Ultrasound Examination and Navigation for Repeat/Delayed Reconstruction of the Ankle Extensor Tendons.

Herein, we describe a 46-year-old woman with persistent pain and weakness in her left ankle/foot one year after surgical repair of all three ankle extensor tendons following a penetrating injury. This report presents a unique case whereby US imaging played a paramount role in the diagnosis and surgical management of a previous nonanatomic repair of the ankle extensor tendons after a penetrating injury one year prior. The above-quoted findings were subsequently corrected with end-to-end sutures. On the third postoperative month follow-up, the patient was free of any complaints or complications.

Ulnar Neuropathy at the Elbow: From Ultrasound Scanning to Treatment.

Ulnar neuropathy at the elbow (UNE) is commonly encountered in clinical practice. It results from either static or dynamic compression of the ulnar nerve. While the retroepicondylar groove and its surrounding structures are quite superficial, the use of ultrasound (US) imaging is associated with the following advantages: (1) an excellent spatial resolution allows a detailed morphological assessment of the ulnar nerve and adjacent structures, (2) dynamic imaging represents the gold standard for assessing the ulnar nerve stability in the retroepicondylar groove during flexion/extension, and (3) US guidance bears the capability of increasing the accuracy and safety of injections. This review aims to illustrate the ulnar nerve's detailed anatomy at the elbow using cadaveric images to understand better both static and dynamic imaging of the ulnar nerve around the elbow. Pathologies covering ulnar nerve instability, idiopathic cubital tunnel syndrome, space-occupying lesions (e.g., ganglion, heterotopic ossification, aberrant veins, and anconeus epitrochlearis muscle) are presented. Additionally, the authors also exemplify the scientific evidence from the literature supporting the proposition that US guidance is beneficial in injection therapy of UNE. The non-surgical management description covers activity modifications, splinting, neuromobilization/gliding exercise, and physical agents. In the operative treatment description, an emphasis is put on two commonly used approaches-in situ decompression and anterior transpositions.

Ultrasound-guided perineural vs. peritendinous corticosteroid injections in carpal tunnel syndrome: a randomized controlled trial.

BACKGROUND: Corticosteroid injections are proven to be effective in the management of carpal tunnel syndrome (CTS); however, the optimal injection site still remains unclear. AIM: The aim of this study is to compare the efficacy of perineural vs. peritendinous target sites for corticosteroid injection in CTS. DESIGN: A randomized, single-blind, controlled trial. SETTING: Outpatients, tertiary care center. POPULATION: Forty-six patients were equally randomized into two intervention groups as group A (18 female and five male patients; mean age: 50.0±15.9 years; mean symptom duration: 5.9±3.3 months) and group B (19 female, four male patients; mean age: 54.3±15.0 years; mean symptom duration: 5.9±4.7 months). METHODS: Methylprednisolone acetate (40 mg) and 1 mL of 1% trimecaine hydrochloride was injected next to the median nerve (group A) or among flexor tendons away from the nerve (group B) under ultrasound (US) guidance. The visual analogue scale was used as the primary outcome measure, and the symptom severity scale and functional status scale of the Boston Carpal Tunnel Questionnaire were used as the secondary subjective outcome measures. Two-point discrimination, grip strength, cross-sectional area, and distal motor latency were assessed as objective outcome measures. The data were collected at baseline and at 2, 6 and 12 weeks after the injection. RESULTS: Both groups showed improvement in subjective and objective measures at 2 weeks following the injection - also maintained up to 12 weeks during the follow-up (P<0.05). However, no difference was observed between the two groups (P<0.05). No serious adverse effects were observed in either group. CONCLUSIONS: Both intervention techniques seem to be effective and safe in the conservative treatment of CTS. CLINICAL REHABILITATION IMPACT: Based on this study results, it might be noteworthy that physicians can opt for perineural or peritendinous injections without compromising the treatment efficacy and safety. Herewith, US guidance is, for sure, necessary for performing safe and accurate injections.

Plantar vein thrombosis: an unexpected cause of posttraumatic foot pain explained with ultrasound.

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Ultrasound Imaging and Guidance in Common Wrist/Hand Pathologies.

