RESUMO
Musculoskeletal injuries in adolescents tend to occur in particular locations and have distinct characteristics, as they affect an immature skeleton. Increased engagement in sports, extended training and competition periods, and early specialization in specific sports, among other factors, have contributed significantly to the rise in musculoskeletal sports injuries in adolescents. Furthermore, females show a particularly pronounced increase in sports participation, where anatomical and hormonal factors play crucial roles in the development and increased frequency of sports-related injuries. Consequently, there is a growing demand for diagnostic imaging techniques. Musculoskeletal and pediatric radiologists require a comprehensive understanding of intrinsic and extrinsic risk factors and the successive stages of skeletal development that can influence the specific characteristics of sports injuries in adolescents. These aspects are crucial for the diagnostic, prognostic, and therapeutic management of these injuries and for mitigating chronic conditions that could compromise future sports participation. This review analyzes the primary musculoskeletal injuries in adolescent athletes and highlights the pivotal role of different imaging methods in their diagnosis and management.
RESUMO
Ulnar wrist pain, caused by a broad spectrum of bone and soft tissue injuries, is the most common clinical condition of the wrist. Multiple surgical techniques and their variants in the treatment of these injuries are constantly evolving. Postoperative evaluation of the wrist for many surgeons is limited to serial clinical and radiographic monitoring. However, imaging methods such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and arthrographic techniques (arthrographic CT and arthrographic MRI) play a fundamental role in diagnosing and managing postsurgical complications.The several critical aspects in evaluating the postsurgical wrist imaging spectrum are familiarity with the surgical techniques, knowledge of the original clinical problem, understanding the strength and limitations of the different radiologic modalities, and effective communication between surgeon and radiologist.
Assuntos
Traumatismos do Punho , Punho , Artralgia , Humanos , Imageamento por Ressonância Magnética , Ulna , Punho/diagnóstico por imagem , Punho/cirurgia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgiaRESUMO
Ischiofemoral impingement syndrome (IFI) is an underrecognized form of atypical, extra-articular hip impingement defined by hip pain related to narrowing of the space between the ischial tuberosity and the femur. The etiology of IFI is multifactorial and potential sources of ischiofemoral engagement include anatomic variants of the proximal femur or pelvis, functional disorders as hip instability, pelvic/spinal instability, or abductor/adductor imbalance, ischial tuberosity enthesopathies, trauma/overuse or extreme hip motion, iatrogenic conditions, tumors and other pathologies. Magnetic resonance imaging (MRI) is the diagnostic procedure of choice for assessing IFI and may substantially influence patient management. The injection test of the ischiofemoral space (IFS) has both a diagnostic and therapeutic function. Endoscopic decompression of the IFS appears useful in improving function and diminishing hip pain in patients with IFI but conservative treatment is always the first step in the treatment algorithm. Because of the ever-increasing use of advanced MRI techniques, the frequent response to conservative treatment, and the excellent outcomes of new endoscopic treatment, radiologists must be aware of factors that predispose or cause IFI. In addition, focused treatment in these conditions is often more important than in secondary impingement. In this article, we briefly describe the anatomy of the IFS, review the clinical examination and symptoms, assess the diagnostic imaging criteria and pathophysiological mechanisms, and develop an understandable classification of IFI, with particular focus on its etiology, predisposing factors, and associated musculoskeletal abnormalities. We also assess the role of the radiologist in the diagnosis, treatment, and preoperative evaluation of both primary and secondary IFI.
Assuntos
Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/terapia , Ísquio/diagnóstico por imagem , Terapia Combinada , Descompressão Cirúrgica , Endoscopia , Medicina Baseada em Evidências , Impacto Femoroacetabular/patologia , Humanos , Imageamento por Ressonância Magnética , Resultado do TratamentoRESUMO
Along with ageing population, there has been an increase in the prevalence and incidence of chronic and debilitating conditions, such as dementia which, in turn, has increased the demands for long term care in the community. This is challenging current health care systems that wish to provide an appropriate response whilst intensify its efforts to contain costs. This paper, through a critical reflection, argues for an integrative, positive, and systemic care approach, focused not only on the person with dementia but also on the entire family unit. For this purpose, it approaches the impact that dementia has for the family, and therefore for Primary Health Care professional. In addition care strategies aimed at strengthening the whole family system are suggested.
