Clinical efficacy of ultrasound-guided injection in the treatment of olecranon subcutaneous bursitis.

BACKGROUND: Recent studies have shown that ultrasound-guided injection of glucocorticoids is superior to blind puncture methods. OBJECTIVE: To evaluate clinical efficacy of ultrasound-guided drug injection in the treatment of olecranon subcutaneous bursitis. METHODS: From June 2016 to September 2018, 45 patients diagnosed with obvious synovial effusion and treated with ultrasound-guided injection therapy for olecranon bursitis were included in this study. Under the guidance of ultrasound, the synovial effusion aspiration was performed and 2 ml of the compound betamethasone mixture was injected into the bursae and dressed under pressure. Ultrasound examination was performed 2 weeks after operation and the secondary fluid aspiration and drug injection treatment were performed. The depth of synovial effusion, the thickness of synovial hyperplasia and the blood flow signal were measured 4 weeks after operation to evaluate the therapeutic effect. RESULTS: After first treatment, the recurrence rate of the olecranon mass were 40%. After secondary treatment, recurrence of olecranon mass occurred in 6 of the 45 patients with a recurrence rate of 13.3%. After 4 weeks of follow-up, the depth of olecranon synovial effusion, the average thickness of synovial hyperplasia and the blood flow signal decreased significantly after treatment (P < 0.05). CONCLUSIONS: Ultrasound-guided drug injection is safe and effective in treating olecranon subcutaneous bursitis. Although the recurrence rate is high after the first treatment, the second treatment is simple and can reduce the recurrence rate. The patients have a high acceptance rate, which is worthy of clinical promotion.

The anterior knee: normal variants, common pathologies, and diagnostic pitfalls on MRI.

The anterior aspect of the knee is host to an array of normal variants and potential pathology. These normal anatomic variants are often encountered and may mimic pathologies, leading to unnecessary work-up and treatments. On the other hand, there are several subtle abnormalities that may be easily overlooked or mistaken for variants or other injuries or diseases. Recognition of these diagnostic challenges is essential for radiologists to make an accurate diagnosis. This article reviews normal anatomical variants of ligaments, tendons, bones, and other important structures of the anterior knee, focusing on magnetic resonance imaging features. Commonly encountered injuries and abnormalities of the anterior knee and their diagnostic pitfalls are also discussed, highlighting findings on magnetic resonance imaging.

Magnetic Resonance Imaging of Cysts, Cystlike Lesions, and Their Mimickers Around the Knee Joint.

While interpreting routine magnetic resonance imaging (MRI) of the knee joint, a radiologist may encounter various cystic lesions such as ganglion, synovial, and meniscal cysts, among others. In some cases, MRI may demonstrate cystlike lesions around the knee due to fluid distention of normal bursa and recesses, the diagnosis of which should not be difficult if a radiologist is familiar with their characteristic location and MRI appearance. In addition, there are cyst mimickers such as hematomas, abscesses, vascular lesions, and neoplasms around knee joint that may pose a diagnostic challenge on routine MRI. Due to their atypical location and variable morphology, contrast administration is helpful as the enhancement pattern aids to differentiate them from cysts and cystlike lesions. This pictorial essay aims to classify cysts, cystlike lesions, and cyst mimickers in and around the knee joint based on their anatomic location and highlight their characteristic MRI features.

Low-dose external beam radiotherapy for greater trochanteric pain syndrome : Target volume definition and treatment outcome.

PURPOSE: Low-dose external beam radiotherapy (ED-EBRT) is frequently used in the therapy of refractory greater trochanteric pain syndrome (GTPS). As studies reporting treatment results are scarce, we retrospectively analyzed our own patient collectives. PATIENTS AND METHODS: In all, 60 patients (74 hips) received LD-EBRT (6 × 0.5 Gy in 29 hips, 6 × 1 Gy in 45). The endpoint was the patient's reported subjective response to treatment. The influence of different patient and treatment characteristics on treatment outcome was investigated. RESULTS: At the end of LD-EBRT, 69% reported partial remission, 4% complete remission, no change 28%. A total of 3 months later (n = 52 hips), the results were 37, 33, and 30% and 18 months after LD-EBRT (n = 47) 21, 51, and 28%. In univariate analysis "inclusion of the total femoral head into the PTV" and "night pain before LD-EBRT" were correlated with symptom remission at the end of LD-EBRT, while "initial increase in pain during LD-EBRT" was significantly associated with treatment failure. In multivariable modeling "initial increase in pain" was identified as a risk factor for treatment failure (p = 0.007; odds ratio [OR] 0.209; 95% confidence interval [CI] 0.048-0.957), while "night pain" was an independent factor for remission (p = 0.038; OR 3.484; 95% CI 1.004-12.6). Three months after LD-EBRT "night pain" and "inclusion of the complete femoral neck circumference into the PTV" were predictive for remission. CONCLUSION: LD-EBRT represents a useful treatment option for patients suffering from GTPS. Three months after therapy two-thirds of the patients reported a partial or complete symptom remission. Especially patients who suffered from nocturnal pain seemed to benefit. Treatment appeared to be more effective when the entire circumference of the femoral neck was encompassed.

