Transient sternoclavicular joint arthropathy, a self-limited disease.

BACKGROUND: The sternoclavicular joint (SCJ) is a true diarthrodial synovial joint and therefore vulnerable to the same disease processes as in other synovial joints. We identified a group of patients with monarticular arthritis of the SCJ that had a benign process and a self-limited disease course. METHODS: This retrospective study included 25 female patients who presented with pain or swelling of the SCJ between January 2000 and December 2010. Their mean age was 59 years, and the average follow-up was 44 months. All patients underwent baseline radiographic imaging, technetium bone scan, computed tomography, and magnetic resonance imaging. Blood profiles were negative for rheumatoid factor in all patients. Functional outcome was assessed with the Rockwood SCJ score. RESULTS: The patients presented with complaints of pain (72%), local swelling (88%), and redness (8%) that progressed during 4 weeks. The physical examination revealed tenderness (84%), swelling (88%), and limited range of motion (16%). These findings persisted for a median of 5 months. Plain radiographs showed arthritic changes in 5 patients (20%). Increased uptake was observed in all 9 patients who underwent a bone scan. Soft tissue swelling was demonstrated on computed tomography in 5 patients (20%) and on magnetic resonance imaging in 5 patients (20%). One patient had osteoarthritic changes on magnetic resonance imaging. Pain resolved spontaneously in all patients, leaving only swelling in 9 patients and tenderness in 1 patient. CONCLUSION: Our experience is that SCJ arthropathy may often be a self-limited disease. After being treated solely with nonsteroidal anti-inflammatory medication, 24 of the 25 study patients showed complete regression of pain and return to full function without recurrence of symptoms. Basic blood tests and radiographs are sufficient to rule out a septic joint.

[Guidelines for wise utilization of knee imaging].

BACKGROUND: The knee is a complex structure afflicted with diverse pathologies. Correct management of knee complaints demands wise utilization of imaging modalities, considering their accuracy in the specific clinical situation, the patient's safety and availability and financial issues. Some of these considerations are universal, while others are local, depending on medical and insurance systems. There is controversy and unclearness regarding the best imaging modality in different clinical situations. PURPOSE: To develop clinical guidelines for utilizing knee imaging. METHODS: Leading physicians in specialties associated with knee disease and imaging were invited to participate in a panel on the guidelines. Controversies were settled in the main panel or in sub-panels. RESULTS: The panel agreed on the principles in choosing from the various modalities, primarily medical accuracy, followed by patient safety, availability and cost. There was agreement that the physician is responsible to choose the most appropriate diagnostic tool, consulting, when necessary, on the advantages, limitations and risks of the various imaging modalities. A comprehensive table was compiled with the importance of the different imaging modalities in various clinical situations. DISCUSSION AND SUMMARY: For the first time, Israeli guidelines on wise utilization of knee imaging are presented. They take into consideration the clinical situations and also availability and financial issues specific to Israel. These guidelines will serve physicians of several disciplines and medical insurers to improve patient management efficiently.

Preauthorization of CT and MRI examinations: assessment of a managed care preauthorization program based on the ACR Appropriateness Criteria and the Royal College of Radiology guidelines.

PURPOSE: To evaluate computed tomography (CT) and magnetic resonance imaging (MRI) utilization patterns before and after the implementation of a preauthorization program based on the ACR Appropriateness Criteria((R)) and the guidelines of the Royal College of Radiologists. MATERIALS AND METHODS: All CT and MRI requests received at the preauthorization center and CT and MRI examinations actually performed were identified by our health care service's centralized computerized database between January 1, 2000, and December 31, 2003. The obligatory preauthorization of CT and MRI requests was established for CT in September 2001 and for MRI in February 2002. All ambulatory CT and MRI examination requests sent for approval during the study period by most of our health care physicians were included in the study. The preauthorization program model is presented, and multiple parameters were evaluated from January 2000 to December 2003, before and after preauthorization was established. RESULTS: Before preauthorization was required, the CT and MRI utilization rates were constantly increasing by 20% and 5% per year for CT and MRI, respectively. After preauthorization was implemented, CT and MRI annual performance rates decreased from 25.9 and 7 examinations per 1,000, respectively, in 2000 to 17.3 and 5.6 examinations per 1,000, respectively, in 2003. The decreases in the utilization of MRI and CT imaging between 2001 and 2003 were 9% (12,129 compared with 11,070 MRI examinations) and 33% (81,223 compared with 57,204 CT examinations), respectively, resulting in substantial, statistically significant cost savings. The deferral rate ranged from 7.5% to 12.2% (mean = 9.8%) for CT and 13.9% to 21.4% (mean = 17%) for MRI. Deferred cases in CT were most commonly in neuroradiology, musculoskeletal radiology, and CT angiography (ranges of deferred cases 9% to 12%, 11% to 12%, and 10% to 12%, respectively). Deferred cases in MRI were most commonly in abdominal and chest radiology (ranges of deferred cases 32% to 37% and 20% to 31%, respectively). Computed tomography was more commonly utilized inappropriately by pediatric professions, and MRI was more commonly utilized inappropriately by medical subspecialty professions. CONCLUSION: Preauthorization of CT and MRI requests results in a substantial decrease in utilization of these modalities with reduction in imaging costs.