Scapholunate ligamentous communicating defects in symptomatic and asymptomatic wrists: characteristics

PURPOSE: To determine whether the sizes and locations of scapholunate ligamentous communicating defects are different in symptomatic and asymptomatic cases. MATERIALS AND METHODS: Bilateral wrist arthrograms were reviewed for 30 consecutive patients with a history of wrist trauma and unilateral wrist pain who had at least one scapholunate ligamentous communicating defect and unremarkable conventional radiographs. The location and size of each ligamentous defect was recorded. Differences between symptomatic and asymptomatic wrists were analyzed with the chi(2) or Fisher exact test. RESULTS: Most communicating defects in both groups were incomplete and ranged from pinhole size to large. There was a higher frequency of complete disruption in the symptomatic wrists (nine [32%] of 28 wrists) than in the asymptomatic wrists (two [10%] of 20 wrists; P: =.092). Communicating defects involved the dorsal portion in 18 (64%) of the 28 symptomatic cases and in five (25%) of the 20 asymptomatic cases (P: =.007). CONCLUSION: The data suggest that the demonstration of a complete ligamentous disruption or involvement of the dorsal portion of the ligament may indicate a traumatic cause rather than a degenerative change.     

MRI does not effectively diagnose ulnar-sided wrist pain in elite tennis players

ObjectivesUlnar-sided injuries of the non-dominant wrist are common in elite tennis players using a double-handed backhand technique. This study investigated the radiological changes of the non-dominant wrist in elite symptomatic and asymptomatic players using this technique as well as healthy controls. We compared clinical findings to radiological abnormalities.DesignCross-sectional design with blinded radiological assessment, and contemporaneous clinical assessment of symptomatic players.MethodsMagnetic resonance images (MRI) of wrists related to non-dominant ulnar-sided pain, were taken in 14 symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls which were then independently reviewed for abnormalities by blinded radiologists. Total abnormalities and global between-group differences in the triangular fibrocartilage complex (TFC), ulnar collateral ligament (UCL), extensor carpi ulnaris (ECU) and supporting structures, osseous-articular lesions and ganglia were assessed. These were then compared to clinical examinations of the symptomatic players to assess agreement.ResultsSymptomatic players reported a mean 3.64 abnormalities, being exactly 1 abnormality greater than asymptomatic players (2.64) and controls (2.50), suggesting similar asymptomatic lesions in all three groups. Players with pain reported significantly more osseous-articular lesions, ECU tendon and dorsal radio-ulnar ligament abnormalities, while changes to the UCL may reflect an isolated problem in specific wrists. There were no between-group differences in the presence of ganglia, most TFC structures nor ECU subsheath tear and subluxation.ConclusionsClinicians should carefully consider radiological changes alongside their clinical diagnosis of non-dominant wrist pain in tennis players due to possible tennis-related changes and/or asymptomatic findings.     

Characteristics of triangular fibrocartilage defects in symptomatic and contralateral asymptomatic wrists

PURPOSE: To characterize triangular fibrocartilage (TFC) defects in symptomatic and contralateral asymptomatic wrists. MATERIALS AND METHODS: Communicating and noncommunicating defects of the TFC were depicted on bilateral wrist arthrograms in 56 patients with unilateral wrist pain and without associated lesions of the scapholunate or lunotriquetral ligaments. The exact location of each TFC lesion was noted. RESULTS: Communicating defects were noted in 36 (64%) of 56 symptomatic and in 26 (46%) of 56 asymptomatic wrists. Twenty-five (69%) of 36 communicating defects were bilateral. Except for one defect in each group of symptomatic and asymptomatic wrists, all communicating defects were noted radially. Noncommunicating defects were noted in 28 (50%) of 56 symptomatic wrists and in 15 (27%) of 56 asymptomatic wrists. Eleven (39%) of 28 noncommunicating defects were bilateral. On the symptomatic side, 28 of 36 noncommunicating defects (including eight multiple defects) were located proximally at the ulnar side. On the asymptomatic side, 11 of 17 noncommunicating defects (including two multiple defects) were at or near the ulna. CONCLUSION: Noncommunicating TFC defects, which typically are located on the proximal side of the TFC near its ulnar attachment, have a more reliable association with symptomatic wrists than do communicating defects. Radial-sided communicating defects described in the literature (Palmer type 1A and 1D) as posttraumatic commonly are seen bilaterally and in asymptomatic wrists.     

