Forearm flexor injury is associated with medial ulnar collateral ligament injury in throwing athletes.

BACKGROUND: Elbow ulnar collateral ligament (UCL) injuries have become increasingly common in throwing athletes. The forearm flexors (FF) have been studied as biomechanical stabilizers for the medial elbow. However, there are no studies investigating the association of concomitant UCL injuries and FF injuries in throwing athletes. OBJECTIVE: To determine if throwing athletes with a complete UCL injury had a greater likelihood of concomitant FF injury than those with a partial UCL injury. DESIGN: Descriptive retrospective epidemiological study. SETTING: Academic, tertiary care medical center. PATIENTS: Throwing related UCL injuries in patients aged 12-24 years. INTERVENTIONS/METHODS: Electronic medical records and key word searches identified all patients from January 1, 2010 to December 31, 2019. A board certified and fellowship trained musculoskeletal radiologist reviewed all advanced imaging studies. RESULTS: Fifty-four patients (46 male, 8 female, mean age 17.1 years, SD 2.3) were included. Fifty-four UCL injuries (21 complete ruptures, 16 proximal partial injuries, 17 distal partial injuries) were confirmed by magnetic resonance imaging (MRI). Twenty-eight FF injuries (22 strains, 6 tears) were diagnosed with MRI and/or MRI-arthrogram. There was a significant association between sustaining a FF injury and UCL reconstruction (UCL-R) (X2  = [1, N = 54], = 3.97, P = .046) (15/22, 68.2%), as well as FF injury and UCL injury location (X2  = [1, N = 33], = 3.86, P = .049) (10/17, distal partial UCL injury, 58.8%). Analysis of FF injury and complete UCL tear is not significant (X2  = [1, N = 54], = 3.02, P = .08) (14/21, 66.7%). CONCLUSIONS: The data indicate that FF injury is associated with UCL injury in throwing athletes. Future prospective studies should investigate causation versus correlation of FF and UCL injury in throwing athletes. The results of this study have applications to multiple sports medicine areas that include but are not limited to surgical, nonsurgical, prehabilitation, rehabilitation, and sports performance. This study reveals a strongly significant association between FF injury and concomitant UCL injury in throwing athletes.

Myositis ossificans: a rare neonatal presentation.

Myositis ossificans is a benign, ossifying, soft-tissue pseudotumor that most commonly occurs in men ages 30-40 years after trauma. Myositis ossificans may also occur in children, but it is extremely rare in those younger than 10 years of age. While myositis ossificans can often mimic malignant soft-tissue tumors, it has many unique findings that can aid in diagnostic differentiation. This differentiation is critical to avoid unnecessary risk with potentially harmful procedures. We present a very unusual presentation of myositis ossificans in the immediate post-birth perinatal period, as well as a review of key imaging findings.

Fluoroscopically-guided therapeutic injection of the proximal tibiofibular joint in a patient with lateral knee pain.

Proximal tibiofibular joint (PTFJ) pathology is an uncommon but perhaps underappreciated cause of lateral knee pain. While imaging guided therapeutic injections for diagnosis and management of joint related symptoms are now commonplace and numerous techniques for accessing most joints in the body have been documented, a technique for fluoroscopically guided injection of the PTFJ has not been yet described in the literature. We present a case of an adult patient who presented with lateral knee pain refractory to conservative management who opted for a fluoroscopically-guided therapeutic injection of her PTFJ.

Comparison of metal artifact reduction using single-energy CT and dual-energy CT with various metallic implants in cadavers.

OBJECTIVES: The purpose of this study was to compare the effectiveness of metal artifact reduction using Single Energy Metal Artifact Reduction (SEMAR) and Dual Energy CT (DECT). MATERIALS AND METHODS: Six cadavers containing metal implants in the head, neck, abdomen, pelvis, and extremities were scanned with Standard, SEMAR, and DECT protocols on a 320-slice CT scanner. Four specialized radiologists blinded to acquisition methods rated severity of metal artifacts, visualization of anatomic structures, diagnostic interpretation, and image preference with a 5-point grading scale. RESULTS: Scores were significantly better for SEMAR than Standard images in the hip, knee, pelvis, abdomen, and maxillofacial scans (3.25 ±â€¯0.88 versus 2.14 ±â€¯0.93, p < 0.001). However, new reconstruction artifacts developed in SEMAR images that were not present in Standard images. Scores for severity of metal artifacts and visualization of smooth structures were significantly better for DECT than Standard images in the cervical spine (3.50±0.50 versus 2.0±0.58, p < 0.001) and was preferred over Standard images by one radiologist. In all other cases, radiologists preferred the Standard image over the DECT image due to increased image noise and reduced low-contrast resolution with DECT. In all cases, SEMAR was preferred over Standard and DECT images. CONCLUSION: SEMAR was more effective at reducing metal artifacts than DECT. Radiologists should be aware of new artifacts and review both the original and SEMAR images. When the anatomy or implant is relatively small, DECT may be superior to SEMAR without additional artifacts. However, radiologist should be aware of a reduction in soft tissue contrast.