Assuntos
Demência/terapia , Saúde da Família , Atenção Primária à Saúde , Atenção à Saúde , Humanos , Assistência de Longa DuraçãoRESUMO
Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included "piriformis syndrome," a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. The concept of fibrous bands playing a role in causing symptoms related to sciatic nerve mobility and entrapment represents a radical change in the current diagnosis of and therapeutic approach to DGS. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. A broad spectrum of known pathologies may be located nonspecifically in the subgluteal space and can therefore also trigger DGS. These can be classified as traumatic, iatrogenic, inflammatory/infectious, vascular, gynecologic and tumors/pseudo-tumors. Because of the ever-increasing use of advanced magnetic resonance neurography (MRN) techniques and the excellent outcomes of the new endoscopic treatment, radiologists must be aware of the anatomy and pathologic conditions of this space. MR imaging is the diagnostic procedure of choice for assessing DGS and may substantially influence the management of these patients. The infiltration test not only has a high diagnostic but also a therapeutic value. This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments, with emphasis on MR imaging and endoscopic correlation.
Assuntos
Artralgia/prevenção & controle , Endoscopia/métodos , Articulação do Quadril/patologia , Imageamento por Ressonância Magnética/métodos , Síndrome do Músculo Piriforme/diagnóstico , Síndrome do Músculo Piriforme/terapia , Anti-Inflamatórios/uso terapêutico , Artralgia/diagnóstico , Nádegas/patologia , Nádegas/cirurgia , Terapia Combinada/métodos , Diagnóstico Diferencial , Articulação do Quadril/cirurgia , Humanos , Fármacos Neuromusculares/uso terapêutico , Modalidades de FisioterapiaRESUMO
PURPOSE: To retrospectively evaluate the diagnostic accuracy of magnetic resonance (MR) arthrography of the hip with leg traction in the evaluation of ligamentum teres lesions and to evaluate whether there is increased articular distraction, possibly indicating secondary instability, in hips with ligamentum teres injuries. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained for this retrospective study. MR arthrograms of the hip with leg traction of 184 consecutive patients, including 108 men (mean age, 32.6 years; range, 19-53 years) and 76 women (mean age, 38.5 years; range, 18-56 years), who underwent hip arthroscopy were assessed for the presence of ligamentum teres lesions. The MR arthrographic findings were independently assessed by two radiologists who were blinded to the arthroscopic results. The inclusion criteria stipulated no previous surgery, arthroscopy within 1 month after MR arthrography, and availability of a detailed surgical report with ligamentum teres findings. The arthroscopy findings served as the reference standard. Sensitivity, specificity, accuracy, and K statistics for interobserver and intraobserver agreement were calculated. RESULTS: At arthroscopy, 32 ligamentum teres injuries were found. The ligamentum teres was normal in 152 (82.6%) patients and had suffered low-grade partial tears in 15 (8.1%) patients, high-grade partial tears in 10 (5.4%) patients, and complete ruptures in 7 (3.8%) patients. MR arthrography with axial traction demonstrated moderate sensitivity and high specificity for both low-grade (62/93%) and high-grade (66/96%) partial tears. Grouping low- and high-grade partial tears increased the diagnostic performance of MR arthrography, yielding a sensitivity of 87% and a specificity of 95%. For complete ligamentum teres tears, MR arthrography with leg traction demonstrated high sensitivity (92%) and specificity (98%). Articular distraction was significantly increased in patients with complete ruptures of the ligamentum teres (p = 0.001). CONCLUSION: MR arthrography with leg traction offers accurate diagnosis of ligamentum teres injuries. Patients with complete tears of the ligamentum teres exhibit increased articular distraction that may indicate secondary hip instability.
Assuntos
Lesões do Quadril/patologia , Articulação do Quadril/patologia , Imageamento por Ressonância Magnética , Ligamentos Redondos/lesões , Ligamentos Redondos/patologia , Tração , Adolescente , Adulto , Artrografia , Feminino , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJECTIVE: The purpose of this article is to provide an overview of Kienböck disease focusing on imaging findings, including the relevant anatomy, pathophysiology, and treatment of Kienböck disease and the differential diagnoses (pseudo-Kienböck lesions). CONCLUSION: Kienböck disease is a condition marked by avascular necrosis of the lunate bone. MRI is useful in diagnosis and staging and should be considered, after conventional radiography, for patients with suspected Kienböck disease.
