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Probyn L, Flores D, Rowbotham E, Cresswell M, Atinga A. High-resolution ultrasound in the evaluation of the adult hip. J Ultrason 2023; 23:e223-e238. [PMID: 38020511 PMCID: PMC10668929 DOI: 10.15557/jou.2023.0031] [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: 06/30/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Abstract
This paper reviews ultrasound of the hip, which is a commonly requested examination for symptomatic hip issues. This includes both intra-articular and extra-articular causes of hip pain. Ultrasound is easily accessible, lacks radiation exposure, and allows for evaluation of the contralateral hip as well as assessment of dynamic maneuvers. Ultrasound can be used to guide interventional procedures. Ultrasound of the hip can be challenging due to the deep location of structures and complex anatomy. Typically, high-frequency transducers are used to examine the hip, however the choice of ultrasound transducer depends on the patient's body habitus, with lower frequency transducers required to penetrate deep structures in obese patients. It is important to have an approach to ultrasound of the hip which includes assessment of the anterior, lateral, posterior, and medial aspects of the hip. The technique and relevant anatomy of each of these compartments are discussed as well as the use of Doppler examination of the hip. Several dynamic maneuvers can be performed to help determine the cause of hip pathology in various locations, and these are described and illustrated. Ultrasound is useful for guided procedures about the hip, and these indications will be reviewed.
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Affiliation(s)
- Linda Probyn
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Dyan Flores
- Department of Medical Imaging, University of Ottawa, Ottawa, Canada
| | - Emma Rowbotham
- Department of Medical Imaging, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Mark Cresswell
- Department of Medical Imaging, University of British Columbia, Vancouver, Canada
| | - Angela Atinga
- Department of Medical Imaging, University of Toronto, Toronto, Canada
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Sun Y, Liu R, Tian Y, Fu Q, Zhao Y, Xu Y, Cui L. Ultrasound Assessment of Hip Subspine Bone Morphology Soft-tissue Correlates with Clinical Diagnosis of Impingement. Arthroscopy 2023; 39:2144-2153. [PMID: 37100213 DOI: 10.1016/j.arthro.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE To determine the ultrasound imaging manifestations associated with subspine impingement (SSI), including the osseous and soft-tissue injuries adjacent to anterior inferior iliac spine (AIIS) and to investigate the diagnostic value of ultrasound for SSI. METHODS We retrospectively evaluated patients who attended the sports medicine department of our hospital and underwent arthroscopic treatment for femoroacetabular impingement (FAI) between September 2019 and October 2020, with preoperative hip joint ultrasound and computed tomography (CT) examination within 1 month before surgery. All of the FAI patients were divided into the SSI group and non-SSI group, according to the clinical and intraoperative findings. The preoperative ultrasound and CT findings were assessed. The sensitivity, specificity, and positive predictive value (PPV) of some indicators were calculated and compared. Multivariable logistic regression and receiver operating characteristic curve (ROC) were also used. RESULTS A total of 71 hips were included, with a mean age of 35.4 ± 10.4 years, 56.3% were women. Of these, 40 hips had clinically confirmed SSI. The bone morphology type III, heterogeneous hypoecho in anterosuperior joint capsule and the direct head of rectus femoris (dRF) tendon adjacent to AIIS on the Standard Section of the dRF in ultrasound were associated with SSI. Among them, the heterogeneous hypoecho in the anterosuperior joint capsule had the best diagnostic value for the SSI (85.0% sensitivity, 58.1% specificity, AUC = 0.681). The AUC of the ultrasound composite indicators was 0.750. The AUC and PPV of CT low-lying AIIS for the SSI diagnosis was 0.733 and 71.7%, which could be improved when CT was combined with the ultrasound composite indicators with AUC = 0.831 and PPV = 85.7%. CONCLUSIONS Bone morphology abnormalities and soft-tissue injuries adjacent to the AIIS through sonographic evaluation were associated with SSI. Ultrasound could be used as a feasible method to predict SSI. The diagnostic value for SSI could be improved when ultrasound is combined with CT. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Youjing Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing, China; Department of Ultrasound, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Rongge Liu
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yu Tian
- School of Public Health, Capital Medical University, Beijing, China
| | - Qiang Fu
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yuqing Zhao
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yan Xu
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China.
