Discussing sexual health with patients eligible for spine surgery: An online survey in spine surgeon and pain physicians.

Introduction: Spinal pain syndromes have a severe impact on the patient's sex life, contributing to a decrease in sexual function and sexual satisfaction. Despite the importance of sexual health on mental and physical wellbeing, sexual health is rarely discussed during consultations. Research question: The aim of this study is to explore to what extent influencing factors can alter the discussion about sexual health during consultations. More specifically, we will evaluate the influence of healthcare profession, sex of the patient and the surgical approach that is proposed. Material and methods: An online survey was sent to neurosurgeons, pain physicians and orthopedists in Belgium and The Netherlands in April 2019. Participants were asked about; counseling routine, knowledge, and opinion on sexual health. Answers were scored on a 5-point Likert scale. Independence between the response levels and type of surgery as well as profession were tested. Results: In total, 350 respondents were approached of whom 57 completed the survey. The majority of respondents (61.4%) indicated that they rarely or never discussed sexual disturbances. Profession and type of surgery had an influence on discussing erectile dysfunction, retrograde ejaculation, and alterations in orgasms. Thirty-five percent of healthcare providers considered it the patient's responsibility to bring up the subject of sexual health. Discussion and conclusion: Sexual health is rarely addressed by healthcare providers during spinal care. Profession as well as type of surgery seems to play a role on whether sexual health is discussed during consultations.

Automated analysis of trapeziometacarpal joint kinematics using four-dimensional computed tomography.

The aim of this study was to develop an automated approach model to define in vivo kinematics of the trapeziometacarpal (TMC) joint using four-dimensional computed tomography. A total of 15 healthy volunteers were included and their TMC joint kinematics were studied during a retropulsion-opposition-retropulsion movement. We used cardan angles estimated from transformation matrices using a ZYX-decomposition and analysed the motion of the thumb metacarpal relative to the trapezium, the thumb metacarpal relative to the index metacarpal, and the trapezium relative to the index metacarpal. The study also included an analysis of the joint hysteresis effect and a joint proximity model that estimated the joint contact area during a retropulsion-opposition-retropulsion movement. The automated approach significantly decreased the time needed to analyse each case and makes this model applicable for further research on TMC kinematics.

Tardigrade and Manifold Sign: Two New Signs in Dupuytren's Disease.

Dupuytren's disease (DD) is a chronic benign fibroproliferative disorder of the palmar and digital fasciae. It is characterized by formation of nodules and fibrous cords that may eventually lead to contractures with permanent flexion of the finger joints. Correction of the flexion contractures in advanced disease is still performed by open limited fasciectomy; ultrasonography (US)-guided minimally invasive treatment is preferred for early disease.We provide an overview of the detailed anatomy of the palmar aponeurosis and the structures that may be involved in DD. Although magnetic resonance imaging is used as the gold standard, these small anatomical structures are often better visible on US. We describe two new morphological signs due to thickening of these small structures in patients with DD: the tardigrade sign and the manifold sign. Familiarity with detailed imaging anatomy and these new imaging signs of DD will help confirm a correct and early diagnosis and distinguish this disease from various other entities.

Ultrasound of Lipomatosis of Nerve Associated with Macrodactyly: 'Spaghetti and Chocolate Cookie' Appearance.

We studied the US imaging findings of lipomatosis of nerve and macrodystrophia lipoma in three patients. Three patients were seen at three affiliated institutions with an enlarged digit. They all underwent US, subsequently followed by an MRI study. The nerves showed marked enlargement and extension over a length of 9-16 cm. Digital branches were always involved. The appearance on cross section was an enlarged hyperechoic endoneurium with inlying thickened and hypoechoic fascicles. On transverse images this resulted in a 'chocolate cookie' aspect and in the long axis a 'spaghetti-like' image. The US appearance of lipomatosis of nerve, not unlike MRI, is rather typical. With US, care should be taken in areas that are more difficult to assess as the sole of the foot, or where the 'chocolate cookie' appearance is not so obvious, such as the digits.

Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis.

