Evaluation of the plantaris tendon: cadaver anatomy study with ultrasonographic and clinical correlation with tennis leg injury in 759 calves.

OBJECTIVE: The role of the plantaris muscle (PM) in the literature is not clear. The objectives of this study were as follows: (1) to study PM at the interface between the medial gastrocnemius and soleus muscle in a cadaveric series, (2) to compare anatomic results with ultrasound (US) in the general population, and (3) to identify the potential role of the PM in the genesis of tennis leg (TL) injury. METHODS: First, a cadaveric study was undertaken on six cadavers for descriptive and functional PM anatomy. Second, US evaluation was carried out for 670 calves in 335 subjects with no suspicion of a clinical tear in the thigh or calf muscle (group 1) and for 89 calves in 89 patients with tear symptoms (group 2). Study criteria were the presence or absence of PM tendon and the width measurement if present. RESULTS: The PM was present in all cadavers. Traction on the tendon showed its "limited" mobility due to the connective tissue adherence mentioned with no apparent gliding of PM, promoting TL injury. In US, 37 PM were absent (4.35%) in 23 subjects. PM tendon width measurement of group 1 and group 2 was, respectively, 3.93 + / - 1.10 mm and 3.96 + / - 1.10 mm. No statistically significant differences between width measurements were found according to side (P = 0.74) or group (P = 0.69). Significant differences in width were only found between genders in group 1 (P = 0.014). CONCLUSION: PM were absent in 4.35% population. The contraction of PM can promote tennis leg injury by increasing the shear forces at the level of the distal inter-aponeurotic region.

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.

[Ultrasound evaluation of the greater occipital nerve]. / Démonstration échographique du nerf grand occipital.

PURPOSE: To demonstrate the appearance of the greater occipital nerve on ultrasound. MATERIALS AND METHODS: The greater occipital nerve was evaluated in 21 patients (9 males-12 females; mean age=52 years, range: 20-71; mean weight=74.5kg, range: 50-125) at the time of carotid duplex ultrasound. All examinations were preformed by the same sonographer using a single ultrasound unit. The anatomical landmark used to locate the nerve was the inferior obliquus capitis muscle. MRI and CT images were available in two cases and anatomical cadaver sections were also available. RESULTS: The greater occipital nerve could be identified at the level of the inferior obliquus capitis muscle in 90.47% (19/21) of cases, even in obese patients. In three slender patients (14.38%), the nerve could be identified at the level of the trapezius aponeurosis and next to the V3 segment of the vertebral artery. The mean anteroposterior diameter of the nerve at the level of the inferior obliquus capitis muscle was 1.65mm (range: 1.14mm-2.8mm). CONCLUSION: The greater occipital nerve could be detected at the level of its first genu by ultrasound in 90% of patients, even in obese 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).

[Value of imaging in posterolateral corner injuries of the knee]. / Apport de l'imagerie dans les lésions du point d'angle postéro-latéral du genou.

Lesions of the posterolateral corner are usually post-traumatic in etiology. They are most frequently associated with tear of the ACL and/or PCL. When unrecognized, they may lead to short-term failure of cruciate ligament reconstruction or long-term knee joint degeneration. Early detection of such lesions, especially in the preoperative period, is important since more severe injuries usually require dedicated early surgical management. The anatomy of the posterolateral corner will be reviewed and the normal and abnormal imaging features on MRI and US will be illustrated. The main clinical and surgcal features will also be presented.

Impact of the rise of artificial intelligence in radiology: What do radiologists think?

PURPOSE: The purpose of this study was to assess the perception, knowledge, wishes and expectations of a sample of French radiologists towards the rise of artificial intelligence (AI) in radiology. MATERIAL AND METHOD: A general data protection regulation-compliant electronic survey was sent by e-mail to the 617 radiologists registered in the French departments of Nord and Pas-de-Calais (93 radiology residents and 524 senior radiologists), from both public and private institutions. The survey included 42 questions focusing on AI in radiology, and data were collected between January 16th and January 31st, 2019. The answers were analyzed together by a senior radiologist and a radiology resident. RESULTS: A total of 70 radiology residents and 200 senior radiologists participated to the survey, which corresponded to a response rate of 43.8% (270/617). One hundred ninety-eight radiologists (198/270; 73.3%) estimated they had received insufficient previous information on AI. Two hundred and fifty-five respondents (255/270; 94.4%) would consider attending a generic continuous medical education in this field and 187 (187/270; 69.3%) a technically advanced training on AI. Two hundred and fourteen respondents (214/270; 79.3%) thought that AI will have a positive impact on their future practice. The highest expectations were the lowering of imaging-related medical errors (219/270; 81%), followed by the lowering of the interpretation time of each examination (201/270; 74.4%) and the increase in the time spent with patients (141/270; 52.2%). CONCLUSION: While respondents had the feeling of receiving insufficient previous information on AI, they are willing to improve their knowledge and technical skills on this field. They share an optimistic view and think that AI will have a positive impact on their future practice. A lower risk of imaging-related medical errors and an increase in the time spent with patients are among their main expectations.

