Median nerve instability in the wrist: Ultrasound diagnosis.

Instability of the nerves, which does not follow traumatic injury, is relatively rare. The ulnare nerve is most typically involved. Median nerve instability is far less common. The identification of instability of the median nerve in the wrist is definitely an indication for ultrasound examination before carpal tunnel release.

Psoriatic arthritis: Ultrasound peculiarities with particular emphasis on enthesitis.

The prevalence of psoriatic arthritis among patients with psoriasis has a marked variability with ethnic and geographic variations. Inflammatory changes associated with psoriatic arthritis include bone erosion, tenosynovitis, and synovial hypertrophy, but enthesitis is considered the hallmark. Both X-ray and magnetic resonance imaging (MRI) are usefull in the diagnosis of psoriatic arthritis, but ultrasonography is the best imaging modality to assess entheses. Ultrasound findings of enthesitis include a loss of the regular fibrillar architecture, hypoechoic thickening, hypervascularization of tendons, ligaments, and joint capsules at their bony attachment, bony changes (including irregularities and erosions). Ultrasound has also proved the ability to detect inflammatory subclinical findings and to be useful in the follow-up of therapies.

Soleus strain: an underestimated injury?

The medial gastrocnemius is the most commonly injured muscle in the calf, and while traumatic lesions of the medial gastrocnemius are frequently described in the medical literature and clinical and sonographic diagnoses are easy, those of the soleus are less easily recognisable clinically or by sonography. We present a case of traumatic lesions of the medial gastrocnemius, diagnosed clinically and with ultrasound, while MRI also detected two lesions of the soleus. The case presented and the review of the literature highlight how clinical and ultrasound examinations can lead to misunderstandings about traumatic injury to the soleus.

Distal Biceps Brachii Tendon Insertion: A Simple Method of Ultrasound Evaluation.

Different ultrasound approaches have been proposed to evaluate the distal biceps brachii tendon, such as lateral, posterior, medial, and anterior, all allowing good visualization of the distal biceps tendon and its pathologic appearances. Here we describe a new method of ultrasound evaluation of the distal biceps tendon insertion with the patient in the so-called crab position. The crab position is used to evaluate the posterior compartment of the elbow but also the lateral and medial compartments. This position allows for coverage of 75% the elbow in a single position, with less discomfort for the patient and a fair amount of saved time. In this position, after the evaluation of the common extensor tendon in the long axis, turning the transducer 90° and moving it distally allows for optimal visualization of the distal biceps brachii tendon in the axial plane. It is a simple, quick approach that allows for excellent visualization of the insertion of the distal biceps brachii tendon while avoiding an anisotropic effect.

Sonography before and after carpal tunnel release: video article.

Carpal tunnel release for compression of the median nerve at the wrist is a common procedure, often resulting in good clinical outcomes. There are, however, many anatomical variations in and around the carpal tunnel and it is important to be aware of these during carpal tunnel release. After surgery, recurrent carpal tunnel syndrome is uncommon, but difficult to diagnose and treat. Ultrasonography is often necessary for the evaluation of the anatomical variations before carpal tunnel release and to evaluate the most common complications after carpal tunnel release.