PURPOSE: (I) To determine the incidence of periprosthetic tibial fractures in cemented and cementless unicompartmental knee arthroplasty (UKA) and (II) to summarize the existing evidence on characteristics and risk factors of periprosthetic fractures in UKA. METHODS: Pubmed, Cochrane and Embase databases were comprehensively searched. Any clinical, laboratory or case report study describing information on proportion, characteristics or risk factors of periprosthetic tibial fractures in UKA was included. Proportion meta-analysis was performed to estimate the incidence of fractures only using data from clinical studies. Information on characteristics and risk factors was evaluated and summarized. RESULTS: A total of 81 studies were considered to be eligible for inclusion. Based on 41 clinical studies, incidences of fractures were 1.24% (95%CI 0.64-2.41) for cementless and 1.58% (95%CI 1.06-2.36) for cemented UKAs (9451 UKAs). The majority of fractures in the current literature occurred during surgery or presented within 3 months postoperatively (91 of 127; 72%) and were non-traumatic (95 of 113; 84%). Six different fracture types were observed in 21 available radiographs. Laboratory studies revealed that an excessive interference fit (press fit), excessive tibial bone resection, a sagittal cut too deep posteriorly and low bone mineral density (BMD) reduce the force required for a periprosthetic tibial fracture to occur. Clinical studies showed that periprosthetic tibial fractures were associated with increased body mass index and postoperative alignment angles, advanced age, decreased BMD, female gender, and a very overhanging medial tibial condyle. CONCLUSION: Comparable low incidences of periprosthetic tibial fractures in cementless and cemented UKA can be achieved. However, surgeons should be aware that an excessive interference fit in cementless UKAs in combination with an impaction technique may introduce an additional risk, and could therefore be less forgiving to surgical errors and patients who are at higher risk of periprosthetic tibial fractures. LEVEL OF EVIDENCE: V.

Ultrasound anatomy of the fingers: flexor and extensor system with emphasis on variations and anatomical detail.

Many anatomical details and variants occur in the finger tendons and soft tissue structures. These may lead to misdiagnosis if the radiologist is not well aware of them. We discuss the midhand extensor tendons, dorsal hood, junctura tendinea, conjoint tendons, transverse retinacular ligament, triangular ligament as well as central and distal slip anatomy and ultrasound correlation. The dorsal hood is an important structure to center the tendons at the midportion of the MCP heads, and the sagittal bands are its main components. Two tendons are present at the second digit, and two or more at the fifth digit. The extensor mechanism is anatomically interrelated with the palmar lumbricals and interosseous tendons. At the palmar side, the flexor superficialis and profundus tendons show varying relationships along the finger. The flexor profundus passes through an opening in the flexor superficialis. We also discuss the chiasma crurale, ridges at the flexor superficialis insertions and bifid flexor profundus tendon. Although a typical distribution of annular pulleys can be observed, many variants may be present of which we address some. The volar plate is a midline fibro-cartilaginous meniscus attached proximally to the well-identifiable checkrein ligaments and distally to the base of the phalanges. Knowledge of these details and variations allows for better understanding of the finger and hand ultrasound.Many anatomical details and variants occur in the finger tendons and soft tissue structures. These may lead to misdiagnosis if the radiologist is not well aware of them. We discuss the midhand extensor tendons, dorsal hood, junctura tendinea, conjoint tendons, transverse retinacular ligament, triangular ligament as well as central and distal slip anatomy and ultrasound correlation. The dorsal hood is an important structure to center the tendons at the midportion of the MCP heads, and the sagittal bands are its main components. Two tendons are present at the second digit, and two or more at the fifth digit. The extensor mechanism is anatomically interrelated with the palmar lumbricals and interosseous tendons. At the palmar side, the flexor superficialis and profundus tendons show varying relationships along the finger. The flexor profundus passes through an opening in the flexor superficialis. We also discuss the chiasma crurale, ridges at the flexor superficialis insertions and bifid flexor profundus tendon. Although a typical distribution of annular pulleys can be observed, many variants may be present of which we address some. The volar plate is a midline fibro-cartilaginous meniscus attached proximally to the well-identifiable checkrein ligaments and distally to the base of the phalanges. Knowledge of these details and variations allows for better understanding of the finger and hand ultrasound.

Camptodactyly resulting from anatomical variation of lumbrical muscles: imaging findings.