Evaluation of imaging utilization prior to referral of musculoskeletal tumors: a prospective study.

BACKGROUND: Imaging studies are essential when evaluating a patient with a musculoskeletal neoplasm, and they represent a potential waste of resources when used inappropriately. The objective of this study was to prospectively evaluate a consecutive series of patients for inappropriate utilization of imaging prior to referral to a tertiary care facility. Our hypothesis was that advanced imaging is overutilized prior to referral of musculoskeletal neoplasms to a tertiary care center. METHODS: All new patients referred for evaluation of a musculoskeletal neoplasm were prospectively analyzed over a three-month time period. All pre-referral imaging studies were recorded, including radiographs, computed tomographic scans, magnetic resonance imaging scans, bone scans, and 18-fluorodeoxyglucose positron emission tomography scans. Studies were reviewed by two musculoskeletal radiologists and two orthopaedic oncologists and were defined with use of specific preselected criteria as inappropriate if they were not indicated for diagnosis or treatment, if they required repeating because of excessive time since the study was obtained, or if they had poor image quality or technique. RESULTS: We evaluated 298 consecutive patients (550 imaging studies). The inappropriate utilization rate was 1.5% (three of 204) for radiographs, 36.5% (twenty-three of sixty-three) for computed tomographic scans, 26.7% (fifty-six of 210) for magnetic resonance imaging scans, 45.1% (twenty-three of fifty-one) bone scans, and 45.5% (ten of twenty-two) for positron emission tomography scans. The overall inappropriate use of advanced imaging (magnetic resonance imaging, computed tomography, bone scan, positron emission tomography) was 32.4% (112 of 346 images). With regard to inappropriate use of magnetic resonance imaging, there was no difference between orthopaedic surgeons (28.2%) and primary care physicians (26.5%). CONCLUSIONS: Our data indicate a high prevalence (32.4%) of inappropriate advanced imaging of musculoskeletal tumors prior to referral. This represents a substantial cost to the patient and health-care system, a potential delay of referral, an increase in radiation exposure, and identification of other incidental findings.

Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system.

Fat suppression is an important technique in musculoskeletal imaging to improve the visibility of bone-marrow lesions; evaluate fat in soft-tissue masses; optimize the contrast-to-noise ratio in magnetic resonance (MR) arthrography; better define lesions after administration of contrast material; and avoid chemical shift artifacts, primarily at 3-T MR imaging. High-field-strength (eg, 3-T) MR imaging has specific technical characteristics compared with lower-field-strength MR imaging that influence the use and outcome of various fat-suppression techniques. The most commonly used fat-suppression techniques for musculoskeletal 3-T MR imaging include chemical shift (spectral) selective (CHESS) fat saturation, inversion recovery pulse sequences (eg, short inversion time inversion recovery [STIR]), hybrid pulse sequences with spectral and inversion-recovery (eg, spectral adiabatic inversion recovery and spectral attenuated inversion recovery [SPAIR]), spatial-spectral pulse sequences (ie, water excitation), and the Dixon techniques. Understanding the different fat-suppression options allows radiologists to adopt the most appropriate technique for their clinical practice.

Optic neuropathy secondary to cat scratch disease: distinguishing MR imaging features from other types of optic neuropathies.

BACKGROUND AND PURPOSE: MR imaging characteristics of optic neuropathy caused by cat scratch disease have not yet been described; this lack of information may result in incorrect diagnosis and may contribute to initiation of inappropriate therapy. Our study was based on the hypothesis that cat scratch disease-related optic neuropathy has distinct MR imaging features compared with those of other types of optic neuropathies. METHODS: Eighty-two patients with various causes of optic neuropathy and available MR imaging examinations were included in this study. Two readers blinded to the diagnosis reviewed the MR images independently in regard to presence, location, and extent of optic nerve enhancement. The MR imaging findings were correlated with the final diagnosis. RESULTS: Eleven percent (9/82) of the patients received a final diagnosis of cat scratch disease. Optic nerve enhancement in patients with cat scratch disease (5/37) was localized to a 3- to 4-mm segment at the optic nerve-globe junction. All other patients with optic neuropathy (31/37) with one exception showed enhancement away from the optic nerve-globe junction or a long-segment enhancement when the optic nerve-globe junction was also involved. Four patients with cat scratch disease did not show any optic nerve MR abnormalities. CONCLUSION: Unilateral, short-segment enhancement localized to the optic nerve-globe junction is highly specific for cat scratch disease as the underlying cause of optic neuropathy and may help in establishing the diagnosis of this condition.