Osteoarthritis in shoulders with traumatic anterior instability: preoperative survey using radiography and computed tomography

The purposes of this report are to determine the incidence of preoperative osteoarthritis in shoulders with traumatic anterior instability and to detect the factors leading to its development. The radiographs and computed tomograms of shoulders in 282 patients with unilateral instability and without previous surgery, whose age was younger than 40 years and who had no possibility of nontraumatic secondary osteoarthritis, were examined by use of a simplified modification of Samilson and Prieto's criteria. Osteoarthritis was found in 32 joints (11.3%) (mild in 30 and moderate in 2) on the radiographs. Computed tomography (CT) revealed arthritic changes in 88 shoulders (31.2%), including all 32 radiographically osteoarthritic joints. The marginal spur of the humeral head initially occurred in the anteroinferior aspect and mainly extended downward. The total number of dislocations and/or subluxations and frequency of dislocation and/or subluxation of 32 radiologically osteoarthritic joints were significantly larger and higher, respectively, than those of 194 non-osteoarthritic joints (P < .02). The total number of dislocations and/or subluxations (P < .01) and the number of subluxations (P < .05) were significantly different between osteoarthritic joints and nonarthritic joints classified by CT findings. The rate detected by CT was higher than those of any other previous radiographic survey that may have underestimated the incidence rate. Most postoperative osteoarthritis cases recognized on radiographs in short-term or midterm follow-up studies are assumed to be preoperatively generated.     

The Constant score in normal shoulders

Relative Constant-Murley shoulder scores are based on an age- and sex-matched normal population from Constant's original research. The purpose of this study was to determine normal Constant scores in a contemporary population and compare these values with those originally established by Constant. Two subject groups were analyzed. The first group comprised 1620 clinic patients whose normal shoulders were scored by resident physicians instructed on the Constant scoring technique. The second group comprised 115 healthy volunteers whose normal shoulders were scored by 1 experienced physician-researcher. There were no significant score differences between the two groups, indicating that, after instruction, scoring did not depend on tester experience. In both groups, there were significant score differences between sex and age groups. Similar to Constant's study, age-related declines in scores and strength existed for both sexes but were less pronounced. Using Constant's original values to calculate relative scores can overestimate shoulder function in women aged over 40 years and men aged over 60 years. If relative Constant scores are used, absolute scores should be concurrently reported to allow comparisons with different populations.     

Glenohumeral motion in patients with rotator cuff tears: a comparison of asymptomatic and symptomatic shoulders

The purpose of this study was to determine whether there was a relationship between altered scapular plane glenohumeral kinematics end shoulder pain. Subjects were divided into 3 groups: normal volunteers (n = 10), patients with symptomatic rotator cuff tears severe enough to warrant surgery (n = 10), and subjects with no symptoms who had tears documented on magnetic resonance imaging and normal examination (n = 10). Humeral kinematics were observed with a computer-enhanced modification of the Poppen and Walker technique. Scapular plane x-ray films were obtained at 0 degree, 30 degrees, 60 degrees, 90 degrees, 120 degrees, and 150 degrees of elevation. Measurements were made by 3 independent observers blinded to the diagnosis, and data interpretation was performed based on mean values for independent observers. Results showed a high degree of interobserver and intraobserver reliability (coefficients = 0.96 and 0.95, respectively). The symptomatic and asymptomatic groups showed progressive superior translation of the humeral head on the glenoid with increasing arm elevation. The normal group, in contrast, maintained a constant center of rotation along the geometric center of the glenoid. Symptomatic and asymptomatic rotator cuff tear groups showed superior head migration from 30 degrees to 150 degrees, which was significantly different from those seen in the normal group. No significant difference between the symptomatic and asymptomatic groups was demonstrated with the small numbers used in this study. The presence of a rotator cuff tear was associated in a disruption of normal glenohumeral kinematics in the scapular plane. Because significant superior migration of the humeral head was seen in both the asymptomatic and symptomatic rotator cuff groups, painless and normal shoulder motion is possible in the presence of abnormal glenohumeral kinematics. Abnormal glenohumeral kinematics alone was not an independent factor, which could explain the occurrence of symptoms.     

Xenon-enhanced computed tomography quantifies normal maxillary sinus ventilation.

