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Victor K, Verstuyft LA, Berghs BM. Hydrothermal ablation in recurrent or chronic olecranon bursitis: a prospective study. J Shoulder Elbow Surg 2024; 33:1999-2007. [PMID: 38685380 DOI: 10.1016/j.jse.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/17/2024] [Accepted: 03/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Olecranon bursitis can be difficult to treat, resulting in persistent or recurrent symptoms. Bursectomy is a frequently applied treatment option for refractory cases but has high complication rates. This is the first in vivo study to investigate the safety and efficacy of hydrothermal ablation, a new treatment modality for recurrent or chronic olecranon bursitis that aims to cause thermal obliteration of the bursal lining by irrigation with heated saline. METHODS First, a pilot animal trial was set up to determine a safe irrigation temperature window. Second, in a human trial the bursae of patients with chronic, recurrent, or refractory olecranon bursitis were irrigated with a 3-mL/s flow of physiological saline for a duration of 180 seconds at temperatures between 50°C and 52°C. Patients were followed up for 6 months, allowing for assessment of the surgical site to screen for adverse events, volumetric ultrasonographic assessment of the bursae, and collection of the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Patient Global Impression Score, and Clinical Global Impression Score, as well as data on return to activities or work. RESULTS Twenty-four elbows were prospectively included and underwent a full cycle of hydrothermal ablation. The mean age was 58.4 years (range 40.5-81.5), including 20 male and 4 female patients. None had clinical signs of septic bursitis. Bursal fluid cultures were positive in only 1 case. The average preoperative bursal volume was 11.18 mL (range 4.13-30.75). Eighteen of 24 elbows (75%) were successfully treated, showing a complete remission of symptoms or decided improvement within 6 weeks and without any signs of recurrence during the entire follow-up period of 6 months. The average reduction of ultrasonography-measured bursal volume was 91.9% in the group of patients who responded to treatment. In patients without recurrence, the mean QuickDASH scores before and after treatment were 13.6 (range 0-50) and 3.1 (range 0-27.5), respectively, showing a statistically significant improvement. All patients were able to fully return to work within 6 weeks after the index procedure. No serious adverse events were encountered. Moderate local adverse events were found in 2 patients. Increasing temperatures of irrigation did not result in a higher treatment efficacy. CONCLUSION Hydrothermal ablation at temperatures between 50°C and 52°C is a safe treatment option for recurrent or chronic olecranon bursitis with fewer complications than open bursectomy and a comparable efficacy.
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Affiliation(s)
- Klaas Victor
- Department of Orthopaedics, AZ Sint-Jan/Sint-Lucas Bruges, Bruges, Belgium.
| | | | - Bart M Berghs
- Department of Orthopaedics, AZ Sint-Jan/Sint-Lucas Bruges, Bruges, Belgium
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McDermott D, Wakefield D, Kowalsky M, Sethi P, Vitale MA, Morrey BF. Intrabursal Doxycycline Sclerotherapy for Recurrent Olecranon Bursitis of the Elbow: A Case Control Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:504-509. [PMID: 39166200 PMCID: PMC11331157 DOI: 10.1016/j.jhsg.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/13/2024] [Indexed: 08/22/2024] Open
Abstract
Purpose This study aimed to determine the efficacy and safety of intrabursal injection of doxycycline sclerotherapy to treat olecranon bursitis (OB) refractory to conservative management. Methods We retrospectively reviewed 27 patients with recurrent OB who were treated over 11 years with intrabursal injections of doxycycline. They were compared with a control group of 18 patients with recurrent OB who underwent surgical bursectomy. Patients were re-evaluated by the treating physician for recurrence of bursitis and treatment complications and completed a questionnaire to assess satisfaction, pain, and other patient-reported outcomes. Results Eight patients (29.6%) undergoing doxycycline sclerotherapy had recurrence, requiring one more doxycycline lavage within the first 4 weeks of initial doxycycline treatment. Three patients (16.7%) undergoing surgery had recurrence after surgery, requiring repeat aspiration. There were no patients in either doxycycline or surgical groups with recurrence of bursitis at the final follow-up (median = 195 and 1,055 days, respectively). No patients in the doxycycline group ultimately required surgical bursectomy, and no patients undergoing surgery required repeat surgeries. A regression model controlling for covariates did not find a significant difference between groups in the likelihood of physician-identified complication or repeat aspiration after doxycycline lavage or surgical bursectomy. Of patients undergoing doxycycline sclerotherapy, 85.7% of patients reported high satisfaction (Likert score: 8-10), and 95.2% reported that they would pursue this treatment again. Conclusions Use of intrabursal doxycycline as a sclerosing agent for recurrent OB was safe and effective, with high patient satisfaction and no ultimate recurrence of bursitis at the final follow-up. This may be an effective alternative to surgical bursectomy for patients with recurrent OB refractory to conservative management. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Daniel McDermott