Dynamic MR imaging of carpal tunnel syndrome

 Objective. To evaluate the diagnostic value of the MR imaging syndrome before and after performance of provocative exercises in patients with dynamic carpal tunnel syndrome. Design. Fat-suppressed proton-density and T2-weighted spin-echo images of the wrist were obtained prior to and after provocative, standardized exercises. Images were interpreted in masked fashion with regard to six MR criteria of carpal tunnel syndrome: (a) bowing of the transverse ligament, (b) and (c) deformation of the median nerve at the pisiform and hamate levels respectively, (d) signal abnormality of the median nerve, (e) presence of fluid in the wrist joints and/or carpal tunnel, and (f) presence of synovial swelling. Patients. Twenty-one wrists in 20 patients with subjective complaints of carpal tunnel syndrome and equivocal or negative clinical findings and negative electrodiagnostic examinations were included (age range 21–61 years, mean 37 years, 2 men and 18 women). The diagnosis of dynamic carpal tunnel syndrome was made and confirmed by surgery in 18 of the 21 symptomatic wrists. The control group consisted of 15 asymptomatic wrists in volunteers (age range 22–60 years, mean 35 years, 8 men and 7 women). Results and conclusions. Sensitivities and specificities of the six MR criteria were 90.5–100%, and 6.7–86.7%, respectively, both before and after exercise. Likelihood ratios proved statistically significant differences between the symptomatic and asymptomatic wrists (P<0.0001–0.0002) for the prevalence of all MR criteria with the exception of fluid within the carpal joints and/or carpal tunnel. Changes of the MR appearance after exercise had a low sensitivity (4.8–71.4%) but high specificity (86.7–100%) for dynamic carpal tunnel syndrome. In conclusion, MR imaging contributes to the diagnosis of carpal tunnel syndrome when clinical signs are confusing and electrodiagnostic studies are negative. Dynamic examinations improve specificity of MR imaging for such diagnosis.     

Patients with suspected meniscal tears: prevalence of abnormalities seen on MRI of 100 symptomatic and 100 contralateral asymptomatic knees

OBJECTIVE: The purpose of this study was to evaluate the prevalence of MR abnormalities of the knee on the symptomatic and contralateral asymptomatic sides in patients with suspected meniscal tears. SUBJECTS AND METHODS. One hundred patients (mean age, 42.7 years; range, 18-73 years) referred for suspected meniscal tears were prospectively examined with MRI of both knees when the contralateral knee was asymptomatic. The prevalence of various types of meniscal tears and other MR abnormalities was determined. RESULTS: Meniscal tears were found in 57 symptomatic knees and in 36 contralateral asymptomatic knees. In those 57 patients with a meniscal tear on the symptomatic side, the prevalence of asymptomatic tears in the contralateral side was 63% (36/57). Horizontal or oblique meniscal tears were found medially in 32 and laterally in 11 symptomatic knees, and medially in 29 and laterally in eight asymptomatic knees. Radial, vertical, complex, or displaced tears were found medially in 18 and laterally in five symptomatic knees, and medially in five and laterally in none of the asymptomatic knees. Collateral ligament abnormalities were found in 53 symptomatic knees and in six asymptomatic knees. Pericapsular soft-tissue abnormalities were found in 64 symptomatic and in 12 asymptomatic knees. Edema-like bone marrow abnormalities were found in 36 symptomatic and in three asymptomatic knees. CONCLUSION: Horizontal or oblique meniscal tears are frequently encountered in both asymptomatic and symptomatic knees and may not always be related to symptoms. However, radial, vertical, complex, or displaced meniscal tears and abnormalities of the collateral ligaments, pericapsular soft tissues, and bone marrow are found almost exclusively on the symptomatic side and appear to be clinically more meaningful.     

