RESUMO
OBJECTIVES: In ultrasound (US) examinations of clinically relevant very small structures of the wrist and hand, the healthy contralateral side can be used as a reference to identify subtle abnormalities. Intraindividual side-to-side variability must be minimal. The aim of this study was to assess the reliability of side-to-side US evaluations of very small structures of the wrist and hand. METHODS: Forty-one healthy volunteers were prospectively studied. Small structures of the wrist and hand were evaluated bilaterally by 2 musculoskeletal radiologists in separate sessions. The first annular pulleys of the second finger and the thumb, sagittal band of the third finger, extensor and flexor retinacula, ulnar collateral ligament of the thumb, radial collateral ligament of the second finger, and palmar cutaneous branches of the median and ulnar nerves were considered. To assess intra- and inter-reader agreement, 10 of 41 (24%) examinations were repeated. Nonparametric statistics were used. RESULTS: Data were not normally distributed (P > .001). Intra-reader agreement was κ = 0.674 (95% confidence interval [CI], 0.57-0.78), and inter-reader agreement was κ = 0.935 (95% CI, 0.92-0.95). The mean value ± SD for all of the structures was 0.78 ± 0.44 mm. The overall coefficient of variation was 9.8% ± 0.07%. The intraclass correlation coefficient was 0.97 (95% CI, 0.96-0.98). CONCLUSIONS: In clinical practice, the healthy contralateral side can be used as a reference during a real-time musculoskeletal US evaluation of small (<2-mm) structures.
Assuntos
Mãos/anatomia & histologia , Ultrassonografia/métodos , Articulação do Punho/anatomia & histologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Punho , Adulto JovemRESUMO
PURPOSE: The objectives of this study were to assess the influence of weight-bearing on tibiofemoral osteoarthritis, including medial meniscal extrusion, by using a low-field (0.25 T) rotating clino-orthostatic permanent-magnet magnetic resonance (MR) scanner, and to analyse correlations of medial meniscal extrusion with the patient's Kellgren-Lawrence score, body mass index, and all the osteoarthritis features of the WORMS scoring system. MATERIALS AND METHODS: Twenty-six patients (69.2% women and 30.8% men; mean age 67 ± 9.7 years) with medial tibiofemoral knee osteoarthritis were prospectively enrolled and MR sequences were acquired in both clino- and orthostatic position. MR images were assessed by two independent radiologists, according to the WORMS scale. Medial meniscal extrusion was measured and its clino-orthostatic difference (∆MME) was calculated. RESULTS: Intra- and inter-observer agreement of the WORMS Global Score readings was high by Cohen's K test (>0.81). No significant clino-orthostatic changes in the scoring parameters of the medial tibiofemoral joint were shown by Wilcoxon's test. Medial meniscal extrusion measured on orthostatic images was significantly higher than that measured in clinostatic position (p < 0.0001). At univariate analysis, the Kellgren-Lawrence score, WORMS Global Score, cartilage loss, meniscal damage, and osteophytes were significantly correlated to ∆MME (p < 0.005). Using a multiple regression model, tibiofemoral cartilage loss was found to correlate independently with ∆MME (p = 0.0499). CONCLUSIONS: Medial meniscal extrusion, evaluated with an open-configuration, rotating MR scanner, increased from the clinostatic to the orthostatic position. ∆MME, a new meniscal parameter, correlated with several important features of medial tibiofemoral osteoarthritis.
Assuntos
Imageamento por Ressonância Magnética/instrumentação , Meniscos Tibiais/patologia , Osteoartrite do Joelho/patologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Posicionamento do Paciente , Projetos Piloto , Estudos Prospectivos , Suporte de CargaRESUMO
A 22 years-old-man was admitted to emergency after trauma. He suffered multiple deep cuts on his left leg. A lesion of the ischiatic nerve was suspected, and an ultrasound (US) evaluation was requested to confirm it. The study was conducted in the emergency room using a linear ultrasound transducer of 6-15 MHz and demonstrated the completely truncation of the ischiatic nerve (neurotmesis - Sunderland Grade V) with the proximal end retracted up to about 3cm from the edge of the wound. It was a very useful information for the neurosurgeon who after performed an end-to-end neurorrhaphy with suturation of perineurium. This short report underlines the importance of US, that thanks to its high spatial resolution and its time- and cost-effectiveness, can be considered a very important tool for the physician in emergency room to characterize peripheral nerve lesions.
Assuntos
Perna (Membro)/diagnóstico por imagem , Perna (Membro)/inervação , Traumatismos dos Nervos Periféricos/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Serviço Hospitalar de Emergência , Humanos , Perna (Membro)/cirurgia , Masculino , Traumatismos dos Nervos Periféricos/cirurgia , Adulto JovemRESUMO
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Assuntos
Calcinose/diagnóstico por imagem , Fibroma/diagnóstico por imagem , Dedos/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Calcinose/complicações , Calcinose/cirurgia , Fibroma/complicações , Fibroma/cirurgia , Dedos/cirurgia , Humanos , Masculino , Neoplasias de Tecidos Moles/complicações , Neoplasias de Tecidos Moles/cirurgiaRESUMO
UNLABELLED: Adhesive capsulitis of the shoulder is a clinical condition characterized by progressive limitation of active and passive mobility of the glenohumeral joint, generally associated with high levels of pain. Although the diagnosis of adhesive capsulitis is based mainly on clinical examination, different imaging modalities including arthrography, ultrasound, magnetic resonance, and magnetic resonance arthrography may help to confirm the diagnosis, detecting a number of findings such as capsular and coracohumeral ligament thickening, poor capsular distension, extracapsular contrast leakage, and synovial hypertrophy and scar tissue formation at the rotator interval. Ultrasound can also be used to guide intra- and periarticular procedures for treating patients with adhesive capsulitis. KEY POINTS: ⢠Diagnosis of adhesive capsulitis is mainly based on clinical findings. ⢠Imaging may be used to exclude articular or rotator cuff pathology. ⢠Thickening of coracohumeral and inferior glenohumeral ligaments are common findings. ⢠Rotator interval fat pad obliteration has 100 % specificity for adhesive capsulitis. ⢠Ultrasound can be used to guide intra- and periarticular treatments.
Assuntos
Doenças do Tecido Conjuntivo , Hiperpigmentação , Anormalidades da Pele , Atrofia , Humanos , UltrassonografiaRESUMO
BACKGROUND: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare syndrome consisting of acute symmetrical tenosynovitis of the hands and wrists associated with pain and marked pitting edema of the dorsum of the hands or the feet. Persistent rheumatoid factor seronegativity and elevated acute phase reactants are the rule, while radiographic findings are characterized by the absence of bony erosions. The syndrome has occasionally been associated with a wide range of diseases including solid and hematological malignancies, polymyalgia rheumatica, and other inflammatory rheumatic diseases. METHODS: Two patients with skin eruption on hands and feet associated with arthromyalgias have been investigated to confirm diagnosis of RS3PE and to detect comorbidities. A revision of all the possible medical conditions correlated to RS3PE has been performed. RESULTS: We report two cases of RS3PE associated with Parvovirus B19 infection/reactivation. There are very few reports on the association between RS3PE and infectious agents, and in only one case the syndrome has been correlated to parvovirus infection. CONCLUSIONS: We want to underline the importance for patients with RS3PE to be seen by dermatologists who should become familiar with this syndrome and remark that Parvovirus B19 infection may be a potential cause of RS3PE.