Assuntos
Diagnóstico por Imagem , Osteonecrose/diagnóstico , Humanos , Osteonecrose/fisiopatologia , Osteonecrose/terapia , Fatores de RiscoRESUMO
OBJECTIVE: The purpose of this article is to review the embryologic development, anatomy, and histology of the synovial plicae of the elbow. The pathophysiologic features, clinical manifestations, imaging findings, and treatment of elbow synovial fold syndrome will also be reviewed. CONCLUSION: Elbow synovial fold syndrome is an uncommon entity that is often confused with lateral epicondylitis. Knowledge of the clinical and imaging diagnosis of this entity is essential for the appropriate management of patients.
Assuntos
Diagnóstico por Imagem , Articulação do Cotovelo/patologia , Artropatias/diagnóstico , Membrana Sinovial/patologia , Articulação do Cotovelo/anatomia & histologia , Articulação do Cotovelo/fisiopatologia , Humanos , Artropatias/fisiopatologia , Síndrome , Membrana Sinovial/anatomia & histologia , Membrana Sinovial/fisiopatologiaRESUMO
The study of the wrist represents a major diagnostic challenge because of its complex anatomy and the small size of individual structures. Recent advances in imaging techniques have increased our diagnostic capabilities. However, 3T magnets, multichannel specific wrist coils, and new MRI sequences have not restricted the indications of arthrographic imaging techniques (CT arthrography and MR arthrography). Distension of the different wrist compartments at CT arthrography and MR arthrography significantly improves the diagnostic accuracy for triangular fibrocartilage (TFC) complex injuries and carpal instability. Dedicated multichannel wrist coils are essential for an adequate study of the wrist, but the placement of these coils and the positioning of the wrist are also important for proper diagnosis. The development of dynamic multislice CT studies allows a diagnostic approach that combines dynamic information and the accurate assessment of ligaments and the TFC complex. New advances in arthroscopy have changed the anatomical description of the TFC with a functional division in the proximal and distal TFC complex, and they have allowed a better characterization of lesions of the TFC complex with subclassification of Palmer 1B and 1D lesions and description of new lesions not included in the Palmer classification, such as capsular injuries.
Assuntos
Artrografia/métodos , Instabilidade Articular/diagnóstico , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Traumatismos do Punho/diagnóstico , Humanos , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/patologiaRESUMO
OBJECTIVE: The purpose of this review is to describe the gross anatomic and MRI appearance of the quadratus femoris muscle and the MRI appearance of common lesions of the quadratus femoris. CONCLUSION: Lesions of the quadratus femoris have been implicated as a cause of hip pain. It therefore is important to be familiar with the anatomy of the quadratus muscle and to be able to diagnose the causes of abnormal signal intensity in the quadratus femoris, which include tears and impingement.
Assuntos
Articulação do Quadril/patologia , Aumento da Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Músculo Esquelético/patologia , Doenças Musculares/patologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Adulto JovemRESUMO
OBJECTIVE: The objective of this article is to present a comprehensive review of apophysitis of the lower limb regarding anatomy, physiopathology, clinical findings, differential diagnosis, and imaging features with special emphasis on MRI. CONCLUSION: Apophysitis, which is inflammation of the traction epiphysis resulting from chronic trauma, is a common abnormality that affects the growing child. Understanding the physiopathology of apophysitis is essential for a precise diagnosis on MRI. Accurate identification of key MRI features of this entity may prevent misdiagnosis and inappropriate management of apophysitis.
Assuntos
Traumatismos em Atletas/diagnóstico , Epífises/lesões , Traumatismos da Perna/diagnóstico , Imageamento por Ressonância Magnética/métodos , Osteocondrite/diagnóstico , Traumatismos em Atletas/fisiopatologia , Diagnóstico Diferencial , Humanos , Traumatismos da Perna/fisiopatologia , Osteocondrite/fisiopatologiaRESUMO
The ligamentum teres has traditionally been viewed as an embryonic remnant with no role in the biomechanics or vascularity of adult hips. However, the ligamentum teres is a strong intraarticular ligament that is anatomically and biochemically similar to the anterior cruciate ligament of the knee. It is composed of two bands that originate from the acetabular transverse ligament and the pubic and ischial margins of the acetabular notch. Among other functions, the ligamentum teres is an important stabilizer of the hip, particularly in adduction, flexion, and external rotation. Abnormalities of the ligamentum teres account for 4%-15% of sports-related injuries and should be considered in the differential diagnosis of patients with hip pain. Lesions of the ligamentum teres include partial or complete traumatic tears, degenerative tears, avulsion fractures of the ligament at its insertion into the fovea capitis femoris, and a congenital absence of the ligament. Magnetic resonance arthrography and computed tomographic arthrography are the preferred modalities for precise preoperative diagnosis of ligamentum teres injuries and may be used to rule out other associated intraarticular injuries. Treatment of these lesions is still evolving; at present, treatment of most injuries is limited to arthroscopic débridement.