[Plain radiographs of the wrist and hand]. / Les radiographies simples du poignet et de la main.

The purpose of this review is to describe the value of the different radiographic projections of the wrist and hand, provide criteria for quality control and key interpretation points. Plain radiographs of the hand and wrist are still, in this era of cross-sectional imaging, of great importance in the assessment and understanding of bone and joint disorders, particularly in the setting of trauma. Indeed postero-anterior and lateral views have to be completed with additional projections depending on the suspected lesion and clinical presentation.

Contribution of arthroscopy to the treatment of intraarticular fracture of the distal radius: Retrospective study of 40 cases.

Our study aimed to compare the anatomical result after treatment of intraarticular distal radius fracture with locking volar plates with and without arthroscopy. This was a retrospective, single-center study of intraarticular fractures. A volar locked plate was used for fracture fixation in all patients. Twenty patients were operated on with fluoroscopy only ("plate" group) and 20 operated using arthroscopy assistance ("arthroscopy" group). All patients underwent a CT scan before surgery and at 3 months postoperative. The main outcome measure was the residual intraarticular step-off (measured in millimeters). Other studied outcomes were the residual gap between fragments and extra-articular reduction. The two groups were similar preoperatively in all aspects except the size of the gap between fragments. The residual step-off was significantly less in the arthroscopy group: 1.9mm (Q1 1.7; Q3 2.25) for plate versus 0.8mm (Q1 0.7; Q3 1.5) for arthroscopy (P=0.001). The change from the preoperative to the postoperative measurement was significantly greater in the arthroscopy group: 0.1 mm (Q1 -0.5; Q3 0.8) for plate and -1mm (Q1 -1.9; Q3 -0.6) for arthroscopy (P=0.0002). The residual gap was similar between both groups: 2.4mm (Q1 1.9; Q3 3.5) for plate vs. 2.3mm (Q1 1.1; Q3 2.8) for arthroscopy (P=0.37). The change in gap was not significantly different between the two groups: -0.9mm (Q1 -1.8; Q3 -0.1) for plate vs. -2.9mm (Q1 -4.4; Q3 -1.7) for arthroscopy (P=0.32). There was no difference in the extra-articular reduction. Damage was found to the scapholunate ligament in 30% and the TFCC in 30% of arthroscopy cases. Arthroscopy improves intraarticular reduction without altering extra-articular reduction in patients with intraarticular fractures of the distal radius, and it allows for assessment and treatment of any injuries discovered. We must now follow these patients over the long-term to assess the clinical benefit. LEVEL OF EVIDENCE: 3.

Prospective observational study of midtarsal joint sprain: Epidemiological and ultrasonographic analysis.

INTRODUCTION: Foot and ankle injuries (FAI) are very common, with about 6000 cases per day in France. Unlike lateral ankle sprain (LAS), the diagnosis of midtarsal joint sprain (MJS, also known as Chopart's joint sprain) is not widely known. This prospective study aims to detail the epidemiology of MJS and compare it to LAS. PATIENTS AND METHOD: The study was conducted within our institution over a period of 16 months. Patients with clinical signs predictive of MJS without radiographic bone lesion underwent ultrasound assessment. MJS was diagnosed in case of at least 1 lesion of the dorsal midtarsal joint ligaments. RESULTS: A total of 2412 patients consulted for FAI; 188 had clinical and radiographic criteria for ultrasound examination. Eighty-two cases of MJS were diagnosed (3.4% of FAIs). Sports injuries were more frequent in MJS (P=0.04), and mechanisms more varied than in LAS, with inversion injury in 75% of cases and plantar hyperflexion in 22%. Sprain was severe in 70% of cases, with complete ligament tear. Clinical and ultrasound analyses correlated in only 40% of cases of MJS, versus 98% for LAS. CONCLUSION: MJS is frequent, difficult to diagnose clinically, and often severe. Clinical presentation and injury mechanisms differ from ankle sprain. Ultrasound seems to be an indispensable tool in diagnosis.