OBJECTIVE: The purpose of this study was to determine the applicability, safety, and normal parameters of a xenon-enhanced CT technique to quantify maxillary sinus ventilation.Patients And Methods: Nine healthy subjects inhaled a xenon-oxygen-air mixture through their noses while repeated CT scans were performed through the same section of their sinuses. Images were obtained every 1 to 3 minutes and analyzed to measure the density of the gas in the maxillary sinus as a function of time. RESULTS: Individual nasal cavity time constants ranged from 0.5 to 18 minutes. Studies performed after decongestion showed poorer sinus ventilation. CONCLUSIONS: The xenon-CT washin/washout technique is safe, effective, and gives representative data.     

High-resolution, cross-sectional computed tomography of the normal spine

CT has proved to be an excellent method of studying the spine in cross section. The osseous axial skeleton may be imaged without the need for contrast media. Analysis of the contents of the spinal canal requires administration of intrathecal contrast material, except in the lumbar region, where epidural fat serves as a natural contrast agent. This article illustrates and discusses normal axial CT anatomy of the spine.     

Pulmonary artery diameter: means and normal limits—assessment by computed tomography angiography

Open in a separate window OBJECTIVESNormal pulmonary artery (PA) diameter remains blurred and the definitions of PA aneurysm are heterogenous. We aimed to assess PA diameters, identify a threshold for normal diameters, define PA aneurysms, possible predictors of PA size and evaluate the correlation with mid-ascending aortic diameters.METHODSBetween April 2018 and August 2019, 497 consecutive patients who underwent whole-body computed tomographic angiography were reviewed. Clinical and imaging data were collected from our institutional database. Precise three-dimensional centreline measurements were taken. Linear regression analysis was performed to detect parameters associated with PA diameter. A two-stage model was created to identify potential predictors and the resulting statistically significant interactions were tested. Data were grouped and PA, standard deviation, and upper normal limits were calculated.RESULTSAmong 497 patients with an average age of 51.4 (20.2) (74.6% males), the mean PA diameter measured 32.0 (4.6) mm [female: 31.2 (4.7) mm vs male: 32.2 (4.5) mm; P = 0.032]. The mean PA length, left PA and right PA diameters were similar between male and female patients. We found a significant correlation (r = 0.352; P < 0.001) between the PAs and mid-ascending aortic diameters. Body surface area (P = 0.032, β =  4.52 [0.40; 8.64] 95% CI) was the only significant influencing variable for PA diameter.CONCLUSIONSThe normal mean PA diameter in a reference cohort is 32.0 (4.6) mm. Body surface area is the only influencing variable of PA diameter. The normal diameters measured and corresponding upper limits of normal revealed that a PA aneurysm should not be considered below a threshold of 45 mm.     

Analysis of radiocarpal and midcarpal motion in stable and unstable rheumatoid wrists using 3-dimensional computed tomography

PURPOSE: The kinematic evaluation of carpal motion, especially midcarpal motion, in rheumatoid arthritis (RA) has been extremely difficult because of limited imaging techniques previously available. The purpose of this study was to evaluate the amount of radiocarpal and midcarpal motion in the flexion-extension plane in both stable and unstable rheumatoid wrists using three-dimensional computed tomography. METHODS: We acquired in vivo kinematic data on 30 wrists with RA by three-dimensional computed tomography with the wrist in 3 positions: neutral, maximum flexion, and maximum extension. All cases were radiographically classified into 1 of 2 subtypes, the stable form or unstable form, according to the classification by Flury et al. We evaluated the precise range of radiocarpal and midcarpal motion using a markerless bone registration technique and calculated the individual contributions to the total amount of wrist motion in the flexion-extension plane in the different radiographic subtypes of RA. RESULTS: The average range of motion of radiocarpal and midcarpal joint was 27 degrees +/-15 and 32 degrees +/-17, respectively. The average contribution of midcarpal motion to the total amount of wrist motion was 54%. The average contribution of midcarpal motion in the unstable form was 67%, which was significantly higher than 47% (p< .05) in the stable form. CONCLUSIONS: Midcarpal motion of rheumatoid wrists in the flexion-extension plane was better preserved than previously thought. The contribution of midcarpal motion to the total amount of wrist motion was significantly greater (p< .05) in the unstable form than in the stable form of RA.     

Spinal osteochondroma diagnosed by computed tomography

Acta Neurochirurgica - This paper reports two cases of spinal osteochondroma, in which preoperative diagnosis was greatly facilitated by CT scan examination. Moreover, by giving a precise...     