Anterior tibial tendon abnormalities: MR imaging findings

PURPOSE: To retrospectively evaluate the magnetic resonance (MR) imaging findings of anterior tibial tendon (ATT) abnormalities. MATERIALS AND METHODS: Institutional review board approval was not necessary for review of patient images and was granted for examination of the volunteers; informed consent was obtained. MR imaging findings in 28 consecutive patients (20 women, eight men; mean age, 63.2 years) clinically suspected of having an ATT abnormality were compared with those in an age- and sex-matched control group of 28 asymptomatic volunteers (20 women, eight men; mean age, 62.9 years). Surgical correlation was available for 11 patients. The short-axis diameter of the ATT and the longitudinal extent of signal intensity abnormalities were measured (Mann-Whitney U test). Signal intensity abnormalities of the ATT and irregularities of the underlying tarsal bones were analyzed in consensus by two blinded radiologists (chi2 test). RESULTS: In the symptomatic group, three cases of tendinosis and 13 partial and 12 complete ATT tears were diagnosed. In 11 cases (one case of tendinosis and two cases of partial and eight cases of complete ATT tear), surgical correlation was available and the MR imaging diagnosis was confirmed. In the asymptomatic group, four cases of tendinosis of the ATT were seen. The ATT diameter was significantly thicker in symptomatic patients at 1 cm (5.1 vs 3.1 mm in control group, P < .001), 3 cm (5.8 vs 3.4 mm, P < .001), and 6 cm (5.4 vs 4.3 mm, P = .006) proximal to the distal point of insertion. Most ATT abnormalities (in 23 [82%] of 28 patients) were located within the first 3 cm proximal to the insertion. Signal intensity abnormalities were seen in the anterior portion of the ATT in two (7%) of the 28 symptomatic patients and in the posterior portion in 11 (39%); diffuse involvement was seen in 15 (54%). Bone spurs on the navicular surface (nine [32%] patients vs no [0%] control subjects, P = .001), a ridged shape of the medial surface of the medial cuneiform bone (13 [46%] vs one [4%], P < .001), and osteophyte formation at the first tarsometasarsal joint (eight [29%] vs two [7%], P = .036) were significantly more common in the symptomatic patient group. CONCLUSION: Characteristic findings of ATT abnormalities include tendon thickening (> or =5 mm) and diffuse or posterior signal intensity abnormalities of the tendon within 3 cm from the distal point of insertion.     

MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects

Objective. To determine the prevalence and extent of residual defects or retears and bursitis-like subacromial abnormalities on MR images after rotator cuff repair in asymptomatic subjects, and to define the clinical relevance of these findings. Design and patients. Fourteen completely asymptomatic patients and 32 patients with residual symptoms were investigated 27–53 months (mean 39 months) after open transosseous reinsertion of the rotator cuff. Coronal T2-weighted turbo spin-echo and turbo STIR or T2-weighted fat-suppressed MR images were obtained. The prevalence and extent of residual defects or retears of the rotator cuff and bursitis-like subacromial abnormalities were determined. Results. Residual defects or retears were detected in three (21%) and bursitis-like abnormalities in 14 (100%) of the 14 asymptomatic patients. Fifteen (47%) residual defects or retears and 31 (97%) bursitis-like abnormalities were diagnosed in the 32 patients with residual symptoms. The size of the residual defects/retears was significantly smaller in the asymptomatic group (mean 8 mm, range 6–11 mm) than in the symptomatic group (mean 32 mm, range 7–50 mm) (t-test, P=0.001). The extent of the bursitis-like subacromial abnormalities did not significantly differ (t-test, P>0.05) between asymptomatic (mean 28×3 mm) and symptomatic patients (mean 32×3 mm). Conclusion. Small residual defects or retears (<1 cm) of the rotator cuff are not necessarily associated with clinical symptoms. Subacromial bursitis-like MR abnormalities are almost always seen after rotator cuff repair even in patients without residual complaints. They may persist for several years after rotator cuff repair and appear to be clinically irrelevant. Received: 19 November 1999 Revision requested: 7 February 2000 Revision received: 28 February 2000 Accepted: 14 March 2000     

Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography

The use of standard lateral roentgenography for diagnosing distal radioulnar joint (DRUJ) subluxation and dislocation was investigated. Using a wrist support, bilateral standard lateral roentgenograms of the wrist were obtained in 42 patients with normal wrists and in 56 patients with a unilateral wrist injury. In normal wrists the difference between the radioulnar distance in the right and the left wrist did not exceed 4 mm when the difference in the pisoscaphoid distance was less than 3 mm. Of the 36 patients with wrist injury whose difference in pisoscaphoid distance was less than 3 mm, 15 had a radioulnar distance of 5 mm or more, and computed tomography (CT) confirmed DRUJ dislocation in 14. Concordance between lateral roentgenograms and CT was present in 33 of 36 patients (92%). These results demonstrate the value of a standardized technique for bilateral lateral roentgenography in diagnosing DRUJ subluxation and dislocation.     