- ONS Foundation for Clinical Research and Education, ONS, Greenwich, CT
| | - Dorothy Wakefield
- ONS Foundation for Clinical Research and Education, ONS, Greenwich, CT
| | - Marc Kowalsky
- ONS Foundation for Clinical Research and Education, ONS, Greenwich, CT
- Department of Orthopaedic Surgery, Greenwich Hospital, Yale-New Haven Health, Greenwich, CT
| | - Paul Sethi
- ONS Foundation for Clinical Research and Education, ONS, Greenwich, CT
- Department of Orthopaedic Surgery, Greenwich Hospital, Yale-New Haven Health, Greenwich, CT
| | - Mark A. Vitale
- ONS Foundation for Clinical Research and Education, ONS, Greenwich, CT
- Department of Orthopaedic Surgery, Greenwich Hospital, Yale-New Haven Health, Greenwich, CT
| | - Bernard F. Morrey
- Mayo Clinic, Department of Orthopaedic Surgery, Rochester, MN
- University of Texas Health Center, San Antonio, TX
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Daniels SP, Fritz J. Acute and Chronic Elbow Disorders. Magn Reson Imaging Clin N Am 2023; 31:269-284. [PMID: 37019550 DOI: 10.1016/j.mric.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Elbow pain is very common and can be due to many pathologic conditions. After radiographs are obtained, advanced imaging is often necessary. Both ultrasonography and MR imaging can be used to evaluate the many important soft-tissue structures of the elbow, with each modality having advantages and disadvantages in certain clinical scenarios. Imaging findings between the two modalities often correlate. It is important for musculoskeletal radiologists to understand normal elbow anatomy and how best to use ultrasonography and MR imaging to evaluate elbow pain. In this way, radiologists can provide expert guidance to referring clinicians and best guide patient management.
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Jensen J, Vavken P. [Evidence-Based Treatment and Differential Diagnoses of Olecranon Bursitis]. PRAXIS 2022; 111:682-686. [PMID: 36102022 DOI: 10.1024/1661-8157/a003889] [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
Evidence-Based Treatment and Differential Diagnoses of Olecranon Bursitis Abstract. Bursitis olecrani is a common clinical diagnosis that can have systemic, infectious and traumatic causes. In this article we want to present the diagnostics, possible differential diagnoses, complications and the current therapy recommendations as a practical guide.
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Yan YY, Holmes RD, Mallinson PI, Andrews GT, Munk PL, Ouellette HA. Imaging Review of Hockey-Related Upper Extremity Injuries. Semin Musculoskelet Radiol 2022; 26:3-12. [PMID: 35139555 DOI: 10.1055/s-0041-1731422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ice hockey is a fast-paced contact sport with a high incidence of injuries. Upper extremity injury is one of the most common regions of the body to be injured in hockey. This imaging review will equip the radiologist with a knowledge of the more common and severe upper extremity injuries that occur in this sport.
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Affiliation(s)
- Yet Yen Yan
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - R Davis Holmes
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Paul I Mallinson
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Gordon T Andrews
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Peter L Munk
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Hugue A Ouellette
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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Griffith JF. How to Report: Elbow MRI. Semin Musculoskelet Radiol 2021; 25:661-669. [PMID: 34861711 DOI: 10.1055/s-0041-1736190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The elbow is the least common of the main joints examined with magnetic resonance imaging (MRI), thus radiologists may be less familiar with writing these reports. This article addresses the main pathologies encountered in and around the elbow, emphasizing the specific features that need reporting and providing examples of terminology to use when describing these abnormalities.
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Affiliation(s)
- James Francis Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
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Abstract
The clinical diagnosis of musculoskeletal infections can be challenging due to non-specific signs and symptoms on presentation. These infections include infectious myositis, necrotising fasciitis, septic arthritis, septic bursitis, suppurative tenosynovitis, osteomyelitis, spondylodiscitis and periprosthetic infections. Diagnostic imaging is routinely employed as part of the investigative pathway to characterise the underlying infectious disease pattern, allowing expedited and customised patient management plans to optimise outcomes. This article provides an update on the various imaging modalities comprising of radiography, computed tomography, ultrasonography, magnetic resonance imaging and radionuclide procedures, and incorporates representative images of key findings in the different forms of musculoskeletal infections.