Intestinal injuries missed by computed tomography

Isolated intestinal injuries are frequently difficult to diagnose using only physical examination and routine laboratory studies. Between 1980 and 1988, ten patients were identified who had intestinal injuries and had computed tomographic (CT) scans before operation. For none of these scans was the initial reading considered diagnostic of intestinal injury. All patients came to laparotomy from 2 hours to 3 days following injury, and no patient died because of missed intestinal injury. Retrospective review of the scans revealed two to be diagnostic of intestinal perforation with free intraperitoneal air or extravasated contrast. The remaining eight scans had findings suggestive of injury. However, six additional patients had similar suggestive findings and had no evidence of intestinal injury. One patient with missed duodenal injury had not been given gastrointestinal contrast. Computed tomographic findings of intestinal trauma may be subtle or nonspecific and require optimal technique and care in interpretation. The timely treatment of this injury continues to rely on a high index of clinical suspicion and serial examinations by an experienced surgeon.     

Pneumothorax revealed by postoperative computed tomography

We report a case of pneumothorax revealed by postoperative computed tomography. A 39-year-old obese woman (height 153 cm, weight 70 kg) with fractures of the radius, ulna, clavicle, and femur in a traffic accident, was scheduled for osteosynthesis. Anesthesia was induced with thiopental and maintained with 50% nitrous oxide in oxygen and sevoflurane. The Spo2 decreased from 99% to 94% during the surgery. Bilateral chest sounds were symmetrical. The Spo2 increased to 100% after discontinuation of nitrous oxide. Pneumothorax was not evident on a postoperative chest X-ray, but computed tomography of the chest demonstrated right-sided pneumothorax. An ECG electrode had overlapped the fractured rib on the preoperative chest X-ray.     

Glenohumeral joint instability in normal adolescents. Incidence and significance.

One hundred and fifty asymptomatic shoulders in 75 schoolchildren were studied. The shoulders were tested for instability and a hyperextensometer was used to assess joint laxity. Signs of instability were found in 57% of the shoulders in boys and 48% in girls; the commonest sign was a positive posterior drawer test which was found in 63 shoulders. A positive sulcus sign was found in 17 shoulders and 17 subjects had signs of multidirectional instability. General joint laxity was not a feature of subjects whose shoulders had positive instability signs.     

Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography

BACKGROUND: Computed tomography (CT) is the most common method of staging lung cancer. We have previously shown endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) to be highly accurate in staging patients with nonsmall cell lung cancer (NSCLC) who have enlarged mediastinal lymph nodes on CT scan. In this study we report the accuracy and yield of EUS-FNA in staging patients without enlarged mediastinal lymph nodes by CT. METHODS: Patients with NSCLC and CT scan showing no enlarged mediastinal lymph nodes (> 1 cm for all nodes except > 1.2 cm for subcarinal) in the mediastinum underwent EUS. Fine needle aspiration was performed on at least one lymph node, if present, in the upper mediastinum, aortopulmonary window, subcarinal, and periesophagus regions. Each specimen was evaluated with on-site cytopathology and confirmed with complete cytopathologic examination. RESULTS: Sixty-nine patients without enlarged mediastinal lymph nodes were evaluated. Endoscopic ultrasound detected malignant mediastinal lymph nodes in 14 of 69 patients as well as other advanced (American Joint Committee on Cancer [AJCC] stage III/IV) in 3 others (1 left adrenal, and 2 with mediastinal invasion of tumor) for a total of 17 of 69 (25%, 95% confidence interval: 16% to 34%) patients. Eleven additional patients were found to have advanced disease by bronchoscopy (2), mediastinoscopy (2), and thoracotomy with mediastinal lymph node dissection (7). The sensitivity of EUS for advanced mediastinal disease was 61% (49% to 75%), and the specificity was 98% (95% to 100%). CONCLUSIONS: Endoscopic ultrasound guided fine needle aspiration can detect advanced mediastinal disease and avoid unnecessary surgical exploration in almost one of four patients who have no evidence of mediastinal disease on CT scan. In addition to previously reported results in patients with enlarged lymph nodes on CT, these data suggest that all potentially operable patients with nonmetastatic NSCLC may benefit from EUS staging.     