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The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:E23-E35. [PMID: 37130137 DOI: 10.1002/jum.16228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
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Egli H, Totschnig L, Samartzis N, Kalaitzopoulos D. Biker's nodule in women: A case report and review of the literature. Case Rep Womens Health 2023; 39:e00539. [PMID: 37719130 PMCID: PMC10502335 DOI: 10.1016/j.crwh.2023.e00539] [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: 08/08/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023] Open
Abstract
Biker's nodule, also known as ischial hygroma, is a rare condition described predominantly in male cyclists. Only a few cases of affected female cyclists or horse riders have been reported. This case presents a biker's nodule in a 57-year-old woman who was referred due to a progressively enlarging tumor on her right labia majora. Due to discomfort and pain, the patient opted for surgical excision. The histological examination showed the aforementioned diagnosis. Alongside the case report, a review of the literature on biker's nodules in the female population has been included. Physicians should be aware of this entity and inquire about the patient's physical activity as part of the medical history assessment.
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Affiliation(s)
- H. Egli
- Department of Gynecology and Obstetrics, Cantonal Hospital of Schaffhausen, Switzerland
| | | | - N. Samartzis
- Department of Gynecology and Obstetrics, Cantonal Hospital of Schaffhausen, Switzerland
| | - D.R. Kalaitzopoulos
- Department of Gynecology and Obstetrics, Cantonal Hospital of Schaffhausen, Switzerland
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5
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Pirri C, Pirri N, Stecco C, Macchi V, Porzionato A, De Caro R, Özçakar L. Hearing and Seeing Nerve/Tendon Snapping: A Systematic Review on Dynamic Ultrasound Examination. SENSORS (BASEL, SWITZERLAND) 2023; 23:6732. [PMID: 37571516 PMCID: PMC10422582 DOI: 10.3390/s23156732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
Nerve/tendon snapping can occur due to their sudden displacement during the movement of an adjacent joint, and the clinical condition can really be painful. It can actually be challenging to determine the specific anatomic structure causing the snapping in various body regions. In this sense, ultrasound examination, with all its advantages (especially providing dynamic imaging), appears to be quite promising. To date, there are no comprehensive reviews reporting on the use of dynamic ultrasound examination in the diagnosis of nerve/tendon snapping. Accordingly, this article aims to provide a substantial discussion as to how US examination would contribute to 'seeing' and 'hearing' these pathologies' different maneuvers/movements.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Nina Pirri
- Department of Medicine—DIMED, School of Radiology, Radiology Institute, University of Padua, 35122 Padova, Italy;
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey;
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Drakonaki EE, Martinoli C, Vanhoenacker FM, Detoraki A, Dalili DE, Adriaensen M. The Beauty of Musculoskeletal Ultrasound: Spot Diagnoses. ROFO-FORTSCHR RONTG 2023; 195:385-392. [PMID: 36630982 DOI: 10.1055/a-1965-9961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Ultrasound is a powerful technique in musculoskeletal (MSK) imaging, and it can replace MR imaging in many specific clinical scenarios. This article will feature some common and less common spot diagnoses in musculoskeletal ultrasound. SPOT DIAGNOSIS Cases were collected by members of the Educational Committee of the ESSR ( European Society of Musculoskeletal Radiology) with expertise in musculoskeletal ultrasound. Sixteen clinical entities are discussed based on the features that allow US spot diagnosis. CONCLUSION Clinical history, location, and ultrasound appearance are the keys to spot diagnoses when performing musculoskeletal ultrasound. KEY POINTS · Musculoskeletal ultrasound can be the primary and only modality in common spot diagnoses in specific clinical settings.. · Clinical history, location, and ultrasound appearance are keys to spot diagnoses.. · Knowledge of spot diagnoses in musculoskeletal ultrasound facilitates daily clinical practice.. CITATION FORMAT · Drakonaki EE, Martinoli C, Vanhoenacker FM et al. The Beauty of Musculoskeletal Ultrasound: Spot Diagnoses. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1965-9961.