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Nchinda NN, Wolf JM. Clinical Management of Olecranon Bursitis: A Review. J Hand Surg Am 2021; 46:501-506. [PMID: 33840568 DOI: 10.1016/j.jhsa.2021.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/28/2020] [Accepted: 02/11/2021] [Indexed: 02/02/2023]
Abstract
Olecranon bursitis is a disease characterized by inflammation of the olecranon bursa, most often due to microtrauma. Although it is a common condition, there is a lack of evidence-based recommendations for the management of nonseptic olecranon bursitis. The condition is often self-limited and resolves with conservative methods such as rest, ice, compression, orthosis wear, and nonsteroidal anti-inflammatory medications. Older studies have shown resolution of symptoms with intrabursal corticosteroid injections and surgical bursectomy. More recent literature has demonstrated adverse effects of intrabursal injections and surgery compared with noninvasive management for initial treatment of nonseptic olecranon bursitis. In order to better tailor decision-making, it is important that hand surgeons understand the comparative efficacies of each option for management of nonseptic olecranon bursitis.
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Tomsan H, Grady MF, Ganley TJ, Nguyen JC. Pediatric Elbow: Development, Common Pathologies, and Imaging Considerations. Semin Roentgenol 2021; 56:245-265. [PMID: 34281678 DOI: 10.1053/j.ro.2021.05.007] [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)
- Hanna Tomsan
- Department of Radiology, Mercy Catholic Medical Center, Darby, PA
| | - Matthew F Grady
- Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Theodore J Ganley
- Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jie C Nguyen
- University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA.
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Akkus G, Karagun B, Çetinalp NE, Açıkalın A, Evran M, Sengöz S, Sert M, Zorludemir S, Tetiker T. Clinical Relevance and Immunohistochemical Patterns of Silent Pituitary Adenomas: 10 Years of Single-centre Experience. Curr Med Imaging 2021; 17:310-317. [PMID: 33357196 DOI: 10.2174/1573405616666201223125642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Silent pituitary adenomas are clinically non-functional (i.e., without clinically evident pituitary hormone production). INTRODUCTION The aim of this study was to investigate subjects with silent pituitary adenomas for possible variations in their clinical status. METHODS A total of 102 patients who had undergone surgery for pituitary adenoma and had been diagnosed with silent pituitary adenoma was included in the study. The patients' preoperative and postoperative hormonal parameters and magnetic resonance imaging (MRI) features were collected, and pathological specimens were re-evaluated. RESULTS Immunohistochemistry results of the 102 patients were as follows: hormone-negative adenomas (n=35) 35.5%; FSH+LH-positivity (n=32) 31.3%; ACTH-positivity (n=11) 10.7%; α-subunit- positivity (n= 9) 8.8%; prolactin-positivity (n=8) 7.8%; GH-positivity (n=6) 5.4%; and plurihormonal adenoma (n=1). The mean sizes of SGA, SGHA, and SCA were 28.0±12.7, 30.0±16.0, and 27.7±8.9mm (p>0.05), respectively. With the exception of silent gonadotroph adenomas (SGAs), female gender dominance was shown in patients with silent growth hormone adenoma (SGHA) and silent corticotroph adenoma (SCA). Although no clinical relevance was observed in relation to hormonal excess, preoperative GH (4.21±4.6, vs. 0.27±0.36 p=0.00) was slightly more elevated in SGHA than in GH-negative adenomas. Additionally, preoperative basal ACTH values (47.3±28.7 vs. 23.9±14.4, p=0.003) were also higher in SCA compared to the other types. Our findings revealed SCAs to be of more aggressive behaviour than SGHAs and SGAs due to invasiveness in radiological imaging, their elevated re-operation, and postoperative ACTH values. CONCLUSION Silent pituitary adenomas represent a challenging diagnostic tumour group. Careful initial evaluation of patients with pituitary adenomas should consider any mild signs and symptoms of functionality, particularly in cases of GH- and ACTH-secreting adenomas.
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Affiliation(s)
- Gamze Akkus
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Barış Karagun
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Nuri E Çetinalp
- Cukurova University, Faculty of Medicine, Division of Neurosurgery, Adana, Turkey
| | - Arbil Açıkalın
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Mehtap Evran
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Sinem Sengöz
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Murat Sert
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Suzan Zorludemir
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Tamer Tetiker
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
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Abstract
The Society of Skeletal Radiology (SSR) Practice Guidelines and Technical Standards Committee identified musculoskeletal infection as a White Paper topic, and selected a Committee, tasked with developing a consensus on nomenclature for MRI of musculoskeletal infection outside the spine. The objective of the White Paper was to critically assess the literature and propose standardized terminology for imaging findings of infection on MRI, in order to improve both communication with clinical colleagues and patient care.A definition was proposed for each term; debate followed, and the committee reached consensus. Potential controversies were raised, with formulated recommendations. The committee arrived at consensus definitions for cellulitis, soft tissue abscess, and necrotizing infection, while discouraging the nonspecific term phlegmon. For bone infection, the term osteitis is not useful; the panel recommends using terms that describe the likelihood of osteomyelitis in cases where definitive signal changes are lacking. The work was presented virtually to SSR members, who had the opportunity for review and modification prior to submission for publication.
