Ultrasonography for the Busy Orthopaedic Surgeon: The Upper Extremity.

Ultrasonography is increasingly used in the diagnosis and treatment of musculoskeletal conditions and injuries. Ultrasonography possesses multiple advantages compared with other methods of imaging, including low cost, lack of radiation exposure, speed, and means for dynamic examination. Because of these advantages, many orthopaedic surgeons are routinely using ultrasonography to diagnose musculoskeletal conditions of the upper extremity. Musculoskeletal ultrasonography is technically challenging, but with proper guidance and practice, every orthopaedic surgeon can confidently integrate ultrasonography into their clinical practice.

Ultrasonography for the Busy Orthopaedic Surgeon: The Lower Extremity.

Ultrasonography has the potential to become a fundamental component of the diagnosis and management of musculoskeletal conditions and injuries. Moreover, in the context of modern healthcare systems that are focused on optimizing value, ultrasonography has the advantage of minimizing costs when compared with other advanced imaging modalities. Because of its low cost, lack of radiation exposure, speed, and capability to diagnose dynamic conditions, more orthopaedic surgeons are routinely integrating musculoskeletal ultrasonography into their daily practice. It is important to provide a comprehensive review of and approach to common musculoskeletal conditions of the lower extremity for the busy orthopaedic surgeon.

Anterior horn lateral meniscus tear, repair, and meniscectomy.

The purpose of this study was to describe the effect of anterior horn of the lateral meniscus (AHLM) tears on tibiofemoral contact pressures and the ability to restore normal parameters with repair. Eight fresh-frozen cadaveric knees were used. The specimens were subjected to a load of 1,000 N at 0 and 30 degrees of flexion and peak pressure, force and contact area were recorded. The test was repeated for four different instances. Peak force in the lateral compartment was significantly increased at 0 degrees of knee flexion from 37 N intact to 47 N after the tear and 56 N postmeniscectomy. At 0 degrees of knee flexion, the peak pressure of the lateral meniscus was significantly increased from 1.1 MPa in the intact state to 1.9 MPa after meniscectomy. The peak pressure in the nontraumatized medial compartment was significantly increased after partial lateral meniscectomy (p < 0.05). This cadaveric study demonstrated a significant increase in tibiofemoral peak forces in both the medial and lateral compartments with a tear of the AHLM. It also showed an increase in peak contact pressure after meniscectomy. With repair, the preinjury condition peak forces were restored to normal, suggesting the importance of repairing tears of the AHLM.

Heated lidocaine/tetracaine patch for treatment of patellar tendinopathy pain.

INTRODUCTION: The pain of patellar tendinopathy (PT) may be mediated by neuronal glutamate and sodium channels. Lidocaine and tetracaine block both of these channels. This study tested the self-heated lidocaine-tetracaine patch (HLT patch) in patients with PT confirmed by physical examination to determine if the HLT patch might relieve pain and improve function. METHODS: Thirteen patients with PT pain of ≥14 days' duration and baseline average pain scores ≥4 (on a 0-10 scale) enrolled in and completed this prospective, single-center pilot study. Patients applied one HLT patch to the affected knee twice daily for 2-4 hours for a total of 14 days. Change in average pain intensity and interference (Victorian Institute of Sport Assessment [VISA]) scores from baseline to day 14 were assessed. No statistical inference testing was performed. RESULTS: Average pain scores declined from 5.5 ± 1.3 (mean ± standard deviation) at baseline to 3.8 ± 2.5 on day 14. Similarly, VISA scores improved from 45.2 ± 14.4 at baseline to 54.3 ± 24.5 on day 14. A clinically important reduction in pain score (≥30%) was demonstrated by 54% of patients. CONCLUSION: The results of this pilot study suggest that topical treatment that targets neuronal sodium and glutamate channels may be useful in the treatment of PT.

Utilization of sonography and a stress device in the assessment of partial tears of the ulnar collateral ligament in throwers.

The non-invasive assessment of medial elbow pain in throwers can be challenging. Valgus stress transmitted to the elbow during the late cocking and acceleration phases of the throwing motion can result in injury to the medial ligamentous structures of the elbow, bony surfaces, and common tendon of the forearm flexors. The utilization of musculoskeletal (MSK) ultrasound in combination with the Telos Stress Device (TSD) (Austin & Associates Fallston, MD) can be an alternate quick assessment when radiography is not be available.