[Tendons: inflammatory and degenerative pathology]. / Les tendons: lésions inflammatoires et dégénératives.

Tendons may be affected by a variety of pathologic conditions, including those caused by overuse and inflammatory diseases. Sonography is a very sensitive means of detecting tendonous pathology because of its spatial resolution and its comparative and dynamic capabilities. Moreover its wide availability makes it the preferred first-line imaging modality in these cases. This paper reviews the inflammatory and degenerative conditions that may involve the tendons and their sonographic appearances.

Transpedicular screw placement: image-guided versus lateral-view fluoroscopy: in vitro simulation.

STUDY DESIGN: In vitro evaluation of monitoring screw placement using an image-guided system compared with the routine use of an image intensifier. OBJECTIVES: To compare a new computer-guided method of monitoring pedicle screw placement with a well-known method of monitoring using an image intensifier, using measurements of screw placement time and accuracy. SUMMARY OF BACKGROUND DATA: Pedicle screw placement relies on the identification of anatomic landmarks for the point of entry of the pedicle. The direction and depth of screw penetration are guided by an intraoperative lateral-view image intensifier. The use of frameless stereotaxy for computer-aided pedicle screw placement may increase the accuracy and safety of the screw insertion. To the authors' knowledge, there are no published data comparing these systems on the basis of operative time and screw placement accuracy. METHOD: Eight human cadaveric sections of five vertebrae each were used for an in vitro simulation of pedicle screw placement. Four spine surgeons were chosen to simulate the transpedicular screw placement. Each surgeon placed one screw into each pedicle of two spine sections (10 vertebrae, 20 screws). The surgeon was assisted by the lateral-view image intensifier on one spine section and by the navigational system on the second one. The four surgeons placed 80 pedicle screws. Forty screw placements were monitored by fluoroscopy and 40 by the image-guided navigational system. The time spent to place one screw was recorded, as well as the remarks by each surgeons on each method. Spines were rescanned, and the positions of the screws were compared between the group on which the image intensifier has been used and the group on which the navigational system had been used. RESULTS: In the image-guided technique group, one thoracic screw disrupted the lateral cortex of the pedicle, the average distance to the anterior wall of the body was 5 mm, and the average time for the insertion of one screw was 13.5 minutes. In the other group, two screws disrupted the inner cortex of a thoracic pedicle, the average distance to the anterior wall was 10.7 mm, and the average time for the insertion of one screw was 4 minutes. CONCLUSIONS: In vitro computer-aided pedicle screw insertion is more accurate than lateral-view fluoroscopy in the thoracic spine. The main disadvantage is the time consumption compared with that required by lateral-view fluoroscopy. The total time of the surgical operation should be decreased with the future development of these techniques.

[Lumbar lateral recess and intervertebral foramen. Radio-anatomical study]. / Récessus latéral et foramen intervertébral lombaire. Etude radio-anatomique.

The recent developments in Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) allow an accurate analysis of the anatomical structures of the lateral recess and of the neural foramen (vertebral body, pedicle, zygapophyseal joints, ligamentum flavum, intervertebral disk) and their contents (spinal ganglion, nerves roots, foraminal veins, surrounding fat). The aim of this study is 1) to describe the normal anatomy and variants of the lateral recess and of the lumbar neural foramen, and 2) to present the main diseases involving this anatomical area.

[Imaging of synovial lesions, neoplastic or non-neoplastic]. / Imagerie des affections synoviales, tumorales ou non.

The purpose of this paper is to present the contribution of imaging in the assessment of synovial diseases, especially in the differentiation between infectious synovitis and rheumatoid arthritis, and in the diagnosis of tumoral and pseudotumoral synovial lesions (idiopathic (osteo)chondromatosis, pigmented villonodular synovitis, synovial hemangioma, lipoma arborescens...).

[The lumbar epidural space. Radio-anatomical study]. / L'espace épidural à l'étage lombaire. Etude radio-anatomique.

The epidural space which extends along the spine, surrounds the dural sac and is bounded by the bony and ligamentous structures of the vertebral canal. The knowledge of the anatomy of this region is important because the high frequency of the pathological processes in this area (tumoral, infections, vascular). The purpose of this presentation is to present the normal radio-anatomy of the lumbar epidural space and then the main pathological processes of this region.