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Abstract
Elbow pain can cause disability, especially in athletes, and is a common clinical complaint for both the general practitioner and the orthopaedic surgeon. Magnetic resonance imaging (MRI) is an excellent tool for the evaluation of joint pathology due to its high sensitivity as a result of high contrast resolution for soft tissues. This article aims to describe the normal imaging anatomy and biomechanics of the elbow, the most commonly used MRI protocols and techniques, and common MRI findings related to tendinopathy, ligamentous and osteochondral injuries, and instability of the elbow.
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Porrino J, Wang A, Taljanovic M, Stevens KJ. Comprehensive Update of Elbow Magnetic Resonance Imaging. Curr Probl Diagn Radiol 2020; 50:211-228. [PMID: 32561154 DOI: 10.1067/j.cpradiol.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022]
Abstract
We present a comprehensive update of elbow magnetic resonance imaging, detailing the complex anatomy and pathology of the elbow. A variety of pathologies may affect the elbow joint, and many of the symptoms overlap. As such, magnetic resonance imaging of the elbow serves as an invaluable clinical tool for the clinician in the diagnosis and management of patients presenting with elbow pain.
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Affiliation(s)
- Jack Porrino
- Yale University, Radiology and Biomedical Imaging, New Haven, CT.
| | - Annie Wang
- Yale University, Radiology and Biomedical Imaging, New Haven, CT
| | - Mihra Taljanovic
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, AZ
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Allen GM, Johnson R. Radiographic/MR Imaging Correlation of the Elbow. Magn Reson Imaging Clin N Am 2019; 27:587-599. [DOI: 10.1016/j.mric.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ivanoski S, Nikodinovska VV. Sonographic assessment of the anatomy and common pathologies of clinically important bursae. J Ultrason 2019; 19:212-221. [PMID: 31807327 PMCID: PMC6856779 DOI: 10.15557/jou.2019.0032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 07/25/2019] [Indexed: 12/19/2022] Open
Abstract
High-resolution ultrasonography has many advantages in the imaging of the musculoskeletal system, when compared to other imaging methods, particularly in superficial, easily accessible parts of the body. It is a perfect diagnostic tool for visualizing the most common pathologies of the musculoskeletal system, including the bursae. Inflammation of bursae is frequent, and it can mimic other diseases of the musculoskeletal system. Therefore, knowledge of normal ultrasound anatomy of the bursae, their exact location in the human body, and the sonographic signs of their most common pathologies is essential for establishing a quick and accurate diagnosis by ultrasound. Common conditions affecting bursae, leading to bursitis, include acute trauma, overuse syndromes, degenerative diseases, inflammatory conditions (rheumatoid arthritis, psoriatic arthritis, gout etc.), infections such as tuberculosis, synovial tumors and tumor-like conditions (pigmented villonodular synovitis, osteochondromatosis), and many more. This review article presents and explains ultrasound examples of the most frequent pathological conditions affecting bursae. Images include normal and pathological conditions of bursae around the shoulder joint, elbow, hip, knee, and ankle joint.
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Affiliation(s)
- Slavcho Ivanoski
- Special Hospital for Orthopedic Surgery and Traumatology "St. Erasmus", Ohrid, Macedonia
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Lormeau C, Cormier G, Sigaux J, Arvieux C, Semerano L. Management of septic bursitis. Joint Bone Spine 2018; 86:583-588. [PMID: 31615686 DOI: 10.1016/j.jbspin.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
Superficial septic bursitis is common, although accurate incidence data are lacking. The olecranon and prepatellar bursae are the sites most often affected. Whereas the clinical diagnosis of superficial bursitis is readily made, differentiating aseptic from septic bursitis usually requires examination of aspirated bursal fluid. Ultrasonography is useful both for assisting in the diagnosis and for guiding the aspiration. Staphylococcus aureus is responsible for 80% of cases of superficial septic bursitis. Deep septic bursitis is uncommon and often diagnosed late. The management of septic bursitis varies considerably across centers, notably regarding the use of surgery. Controlled trials are needed to establish standardized recommendations regarding antibiotic treatment protocols and the indications of surgery.