We report three cases of camptodactyly in adolescent patients, presenting with a passive flexion deformity of the fifth finger. Ultrasound findings include aberrant lumbrical insertion and decreased lumbrical size, confirmed with magnetic resonance imaging, and aberrant dynamics. Surgery confirmed these findings in one patient. To the best of our knowledge, these imaging findings have not been reported previously.

Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves.

The high resolution and dynamic capability of ultrasound make it an excellent tool for assessment of superficial structures. The ligaments, tendons, and nerves about the elbow can be fully evaluated with ultrasound. The medial collateral ligament consists of an anterior and posterior band that can easily be identified. The lateral ligament complex consists of the radial collateral ligament, ulnar insertion of the annular ligament, and lateral ulnar collateral ligament, easily identified with specialized probe positioning. The lateral ulnar collateral ligament can best be seen in the cobra position. On ultrasound medial elbow tendons can be followed nearly up to their common insertion. The pronator teres, flexor carpi radialis, palmaris longus, and flexor digitorum superficialis can be identified. The laterally located brachioradialis and extensor carpi radialis longus insert on the supracondylar ridge. The other lateral tendons can be followed up to their common insertion on the lateral epicondyle. The extensor digitorum, extensor carpi radialis brevis, extensor digiti minimi, and extensor carpi ulnaris can be differentiated. The distal biceps tendon is commonly bifid. For a complete assessment of the distal biceps tendon specialized views are necessary. These include an anterior axial approach, medial and lateral approach, and cobra position. In the cubital tunnel the ulnar nerve is covered by the ligament of Osborne. Slightly more distally the ulnar nerve courses between the two heads of the flexor carpi ulnaris. An accessory muscle, the anconeus epitrochlearis can cover the ulnar nerve at the cubital tunnel, and is easily identified on ultrasound. The radial nerve divides in a superficial sensory branch and a deep motor branch. The motor branch, the posterior interosseous nerve, courses under the arcade of Frohse where it enters the supinator muscle. At the level of the dorsal wrist the posterior interosseous nerve is located at the deep aspect of the extensor tendons. The median nerve may be compressed at various sites, including the lacertus fibrosis, between the pronator teres heads, and the sublimis bridge. These compression sites can be identified with ultrasound.

Thickness of extensor tendons at the proximal intersection: sonographic measurements in asymptomatic volunteers.

OBJECTIVES: An important sign of proximal intersection syndrome is thickening of the tendons at the area where the first extensor compartment tendons cross over the second compartment. Normal values for the thickness of the tendons have not been reported. Our purpose was to measure the thickness of the tendons with sonography at the level of the intersection in healthy volunteers and assess differences between men and women, dominant and nondominant sides, and different tendons. METHODS: Forty-one asymptomatic volunteers (25 women and 16 men) were examined by 2 radiologists experienced in musculoskeletal sonography. The thickness of the tendons in the first and second compartments was measured at their intersection at standardized proximal and distal levels. Descriptive statistics were obtained. Differences between men and women, dominant and nondominant sides, and different tendons were evaluated by a Student t test. RESULTS: The 95% confidence intervals for measurements of superimposed tendon groups varied between 0.30 and 0.40 cm in women and between 0.36 and 0.48 cm in men. There were no statistically significant differences in comparisons of the different tendon groups (P > .05). There were statistically significant differences (P < .05) between tendon thickness in men and women except for the right extensor carpi radialis longus + abductor pollicis longus (proximal measurement) and extensor carpi radialis brevis + extensor pollicis brevis (distal measurement). On comparison of dominant and nondominant sides, there were no statistically significant differences. CONCLUSIONS: Normal tendon thickness should be between 0.30 and 0.40 cm in women and 0.36 and 0.48 cm in men. A comparison between asymptomatic and symptomatic sides and proximal and distal measurements is recommended.

Ultrasound of the sural nerve: normal anatomy on cadaveric dissection and case series.

The sural nerve is a small sensory nerve innervating the lateral aspect of the ankle and foot. Clinical symptoms of pathology may present as atypical sensory changes in this region. We present the normal anatomy and ultrasound technique for examination of the sural nerve based on an anatomical dissection, as well as imaging in a normal volunteer. We also present a case series (n=10) of different conditions of the sural nerve that we encountered based on a review of interesting cases from 4 institutions. The pathological conditions included neuropathy related to stripping or venous laser surgery, compression by abscess, Lyme disease, nerve tumors, traumatic transsection, and encasement by fibrous plaque and edema. Ultrasound with its exquisite resolution is the preferred imaging method for examining the sural nerve in patients with unexplained sensory changes at the lateral aspect of the ankle and foot.