Gadolinium-enhanced MR imaging of the wrist in rheumatoid arthritis: value of fat suppression pulse sequences

 Objective. To determine the usefulness of fat-suppressed gadolinium (Gd)-enhanced MR imaging of the wrist in patients with rheumatoid arthritis (RA). Design and patients. Fat-suppressed Gd-enhanced T1-weighted spin-echo (SE) images were obtained and compared with other standard techniques in 38 wrists of 27 patients (22–77 years) with RA. Scoring based on the degree of synovial enhancement of each joint was developed and the total scores (J-score) were correlated with radiographic stage, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and symptomatic change in the follow-up study. Results. Synovial proliferations showed marked enhancement in all the wrists. In addition, contrast enhancement in the bone marrow and tenosynovium was seen in 36 and eight wrists respectively. Fat-suppressed Gd-enhanced T1-weighted images demonstrated these abnormalities better than other techniques. The J-scores correlated well with values of CRP (P=0.0034), but not with radiographic stages and ESR. Conclusion. Fat-suppressed Gd-enhanced T1-weighted SE images can clearly demonstrate most of the essential lesions in RA including the proliferative synovium, bone erosion, bone marrow inflammatory change, and tenosynovitis. Scoring based on the extent of Gd-enhancement of synovium can be useful in the assessment of the inflammatory status.     

Magnetic resonance imaging of dialysis-related amyloidosis of the shoulder and hip

 Objective. The purpose of this study was to evaluate the usefulness of MRI in identifying abnormalities of the periarticular structures in patients with symptoms of dialysis-related amyloid arthropathy. Design and patients. MR images of shoulders and hips in 5 dialysis patients with symptoms of amyloid arthropathy were compared to images of shoulders and hips in 4 asymptomatic dialysis patients, shoulders in 9 nondialysis patients, and hips in 12 nondialysis patients. These were evaluated for the presence of focal periarticular osseous lesions, tendinous and capsular thickening, and periarticular fluid. Results. Increased thickness of the supraspinatus tendon was found in both symptomatic and asymptomatic patients. Capsular thickening at the hip was present in all symptomatic patients, and in 3 of 8 asymptomatic hips. Joint and bursal fluid was common in the symptomatic group, and was present in some asymptomatic individuals. Osseous lesions were detected in the absence of plain film findings, and demonstrated variable signal intensity. Conclusions. MRI is useful in detecting signs of dialysis-related amyloidosis. Findings of a milder degree in asymptomatic dialysis patients suggests that MRI may also be valuable in the early diagnosis of this syndrome.     

Bilateral three-compartment wrist arthrography in patients with unilateral wrist pain: findings and implications for management

Bilateral three-compartment wrist arthrography was performed in 30 patients with unilateral posttraumatic wrist pain to assess the incidence of bilateral findings. The mean age of patients was 30 (range 18–55) years. Thirty-three percent of patients were normal bilaterally, 30% had unilateral communication in the symptomatic wrist, 30% had communications in both the symptomatic and asymptomatic wrists and 7% had communication in the asymptomatic wrist only. Unilateral three-compartment wrist arthrography is not recommended in the assessment of unilateral post-traumatic wrist pain; no advantage of three-compartment injection over radiocarpal injection alone was shown.     

