An anatomical study of the indirect tendon of the rectus femoris using ultrasonography.

UNLABELLED: The aim of this study was to demonstrate that ultrasound can allow a precise assessment of the indirect tendon of the rectus femoris using a new lateral approach. METHODS AND MATERIALS: Four hips were dissected for the anatomical study of the proximal rectus femoris insertions. Under ultrasonographic guidance, spinal needles piercing the direct tendon were placed in the indirect tendon, following by dissection. Then, high-resolution ultrasound was performed in 20 volunteers with assessment of the indirect tendon of the rectus femoris. RESULTS: At dissection, the spinal needles were located in or immediately adjacent to the indirect tendon, thus confirming that it was correctly depicted by ultrasound. The indirect tendon could be identified in each cadaver and each volunteer with ultrasound. The optimal position of the probe to allow assessment of the indirect tendon could be defined. No significant changes in the appearance or thickness of the tendon could be observed. CONCLUSION: The results of our study showed that the indirect tendon of the rectus femoris muscle can be clearly depicted by sonography in healthy adult subjects. The potential applications of this new use of sonography must now be confirmed by clinical studies. KEY POINTS: • The anatomy of the proximal rectus femoris is reviewed • Until now, sonography was limited for assessing direct and conjoined tendons • The indirect tendon can be clearly depicted by sonography • A new lateral approach for studying the indirect tendon is described.

Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain.

Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment.

Innovative methods to assess upper limb strength and function in non-ambulant Duchenne patients.

Upper limb assessment in non-ambulant patients remains a challenge. We have designed new tools to precisely assess pinch (MyoPinch), grip (MyoGrip), wrist flexion and extension (MyoWrist) strength. We have also designed a new tool to assess the ability of patients to produce repetitive flexion/extension movements of wrist and fingers (MoviPlate). We have assessed the feasibility and reliability of these new tools in 30 non-ambulant patients with Duchenne muscular dystrophy and in 30 age-matched male controls. Existing measures, such as Motor Function Measure, Tapping, and the Brooke Upper Extremity Functional Rating Scale were also performed. Results demonstrated that assessments were feasible in nearly all upper limbs tested for MyoGrip, MyoPinch and MoviPlate. The reliability of all tests, including MyoWrist which was not feasible in the patients presenting with contractures, was excellent in patients as in controls. Motor capacities decrease with the number of months spent in the wheelchair. The scores in the tests were partially correlated with each other, and with clinical measures such as vital capacity, Motor Function Measure, functional hand scale and Brooke score. This study validates a panel of upper limb muscle strength and function measures for Duchenne Muscular Dystrophy which can be applied from controls to extremely weak patients.

[Spinal infections: typical and atypical imaging features]. / Infections rachidiennes: aspects typiques et atypiques.

While the imaging features of established spondylodiscitis are well known, other presentations may be misleading. The purpose of this article is to review the typical imaging features of spondylodiscitis as well as some more atypical and unusual imaging features (early spondylodiscitis, sceptic spondylitis, septic arthritis of facet joints, primary epidural abscess, unusual germs, neonate).

Somatosensory cortical activation identified by functional MRI in preterm and term infants.

Functional MRI (fMRI) has not previously been used systematically to investigate brain function in preterm infants. We here describe statistically robust and reproducible fMRI results in this challenging subject group using a programmable somatosensory stimulus synchronized with MR image acquisition which induced well-localized positive blood oxygen level dependent (BOLD) responses contralateral to the side of the stimulation in: 11 preterm infants (median post menstrual age 33 weeks and 4 days, range 29+1 to 35+3); 6 control infants born at term gestational age; and 18 infants born preterm (median gestational age at birth 30 weeks and 5 days, range 25+4 to 36+0) but studied at term corrected gestational age. Bilateral signals were identified in 8 of the ex-preterm infants at term age. Anatomical confirmation of appropriate activations was provided with diffusion tensor imaging (DTI) based tractography which identified connecting pathways from the regions of activation through the ipsilateral corticospinal tracts and posterior limb of the internal capsule. These results demonstrate that it is possible to reliably identify positive BOLD signals in the infant brain and that fMRI techniques can also be applied in the study of preterm infants.