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Affiliation(s)
- Christian Lormeau
- Service de rhumatologie, centre hospitalier de Niort, 40, avenue Charles-de-Gaulle, 79021 Niort, France.
| | - Grégoire Cormier
- Service de rhumatologie, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85928 La Roche-sur-Yon, France
| | - Johanna Sigaux
- Inserm, UMR 1125, 1, rue de Chablis, 93017 Bobigny, France; Sorbonne Paris Cité, université Paris 13, 1, rue de Chablis, 93017 Bobigny, France; Service de rhumatologie, groupe hospitalier Avicenne-Jean-Verdier-René-Muret, Assistance publique-Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93017 Bobigny, France
| | - Cédric Arvieux
- Clinique des maladies infectieuses, CHU de Rennes Pontchaillou, rue Henri-Le-Guilloux, 35043 Rennes, France; Centre de référence en infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), CHU de Rennes, 35043 Rennes cedex, France
| | - Luca Semerano
- Inserm, UMR 1125, 1, rue de Chablis, 93017 Bobigny, France; Sorbonne Paris Cité, université Paris 13, 1, rue de Chablis, 93017 Bobigny, France; Service de rhumatologie, groupe hospitalier Avicenne-Jean-Verdier-René-Muret, Assistance publique-Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93017 Bobigny, France
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Ruangchaijatuporn T, Gaetke-Udager K, Jacobson JA, Yablon CM, Morag Y. Ultrasound evaluation of bursae: anatomy and pathological appearances. Skeletal Radiol 2017; 46:445-462. [PMID: 28190095 DOI: 10.1007/s00256-017-2577-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/08/2017] [Accepted: 01/12/2017] [Indexed: 02/02/2023]
Abstract
A bursa is an extra-articular sac that may communicate with a joint and functions to decrease friction between tendons and either bone or skin. Bursae can be classified as native and non-native (adventitious) bursae. The native bursae are lined with a synovial membrane and occur at predictable anatomical sites; knowledge of these normal structures can help distinguish them from other pathological entities. An adventitious bursa can form at sites of friction rather than at predictable anatomical sites, but otherwise have imaging features similar to native bursae. Bursal distention can occur from many pathological processes, most commonly resulting from chronic overuse injury. When imaging bursal pathological conditions, there is often an overlap of imaging findings, regardless of the cause. In general, ultrasound of a distended bursa reveals a fluid collection with either simple anechoic or more complex hypoechoic fluid. Bursal distention is characteristically unilocular and compressible, unlike other structures such as ganglion cysts, which are usually multilocular and non-compressible. This article reviews the anatomical locations of common bursae and shows pathological examples using ultrasound. Knowledge of typical locations and imaging appearances of bursae can aid in narrowing the differential diagnosis and guiding further management and treatment decisions.
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Affiliation(s)
- Thumanoon Ruangchaijatuporn
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rachathewi, Bangkok, 10400, Thailand
| | - Kara Gaetke-Udager
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, TC 2852B, Ann Arbor, MI, 48109, USA.
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, TC 2852B, Ann Arbor, MI, 48109, USA
| | - Corrie M Yablon
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, TC 2852B, Ann Arbor, MI, 48109, USA
| | - Yoav Morag
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, TC 2852B, Ann Arbor, MI, 48109, USA
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Saul D, Dresing K. [Treatment of traumatic lesions of the bursa olecrani and chronic bursitis olecrani]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2017; 29:253-265. [PMID: 28175943 DOI: 10.1007/s00064-017-0483-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Complete olecranon bursectomy with debridement, protection of veins and nerves. Risk-adapted antibiotic therapy and early functional aftercare. INDICATIONS Acute, traumatic laceration of the bursa olecrani, chronic therapy-resistant bursitis olecrani. CONTRAINDICATIONS For traumatic bursa injuries: general contraindications for anesthesia and surgery; chronic bursitis: initially not closable skin defect (plastic surgery required), hemodynamically instable patient (e.g. systemic inflammatory response syndrome [SIRS] or sepsis), pre-existing skin infection. SURGICAL TECHNIQUE Local anesthesia beyond the lesion, careful debridement, identification and removal of the entire bursa, excision of contaminated skin, lavage, drain insertion (Redon, Easy-flow, Penrose). Wound closure, elastic bandage, and splint. POSTOPERATIVE MANAGEMENT Elastic bandage for 2 days, followed by drain removal. Wound assessment, early functional aftercare without splint, antibiotic therapy in septic bursitis for 2 weeks, PRICE scheme. Removal of stitches after 10-12 days. RESULTS Over 5 years, 138 cases of traumatic bursa lesion or chronic bursitis olecrani were treated in our clinic, 82 patients underwent surgery. Ten patients were treated with vacuum-assisted closure therapy and consecutive wound healing; fistulae occurred in two patients and in another two dehiscence developed. All of the defects could be closed without flaps.