Assuntos
Lesões do Quadril/diagnóstico , Ligamentos Articulares/lesões , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Artroscopia , Fenômenos Biomecânicos , Lesões do Quadril/fisiopatologia , Lesões do Quadril/terapia , Humanos , Ligamentos Articulares/anatomia & histologia , Ligamentos Articulares/fisiologiaRESUMO
AIM: This paper is a report of a review undertaken to identify, critically analyse and synthesize the psychosocial experience of cancer recurrence for survivors and family members. BACKGROUND: Recurrence of cancer is an event after which life changes for families. Individuals move from being short- or long-term survivors of cancer to being patients once more. Families move from a state of fear of recurrence to one of uncertainty and distress as a result of the new crisis. DATA SOURCES: MEDLINE, CINAHL and CancerLit databases were searched for the period January 1980-2007. Reference lists of papers were conducted for relevant studies. The search terms recurrence, recurrent cancer, experience, survivor and family were searched for separately and in combination. REVIEW METHODS: A narrative review was conducted. Data were categorized in terms of issues during survivorship and concerns after recurrence. RESULTS: Three main categories were identified that explained survivors' and families' experiences of recurrent cancer: (1) fear of recurrence during survivorship, (2) when cancer recurs: families facing new challenges and (3) distress because of recurrence. CONCLUSION: Recurrence is a distressing experience for survivors and families because they have to face again psychosocial effects of cancer, such as uncertainty, distress and concerns about death. Care should not be addressed simply to survivors, but should include the general well-being of families beyond their survivorship and support to manage better psychosocial issues occurring when a member has a recurrence of cancer.
Assuntos
Família/psicologia , Recidiva Local de Neoplasia/psicologia , Neoplasias/psicologia , Sobreviventes/psicologia , Adaptação Psicológica , Ensaios Clínicos como Assunto , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estresse PsicológicoRESUMO
The purpose of the study was to prospectively assess magnetic resonance (MR) imaging findings of lower limb musculature in an axonal Charcot-Marie-Tooth disease (CMT2) pedigree due to mutation in the dynamin 2 gene (DNM2). The series comprises a proband patient aged 55 years and her two affected daughters aged 32 and 23. MR imaging study included T1- and fat suppressed T2-weighted spin-echo sequences. MR imaging study showed extensive fatty infiltration of all calf muscle compartments with relative preservation of the deep posterior one. Fatty muscle infiltration increased distally in 19 out of 66 (23%) visualized calf muscles in the three patients, but this percentage increased to 64% in the youngest and least severe patient. Muscle edema without contrast enhancement was present in 23% of calf muscles. There was massive fatty atrophy of foot musculature. We conclude that MR imaging study accurately depicts lower limb muscle involvement in CMT2 caused by DNM2 mutation.
Assuntos
Doença de Charcot-Marie-Tooth/patologia , Saúde da Família , Perna (Membro) , Imageamento por Ressonância Magnética/métodos , Músculo Esquelético/patologia , Adulto , Doença de Charcot-Marie-Tooth/genética , Dinamina II/genética , Feminino , Humanos , Pessoa de Meia-Idade , MutaçãoRESUMO
MR arthrography has become an important tool for the assessment of a variety of ankle disorders. MR arthrography permits more sensitive imaging of suspected intra-articular pathology in cases in which conventional MR imaging is either insufficient or inadequate for diagnosis or treatment planning. The main indications for MR arthrography are the evaluation of ligamentous injuries, impingement syndromes, cartilage lesions, osteochondral lesions of the talus, loose bodies, and several synovial joint disorders. Indirect MR arthrography can be a useful adjunct to conventional MR imaging and may be preferable to direct MR arthrography in those cases in which an invasive procedure is contraindicated or image guidance is not available.
