RESUMO
Ultrasound is a useful tool to investigate soft tissue masses in the wrist and hand. In most situations ultrasound helps distinguish between a cyst and a tissue mass. This article provides a simple clinical approach to the use of ultrasound imaging for the diagnosis and preoperative assessment of wrist and hand masses.
Assuntos
Mãos , Neoplasias/diagnóstico por imagem , Idoso , Contratura de Dupuytren/diagnóstico por imagem , Humanos , Masculino , Ultrassonografia , PunhoRESUMO
In the past, needle aspirations or injections involving the motor system were always carried out either blind or guided by fluoroscopy. Over the last few years, sonography has begun to offer an interesting alternative. Its advantages are that it is a relatively inexpensive technique, while not emitting ionising radiation and being easily accessible. There has been a great deal of technical progress including high frequency transducers, which have led to performance improvements in terms of both diagnosis and treatment of pathologies of the motor system. Due to these technical advances and to sterile covers for the transducers, it is now possible to visualise and to aspirate or inject into a peripheral joint, a tendon sheath or a bursa with or without effusion. This technique does not require a contrast medium injection because the needle position can be checked directly. Minimally invasive, it allows a number of interventions to be carried out with a very low complication rate since the entire path of the needle is followed using sonography, which means that nerves, vessels and other structures can be avoided because they are visualised directly in real time.
Assuntos
Doenças Ósseas/tratamento farmacológico , Artropatias/etiologia , Ultrassonografia de Intervenção/métodos , Desenho de Equipamento , Humanos , Injeções Intralesionais/métodos , Guias de Prática Clínica como Assunto , Ultrassonografia de Intervenção/instrumentaçãoRESUMO
In this case series, out of 823 ultrasound-guided injections carried out over a period of one and a half years, 60% were of the lower limb (LL). In the hip (61% of LL injections), the main indications were pathologies of the gluteal tendons and bursae (80%) and pathologies of periprosthetic soft tissue; in the knee (15% of LL punctures), these procedures were for cysts (51%), tendinopathies and bursopathies (18%), and joint aspirations (7%); in the calf, haematoma drainage; in the foot and the ankle (24% of LL punctures), Morton's neuroma (47%), tenosynovitis (22%), pathologies of the plantar fascia (13%), cysts (7%), joint aspirations (5%), and bursopathies. For each of these indications, we will detail the specific technique and equipment used, useful tips, and post-procedure care.
Assuntos
Extremidade Inferior , Doenças Musculoesqueléticas/diagnóstico por imagem , Doenças Musculoesqueléticas/terapia , Ultrassonografia de Intervenção/métodos , Humanos , Guias de Prática Clínica como AssuntoRESUMO
Forty percent of the 823 ultrasound-guided injections performed in our centre over a year and a half concerned the upper limb, injections involving the shoulder, for subacromial bursitis and the treatment of calcific tendinitis, being the prime indications (24%). The wrist represented 8% of the prescriptions, for treatment of tendinopathy, ganglion cysts, carpal tunnel syndrome and rhizarthrosis. Trigger finger, tenosynovitis and pulley ganglia made up 6% of the indications and the elbow 2.5%. Ultrasound improves the accuracy of the procedure by helping guide the path of the needle and allowing the distribution of the substance injected to be visualised. We shall give details of the technique used for each indication, with advice and hints and post-procedure recommendations.
Assuntos
Doenças Musculoesqueléticas/diagnóstico por imagem , Doenças Musculoesqueléticas/tratamento farmacológico , Ultrassonografia de Intervenção , Extremidade Superior , Humanos , Injeções Intralesionais/métodosRESUMO
Tenosynovitis refers to an inflammatory condition involving the synovial sheath of a tendon. Stenosing tenosynovitis is a peculiar entity caused by multiple factors, including local anatomy, mechanical factors, and hormonal factors. The main forms include de Quervain tendinopathy; trigger finger (stenosing tenosynovitis involving the flexor digitorum tendons); stenosing tenosynovitis of the extensor carpi ulnaris, extensor carpi radialis, or extensor comunis tendons; stenosing tenosynovitis of the flexor hallucis tendon; and stenosing tenosynovitis of the peroneal tendons. The cardinal finding on ultrasonography is the presence of a thickened retinaculum or pulley that constricts the osseofibrous tunnel through which the tendon runs.