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Affiliation(s)
- D Saul
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - K Dresing
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-Tissue Infections and Their Imaging Mimics: From Cellulitis to Necrotizing Fasciitis. Radiographics 2016; 36:1888-1910. [DOI: 10.1148/rg.2016160068] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Kumar Y, Khaleel M, Boothe E, Awdeh H, Wadhwa V, Chhabra A. Role of Diffusion Weighted Imaging in Musculoskeletal Infections: Current Perspectives. Eur Radiol 2016; 27:414-423. [PMID: 27165135 DOI: 10.1007/s00330-016-4372-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/27/2016] [Accepted: 04/14/2016] [Indexed: 01/22/2023]
Abstract
Accurate diagnosis and prompt therapy of musculoskeletal infections are important prognostic factors. In most cases, clinical history, examination and laboratory findings help one make the diagnosis, and routine magnetic resonance imaging (MRI) is useful to identify the extent of the disease process. However, in many situations, a routine MRI may not be specific enough especially if the patient cannot receive contrast intravenously, thereby delaying the appropriate treatment. Diffusion-weighted imaging (DWI) can help in many such situations by providing additional information, accurate characterization and defining the extent of the disease, so that prompt treatment can be initiated. In this article, we illustrate the imaging findings of the spectrum of musculoskeletal infections, emphasizing the role of DWI in this domain. KEY POINTS • Abscess in background cellulitis is detected on DWI. • Infectious tenosynovitis shows diffusion restriction as compared to mechanical tenosynovitis. • Pyomyositis with abscess can be differentiated from diabetic myonecrosis on DWI. • Intraosseous abscess is bright on DWI versus devitalized tissue, sequestrum and air. • DWI can be used to differentiate spine infection from simple Modic changes.
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Affiliation(s)
- Yogesh Kumar
- Department of Radiology, Yale New Haven Health System at Bridgeport Hospital, Bridgeport, CT, USA
| | - Mohammad Khaleel
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA
| | - Ethan Boothe
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Haitham Awdeh
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Avneesh Chhabra
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA. .,Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA.
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Harris-Spinks C, Nabhan D, Khodaee M. Noniatrogenic Septic Olecranon Bursitis: Report of Two Cases and Review of the Literature. Curr Sports Med Rep 2016; 15:33-7. [PMID: 26745168 DOI: 10.1249/jsr.0000000000000220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Christine Harris-Spinks
- 1Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO; 2Clinical Research and Multidisciplinary Care, Sports Medicine Division, United States Olympic Committee, Colorado Springs, CO
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Abstract
BACKGROUND Bursitis is a common medical condition, and of all the bursae in the body, the olecranon bursa is one of the most frequently affected. Bursitis at this location can be acute or chronic in timing and septic or aseptic. Distinguishing between septic and aseptic bursitis can be difficult, and the current literature is not clear on the optimum length or route of antibiotic treatment for septic cases. The current literature was reviewed to clarify these points. METHODS The reported data for olecranon bursitis were compiled from the current literature. RESULTS The most common physical examination findings were tenderness (88% septic, 36% aseptic), erythema/cellulitis (83% septic, 27% aseptic), warmth (84% septic, 56% aseptic), report of trauma or evidence of a skin lesion (50% septic, 25% aseptic), and fever (38% septic, 0% aseptic). General laboratory data ranges were also summarized. CONCLUSIONS Distinguishing between septic and aseptic olecranon bursitis can be difficult because the physical and laboratory data overlap. Evidence for the optimum length and route of antibiotic treatment for septic cases also differs. In this review we have presented the current data of offending bacteria, frequency of key physical examination findings, ranges of reported laboratory data, and treatment practices so that clinicians might have a better guide for treatment.
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Affiliation(s)
- Danielle Reilly
- Elbow Shoulder Research Centre, Department of Orthopaedics and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Srinath Kamineni
- Elbow Shoulder Research Centre, Department of Orthopaedics and Sports Medicine, University of Kentucky, Lexington, KY, USA.
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Blackwell JR, Hay BA, Bolt AM, Hay SM. Olecranon bursitis: a systematic overview. Shoulder Elbow 2014; 6:182-90. [PMID: 27582935 PMCID: PMC4935058 DOI: 10.1177/1758573214532787] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 03/27/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Olecranon bursitis is a common condition where the bursal cavity, superficial to the olecranon, becomes inflamed. This can occur either with or without infection and has been given pseudonyms relating to the repeated minor trauma from external pressure that often predisposes. As a result of the multiple aetiologies, olecranon bursitis can present to any medical specialty with reasonable frequency and, although many therapies are described, a single, evidence-based and standardized treatment pathway is not well described. METHODS We summarize the key points within the literature and subsequently propose an evidence-based treatment pathway. RESULTS Relevant evidence is presented from appropriate publications to add rational to existing decision-making processes, together with personal experience and suggested operative bursectomy techniques from an established upper limb surgeon. The common and significant aetiologies are summarized and, in particular, red flag symptoms are highlighted by way of warning to the unsuspecting investigator. CONCLUSIONS The conclusion is provided in diagrammatic form, providing a suggested treatment pathway from history and examination through to operative intervention.