Ultrasound evaluation of bursae: anatomy and pathological appearances.

A bursa is an extra-articular sac that may communicate with a joint and functions to decrease friction between tendons and either bone or skin. Bursae can be classified as native and non-native (adventitious) bursae. The native bursae are lined with a synovial membrane and occur at predictable anatomical sites; knowledge of these normal structures can help distinguish them from other pathological entities. An adventitious bursa can form at sites of friction rather than at predictable anatomical sites, but otherwise have imaging features similar to native bursae. Bursal distention can occur from many pathological processes, most commonly resulting from chronic overuse injury. When imaging bursal pathological conditions, there is often an overlap of imaging findings, regardless of the cause. In general, ultrasound of a distended bursa reveals a fluid collection with either simple anechoic or more complex hypoechoic fluid. Bursal distention is characteristically unilocular and compressible, unlike other structures such as ganglion cysts, which are usually multilocular and non-compressible. This article reviews the anatomical locations of common bursae and shows pathological examples using ultrasound. Knowledge of typical locations and imaging appearances of bursae can aid in narrowing the differential diagnosis and guiding further management and treatment decisions.

Septic retrocalcaneal bursitis in a young soccer player treated with hindfoot endoscopic bursectomy: a case report.

Septic retrocalcaneal bursitis (RB) is extremely rare with no reports on surgical treatment. Here, we describe a rare case of septic RB in a 14-year-old male soccer player who was treated with hindfoot endoscopic bursectomy. A 14-year-old male soccer player complained of right heel pain without trauma histories when he was playing a soccer. Based on physical examination, radiological findings and laboratory results, we diagnosed the patient with septic RB and started to treat with conservative treatment including a non-weightbearing splint and intravenous antibiotics therapy. However, his symptoms and laboratory results did not improve at 4 days after starting intravenous antibiotics therapy, and so we applied hindfoot endoscopic bursectomy for him. At 4 weeks after the surgery, he could return to the original sport at preinjury level without symptoms and complications. Septic RB in a 14-year-old male soccer player was successfully treated with hindfoot endoscopic bursectomy.

The Functional Morphology of the Bursa Copulatrix of a Butterfly That Does Not Digest Spermatophores (Leptophobiaaripa, Pieridae).

The bursa copulatrix of female Lepidoptera is a complex organ where crucial male-female reproductive interactions occur during and after copulation. The bursa copulatrix receives, stores, and digests the spermatophore and other substances transferred by the male during copulation, and is involved in changes in female receptivity, ovogenesis, and oviposition. Although females of the butterfly Leptophobia aripa do not digest the spermatophore, they possess a prominent signum. Since, in general, the function of the signum is considered to be the piercing or tearing of the spermatophore to initiate its digestion, its presence in L. aripa poses a conundrum. We undertook a microscopic study of the different components of the bursa copulatrix (ductus bursae and corpus bursae) and found structural differences that we interpreted in functional terms. We provide a detailed description of the signum and present experimental data regarding its effect on the spermatophore. Our observations led us to propose a novel hypothesis regarding the function of the signum.

Horseshoe abscess of the hand with rice bodies secondary to mycobacterium avium intracellulare infection.

A horseshoe abscess is caused by infection that spreads between the flexor tendon sheath of the thumb or little finger through the radial and ulnar bursae through communication between the two and/or the space of Parona. We present a case of an 80-year-old woman with rheumatoid arthritis who presented with 6 months of right hand and wrist soft tissue swelling, initially treated as a rheumatoid arthritis flare. MRI demonstrates the horseshoe abscess and after surgical irrigation and debridement with synovectomy, cultures demonstrated infection with mycobacterium avium intracellulare (MAI). This case demonstrates the importance of MRI in diagnosing and evaluating the extent of hand infections and for considering mycobacterial organisms for appropriate treatment and antibiotic regimen.

Exostosis Bursata - Multimodality Imaging Approach.

Osteochondromas or exostosis are common benign bone tumours, commonly arising from the metaphyseal region of long bones (femur, humerus, tibia). Osteochondroma of the scapula are rare and cause mechanical irritation leading to bursal formation. We hereby report a case of 30-year-old man who presented with painful chest wall swelling and its multimodality approach to establish the diagnosis.

Imaging of the bursae.

When assessing joints with various imaging modalities, it is important to focus on the extraarticular soft tissues that may clinically mimic joint pathology. One such extraarticular structure is the bursa. Bursitis can clinically be misdiagnosed as joint-, tendon- or muscle-related pain. Pathological processes are often a result of inflammation that is secondary to excessive local friction, infection, arthritides or direct trauma. It is therefore important to understand the anatomy and pathology of the common bursae in the appendicular skeleton. The purpose of this pictorial essay is to characterize the clinically relevant bursae in the appendicular skeleton using diagrams and corresponding multimodality images, focusing on normal anatomy and common pathological processes that affect them. The aim is to familiarize radiologists with the radiological features of bursitis.