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Biomedical subjects

C A Helms

Publications and source records attributed to C A Helms.

At least 19 recordsLinked to original sources
PubMed2001

Bony ankylosis following thermal and electrical injury.

OBJECTIVE: Bony ankylosis has been described following trauma, paralysis, psoriasis, Reiter's syndrome, ankylosing spondylitis, juvenile chronic arthritis and rheumatoid arthritis. Reports of bony ankylosis following thermal and electrical injury are limited. DESIGN AND PATIENTS: Thirteen cases of burn-related joint ankylosis in four patients are presented. CONCLUSION: Patients with burns from thermal or electrical injury may develop bony ankylosis among other radiographic manifestations. This bony ankylosis may result either from bridging extra-articular heterotopic ossification with preservation of the underlying joint or from intra-articular fusion due to joint destruction.

Adult↗
PubMed2001

Discoid lateral meniscus and the frequency of meniscal tears.

OBJECTIVE: To use MRI to determine the incidence of discoid lateral menisci in a large study population, and to compare those patients with those without a discoid meniscus in order to assess the impact of a discoid lateral meniscus on the frequency of meniscal tears. DESIGN AND PATIENTS: Results of 1,250 knee MRI studies were retrospectively reviewed. Using the criterion of three or more meniscal body segments on sequential sagittal images, 56 patients were found to have a discoid lateral meniscus. After exclusion of patients with prior knee surgery, 49 patients with a discoid lateral meniscus were compared with 1,146 patients without a discoid meniscus. Patients were categorized as having tears of the medial meniscus, lateral meniscus, or both menisci. RESULTS: In our study population, there was a 4.5% incidence of discoid lateral meniscus. Seventy-one percent of patients with a discoid lateral meniscus had one or more meniscal tears, compared with 54% of the comparison group (P=0.01). The frequency of solitary lateral meniscal tears in the discoid group was also higher than in the comparison group: 20%.versus 11% (P=0.03). The frequency of solitary medial meniscal tears and concomitant tears of both menisci were not significantly different between the two groups. CONCLUSIONS: The discoid lateral meniscus is an uncommon variant, but not as rare as once believed. Compared with the normal semilunar meniscus, the discoid lateral meniscus has a higher frequency of meniscal tears, and solitary tears of the lateral meniscus are more common in the discoid variant. The frequency of medial meniscal tears is not altered by the presence of a discoid lateral meniscus.

Adolescent↗
PubMed2001

Focal articular cartilage lesions of the superior humeral head: MR imaging findings in seven patients.

OBJECTIVE: We describe the MR imaging findings of focal articular cartilage lesions of the superior humeral head and the clinical features in seven patients. CONCLUSION: Focal articular cartilage lesions of the superior humeral head are rare lesions that may cause clinical symptoms and may be easily overlooked on MR imaging. These lesions occur in a particular location (along the superior surface of the posterior humeral head, medial to the expected location of a Hill-Sachs lesion), are caused by trauma, and do not seem to have a specific mechanism of injury. Because of improvements in MR imaging of cartilage, this area of the shoulder should be inspected for this lesion.

Adolescent↗
PubMed2001

Association of posterior tibial tendon injury with spring ligament injury, sinus tarsi abnormality, and plantar fasciitis on MR imaging.

OBJECTIVE: The purpose of this study was to investigate the frequency of abnormalities of the spring ligament, sinus tarsi, and plantar fascia revealed on MR imaging in a group of patients with advanced injury of the posterior tibial tendon. MATERIALS AND METHODS; MR images from 25 patients with advanced posterior tibial tendon injury were retrospectively examined for spring ligament, sinus tarsi, and plantar fascia abnormalities. These images were randomly compared with those obtained from 25 control patients with normal-appearing posterior tibial tendons. RESULTS: The spring ligament was abnormal in 23 (92%) of 25 patients with a posterior tibial tendon injury and seven (28%) of 25 patients with a normal posterior tibial tendon (p < 0.0001). The sinus tarsi was abnormal in 18 (72%) of 25 patients with posterior tibial tendon injury and nine (36%) of 25 patients with a normal posterior tibial tendon (p < 0.0132). The plantar fascia was abnormal in seven (32%) of 22 patients with posterior tibial tendon injury and two (9%) of 22 patients with a normal posterior tibial tendon (p < 0.0768). Two or more associated abnormalities were present in 20 (80%) of 25 patients with posterior tibial tendon injury and four (16%) of 25 patients with a normal posterior tibial tendon (p < 0.0001). CONCLUSION: Advanced posterior tibial tendon injury has a high association with spring ligament and sinus tarsi abnormalities on MR imaging. There was a low association between advanced posterior tibial tendon injury and plantar fascia abnormality. Patients with posterior tibial tendon injury often have abnormalities of two or more associated structures.