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Affiliation(s)
- Elena E Drakonaki
- Department of Anatomy, University of Crete School of Medicine, Heraklion, Greece.,Department of MSK imaging, Diagnostic and Interventional Ultrasound Practice, Heraklion, Greece
| | - Carlo Martinoli
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Filip Maria Vanhoenacker
- Department of Radiology, University Hospital Antwerp, Edegem (Antwerp), Belgium.,Department of Radiology, AZ Sint-Maarten Duffel-Mechelen, Belgium
| | - Anna Detoraki
- Medical School, Comenius University in Bratislava, Slovakia
| | - Daniel E Dalili
- Department of Radiology, Southend University Hospital, Mid and South Essex NHS Trust, Essex, United Kingdom of Great Britain and Northern Ireland
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Heerlen, Netherlands
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Abstract
Utilization of musculoskeletal ultrasound, in particular for sports medicine, has dramatically increased in recent years. Ultrasound is an important adjunct tool to physical examination and other imaging methods in the evaluation and management of the injured athlete. It offers unique advantages in specific clinical scenarios. Dedicated training and a standardized scanning technique are important to overcome the inherent operator dependence and avoid diagnostic pitfalls. Ultrasound guidance can also improve accuracy in targeted percutaneous injection therapies. This article reviews the general ultrasound appearance of muscle, tendon, ligament, and nerve abnormalities in the athlete with a focus on sport-specific injuries.
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Zbojniewicz AM, Borders HL. The Pediatric Hip. Semin Roentgenol 2021; 56:212-227. [PMID: 34281676 DOI: 10.1053/j.ro.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew M Zbojniewicz
- Advanced Radiology Services, Michigan State University, DeVos Children's Hospital, Grand Rapids, MI.
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Abstract
Athletic injuries of the hip often require radiographs and advanced imaging for diagnosis. Plain radiographs evaluate for osseous injury, provide a structural context behind an athlete's symptoms and examination, and offer a backdrop for interpretation of advanced imaging. An understanding of normal anatomy, imaging findings, and radiographic measurements allows for recognition of pathoanatomy and ability to diagnose accurately. Advanced imaging modalities, including magnetic resonance imaging, computed tomography, and ultrasonography, each play a role in evaluation of the athlete's hip. Although MRI and CT provide high-resolution imaging of the hip, ultrasonography offers the unique ability to perform dynamic imaging and guided injections.
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Affiliation(s)
- Timothy P Lancaster
- Department of Orthopaedic Surgery, University of Virginia Medical Center, PO Box 800159, Charlottesville, VA 22908, USA
| | - Christopher C Chung
- Department of Orthopaedic Surgery, University of Virginia Medical Center, PO Box 800159, Charlottesville, VA 22908, USA
| | - Winston F Gwathmey
- Department of Orthopaedic Surgery, University of Virginia Medical Center, PO Box 800159, Charlottesville, VA 22908, USA.
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De Cima A, Pérez N, Ayala G. MR imaging findings in perineal nodular induration ("cyclist´s nodule"): A case report. Radiol Case Rep 2020; 15:1091-1094. [PMID: 32489511 PMCID: PMC7256236 DOI: 10.1016/j.radcr.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/02/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022] Open
Abstract
Perineal nodular induration (PNI) is a rare condition related to sports linked to the use of a saddle, mostly cycling, thought to be caused by the compression of the soft tissue between the saddle and the ischial tuberosity. We report a case of a 59-year-old amateur cyclist male who presented with 2 bilateral nodular perineal lesions that were evaluated with ultrasound and magnetic resonance imaging (MRI). MRI findings, along with the history of a strong cycling habit, led to the diagnosis of PNI, and a conservative management was adopted. MRI features of PNI are characteristic, and may provide the diagnosis in the proper clinical setting.
