VoE 73 - Musculoskeletal
Ultrasound guided steroid injection for treatment of trigger finger using a less traumatic peri-pulley steroid injection technique.
Learning objectives: To describe the technique of peri-pulley injection of long a acting steroid around the A1- pulley for the treatment of trigger finger and compare this to other more traumatic pulley-disruptive techniques.
Background: Trigger finger (TF) is a common problem prevalent in 2.6% of the general population and 10% in diabetic population. It is commoner in women and has a predilection for the A1 pulley of the thumb. Traditional treatment is surgical release. Blind or ultrasound-guided injection of up to 10 mg of long ac[...]
Findings and procedure details: This was a retrospective case review of 12 patients. Using ultrasound guided sterile technique, and under local anesthesia, up to 10 mg of long acting steroid; methylpredinsolone acetate, is administered with a 27 gauge needle. The involved pulley is identified by ultrasound.[...]
Conclusion: Non-disruptive peri-pulley ultrasound-guided steroid injection for treatment of trigger finger carries a high rate of success. It is less traumatic and technically easier than pulley-puncture approaches. The procedure needs verification with a larger sample size.
Personal information: Dr. Michael G Kawooya, MB, ChB, MMed (Rad), PhD, F.A.I.U.M. Professor of Radiology Ernest Cook Ultrasound Research and Education Institute (ECUREI) WFUMB-Centre of Excellence Kampala, Uganda. email email@example.com
References: Fleisch SB, Spindler KP, Lee DH. Corticosteroid injections in the treatment of trigger finger: a level I and II systematic review. J Am Acad Orthop Surg 2007; 15(3):166-71. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-de Jong B. Corticosteroid injections e[...]
Aims and objectives: Low back pain represents symptomatologic complex characterized by pain localized to lumbar region eventually associated with radicular irradiation.1 A significant number of patients with clinical symptoms of low back pain do not have corresponding imaging abnormalities that would explain severity of[...]
Methods and materials: Study at Clinic of Radiology, Clinical Center University of Sarajevo was conducted on 9 subjects (3 female, 6 male). Mean age of subjects was 51.55 (36-66). All subjects underwent recumbent and axial loaded MRI of lumbar spine (T2 tse sag; T1 tse sag; T2 tirm sag; T2 tse cor, T2 tse tra ms[...]
Results: Mean Body Mass Index (BMI) of all 9 subjects was 30.96. There was a decrease of both anterior and posterior lumbar spine height after axial loading was applied of 1.79%, and 1.5% respectively. At L3/L4 level a decrease of disk height and dural sac cross-sectional area (DSCSA) after axial loading was[...]
Conclusion: Novel MRI systems and accessories allow studying the spine in more realistic loading conditions able to elicit symptoms in patients affected by low back pain. Lumbar spine MRI with axial loading adds more information about disk height, disk cross-sectional area, and dural sac cross-sectional area wh[...]
Personal information: Deniz Bulja MD, M.Sc Neuroradiology Department Clinic of Radiology Clinical Center University of Sarajevo Edin Avdagic MD, M.Sc Neuroradiology Department Clinic of Radiology Clinical Center University of Sarajevo Adnan Sehic PhD Clinic of Radiology Clinical Center University of Sarajev[...]
References: 1 Meucci RD, Fassa AG, Faria NMX. Prevalence of chronic low back pain: systematic review. Revista de Saúde Pública. 2015;49:1. doi:10.1590/S0034-8910.2015049005874 2 Muto M. Update on Spine Imaging. Magn Reson Imaging Clin N Am 2016;Vol24(3):485-648 3 Hiwatashi A, Danielson B, Moritan[...]
Learning objectives: To know typical locations and imaging appearances of common bursae about the knee To use the knowledges for narrowing the differential diagnosis, which can help guide further management
Background: A bursa is an extra-articular, synovial-lined sac that facilitate movement around joints between soft tissues and osseous structures . Bursae can be classified as native and non-native bursae. Anatomic or native bursae present at birth at the predictable anatomical sites. Adventitious or non-nati[...]
Findings and procedure details: Suprapatellar Recess Suprapatellar recess (or bursa or pouch) lies at anterior knee in between the quadriceps tendon and distal femur (Fig. 1)  with intraarticular communication and normally contains thin layer of fluid less than 2 mm . This bursa is rarely isolated from the joint by the supr[...]
Conclusion: There are abundant bursae assisting soft tissue movement over the osseous structure about the knee joint. Knowledge of typical locations and imaging appearances of bursae can help in narrowing the differential diagnosis and can guide further management and treatment decisions.
Personal information: Thumanoon Ruangchaijatuporn, MD. Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University. Building 1, 2nd floor, Ramathibodi Hospital 270 Rama VI Rd. Ratchatewi, Bangkok 10400, Thailand Tel: (66) 22012465 Fax: (66) 22011297 E-mail: firstname.lastname@example.org
References: Synovial joints: anatomy and pathophysiology. In: Resnick D, Kang HS, Pretterklieber ML, eds. Internal derangements of joints. 2 ed. Philadelphia, Pennsylvania: Saunders; 2007:82-85. Beaman FD, Peterson JJ. MR imaging of cysts, ganglia, and bursae about the knee. Radiologic clinics of North America.[...]