The thickness of the sagittal bands in volunteers: high resolution ultrasound of the fingers.

PURPOSE: A sign of injury of the sagittal bands is thickening. The normal values for the thickness of the sagittal bands has not been described before. Our purpose was to measure the thickness of the sagittal bands with ultrasound in normal volunteers and compare differences between radial and ulnar band, dominant and non-dominant hand, different fingers, and men and women. MATERIALS AND METHODS: In 21 volunteers (10 men, 11 women), high resolution ultrasound imaging of the fingers was performed by two radiologists. The index, mid finger, ring finger and little finger were analyzed. The mean values were obtained for each finger. Statistical differences were calculated with a two-tailed Student's t test. RESULTS: The thickness of the sagittal bands showed a wide range of variations. Statistically significant differences were not found between the radial and ulnar band, dominant and non-dominant hand, and different fingers. Between men and women a significant difference was found for the ulnar band of index and ring finger of the dominant hand. CONCLUSION: The measurements of the sagittal bands show a wide range of values. Statistically significant differences for the means were only found for the ulnar band of index and ring finger of the dominant hand between men and women.

Ultrasound findings in injuries of dorsal extensor hood: correlation with MR and follow-up findings.

OBJECTIVE: The aim of this study was to use ultrasound to examine the dorsal hood in nine patients with a clinical suspicion of dorsal hood injuries. MATERIAL AND METHODS: Clinical and imaging files from interesting case logbooks of nine patients were reviewed. Ultrasound was performed by one of the three radiologists experienced in musculoskeletal ultrasound. The examinations were also performed in flexion and in flexion with resistance. MR correlation was obtained in six patients. One patient underwent surgery. To obtain anatomical correlation of the normal dorsal hood 2 embalmed hand specimens were dissected. RESULTS: The sagittal bands were easily depicted in the transverse plane on ultrasound images and presented as hypoechoic bands on both sides of the extensor communis tendons. Injuries of the sagittal bands were seen on ultrasound as hypoechoic thickening of the sagittal bands at the side of the extensor tendons. The normal shape of the sagittal bands was also no longer recognizable. Subluxations or dislocations of the extensor tendons were also seen. When the injuries were located in the fibrous slips between the extensor indicis and the extensor communis of the second finger, subluxations with an increased distance between these 2 tendons were seen, especially in flexion, or in flexion with resistance. CONCLUSION: Ultrasound is a valuable tool for the assessment of the injuries of the dorsal hood and is an easily available method for the diagnosis of the fine soft tissue components of the dorsal hood region.

Spectrum of normal and pathologic findings in the region of the first extensor compartment of the wrist: sonographic findings and correlations with dissections.

OBJECTIVE: The purpose of this presentation is to review pathologic conditions that lead to pain at the radial aspect of the distal radius and to address anatomic variations of the first extensor compartment that exist and may have diagnostic and therapeutic implications. METHODS: Our presentation is based on a review of cases from teaching files and observations made in anatomic specimens. RESULTS: The discussed conditions include de Quervain tenosynovitis, intersection syndrome, and Wartenberg syndrome. Sonographic diagnosis of these conditions is addressed, and correlations are provided with anatomic specimens. CONCLUSIONS: Sonography is able to depict and differentiate between these conditions.

Functional anatomy of the dorsal hood or the hand: correlation of ultrasound and MR findings with cadaveric dissection.

The main aim of this study was to provide an overview of the anatomy of the dorsal hood (DH) based on the dissection of sixteen cadaver hands, correlated with magnetic resonance (MR) and ultrasound findings. A secondary aim was to assess the function of components of the DH. Sixteen embalmed hands were evaluated by MRI and ultrasound before being dissected. Each hand was photographed during each stage of dissection. Secondly we evaluated the role of the different structures of the DH in the stability of the extensor tendon by transection of the different components alternatively at the ulnar and radial sides. MR, ultrasound, and dissection showed that the extensor tendon (ET) is stabilized by the sagittal band (SB) at the level of the metacarpophalangeal (MCP) joint and more distally by the transverse and the oblique bands, respectively. Transection of the radial SB of the second finger leads systematically to ulnar dislocation of the ET. The transection of the ulnar DH does not lead to instability of the ET. The SB is the most important structure of the DH in the stability of the ET at the MCP level. Rupture of the radial SB of the second finger leads systematically to ulnar dislocation of the ET.