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Affiliation(s)
- Andrea De Cima
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Nuria Pérez
- Department of Radiology, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Gerardo Ayala
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
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11
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Serhal A, Adams B, Omar I, Deshmukh S. Fascia lata attachment at the iliac crest: refining our diagnostic criteria of injury on magnetic resonance imaging. Br J Radiol 2020; 93:20200187. [PMID: 32459514 DOI: 10.1259/bjr.20200187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the prevalence and spectrum of pathology of the fascia lata attachment at the iliac crest (FLAIC) on MRI in asymptomatic patients in order to refine our diagnostic criteria for clinically relevant FLAIC injury. METHODS AND MATERIAL Two readers retrospectively evaluated the FLAIC on each side on coronal large field-of-view short tau inversion recovery images on 100 musculoskeletal pelvic MRI exams performed in patients without hip pain (total n = 200). Pathology of the FLAIC was graded using a 3-point Likert scale and discrepancies were resolved by consensus. RESULTS Of the 200 FLAIC included in the study, 72.5% demonstrated normal size and signal intensity. Low to moderate grade pathology of the FLAIC was identified in 27% and high-grade partial thickness pathology was seen in 0.5%. No cases of complete FLAIC rupture were identified. Inter rater agreement between the two readers was good (k=0.660, p < 0.001). There was no statistical difference in FLAIC scores according to gender or age. FLAIC score was positively correlated with higher body mass index. CONCLUSION Incidental low to moderate grade FLAIC pathology is commonly seen on MRI in asymptomatic patients. Abnormal MRI findings of the FLAIC should hence be correlated with explicit clinical symptoms and physical exam findings. ADVANCES IN KNOWLEDGE The Fascia lata is a complex anatomic structure. Its attachment to the iliac crest is an under recognized pathology and sometimes overlooked during evaluation for pelvis and lateral hip pain. Evaluation of the FLAIC is easily done with MRI and abnormality should be correlated to the clinical symptomatology as low grade abnormality is frequently seen in asymptomatic population.
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Affiliation(s)
- Ali Serhal
- Department of Radiology, Northwestern University, Chicago, Illinois, United States
| | - Bradley Adams
- Department of Radiology, Northwestern University, Chicago, Illinois, United States
| | - Imarn Omar
- Department of Radiology, Northwestern University, Chicago, Illinois, United States
| | - Swati Deshmukh
- Department of Radiology, Northwestern University, Chicago, Illinois, United States
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12
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Billham J, Cornelson SM, Koch A, Nunez M, Estrada P, Kettner N. Diagnosing acetabular labral tears with hip traction sonography: a case series. J Ultrasound 2020; 24:547-553. [PMID: 32240531 DOI: 10.1007/s40477-020-00446-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/26/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Three cases of acetabular labral tear (ALT) diagnosed with sonography (US) are reported. We aim to show utility for US with the addition of manual hip traction as an adjunctive modality to the current diagnostic imaging of choice, magnetic resonance arthrography (MRA), for diagnosing ALT. METHODS Three cases of young athletic patients with similar clinical presentations are reported. All received US examination of the hip with attention to the labrum that included a novel long-axis hip traction technique which assisted in diagnosing ALT. RESULTS In the first and second cases, MRA and orthopedic consult were obtained for confirmation of the diagnosis. Arthroscopy was performed to correct the ALT. The third patient declined an MRA. Conservative management consisted of McKenzie method active care, resulting in return to sport in the third case. CONCLUSION These three cases demonstrate the clinical and sonographic presentation of ALT. The dynamic long-axis hip traction protocol facilitated the use of US as an adjunctive modality for diagnosing ALT by increasing the visualization of the defect.