Asymptomatic and neurologically symptomatic HIV-seropositive individuals: prospective evaluation with cranial MR imaging

As part of a prospective multidisciplinary study of individuals seropositive for the human immunodeficiency virus (HIV), cranial magnetic resonance (MR) imaging was performed on 119 HIV-seropositive subjects (95 asymptomatic, 24 symptomatic) and the results were correlated with clinical data. MR images regarded as positive included those showing atrophy and/or white matter lesions. On the basis of these criteria, 96 subjects had normal MR images and 23 had abnormal images. Results of chi 2 analysis revealed a statistically significant difference between the asymptomatic group (12 of 95 [13%] with abnormal scans) and the symptomatic group (11 of 24 [46%] with abnormal scans) (P = .001). In the asymptomatic group, positive MR images showed fewer, smaller, and/or less extensive abnormalities. The researchers conclude that (a) MR imaging can show indirect evidence of HIV infection early in the disease, but abnormalities will be minor and seen only in a small minority of neurologically asymptomatic subjects; (b) the appearance of clinically recognizable neurologic disease correlates with the MR imaging findings of increasingly severe brain atrophy and white matter lesions; and (c) in some HIV-seropositive subjects, despite neurologic disease, MR images can remain normal. Results indicate that routine screening with cranial MR imaging of neurologically asymptomatic HIV-seropositive individuals would likely result in a low yield of positive findings.     

Magnetic resonance imaging abnormalities in symptomatic and contralateral knees: prevalence and associations with traumatic history in general practice

BACKGROUND: After trauma, internal knee lesions are found in approximately two thirds of patients. However, magnetic resonance imaging abnormalities have also been described in asymptomatic volunteers. HYPOTHESIS: Not all visualized lesions in symptomatic posttraumatic knees are the result of recent trauma; there are subgroups of lesions that may be preexistent. STUDY DESIGN: Cross-sectional study (prevalence); Level of evidence, 2. METHODS: Patients visiting their general practitioners after knee trauma were invited for magnetic resonance imaging of both knees. Prevalence of knee abnormalities was compared between symptomatic and asymptomatic knees. Multivariable analysis was performed to investigate the association between lesions that were seen in symptomatic and asymptomatic knees (ie, effusion and meniscal tears) and recent trauma, history of old trauma, age, and osteoarthritis. RESULTS: In 134 participants, ligament lesions were found almost exclusively in symptomatic knees. Meniscal lesions and effusion were almost equally found in symptomatic and asymptomatic knees. Effusion was related to recent trauma (odds ratio, 14.0; 95% confidence interval, 5.0-39.6) and osteoarthritis (odds ratio, 4.7; 95% confidence interval, 1.4-15.5) but not to history of old trauma and age. Meniscal tears were more common in older patients (odds ratio, 1.09; 95% confidence interval, 1.05-1.12) but were not related to osteoarthritis. History of old trauma was more strongly related to the group of radial, longitudinal, and complex meniscal tears (odds ratio, 8.6; 95% confidence interval, 3.3-22.5) than to horizontal tears (odds ratio, 2.3; 95% confidence interval, 0.9-5.6). Recent trauma was not related to horizontal meniscal tears but was strongly related to other types of meniscal tears (odds ratio, 3.2; 95% confidence interval, 1.4-6.9). CONCLUSION: Ligament knee lesions are most probably the result of recent trauma. Radial, longitudinal, and complex meniscal tears are strongly related to trauma, whereas horizontal meniscal tears and effusion may be preexistent in many cases.     

Fiber density index, fractional anisotropy, adc and clinical motor findings in the white matter of patients with glioblastoma

Whether fractional anisotropy (FA), apparent diffusion coefficient (ADC), and fiber density index (FDi) values differ in the white matter close to glioblastomas of both symptomatic and asymptomatic patients was investigated. Twenty patients with glioblastomas underwent magnetic resonance imaging study. The FDi, FA and ADC values were calculated in areas of white matter in close proximity to the tumor (perWM) and encompassing fibers of cortico-spinal tract and in the contralateral normal-appearing white matter (nWM). The clinical compromise of the cortico-spinal tract was graded using Brunnstrom’s criteria. FA and FDi were significantly decreased and ADC increased in perWM compared with the contralateral. Mean FDi, FA, and ADC values comparing perWM and nWM in symptomatic patients showed similar differences. Comparing the perWM of symptomatic and asymptomatic patients, mean FDi and ADC values were lower in symptomatic patients than in asymptomatic ones. A positive correlation was found between the clinical score (CS) and, separately, FDi, FA and ADC per WM values. In a multiple stepwise regression among the same factors, only the ADC of perWM values showed a positive correlation with the CS. An increased ADC plays a major role in reducing the number of fibers (reduced FDi) in symptomatic patients.     