Adult↗
PubMed2001

MR imaging of meniscal contusion in the knee.

OBJECTIVE: We describe focal abnormal signal of the meniscus in the knees of six patients who had a history of acute trauma to the knee. This signal abuts the articular surface of the meniscus on MR imaging but does not meet criteria for a meniscal tear or degeneration. CONCLUSION: Acute trauma to the knee may cause an abnormal signal in the meniscus that does not meet the previously described criteria for a meniscal tear or an intrasubstance degeneration. This abnormal signal could be misinterpreted as a tear because of its contact with the articular surface; this signal is seen most often in our series in the setting of an anterior cruciate ligament tear with adjacent bone contusions. We suggest that this signal may be due to a contusion of the meniscus and that the signal may resolve over time in some patients.

Adult↗
PubMed2001

Cost-effectiveness of immediate MR imaging versus traditional follow-up for revealing radiographically occult scaphoid fractures.

OBJECTIVE: For suspected scaphoid fractures with no radiographic evidence of fracture, treating symptoms with immobilization and radiographic follow-up has long been the standard of care. Modified MR imaging of the wrist is offered at our institution in screening for radiographically occult scaphoid fractures at the time of initial presentation to the emergency department. We show the advantages and comparative costs of this modified protocol versus a traditional protocol. MATERIALS AND METHODS: Our modified protocol consists of coronal thin-section T1-weighted and fast spin-echo T2-weighted MR images with fat saturation. A review of the literature was performed to assess the accuracy of clinical examination, radiography, and other modalities in the evaluation of scaphoid fractures of the wrist. Charges for this procedure are compared with charges for traditional follow-up. RESULTS: Three of four patients with positive results at clinical examination and negative findings on initial radiographs will be needlessly immobilized and monitored. The charges to the patient at our institution for screening MR imaging of the wrist are $770. The total charges to the patient with the traditional protocol, which would not be necessary with screening MR imaging, are $677 or more if a diagnosis is not made at this time. Bone scanning or routine MR imaging is often eventually used. CONCLUSION: Cost analysis at our institution suggests the two protocols are nearly equivalent from a financial standpoint. The loss of productivity for patients who are unnecessarily in casts or splints may be substantial. Screening MR imaging of the wrist in this setting is becoming accepted at our institution in a manner similar to screening MR imaging of the hip.

Adolescent↗
PubMed2000

Increased T2 signal intensity in the distal clavicle: incidence and clinical implications.

OBJECTIVE: The objectives of the current study were (1) to quantify the incidence of increased T2 signal in the distal clavicle and (2) to assess the clinical significance of this finding in patients with chronic acromioclavicular (AC) joint pain. DESIGN AND PATIENTS: Eight patients (five male and three female, 15-41 years of age) with disabling shoulder pain localized to the AC joint and marked increased T2 signal in the distal clavicle are presented. These eight patients underwent MR examination over a 25 month period (August 1996 to September 1998). The dictated reports of all shoulder MR examinations conducted over this same time period were reviewed retrospectively for the presence of signal abnormality in the distal clavicle. Clinical data and, in five patients, findings at shoulder arthroscopy or open surgery, were correlated with the results of MR imaging. One patient underwent arthroscopy on both shoulders. RESULTS: The selected eight patients each presented clinically with disabling shoulder pain localized to the AC joint. One patient is presented twice, as both shoulders were symptomatic (n=9). Plain film examination (9/9) failed to indicate a structural cause of shoulder pain in any of the patients. MR examination demonstrated abnormally increased T2 signal in the distal clavicle in all nine cases and no other cause for AC joint pain. Three patients responded to a course of conservative therapy. Six experienced refractory pain despite conservative therapy. Resection of the distal clavicle was performed in five of the six cases. All patients who underwent resection of the distal clavicle experienced complete resolution of AC joint pain. A retrospective review of the dictated reports for all shoulder MR imaging examinations performed at out institution over a 25 month period (August 1996 to September 1998; n=761) demonstrated a 12.5% incidence of abnormally increased T2 signal in the distal clavicle. CONCLUSIONS: Increased T2 signal in the distal clavicle is a relatively common finding (12.5%) on MR imaging examinations of the shoulder and in most cases is of no clinical significance. However, in patients with chronic AC joint pain and no other abnormality on plain film or MR imaging, increased T2 signal may represent an early manifestation of, or a process similar to, osteolysis of the distal clavicle. Patients with this presentation who continue to suffer from disabling pain following conservative therapy may benefit from surgical resection of the distal clavicle.