ABSTRACT: Wrist/hand pain is a prevalent musculoskeletal condition with a great spectrum of etiologies (varying from overuse injuries to soft tissue tumors). Although most of the anatomical structures are quite superficial and easily evaluated during physical examination, for several reasons, the use of ultrasound imaging and guidance has gained an intriguing and paramount concern in the prompt management of relevant patients. In this aspect, the present review aims to illustrate detailed cadaveric wrist/hand anatomy to shed light into better understanding the corresponding ultrasonographic examinations/interventions in carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, rhizarthrosis, and the radiocarpal joint arthritis. In addition, evidence from the literature supporting the rationale why ultrasound guidance is henceforth unconditional in musculoskeletal practice is also exemplified.

Two Cases of Intramuscular Hemangiomas in the Upper Limbs: From Sonography to Pathology.

ABSTRACT: Intramuscular hemangiomas are benign soft tissue tumors that are rarely found in the upper limbs. Diagnosing these tumors may be challenging owing to their pertinent nonspecific symptoms-often leading to misdiagnoses like tendinitis or muscle strain. In this article, two cases of intramuscular hemangiomas are presented-one in flexor pollicis brevis muscle and the other one in flexor digitorum superficialis muscle. Both subjects had nonspecific clinical symptoms whereby ultrasound imaging led to prompt diagnosis. To this end, the authors strongly advocate sonographic examination as an extension of physical examination in the daily clinical practice of musculoskeletal physicians.

Ultrasonographic evaluation of the distal femoral and talar cartilage thicknesses in patients with poliomyelitis: a cross-sectional observational study.

BACKGROUND: Sequelae of poliomyelitis, coupled with asymmetric impairment and weight-bearing, typically alter walking biomechanics which can be associated with the knee and ankle osteoarthritis. AIM: We aimed to investigate whether the distal femoral and talar cartilage thicknesses were different in patients with poliomyelitis. DESIGN: Cross-sectional observational study. SETTING: Outpatients, tertiary care center. POPULATION: Thirty-six patients (12 males, 24 females) with a history of poliomyelitis and 36 age, gender and body mass index similar healthy subjects (11 males, 25 females) were enrolled. Mean values for age, body mass index and age of the poliomyelitis onset were 70.2±4.6 years, 27.2±5.7 kg/m2, and 3.6±2.4 years. METHODS: Visual Analogue Scale (VAS) was used to assess pain. Lower limb muscle strengths were measured by manual muscle testing. The more affected side was identified according to the lower limb manual muscle testing. Bilateral distal femoral cartilage from the lateral femoral condyle, intercondylar area, medial femoral condyle and talar cartilage thicknesses were measured using ultrasound imaging. RESULTS: Among patients, the onset of poliomyelitis was at 3.6±2.4 years of age, and Functional Ambulation Category scores were 5 (3-5). VAS scores were similar between the sides affected more and less by poliomyelitis. All cartilage thicknesses (except the talar cartilage) of the patients were found to be thinner on the more affected side than the less affected side (all P<0.001). The thickness of talar cartilage was thinner compared to control subjects (P<0.001). Among the patients, quadriceps muscle strength was positively correlated with medial condyle (r=0.377, P=0.024), intercondylar area (r=0.399, P=0.016) and lateral condyle (r=0.363, P=0.030) thicknesses. Knee VAS scores were negatively correlated with talar cartilage thicknesses (r=-0.393, P=0.018). CONCLUSIONS: We found a thinning of the distal femoral condyle in the more affected paretic sides of poliomyelitis patients as compared to both those of less affected sides and those of healthy controls. Talar cartilages on both sides of the patients were thinner compared to control subjects. CLINICAL REHABILITATION IMPACT: Our preliminary findings may contribute to the long-term management of patients with long-term poliomyelitis sequelae.

The utility of ultrasound examination in cubital tunnel syndrome caused by heterotopic ossification.

This case presents the utility of ultrasound examination in diagnostics, providing accurate therapy and follow-up of entrapment syndrome of the ulnar nerve, caused by heterotopic ossification. The heterotopic ossifications were in this case presumably linked to a long-term working with a vibration sander.