Ironman triathletes: MRI assessment of the shoulder

OBJECTIVE: The objective of this paper was to demonstrate the prevalence of shoulder magnetic resonance imaging (MRI) abnormalities, including abnormal bone marrow signal at the acromioclavicular (AC) joint in symptomatic and asymptomatic Ironman Triathletes. MATERIALS AND METHODS: The shoulders of 23 Ironman Triathletes, seven asymptomatic (group I) and 16 symptomatic (group II), were studied by MRI. A separate, non-triathlete group was evaluated specifically for AC joint marrow signal abnormalities to compare with the Ironman Triathletes. RESULTS: Partial thickness tears of the rotator cuff, rotator cuff tendinopathy, and AC joint arthrosis were common findings in both groups of triathletes. Tendinopathy was the only finding that was more prevalent in the symptomatic group, but this was not a statistically significant difference (p = 0.35). There were no tears of the glenoid labrum seen in group I or II subjects. Of note is that 71% (5/7) of group I subjects and 62% (10/16) of group II subjects had increased signal changes in the marrow of the AC joint (p = 0.68). The comparison group showed a lower prevalence (35%, p = 0.06) of this finding. CONCLUSIONS: No statistically significant difference was found among the findings for group 1, group 2, or the comparison group, although the difference between the comparison group and Ironman Triathletes approached statistical significance when evaluating for AC joint abnormal signal. Shoulder MRI of Ironman Triathletes should be interpreted with an appreciation of the commonly seen findings in asymptomatic subjects.     

Sequential cranial MR findings of asymptomatic and neurologically symptomatic HIV+ subjects.

PURPOSE: To compare results of a prospective MR and clinical reevaluation of HIV+ asymptomatic and neurologically symptomatic subjects who had had initially abnormal cranial studies to determine what cranial MR changes occur and how these changes correlate with serial neurologic and neuropsychologic findings. PATIENTS AND METHODS: Thirty-one asymptomatic (n = 20) and neurologically symptomatic (n = 11) subjects seropositive for the human immunodeficiency virus (HIV+) were prospectively reevaluated by cranial magnetic resonance (MR) one to two years following an initially abnormal MR of the brain. RESULTS: All 31 HIV+ subjects with initial abnormal MR had abnormal follow-up scans (showing atrophy and/or white matter lesions). Twenty-seven showed no progression of MR abnormalities (among whom were 18 with minimally abnormal scans who remained asymptomatic with improved or static neuropsychologic performance). Of the four subjects with scan changes (all with clinically suspected HIV encephalopathy), one showed MR, clinical, and neuropsychologic test improvement; the remaining three showed MR (n = 3), neurologic (n = 3), neuropsychologic (n = 1) worsening and autopsy (n = 1) confirmed the presence of HIV-1 containing multinucleated giant cells in the brain. CONCLUSIONS: This study suggests that: 1) Progression of intracranial MR abnormalities due to HIV-1 is seen only in a minority of HIV+ subjects over a 1- to 2-year time period, only in those neurologically symptomatic, and correlates with clinical deterioration. 2) Minor cerebral MR abnormalities seen in HIV+ subjects who remain neurologically asymptomatic do not change over a 1- to 2-year period. 3) Although HIV is known to infect the brain early, it may, nevertheless, not routinely do significant anatomical damage early on in the disease, as based on MR criteria.     

Wrist arthrography: value of the three-compartment injection method

Arthrography of the wrist was performed on 300 consecutive patients by injecting contrast material separately into the radiocarpal (RCJ), midcarpal (MCJ), and distal radioulnar (DRUJ) joints. The addition of MCJ and DRUJ injections to the standard RCJ injection significantly improved diagnostic yield. In 78 (26%) of the 300 cases, the abnormality was found after MCJ or DRUJ injections alone. Of the 103 triangular fibrocartilage complex (TFCC) abnormalities identified, 27 (26%) could be demonstrated after DRUJ injection alone. Of the 145 abnormal RCJ and MCJ communications, 42 (29%) could be seen after MCJ injection alone. Similarly, 22 (15%) of the 145 abnormal RCJ and MCJ communications were seen after RCJ injection alone and would have been missed if only MCJ injection had been performed. Thus, three separate injections into the RCJ, MCJ, and DRUJ are necessary for complete arthrographic evaluation.     