Acromioclavicular Joint↗
PubMed2000

Magnetic resonance imaging findings in anterolateral impingement of the ankle.

OBJECTIVE: To demonstrate the MR imaging findings of anterolateral impingement (ALI) of the ankle. DESIGN AND PATIENTS: Nine patients with a history of ankle inversion injury and chronic lateral ankle pain were imaged with MR imaging, and the findings correlated with the results of arthroscopy. Three additional patients with clinically suspected ALI of the ankle were also included. Ankle MR imaging studies from 20 control patients in whom ALI was not suspected clinically were examined for similar findings to the patient group. RESULTS: MR imaging findings in the patients with ALI included a soft tissue signal mass in the anterolateral gutter of the ankle in 12 of 12 (100%) cases, corresponding to the synovial hypertrophy and soft tissue mass found at arthroscopy in the nine patients who underwent arthroscopy. Disruption, attenuation, or marked thickening of the anterior talofibular ligament was seen in all cases. Additional findings included signs of synovial hypertrophy elsewhere in the tibiotalar joint in seven of 12 patients (58%) and bony and cartilaginous injuries to the tibiotalar joint in five of 12 (42%). None of the control patients demonstrated MR imaging evidence of a soft tissue mass in the anterolateral gutter. CONCLUSIONS: ALI of the ankle is a common cause for chronic lateral ankle pain. It has been well described in the orthopedic literature but its imaging findings have not been clearly elucidated. The MR imaging findings, along with the appropriate clinical history, can be used to direct arthroscopic examination and subsequent debridement.

Adolescent↗
PubMed2000

"Spinolaminar breach": an important sign in cervical spinous process fractures.

OBJECTIVE: To report the sign of "spinolaminar breach" and its likely importance in fractures of the cervical spinous processes. DESIGN: Six cases of spinous process fractures demonstrating disruption of the spinolaminar line or "spinolaminar breach" were analyzed. Lateral and anteroposterior radiographs (n=6), CT scans (n=3) and MRI scans (n=1) were reviewed together by the authors, with consensus being reached as to the radiographic findings. Clinical records were also reviewed. RESULTS: The levels of injury were C6 (n=5) and C5 (n=2). Injuries were associated with delayed anterior subluxation (n=4) and neurological deficit (n=2). Five patients were male and one was female with a mean age of 31 years (range 8-59 years). Injuries resulted from motor vehicle accidents (n=4), a motor cycle accident (n=1) and a fall (n=1). CONCLUSION: "Spinolaminar breach", or disruption of the spinolaminar line, indicates a complex spinous process fracture with extension into the lamina and spinal canal. Spinous process fractures with spinolaminar breach may have associated posterior ligamentous injury with potential for delayed instability and neurological deficit. It is important that radiologists and physicians caring for the trauma patient be aware of this sign in order to avoid misdiagnosis as a "clay shoveler's fracture", which can lead to adverse outcome.

Accidental Falls↗
PubMed2000

The MR imaging appearance of longitudinal split tears of the peroneus brevis tendon.

PURPOSE: Longitudinal split tears of the peroneus brevis tendon have been increasingly reported as a source of lateral ankle pain and disability. MR imaging is useful in identifying the appearance of longitudinal split tears of the peroneus brevis tendon to differentiate this entity from other causes of chronic lateral ankle pain. We observed variations in anatomy associated with these tears. MATERIALS AND METHODS: Twenty-two patients (eleven males, eleven females) were identified as having longitudinal split tears of the peroneus brevis tendon. These cases were reviewed retrospectively to evaluate for the following: shape of the peroneus brevis tendon, high signal in the peroneus brevis tendon, tendon subluxation, appearance of the superior peroneal retinaculum, presence of osseous changes in the ankle, lateral ankle ligaments, presence of a bony fibular spur, flattening of the peroneal groove of the fibula and presence of a peroneus quartus. A control group consisted of twenty ankles imaged for reasons other than lateral ankle pain. The same structures were assessed in this group. A Fisher's exact P-value was used to determine the significance of each finding in the two groups. RESULTS: Statistically significant associated findings were chevron shaped tendon (p = .0001), high signal in the peroneus brevis (p = .0017), bony changes (p = .0001), flat peroneal groove (p = .0001), abnormal lateral ligaments (p = .0004), and lateral fibular spur (p = .0006). CONCLUSIONS: MR imaging is useful in differentiating longitudinal split tears of the peroneus brevis tendon from other lateral ankle disorders. It can show the extent of the abnormality in the tendon and the associated findings of soft tissue and/or bone variations which must be addressed at the time of surgery.