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Affiliation(s)
- John R Blackwell
- Royal Shrewsbury Hospital, Trauma and
Orthopaedics, Shrewsbury, UK,John R Blackwell, Royal Shrewsbury Hospital, Trauma
and Orthopaedics, Mytton Oak Road, Shrewsbury SY3 8XQ, UK. Tel.: + 07834839707. Fax: +00
000 000.
| | - Bruce A Hay
- University of Edinburgh Medical School,
Edinburgh, UK
| | - Alexander M Bolt
- Royal Shrewsbury Hospital, Trauma and
Orthopaedics, Shrewsbury, UK
| | - Stuart M Hay
- Royal Shrewsbury Hospital, Trauma and
Orthopaedics, Shrewsbury, UK
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25
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Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg 2014; 134:359-70. [PMID: 24305696 DOI: 10.1007/s00402-013-1882-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Indexed: 01/18/2023]
Abstract
PURPOSE Olecranon bursitis and prepatellar bursitis are common entities, with a minimum annual incidence of 10/100,000, predominantly affecting male patients (80 %) aged 40-60 years. Approximately 1/3 of cases are septic (SB) and 2/3 of cases are non-septic (NSB), with substantial variations in treatment regimens internationally. The aim of the study was the development of a literature review-based treatment algorithm for prepatellar and olecranon bursitis. METHODS Following a systematic review of Pubmed, the Cochrane Library, textbooks of emergency medicine and surgery, and a manual reference search, 52 relevant papers were identified. RESULTS The initial differentiation between SB and NSB was based on clinical presentation, bursal aspirate, and blood sampling analysis. Physical findings suggesting SB were fever >37.8 °C, prebursal temperature difference greater 2.2 °C, and skin lesions. Relevant findings for bursal aspirate were purulent aspirate, fluid-to-serum glucose ratio <50 %, white cell count >3,000 cells/μl, polymorphonuclear cells >50 %, positive Gram staining, and positive culture. General treatment measures for SB and NSB consist of bursal aspiration, NSAIDs, and PRICE. For patients with confirmed NSB and high athletic or occupational demands, intrabursal steroid injection may be performed. In the case of SB, antibiotic therapy should be initiated. Surgical treatment, i.e., incision, drainage, or bursectomy, should be restricted to severe, refractory, or chronic/recurrent cases. CONCLUSIONS The available evidence did not support the central European concept of immediate bursectomy in cases of SB. A conservative treatment regimen should be pursued, following bursal aspirate-based differentiation between SB and NSB.
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26
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Abstract
CONTEXT The elbow is a complex joint and commonly injured in athletes. Evaluation of the elbow by magnetic resonance imaging (MRI) is an important adjunct to the physical examination. To facilitate accurate diagnosis, a concise structured approach to evaluation of the elbow by MRI is presented. EVIDENCE ACQUISITION A PubMed search was performed using the terms elbow and MR imaging. No limits were set on the range of years searched. Articles were reviewed for relevance with an emphasis of the MRI appearance of normal anatomy and common pathology of the elbow. RESULTS The spectrum of common elbow disorders varies from obvious acute fractures to chronic overuse injuries whose imaging manifestations can be subtle. MRI evaluation should include bones; lateral, medial, anterior, and posterior muscle groups; the ulnar and radial collateral ligaments; as well as nerves, synovium, and bursae. Special attention should be paid to the valgus extension overload syndrome and the MRI appearance of associated injuries when evaluating throwing athletes. CONCLUSION MRI evaluation of the elbow should follow a structured approach to facilitate thoroughness, accuracy, and speed. Such an approach should cover bone, cartilage, muscle, tendons, ligaments, synovium, bursae, and nerves.
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Affiliation(s)
- Srinath C Sampath
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Srihari C Sampath
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Miriam A Bredella
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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27
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Olecranon bursitis as initial presentation of gout in asymptomatic normouricemic patients. THE EGYPTIAN RHEUMATOLOGIST 2014. [DOI: 10.1016/j.ejr.2013.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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28
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Abstract
This article summarizes key MR imaging findings in common athletic elbow injuries including little leaguer's elbow, Panner disease, osteochondritis dissecans, olecranon stress fracture, occult fracture, degenerative osteophyte formation, flexor-pronator strain, ulnar collateral ligament tear, lateral ulnar collateral ligament and radial collateral ligament tear, lateral epicondylitis, medial epicondylitis, biceps tear, bicipitoradial bursitis, triceps tear, olecranon bursitis, ulnar neuropathy, posterior interosseous nerve syndrome, and radial tunnel syndrome. The article also summarizes important technical considerations in elbow MR imaging that enhance image quality and contribute to the radiologist's success.