Slipped capital femoral epiphysis: a physeal lesion diagnosed by MRI, with radiographic and CT correlation

Objective. To define and compare early lesions associated with slipped capital femoral epiphysis (SCFE) on magnetic resonance imaging (MRI), computed tomography (CT) and radiography. Design and patients. Thirteen patients with 15 symptomatic hips due to SCFE underwent radiography and MRI; CT was performed in 12 patients. SCFE was graded on radiographs, head/neck angles and qualitative changes were evaluated on CT, and morphologic/signal abnormalities were determined on MRI. Results. Physeal widening, apparent on T1-weighted MRI, was evident in every case of SCFE, including one presumed “pre-slip.” T2-weighted images demonstrated synovitis and marrow edema but obscured physeal abnormalities. CT head/neck angles ranged from 4–57° for symptomatic to 0–14° for asymptomatic hips. Physeal and metaphyseal changes were variably identified on both radiographs and CT in all cases of SCFE, but not in the pre-slip. Conclusion. MRI clearly delineates physeal changes of both pre-slip and SCFE, and demonstrates very early changes at a time when radiographs and CT may appear normal.     

Lumbar pain and fin swimming

BACKGROUND: It was hypothesised that fin swimming have unique physiopathologic features in particular concerning low back involvement. METHODS: Retrospective study. Setting: elite competitive fin swimmers. Participants: 17 males and 14 females aged from 16 to 23 years. Intervention: piroxicam, sport interruption for a week, proper warming-up and wearing suggestions during out-of-water exercises in the symptomatic group. Absence of intervention in the asymptomatic one. Measures: anthropometric measures (weight, height, legs length discrepancy), isokinetic measures (trunk flexor/extensor ratio) and conventional radiological investigation were taken for all subjects. RESULTS: Low back pain was present in 14 subjects during off season but only 7 referred discomfort in competitive season. 78.5% of symptomatic subjects showed radiological abnormalities while imaging changes were present in 52.9% of the asymptomatic group. Flexor/extensor ratio isokinetically evaluated was less than one in 6 athletes complaining back discomfort. Non steroid medication, physiotherapy, training and wearing cares was suggested. Authors report a pain free return to competition in 57% and a partial resolution in 28% of those symptomatic cases who were not used to training cares (in particular proper "out-of-water" warming up) and wearing precautions (complete wiping and suitable thermic clothing after swimming). CONCLUSIONS: In fin swimming low back pain can be related to the existence of environmental and intrinsic factors. In our series no significant difference in imaging changes was pointed out among asymptomatic or painful athletes. Therefore a cyclic load on the column, in absence of training precautions can make spine abnormalities (in particular schisis, facet derangement and pars lesion) symptomatic.     

Ultrasound features of carpal tunnel syndrome: a prospective case-control study

Purpose The purpose of the study was to examine the most adequate cut-off point for median nerve cross-sectional area and additional ultrasound features supporting the diagnosis of carpal tunnel syndrome (CTS). Material and methods Forty wrists from 31 CTS patients and 63 wrists from 37 asymptomatic volunteers were evaluated by ultrasound. All patients were women. The mean age was 49.1 years (range: 29–78) in the symptomatic and 45.1 years (range 24–82) in the asymptomatic group. Median nerve cross-sectional area was obtained using direct (DT) and indirect (IT) techniques. Median nerve echogenicity, mobility, flexor retinaculum measurement and the anteroposterior (AP) carpal tunnel distance were assessed. This study was IRB-approved and all patients gave informed consent prior to examination. Results In CTS the median nerve cross-sectional area was increased compared with the control group. Median nerve cross-sectional area of 10 mm² (DT) and 9 mm² (IT) had high sensitivity (85% and 88.5%, respectively), specificity (92.1% and 82.5%) and accuracy (89.3% and 82.5%) in the diagnosis of CTS. CTS patients had an increased carpal tunnel AP diameter, flexor retinaculum thickening, reduced median nerve mobility and decreased median nerve echogenicity. Conclusion Ultrasound assists in the diagnosis of CTS using the median nerve diameter cut-off point of 10 mm² (DT) and 9 mm² (IT) and several additional findings.