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Affiliation(s)
- Jessica Billham
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA.
| | - Stacey M Cornelson
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA
| | - Amy Koch
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA
| | - Mero Nunez
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA
| | - Patricia Estrada
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA
| | - Norman Kettner
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA
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Deshmukh S, Abboud SF, Grant T, Omar IM. High-resolution ultrasound of the fascia lata iliac crest attachment: anatomy, pathology, and image-guided treatment. Skeletal Radiol 2019; 48:1315-1321. [PMID: 30617717 DOI: 10.1007/s00256-018-3141-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/05/2018] [Accepted: 12/18/2018] [Indexed: 02/02/2023]
Abstract
Pathology of the fascia lata attachment at the iliac crest (FLAIC) is an under-recognized and often misdiagnosed cause of lateral hip pain. The fascia lata has a broad attachment at the lateral iliac crest with contributions from the tensor fascia lata muscle, the iliotibial band, and the gluteal aponeurosis. The FLAIC is susceptible to overuse injuries, acute traumatic injuries, and degeneration. There is a paucity of literature regarding imaging and image-guided treatment of the FLAIC. We review anatomy and pathology of the FLAIC, presenting novel high-resolution (18-24 MHz) ultrasound images including ultrasound guidance for targeted therapeutic treatment.
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Affiliation(s)
- Swati Deshmukh
- Northwestern Memorial Hospital/Northwestern University, Chicago, IL, 606011, USA.
| | - Samir F Abboud
- Northwestern Memorial Hospital/Northwestern University, Chicago, IL, 606011, USA
| | - Thomas Grant
- Northwestern Memorial Hospital/Northwestern University, Chicago, IL, 606011, USA
| | - Imran M Omar
- Northwestern Memorial Hospital/Northwestern University, Chicago, IL, 606011, USA
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Scanvion Q, Le Garff E, Gosset D, Hédouin V, Mesli V. Medico-legal considerations for Morel-Lavallée lesions. Forensic Sci Med Pathol 2019; 15:612-615. [PMID: 31446612 DOI: 10.1007/s12024-019-00148-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Abstract
The Morel-Lavallée lesion is an infrequent traumatic lesion that the forensic physician may need to evaluate during examination of a victim. Using a review of the literature and an illustrative case, the objective of this paper is to discuss the medico-legal issues (accountability, functional recovery and healing times, and aftermath) associated with Morel-Lavallée lesions. We describe the case of a 24-year-old motorcycle driver who was hit by a car. Clinically, the right lumbar region had a large 16 × 15 cm ecchymosis with subcutaneous fluid swelling found by palpation. A body scan revealed a Morel-Lavallée lesion among other lesions. On day 7, its thickness was decreased by half. Morel-Lavallée lesions are specifically induced by shearing force with moderate-to-high kinetics in an anatomical area with an underlying fascia. The associated functional disability is globally moderate, but a large lesion or recurrences can extend the time needed to recover. Apart from some exceptions, care without any delay in diagnosis and treatment allows evolution of the lesion without functional consequences, but these lesions are frequently unnoticed in the initial phase.
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Affiliation(s)
- Quentin Scanvion
- CHU Lille, Institut de Médecine Légale, EA 7367 UTML - Unité de Taphonomie Médico-Légale, University of Lille, F-59000, Lille, France.
| | - Erwan Le Garff
- CHU Lille, Institut de Médecine Légale, EA 7367 UTML - Unité de Taphonomie Médico-Légale, University of Lille, F-59000, Lille, France
| | - Didier Gosset
- CHU Lille, Institut de Médecine Légale, EA 7367 UTML - Unité de Taphonomie Médico-Légale, University of Lille, F-59000, Lille, France
| | - Valéry Hédouin
- CHU Lille, Institut de Médecine Légale, EA 7367 UTML - Unité de Taphonomie Médico-Légale, University of Lille, F-59000, Lille, France
| | - Vadim Mesli
- CHU Lille, Institut de Médecine Légale, EA 7367 UTML - Unité de Taphonomie Médico-Légale, University of Lille, F-59000, Lille, France
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