MRI findings in athletic groin pain: correlation of imaging with history and examination in symptomatic and asymptomatic athletes.

OBJECTIVE: To determine differences in prevalence and diagnostic accuracy of MRI findings between asymptomatic athletes and athletes with longstanding groin pain. MATERIALS AND METHODS: One hundred twenty-three adult male athletes were approached with 85 consecutive athletes recruited. Group 1 (symptomatic, n = 34) athletes referred for longstanding groin pain (insidious onset, > 3 weeks duration). Group 2 (control, n = 51) athletes referred for injuries remote from the pelvis and no groin pain in the last 12 weeks. All referrers completed a clinical examination proforma documenting absence or presence of pelvis and hip abnormality. All patients completed the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire and underwent a 3T MRI groin and hip protocol. MRIs were scored independently by two musculoskeletal radiologists blinded to clinical details. Statistical analysis was performed to evaluate associations between MRI findings, inter-reader reliability, clinical examination and HAGOS scores. RESULTS: Pubic body subchondral bone oedema, capsule/aponeurosis junction tear and soft tissue oedema were more prevalent in the symptomatic group (p = 0.0003, 0.0273 and 0.0005, respectively) and in athletes with clinical abnormality at symphysis pubis, adductor insertion, rectus abdominis, psoas and inguinal canal (p = 0.0002, 0.0459 and 0.00002, respectively). Pubic body and subchondral oedema and capsule/aponeurosis tear and oedema significantly correlated with lower (worse) HAGOS scores (p = 0.004, 0.00009, 0.0004 and 0.002, respectively). Inter-reader reliability was excellent, 0.87 (range 0.58-1). Symphyseal bone spurring, disc protrusion and labral tears were highly prevalent in both groups. CONCLUSION: Clinical assessment and MRI findings of pubic subchondral bone oedema and capsule/aponeurosis abnormality appear to be the strongest correlators with longstanding groin pain.

Role of dynamic ultrasound in assessment of the snapping elbow and distal biceps tendon injury.

Introduction: Ultrasound is useful in assessing patients with snapping syndromes around the elbow joint. The dynamic nature of the examination allows for direct visualisation of the underlying causative factor.Topic description: We discuss the role of dynamic ultrasound in assessing various snapping syndromes around the elbow, such as ulnar nerve instability, snapping triceps and less commonly, snapping brachialis. Ultrasound is also useful in evaluating the distal biceps tendon, particularly in differentiating partial from complete tendon injury. Discussion: Ulnar nerve instability and snapping triceps can be assessed via a medial approach with the transducer placed transversely between the medial epicondyle and the olecranon. In ulnar nerve instability, the nerve can be seen crossing over the medial epicondyle on elbow flexion. In snapping triceps syndrome, both the ulnar nerve and the distal triceps can be seen dislocating over the medial epicondyle. Dynamic assessment of the distal biceps tendon using a lateral approach minimises anisotropy artefact often seen on the anterior approach. Passive pronation and supination of the forearm will reveal little or no movement in a completely torn tendon whereas moving tendon fibres will be appreciated in partial tears. In a snapping brachialis, the medial portion of brachialis will be seen abnormally translocating anterolateral to the medial border of the trochlea during elbow flexion and snapping back into its normal position on elbow extension. Conclusion: Dynamic ultrasound of the elbow is valuable in diagnosing patients with snapping sensations around the joint and in evaluating the integrity of the distal biceps tendon.

The radiological findings in complex elbow fracture-dislocation injuries.