Sonography of the normal ankle: a target approach using skeletal reference points.

OBJECTIVE: Sonographic examination of the ankle depends on exact knowledge of the specific probe positions to acquire the best images. CONCLUSION: In this article, we discuss these positions and illustrate them with drawings, anatomic slices or dissection, and sonograms. Positions studied include those for best imaging of the anterior tibiotalar joint, anterior tibiofibular ligament, anterior talofibular ligament, calcaneofibular ligament, peroneal tendons, Achilles tendon, flexor hallucis longus, posterior deltoid ligament, anterior deltoid ligament, and posterior medial tendons.

Sonography of the finger flexor and extensor system at the hand and wrist level: findings in volunteers and anatomical correlation in cadavers.

We present a review of sonography of the flexor and extensor system of the hand and wrist in volunteers and cadavers. CT tenography also was performed in cadaveric specimens. Anatomical structures of the extensor system that were assessed with sonography included the extensor tendons and insertions, retinaculum, and dorsal hood. On the flexor side, the variable relationship between the flexor superficialis and profundus could be appreciated. Volar plates, tendon insertions, and annular pulleys could also be investigated. Sonography can show details of the finger flexor and extensor system.

US diagnosis of UCL tears of the thumb and Stener lesions: technique, pattern-based approach, and differential diagnosis.

The thumb is a central component supporting the intricate movements of the hand. Patients with acute thumb pain, particularly after trauma, require prompt evaluation of structural integrity, thus avoiding long-term morbidity such as instability, chronic pain, and osteoarthritis. Injury to the ulnar collateral ligament (UCL) of the thumb requires imaging for diagnosis of surgically important entities such as the Stener lesion. Historically, routine radiography including stress views does not allow such diagnosis and is potentially detrimental to patient care. Both magnetic resonance imaging and ultrasonography (US) are currently used for direct evaluation of the UCL of the thumb and are safe and accurate. US is more dynamic and less time-consuming and may be easier to perform. Furthermore, other disorders such as tenosynovitis, tendon tears, and articular pathologic conditions can involve the thumb and thenar region and may also be diagnosed with US. In this context, US is an underused tool because it is potentially an adjunct to the clinical examination in the appropriate setting. A sound knowledge of the regional anatomy and basic training in the principles of US should equip the imager with the skills necessary to evaluate the UCL of the thumb and its surrounding structures.

Sonography of a rupture of the tendon of the extensor pollicis longus muscle: initial clinical experience and correlation with findings at cadaveric dissection.

OBJECTIVE: The objectives of our study were to report our initial clinical experience with sonography of the wrist for diagnosing a proximal rupture of the tendon of the extensor pollicis longus (EPL) muscle and to perform sonographic-anatomic correlation of the EPL tendon. MATERIALS AND METHODS: Clinical and imaging files of five patients who underwent sonography and subsequent open wrist surgery were reviewed retrospectively. Imaging was performed by four radiologists experienced in musculoskeletal sonography. Tendon retraction was evaluated on sonography and at surgery. In cadavers, sonography was performed in concert by two musculoskeletal radiologists during progressive stages of dissection of four embalmed specimens. One specimen was sliced in the transverse plane. RESULTS: In cadavers, the EPL tendon was located on or adjacent to Lister's tubercle and extended to the base of the thumb. The EPL tendon crossed over the extensor carpi radialis tendons where it exhibited a flattened aspect. In the five patients in the study, a tubular-shaped hypoechoic area was evident at the position of the ruptured EPL tendon on sonograms. At surgery, this area corresponded to fluid, hemorrhage, and scar tissue in the EPL tendon sheath. The assessment of tendon retraction on sonography correlated with findings at surgery. CONCLUSION: Sonography may aid in diagnosing a rupture of the EPL tendon and in the preoperative assessment of gap size and position of the retracted tendon ends. A characteristic tubular hypoechoic area may be seen crossing over the extensor carpi radialis tendons.