Learning objectives: To describe the pathophysiological characteristics and radiological features of the musculoskeletal vacuum phenomenon.
Background: Vacuum phenomenon (VP) refers to the presence of gas in soft tissues or in intraarticular and intraosseous locations. Despite its common occurrence, vacuum phenomenon has not received much focus in the radiological literature with very few bibliographical references.
Findings and procedure details: The vacuum phenomenon (VP) is classified as an abnormal accumulation of gas from the blood serum, in any anatomical area related to the osteoarticular system. It is predominantly composed of Ni with traces of O2 and CO2. The mechanism of its appearance is the result of the transfer of gas from the[...]
Conclusion: The vacuum phenomenon in the musculoskeletal system is produced by transfer of gas from the surrounding soft tissue into a negative pressure zone. Its appearance usually has pathological significance when it appears in degenerative disc spaces, in the bone marrow of osteonecrotic vertebrae, or in fr[...]
References: 1> Maldague, B. E., Noel, H. M., & Malghem, J. J. (1978). The Intravertebral Vacuum Cleft: A Sign of Ischemic Vertebral Collapse 1. Radiology, 129(1), 23-29. 2> D’Anastasi, M., Birkenmaier, C., Schmidt, G. P., Wegener, B., Reiser, M. F., & Baur-Melnyk, A. (2011). Correla[...]
Learning objectives: The purpose of this exhibit is to: Review the definition of transient bone marrow oedema syndrome (BMOS) and the clinical entities that it encompasses Provide an illustrated review of the various imaging appearances of transient BMOS and the key differential diagnoses Provide a brief literature r[...]
Background: Transient bone marrow oedema syndrome (BMOS) encompasses several conditions characterised by temporary painful bone marrow oedema centred around joints. Bone marrow oedema was first described in 1988, in reference to high signal areas seen within bone marrow on T2w sequences in MRI studies of patien[...]
Findings and procedure details: In this exhibit we present three cases from our institution illustrating the key imaging findings of transient BMOS across a variety of modalities. Case 1: A 49 year old female presented with a two month history of right hip pain, on a clinical background of surveillance for a previously re[...]
Conclusion: Transient BMOS comprises multiple entities and is readily identified on MRI with the use of fluid sensitive sequences. Although a benign and transient phenomenon, it is an important imaging diagnosis that should be identified early in the clinical course in order to prevent potential complications f[...]
References: Wilson AJ et al. Transient osteoporosis: transient bone marrow oedema? Radiology 1989; 171: 135-140 Hayes CW et al. MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics 1993; 13: 1001-11; discussion 1012 Korompilias AV[...]
Learning objectives: The aims of this poster is to explain the normal and pathological post operative aspects of shoulder surgery, according to three steps : I) Rotator cuff and biceps surgery II) Instability surgery III) Prosthetic surgery
Background: Before performing any radiological interpretation (MRI, CT-scan, ultrasound), it is mandatory for the radiologist to : - have the surgical report of the patient. - have standard x-rays - perform an oral and physical examination I) Rotator cuff and biceps surgery A) Rotator cuff surgery When [...]
Findings and procedure details: I) Rotator cuff and biceps surgery A) Rotator cuff surgery 1) Anchors Anchors used for rotator cuff surgery are nowadays bioabsorbable anchors. They don’t generate too many artefacts and are clearly visible on[...]
Conclusion: Knowledge of main surgical techniques and modifications induced on control imaging will allow radiologists to better diagnose pathological situations to appropriatly guide patients.
References: Boileau et al., RCO 2007 Maynou et al., RCO 2007 McMenamin et al., Eur J Radiol 2008 Kim et al, Am J Sports Med 2014 Sugaya et al, Arthroscopy 2005 Sugaya et al, JBJS 2007 Yoo et al, J Ultrasound Med 2015 Barth et al, Knee Surg Sports Traumatol Arthrosc. 2015 Zanetti et al, Skeletal Radiol 2000 Tud[...]
Learning objectives: 1. Anatomy of ligamentum teres 2. Normal imaging appearance of ligamentum teres 3. Case review of various abnormalities of ligamentum teres
Background: Ligamentum teres, is a strong intraarticular ligament in the hip joint, which acts like an anterior cruciate ligament of the knee. Conventionally, the function of ligamentum teres was not certain and still in controversy. Previously ligamentum teres was considered as embrionic rem[...]
Findings and procedure details: Part 1. Anatomy of ligamentum teres Ligamentum teres is originate from acetabular transverse ligament, which is composed of two bands, each band from the pubic and ischial margin of the acetabular notch. Part 2. Normal imaging appearance of ligamentum tere[...]
Conclusion: Various abnormal findings associated with ligamentum teres can be seen in Hip MRI or MR arthrography. MR arthrography enables more sensitive detection of ligamentum teres tear. In conclusion, on hip MR arthrography, careful attention should be paid to acetabular labrum or articu[...]
References: 1. Demange MK, Kakuda CMS, Pereira CAM, et al. Influence of the femoral head ligament on hip mechanical function. Acta Orthop Bras 2007; 15:187–90. 2. Cerezal L, Kassarjian A, Canga A, et al. Anatomy, biomechanics,imaging, and management of ligamentum teres injuries.RadioGraphicsT 2010; 30:16[...]