RESUMO
Multiple periarticular structures are present around the hip joint: tendons, bursae, muscles and entheses, fascias, nerves and vessels. Periarticular diseases of the hip in young adults include, in decreasing order of functional impairment: posttraumatic lesions of muscles and tendons that should not be overlooked because of the risk of functional sequelae, enthesopathy detected on plain films and ultrasound, snapping hip syndrome frequent in athletes and tunnel syndromes (such as compression of the lateral femoral cutaneous nerve where ultrasound is valuable). The main pitfalls to avoid are the stress fracture, trauma to a pelvic muscle and calcium deposition.
Assuntos
Articulação do Quadril , Artropatias/diagnóstico , Doenças Musculares/diagnóstico , Humanos , Artropatias/diagnóstico por imagem , Imageamento por Ressonância Magnética , Doenças Musculares/diagnóstico por imagem , Ultrassonografia , Adulto JovemRESUMO
Man, with his erect posture, evolves in a world subject to the laws of gravity. His spine reflects these constraints. The morphology and static of human spine and biomechanical relationships between spine and pelvis are in direct relation with bipedia. Owing to this position the pelvis widened and straightened, characteristic sagittal spinal curves appeared and the perispinal muscles were deeply reorganized. Each pelvis is characterized by an important anatomical landmark: the pelvic incidence that reflects the sagittal morphology of the pelvis. Based on this anatomical characteristic, a chain of reactions determines the more efficient equilibrium of the whole body in the sagittal plane in term of energy consumption. Incidence affects the sacral slope, which determines lumbar lordosis, which itself influences pelvic tilt, thoracic kyphosis, and even hip and knee position. All these landmarks can easily be studied on a sagittal radiograph. Knowledge of these functional relationships is essential to understand the origin of low back pain, sagittal imbalance and above all before surgical treatment of spine disorders especially when arthrodesis is considered.
Assuntos
Ossos Pélvicos/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Idoso , Artroplastia de Quadril , Fenômenos Biomecânicos , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Cifose/diagnóstico por imagem , Lordose/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural/fisiologia , Postura/fisiologia , Radiografia , Sacro/diagnóstico por imagem , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral , Espondilolistese/cirurgia , Vértebras Torácicas/diagnóstico por imagemRESUMO
Man is standing up and he moves himself in a world subject to the gravity's laws. His spine reflects these constraints. Each bivertebral unit that composes the long supple stem of the spine has an anatomic cohesion with some mobility. The mobility of the spine is the sum of the motilities of its elementary units. Despite the criticisms, all deserved, the dynamic radiographies in flexion (seating position) and in extension (standing position, lower limbs straight and buttocks wedged) give major informations with important clinical consequences. Some semiologic points of the radiographic study of the vertebra are perfectly explained by its specific architecture: a radiolucent lesion is difficult to see whereas a sclerotic one is much more easy to individualize; the sclerotic line of the vertebral endplate must be continuous and any interruption is pathologic; the corners of the vertebra must be sharp; the foramen's shape reflects the size of the spinal canal.
Assuntos
Coluna Vertebral/diagnóstico por imagem , Fenômenos Biomecânicos , Humanos , Disco Intervertebral/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Osteólise/diagnóstico por imagem , Complicações Pós-Operatórias , Equilíbrio Postural/fisiologia , Postura/fisiologia , Intensificação de Imagem Radiográfica/métodos , Amplitude de Movimento Articular/fisiologia , Canal Medular/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Espondilolistese/diagnóstico por imagemRESUMO
Carcinomatous lymphangitis of prostatic origin is infrequent and usually carries a poor prognosis. The authors report a case of pulmonary carcinomatous lymphangitis related to a prostatic carcinoma. This case was remarkable for its acute mode of revelation and for its favourable outcome under treatment with LH-RH agonists.