[Value of US imaging of metacarpophalangeal joints in patients with early rheumatoid arthritis]. / Polyarthrite rhumatoïde débutante: apport de l'échographie des articulations métacarpophalangiennes.

Technological advances in the field of ultrasound imaging may have, especially in metacarpophalangeal joints, an impact on decision making in patients with early rheumatoid arthritis. First, the normal anatomy of the metacarpophalangeal joints is briefly reviewed. Then, the authors describe the main ultrasound imaging findings of early RA. The role of ultrasound imaging in the assessment of therapeutic response as well as the benefit of microbubble ultrasound contrast agents are considered.

[Malignant melanoma of soft tissues. Apropos of a case]. / Le mélanome malin des tissus mous. A propos d'une observation.

A case of malignant melanoma of the quadriceps tendon is reported. This is an uncommon soft tissue sarcoma of melanocytic origin. The appearance on MRI depends on its melanin content. The microscopic appearance is distinctive and prognosis is poor. This tumor should be kept in mind when a nodular lesion is detected in specific tendon or aponeurosis.

[Ulnar nerve compression and pseudoarthrosis of the medial metacarpal bases]. / Compression du nerf ulnaire et pseudarthrose des bases métacarpiennes médiales.

A case of compression of the deep branch of the ulnar nerve associated with pseudarthrosis of the base of the fifth metacarpal and the upper shaft of the fourth metacarpal is reported. The delayed procedure consisted in volar decompression of the ulnar nerve by dividing the pisi-hamate ligament and plating and grafting of both fractures. The patient achieved marked improvement four weeks post-operatively and had complete functional recovery at follow-up of 16 years after injury without narrowing of the hamato-metacarpal joint despite synostosis of the bases of the medial metacarpals.

[The biphalangy of the thumb. General review of the literature]. / La biphalange du pouce. Revue générale de la littérature.

The thumb has only two phalanges whereas the other fingers present three. For two millennia, many anatomists tried to solve this riddle. Four different theories can be found in the review of literature, to explain what element misses in the radial column. In the first theory (Galen), the first metacarpal should be the proximal phalanx of the thumb. The particular ossification of the first metacarpal advocates for this theory. In the second theory (Sappey), the first metacarpal should result from the fusion between the true first metacarpal and the proximal phalanx of the thumb, and the proximal epiphysis should be constituted from both metacarpal and phalangeal parts. In the third theory (Paturet), the middle phalanx is thought to be missing. Apart morphological considerations, the main argument refers to symbrachydactyly, which consists in decreasing digital ray length (by reducing the middle phalanx), and usually affects digits excluding the thumb. In case the thumb is affected (in complex symbrachydactylies), the reduction concerns thus the first metacarpal, suggesting that the thumb middle phalanx has already disappeared. In the fourth theory (Pfitzner), the distal phalanx of the thumb should result from the fusion between the second and third phalanges of the thumb. This mechanism, named symphalangy, is well known in the foot, especially in the fifth toe, but also for the other toes, and even in the two ulnar fingers.

[Relationship between the tendon of the long head of the biceps brachii muscle and the glenoid labrum]. / Etude des rapports entre le tendon du chef long du biceps brachial et le labrum glénoïdal.

For many authors, the insertion of the long head of the biceps brachii muscle is exclusively or mainly located on the supraglenoid tubercle. The aim of this work was to study the insertion of the long head of the biceps brachii at macroscopic and microscopic examinations. 31 shoulders of macerated cadavers of both sex (age range: 52-92 years) were dissected by a posterior approach in order to study the glenoid labrum and the origin of the long head of the biceps brachii muscle. At macroscopic examination two types of the proximal part of the long head of the biceps brachii were demonstrated: a flattened shape in 84% of the cases and a hemicylindrical shape in 16% of the cases. Four types of origin were demonstrated at dissection: in 64.5% of the cases the tendon inserted mainly on the postero-superior part of the labrum, in 19.4% of the cases the tendon inserted both on the postero-superior and postero-anterior labrum, in 6.4% of the cases it inserted only on the supraglenoid tubercle and in three cases the tendon inserted on the intertubercular groove. The histologic examination performed on 6 superior part of the bicipitolabral complex have all shown that the tendinous fibers blended with the glenoid labrum. The examination performed on an complete labrum demonstrated tendinous fibers within the glenoid labrum up to the junction between the postero-superior and postero-inferior part of the labrum.