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Affiliation(s)
- Daniel R Wenzke
- Department of Radiology, Evanston Hospital, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL 60201, USA.
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29
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Magnetic resonance imaging of musculoskeletal infections: systematic diagnostic assessment and key points. Acad Radiol 2012; 19:1434-43. [PMID: 22884398 DOI: 10.1016/j.acra.2012.05.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 05/26/2012] [Accepted: 05/30/2012] [Indexed: 01/22/2023]
Abstract
Prompt diagnosis and treatment are essential in preventing the complications of musculoskeletal infection. In this context, imaging is often used to confirm clinically suspected diagnoses, define the extent of infection, and ensure appropriate management. Because of its superior soft-tissue contrast resolution, magnetic resonance imaging (MRI) is the modality of choice for evaluating musculoskeletal infections. This article describes the MRI features along the full spectrum of musculoskeletal infections and provides several illustrative case examples.
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30
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Diagnosis and management of olecranon bursitis. Surgeon 2012; 10:297-300. [DOI: 10.1016/j.surge.2012.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/08/2012] [Accepted: 02/08/2012] [Indexed: 11/24/2022]
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31
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Banffy MB, ElAttrache NS. Injection Therapy in the Management of Musculoskeletal Injuries: The Elbow. OPER TECHN SPORT MED 2012. [DOI: 10.1053/j.otsm.2012.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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32
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Abstract
When assessing joints with various imaging modalities, it is important to focus on the extraarticular soft tissues that may clinically mimic joint pathology. One such extraarticular structure is the bursa. Bursitis can clinically be misdiagnosed as joint-, tendon- or muscle-related pain. Pathological processes are often a result of inflammation that is secondary to excessive local friction, infection, arthritides or direct trauma. It is therefore important to understand the anatomy and pathology of the common bursae in the appendicular skeleton. The purpose of this pictorial essay is to characterize the clinically relevant bursae in the appendicular skeleton using diagrams and corresponding multimodality images, focusing on normal anatomy and common pathological processes that affect them. The aim is to familiarize radiologists with the radiological features of bursitis.
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Affiliation(s)
- Zameer Hirji
- Department of Radiology, McMaster University, Canada
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33
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Sampaio ML, Schweitzer ME. Elbow magnetic resonance imaging variants and pitfalls. Magn Reson Imaging Clin N Am 2010; 18:633-42. [PMID: 21111970 DOI: 10.1016/j.mric.2010.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Imaging variants of the elbow and pitfalls can be disconcerting and can lead to diagnostic mistakes. Inhomogeneities in the magnetic field and coil position can result in signal changes that may simulate abnormality. Bone signal and morphology variants, such as the islands of red marrow and the pseudodefect of the capitellum and intraarticular inclusions such as plicae, may be mistaken for abnormal findings. Variations of the distal biceps and triceps tendons and different aspects of the ligaments and their insertions, as well as nonpathologic signal and width changes in the ulnar nerve, are other examples of common pitfalls in magnetic resonance imaging of the elbow.
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Affiliation(s)
- Marcos Loreto Sampaio
- Musculoskeletal Radiology Department, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Module S, Ottawa, ON K1H 8L6, Canada.
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35
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36
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Damert HG, Altmann S, Schneider W. Weichteildefekte nach komplizierter Bursitis olecrani. Chirurg 2008; 80:448, 450-4. [DOI: 10.1007/s00104-008-1586-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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37
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Theodorou SJ, Theodorou DJ, Resnick D. Imaging findings of complications affecting the upper extremity in intravenous drug users: featured cases. Emerg Radiol 2008; 15:227-39. [DOI: 10.1007/s10140-008-0709-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 01/28/2008] [Indexed: 12/01/2022]
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38
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Papp DF, Khanna AJ, McCarthy EF, Carrino JA, Farber AJ, Frassica FJ. Magnetic resonance imaging of soft-tissue tumors: determinate and indeterminate lesions. J Bone Joint Surg Am 2007; 89 Suppl 3:103-15. [PMID: 17908876 DOI: 10.2106/jbjs.g.00711] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Derek F Papp
- Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA
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39
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Jin W, Lee JH, Yang DM, Kim HC, Ryu CW, Shin HP, Park JS, Ryu KN. Olecranon bursitis communicating with an olecranon cyst in rheumatoid arthritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:857-61. [PMID: 17526619 DOI: 10.7863/jum.2007.26.6.857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Wook Jin
- Department of Radiology, East-West Neo Medical Center, Seoul, Korea.
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