Magnetic resonance imaging in head injured patients with normal late computed tomography scans

In 11 patients who had undergone blunt head injuries, computed tomography (CT) scans of the brain performed 4-24 months posttrauma were normal. The patients showed a variety of cognitive and behavioral disturbances. Magnetic resonance imaging (MRI) studies revealed abnormalities that were mainly confined to the frontal and temporal lobes. Magnetic resonance imaging revealed signals of increased intensity compatible with old contusions, loss of discrimination between gray and white matter, and irregular brain contours. It is suggested that MRI of the brain is a more sensitive technique than CT in the detection of brain lesions during the late posttraumatic period, allowing a better understanding of the patient's clinical and neurobehavioral disturbances.     

Proprioception of the shoulder joint in healthy, unstable, and surgically repaired shoulders

Shoulder proprioception was measured in 90 subjects who were assigned to three experimental groups: group 1 (n = 40), healthy college-age subjects; group 2 (n = 30), patients with anterior instability; and group 3 (n = 20), patients who have had surgical reconstruction. Kinesthesia and joint position sense were measured with a specially designed proprioception testing device. The results revealed no significant differences in proprioception between dominant and nondominont shoulders in group 1 for any test condition. Significant differences (p < 0.05) were revealed between the unstable and uninvolved shoulder for both kinesthesia and joint position sense in group 2. No significant mean differences were revealed between the surgical and contralaterol shoulder in group 3 under any test condition. This series of studies provides evidence that proprioceptive deficits caused by partial deafferentiation result when copsuloligomentous structures are damaged. Reconstructive surgery appears to restore some of these proprioception characteristics.     

Predictability of splenic salvage by computed tomography

The recognition of overwhelming post-splenectomy infection (OPSI) has led to greater efforts to conserve splenic tissue in patients sustaining blunt torso trauma. Nonoperative management of splenic trauma has emerged as a means to enhance splenic salvage yet criteria to assure the safety of such an approach remain ill defined and controversial. Since severity of injury directly influences outcome, a need exists for identification of splenic injuries that require early operation and repair or removal. Using our recently reported classification of splenic trauma, 46 patients with blunt splenic trauma were evaluated preoperatively with computed tomography (CT). Injuries were graded I through IV and were described as capsular or subcapsular disruptions without parenchymal injury (four); capsular and parenchymal injuries not involving the major vessels or hilum (24); injuries involving major vessels and/or the hilum (17); and fragmentation/devascularizing injuries (one). Additional modifiers were added for associated intra-abdominal and/or extra-abdominal injuries. Sixteen patients had their splenic injuries managed nonoperatively and the remainder underwent operation for the splenic injury or associated injuries. The CT classification was confirmed in all patients and we believe early operation optimized splenic salvage. We conclude that: 1) CT is an accurate technique to determine the extent of splenic injury; 2) CT classification of splenic trauma has a high correlation with anatomic findings and need for operation; 3) early operation in patients with severe class II and all class III injuries affords optimal conditions for splenic salvage; and 4) early definitive management of splenic trauma significantly reduces late splenectomy and shortens hospitalization.     

Detection of pannus by multidetector-row computed tomography

Prosthetic valve dysfunction (PVD) due to pannus formation is an infrequent but serious complication. A 72-year-old man who underwent aortic valve replacement was diagnosed with PVD and aneurysm of the Sinus of Valsalva. Multidetector-row computed tomography (MDCT) was used to examine the cause of PVD before reoperation. MDCT demonstrated that tissue regarded as pannus extended from the left ventricular septum into the pivot guard. These findings were confirmed by observations during reoperation. MDCT can be a useful diagnostic technique for the anatomical and functional evaluation of PVD.     

Nutcracker phenomenon demonstrated by three-dimensional computed tomography

We report a 15-year-old girl with nutcracker syndrome (NCP) in whom three-dimensional helical computed tomography (3D helical CT) was useful for diagnosis; angiographic imaging using 3D helical CT provided fine outlines of the vascular structures in NCP, i.e., a compression of the left renal vein between the aorta and the superior mesenteric artery and the abnormal acute angle between them. Thus, a 3D helical CT enables precise depiction of the anatomical characteristics of renal vasculature and, therefore, may be a useful alternative imaging technique instead of conventional examinations, such as invasive venography or digital subtraction angiography. Further study in a large number of children with vascular abnormalities would be worthwhile. Received: 8 February 2001 / Revised: 10 May 2001 / Accepted: 10 May 2001     

Localization of impalpable testis by computed tomography

Computed tomography was used successfully in the preoperative localization of an intra-abdominal testis in an adult.