Assuntos
Traumatismos do Tornozelo/diagnóstico , Articulação do Tornozelo/patologia , Artrografia/métodos , Artropatias/diagnóstico , Imageamento por Ressonância Magnética/métodos , Traumatismos em Atletas/diagnóstico , HumanosRESUMO
MR arthrography has become an important tool for the assessment of a variety of ankle disorders. MR arthrography may facilitate the evaluation of patients with suspected intra-articular pathology in whom conventional MR imaging is not sufficient for an adequate diagnosis and be useful for therapy planning. MR arthrography is valuable in the evaluation of ligamentous injuries, impingement syndromes, cartilage lesions, osteochondral lesions of the talus, loose bodies, and several synovial joint disorders. Indirect MR arthrography is a useful adjunct to conventional MR imaging and may be preferable to direct MR arthrography in cases in which an invasive procedure is contraindicated or when fluoroscopy is not available.
Assuntos
Articulação do Tornozelo/patologia , Artropatias/diagnóstico , Imageamento por Ressonância Magnética/métodos , Traumatismos do Tornozelo/diagnóstico , Doenças das Cartilagens/diagnóstico , Humanos , Corpos Livres Articulares/diagnóstico , Ligamentos Articulares/lesões , Planejamento de Assistência ao Paciente , Membrana Sinovial/patologia , Tálus/lesões , Tálus/patologiaRESUMO
Nephrogenic systemic fibrosis is a fibrosing disorder that affects patients with impaired renal function and is associated with the administration of gadolinium-based contrast media used in MRI. Despite being in a group of drugs that were considered safe, report about this potentially serious adverse reaction was a turning point in the administration guidelines of these contrast media. There has been an attempt to establish safety parameters to identify patients with risk factors of renal failure. The close pharmacovigilance and strict observation of current regulations, with special attention being paid to the value of glomerular filtration, have reduced the published cases involving the use of gadolinium-based contrast media. In a meeting between radiologists and nephrologists we reviewed the most relevant aspects currently and recommendations for its prevention.
Assuntos
Meios de Contraste/efeitos adversos , Gadolínio/efeitos adversos , Rim/efeitos dos fármacos , Rim/fisiopatologia , Dermopatia Fibrosante Nefrogênica/induzido quimicamente , Protocolos Clínicos , Meios de Contraste/administração & dosagem , Meios de Contraste/farmacocinética , Gadolínio/administração & dosagem , Gadolínio/farmacocinética , Humanos , Dermopatia Fibrosante Nefrogênica/terapiaRESUMO
We report on the clinical, electrophysiological, and lower-limb musculature MRI findings in a severe demyelinating Guillain-Barré syndrome (GBS) patient with follow-up over 6 months. After 3 weeks of tetraplegia and mechanical ventilation, there was progressive improvement until almost complete recovery. On day 4 after onset, electrophysiological study revealed absent F waves and widespread conduction block. On four further electrophysiological studies on days 12, 19, 45, and 150, there was marked and reversible slow down of motor conduction velocities in upper-limb nerves, and persistent inexcitability of lower-limb nerves. Mild signs of active denervation were recorded in calf and foot muscles as of day 45. On day 39, MRI T2-weighted fat-suppressed images showed patchy hypersignal of variable intensity involving pelvic, thigh, and calf muscles, which disappeared in a second imaging study on day 190; in this study T1-weighted images did not disclose muscle fatty atrophy. We conclude that in severe demyelinating GBS prolonged motor nerve inexcitability should not necessarily be taken as a predictor of poor prognosis, and that MRI is useful in assessing the topography and evolution of muscle denervation.
Assuntos
Síndrome de Guillain-Barré/patologia , Síndrome de Guillain-Barré/fisiopatologia , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Adulto , Eletromiografia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neurônios Motores/fisiologiaRESUMO
Microinstability and ligament teres lesions are emergent topics on the hip pathology. These entities are an increasingly recognized cause of persistent hip pain and should be considered in the differential diagnosis of the patient with hip pain. Conventional (non-arthrographic) CT and MR have a very limited role in the evaluation of these entities. CTa and MRa have emerged as the modalities of choice for pre-operative imaging of ligamentum teres injuries and microinstability. To date, pre-operative imaging detection of these pathologies is not widespread but with appropriate imaging and a high index of suspicion, preoperative detection should improve. This article discusses current concepts regarding anatomy, biomechanics, clinical findings, diagnosis and treatment of ligament teres lesions and microinstability.