Imaging of peripheral nerve lesions in the lower limb.

Lower limb peripheral neuropathy may have a variety of causes. This article focuses on focal neural lesions because of neural entrapment associated with static mechanical compression or dynamic compression/stretching. Mechanical compression may relate to direct blunt trauma, surgical injury, mass effect associated with adjacent mass lesions, and frictional effects associated with fibrous bands. Stretching neural injury may be associated with abnormalities in alignment such as plano-valgus hindfoot and hindfoot pronation. Recurrent inversion ankle injuries may also cause neural injury. Neural injury may be associated with denervation of the muscles supplied by the nerve. Electromyography (EMG) remains the gold standard for diagnosis of denervation. Diagnostic imaging plays a complementary role to EMG in difficult cases, the anticoagulated patient, and in clarifying the etiology of an EMG-demonstrated neuropathy. Magnetic resonance imaging and ultrasound can be used in peripheral nerve imaging to demonstrate extrinsic compressive lesions, focal neural lesions such as neural edema and swelling, focal neural scarring (posttraumatic neuroma in continuity) and intraneural ganglia. Imaging can also demonstrate the effects of muscle denervation. Focal areas of tenderness can be highlighted using skin markers for magnetic resonance imaging and by transducer palpation on ultrasound. Ultrasound can be particularly useful in assessing for intrinsic lesions in small peripheral nerves because of the superior spatial resolution of ultrasound in assessing superficial structures. Plain x-rays (and sometimes computed tomography scanning) may show significant bone changes and should be the initial imaging modality.

Overuse and impingement syndromes of the shoulder in the athlete.

Overuse and impingement syndromes in the shoulders of athletes are predominantly caused by instability of the glenohumeral joint. Glenohumeral joint instability is usually acquired from repetitive overuse of the rotator cuff and shoulder girdle muscles, or injury of the static and dynamic stabilizers of the glenohumeral joint. Congenital hypermobility of the joint may also contribute to these syndromes in some individuals. The throwing action may lead to a cascade of injuries to the static and dynamic stabilizers of the posterosuperior glenohumeral joint, caused by the repetitive, high-energy nature of the action rather than a specific injury. Injury to the anterosuperior stabilizers of the glenohumeral joint may also lead to anterosuperior impingement syndrome. The role of MR in overuse and impingement syndromes of the shoulder is to accurately diagnose the underlying structural changes and serves to assist the clinician in instituting the appropriate conservative or surgical treatment for individual athletes.

MR imaging of traumatic and overuse injuries of the wrist and hand in athletes.

Traumatic and overuse injuries of the hand and wrist are common in athletes. Increasingly, MR imaging is being used to complement clinical and radiographic assessment in the diagnosis and management of these injuries. MR imaging is able to image accurately the bones, tendons, ligaments, nerves, and other small structures of the hand and wrist. This article provides an overview of traumatic and overuse injuries of the hand and wrist in athletes and a review of the MR imaging appearances.

A "paneful" perforation.

Radiographs of a woman presenting with abdominal pain revealed a large foreign body within the pelvis. A diagnosis of perforation of the colon was made, and at laparotomy an 8.5 cm long glass fragment was removed from the bowel. A laceration to the lower back, sustained in a fall onto a glass coffee table, had been explored and sutured 20 months earlier. Imaging findings showed the subsequent course of the overlooked glass fragment within the pelvis.

Percutaneous gelfoam embolization of chronic enterocutaneous fistulas: report of three cases.

PURPOSE: A relatively simple radiologically guided method for the treatment of enterocutaneous fistula by gelfoam embolization is described. METHODS: Three cases of chronic enterocutaneous fistula are presented. In each case, a sheath was positioned with its tip at the enteric opening of the fistula. Gelfoam was injected to occlude the fistula at its enteric opening. RESULTS: In each case, there was successful closure of the fistula. CONCLUSIONS: Radiologically guided embolization with gelfoam is a safe, relatively simple procedure, which may be useful in the treatment of chronic enterocutaneous fistula.