Elbow fracture-dislocation is a complex injury which can lead to significant bony and soft tissue damage. Surgical intervention is guided towards restoring joint stability, allowing early mobilization and preventing long-term joint stiffness. The most common types are posterolateral, posteromedial, Monteggia type (and variants), and anterior trans-olecranon fracture-dislocations. Posterolateral fracture-dislocation is characterized by a radial head fracture (± anterolateral coronoid fracture) and typically capsuloligamentous disruption (lateral collateral ligaments injury is the most common). A posterolateral fracture-dislocation with radial head and coronoid anterolateral facet fractures is termed a terrible triad injury. In posteromedial fracture-dislocation, there is a fracture of the anteromedial facet of the coronoid, typically with proximal avulsion of the lateral collateral ligaments (± injury to the posterior bundle of the ulnar collateral ligament). Monteggia fracture-dislocation injuries demonstrate proximal ulnar fracture (with possible involvement of the olecranon and the coronoid) and radial head dislocation. These can be divided into apex anterior or apex posterior variants. The latter are commonly associated with radial head fractures and lateral ligamentous injury, and have a worse prognosis. In trans-olecranon fracture-dislocation, there is significant disruption of the greater sigmoid notch and the olecranon, with various involvement of the coronoid and the proximal ulna. The article describes the radiological findings and outlines the management principles in complex elbow fracture-dislocation injuries.

Role of complementary Ct chest in patients presenting with acute abdominal symptoms during covid-19 pandemic: a UK experience.

BACKGROUND: In March 2020, the UK Intercollegiate General Surgery Guidance on COVID-19 recommended that patients undergoing emergency abdominal CT should have a complementary CT chest for COVID-19 screening. PURPOSE: To establish if complementary CT chest was performed as recommended, and if CT chest influenced surgical intervention decision. To assess detection rate of COVID-19 on CT and its correlation with RT-PCR swab results. To determine if COVID-19 changes is reliably detected within the lung bases which are usually imaged in standard abdominal CT. METHODS: Patients with acute abdominal symptoms presenting to a single institution between 1st and 30th April 2020 who had abdominal CT and complementary CT chest were retrospectively extracted from Computerised Radiology Information System. CT COVID-19 changes were categorised according to British Society of Thoracic Radiology reporting guidance. Patient demographics (age and gender), RT-PCR swab results and management pathway (conservative or intervention) were recorded from electronic patient records. Statistical analyses were performed to evaluate any significant association between variables. p values ≤0.05 were regarded as statistically significant. RESULTS: Compliancy rate in performing complementary CT chest was 92.5% (148/160). Thirty-five patients (35/148,23.6%) underwent intervention during admission. There was no significant association (p = 0.9085) between acquisition of CT chest and management pathway (conservative vs intervention). CT chest had 57% sensitivity (CI 18.41% to 90.1%) and 100% specificity (CI 92% to 100%) in COVID-19 diagnosis. Three of ten patients who had classic COVID-19 changes on CT chest did not have corresponding changes in lung bases. CONCLUSION: Compliance with performing complementary CT chest in acute abdomen patients for COVID-19 screening was high and it did not influence subsequent surgical or interventional management.

Resonance metallic ureteric stent in a case of ketamine bladder induced bilateral ureteric obstruction with one year follow up.

INTRODUCTION: Upper urinary tract occlusion is well recognized in patients with chronic ketamine abuse. The mechanism is generally unknown, but the ulcerative cystitis contracture may be responsible for obstruction. We present the first reported use of the Resonance metallic ureteric stent in the management ureteric obstruction caused by ketamine-induced uropathy. PRESENTATION OF CASE: A 31-year-old lady with one-year history of recreational ketamine abuse presented with symptoms related to drug-induced ulcerative cystitis over twelve-months. She presented with acute renal failure with bilateral pyonephrosis and sepsis, and was initially treated with bilateral nephrostomy insertions and antegrade stenting. The J stents recovered the renal function, but the patient suffered from recurrent urinary tract infections (UTI's) with the prosthesis in-situ. The patient successfully underwent bilateral insertion of 12cm 6.0 French Cook Resonance metallic ureteric stents. One year following the placement of the metallic stents, the patient maintained optimal renal function with no episode of UTI. DISCUSSION: Ketamine induced uropathy is a well documented complication of chronic drug-induced ulcerative cystitis. The mechanical strength and inert property of metallic ureteric stents make it an ideal device to manage this problematic benign cause of ureteric obstruction. CONCLUSION: This is the first reported case of therapeutic bilateral metallic ureteric stents in the management of patients with ketamine induced uropathy with one year follow up.