. US of the shoulder: non-rotator cuff disorders. Radiographics 2003; 23:381-401; quiz 534. [PMID: 12640155 DOI: 10.1148/rg.232025100] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The most common indication for shoulder ultrasonography (US) is the diagnosis of rotator cuff disease. However, there is a spectrum of non-rotator cuff abnormalities that are amenable to US examination, including instability of the biceps tendon, glenohumeral joint, and acromioclavicular joint; arthropathies and bursites (inflammatory diseases, degenerative and infiltrative disorders, infections); nerve entrapment syndromes; and space-occupying lesions. Many of these conditions may be overlooked clinically or can even mimic rotator cuff tears, and US can help redirect the diagnosis if a complete shoulder examination rather than a simple rotator cuff assessment is performed. In addition, US can be remarkably helpful in guiding either needle aspiration procedures or local injection therapy in patients with synovial processes. Although radiography, magnetic resonance (MR) imaging, and computed tomographic and MR arthrography are effective modalities for the evaluation of non-rotator cuff disorders, US is both less costly and less invasive and will likely be used more frequently in this setting as experience increases. Once adequate radiographs have been obtained to exclude apparent bone disorders, high-resolution US should be the first-line imaging modality in the assessment of non-rotator cuff disorders of the shoulder, assuming the study is performed with high-end equipment by an experienced examiner.
Collapse
Affiliation(s)
- Carlo Martinoli
- Cattedra "R" di Radiologia-DICMI, Università di Genova, Largo Rosanna Benzi 8, 16132 Genoa, Italy.
| | | | | | | | | | | | | |
Collapse
|
22
|
Aigner N, Petje G, Steinboeck G, Schneider W, Krasny C, Landsiedl F. Bone marrow edema of the forefoot after chevron osteotomy--a rare cause of metatarsalgia: a case report. Foot Ankle Int 2002; 23:447-51. [PMID: 12043991 DOI: 10.1177/107110070202300513] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Treatment options of bone marrow edema syndrome, which is associated with vascular disturbances, are protracted nonoperative treatment or core decompression which still demands several weeks until complete recovery. We obtained excellent results by the use of the vasoactive drug iloprost, a stable prostacyclin analogue, leading to a complete relief of symptoms in cases of bone marrow edema which had initially suggested early avascular necrosis of the second metatarsal head. The bone marrow edema of the second metatarsal bone was thought to be due to altered biomechanics following a distal first metatarsal chevron osteotomy. During the five days of iloprost infusion, the patient reported relief of rest pain. After therapy, the pedobarogram was normalized. The AOFAS forefoot score improved from 44 to 85 points after one month, and to 95 points after three months. At that time, the marrow showed normal signals. Without additional intervention the patient was able to resume normal activities.
Collapse
Affiliation(s)
- Nicolas Aigner
- First General Orthopaedic Department, Orthopaedic Hospital Vienna--Speising, Austria.
| | | | | | | | | | | |
Collapse
|
23
|
|
24
|
Mestan MA, Bassano JM. Posttraumatic osteolysis of the distal clavicle: analysis of 7 cases and a review of the literature. J Manipulative Physiol Ther 2001; 24:356-61. [PMID: 11416827 DOI: 10.1067/mmt.2001.115260] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To discuss the clinical manifestation, radiographic features, and treatment of 7 cases of posttraumatic osteolysis of the distal clavicle. Also, to furnish evidence indicating that the current terminology for this disorder is ambiguous and to propose a new classification system. CLINICAL FEATURES Three cases resulted from acute trauma, and 4 cases were caused by sports-related repetitive microtrauma. All the cases involved young male patients who had similar clinical presentations that included shoulder pain with decreased shoulder range of motion. Radiographic findings ranged from small erosive changes to aggressive osteolysis of the distal clavicle. INTERVENTION AND OUTCOME All the patients were treated with conservative care consisting of sling immobilization, ice, various physiotherapeutic modalities, and mobilization exercises. The patients that followed through with care showed clinical improvement within 3 months. Follow-up radiographic examinations, when performed, demonstrated reconstitution of the distal clavicle of various degrees, although lagging behind clinical evidence of improvement. CONCLUSION Traumatic osteolysis of the distal clavicle may result from acute trauma or repetitive microtrauma. Radiographic changes are varied, including irregularity of the distal clavicle, cystic erosions, and blatant osteolysis. Positive outcomes may be achieved with conservative care; however, patient compliance plays a fundamental role in the overall prognosis.
Collapse
Affiliation(s)
- M A Mestan
- Department of Radiology, Parker College of Chiropractic, Dallas, Tex. 75229-5668, USA.
| | | |
Collapse
|