Adolescent↗
PubMed2000

The relationship of age, gender, and degenerative changes observed on radiographs of the shoulder in asymptomatic individuals.

Radiographs of the shoulders of 84 asymptomatic individuals aged between 40 and 83 years were evaluated to determine changes in 23 specific areas. Two fellowship-trained orthopaedic radiologists graded each area on a scale of 0 to II (normal 0, mild changes I, advanced changes II). Logistic regression analysis indicated age to be a significant predictor of change (p < 0.05) for sclerosis of the medial acromion and lateral clavicle, the presence of subchondral cysts in the acromion, formation of osteophytes at the inferior acromion and clavicle, and narrowing and degeneration of the acromioclavicular joint. Gender was not a significant predictor (p > 0.05) for radiological changes. Student's t-test determined significance (p < 0.05) between age and the presence of medial acromial and lateral clavicular sclerosis, subchondral acromial cysts, inferior acromial and clavicular osteophytes, and degeneration of the acromioclavicular joint. Radiological analysis in conditions such as subacromial impingement, pathology of the rotator cuff, and acromioclavicular degeneration should be interpreted in the context of the symptoms and normal age-related changes.

Acromioclavicular Joint↗
PubMed2000

Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance.

OBJECTIVE: We describe the MR imaging features of medial meniscus flap tears in which the fragment becomes located inferomedial to the tibial plateau and deep in relation to the medial collateral ligament. CONCLUSION: Inferior flap tears of the medial meniscus can be inconspicuous and overlooked by both radiologists and orthopedic surgeons. Inferiorly displaced meniscal fragments may escape detection during arthroscopic surgery unless the fragment is sought with a probing hook. Recognition of this meniscal abnormality on MR imaging is important for preoperative planning.

Adult↗
PubMed2000

Sacral stress fractures in long-distance runners.

OBJECTIVE: Sacral stress fractures in athletes are rare but important to recognize because the symptoms often mimic sciatica and can lead to delay in diagnosis and treatment. The radiographic findings are characteristic and can facilitate early diagnosis and lead to appropriate treatment. CONCLUSION: The clinical presentation of runners with sacral stress fractures can mimic disk disease. However, stress fractures in athletes, especially long-distance runners, must be treated differently. The imaging characteristics appear as linear abnormal signal intensity paralleling the sacroiliac joint on MR imaging and linear sclerosis with cortical disruption on CT. Imaging with bone scintigraphy shows increased uptake that parallels the sacroiliac joint.

Adolescent↗
PubMed2000

The "mini brain": plasmacytoma in a vertebral body on MR imaging.

OBJECTIVE: Patients with solitary plasmacytoma in the spine frequently require a biopsy for diagnosis of their condition. We report an appearance of plasmacytoma in the spine, which is sufficiently pathognomonic to obviate biopsy. CONCLUSION: Identification of a "mini brain" in an expansile lesion in the spine is characteristic of plasmacytoma. It is important that radiologists note this characteristic because biopsy can be avoided in patients with this appearance. Although biopsy might still be required at many institutions, at our institution, surgeons find this appearance sufficiently pathognomonic to bypass biopsy and start treatment.

Adult↗
PubMed1999

Chronic avulsive injuries of childhood.

Children and adolescents are prone to avulsive injuries related to a combination of their propensity for great strength, ability to sustain extreme levels of activity, and immature growing apophyses. Appropriate interpretation of imaging studies showing chronic avulsive injuries is essential so that the irregularity and periostitis that can be associated with chronic avulsions is not misinterpreted as probable malignancy. This article reviews the chronic avulsive injuries of childhood.

Athletic Injuries↗
PubMed1999

Fibrolipomatous hamartoma: pathognomonic on MR imaging.

PURPOSE: To assess the MR imaging characteristics, presenting symptoms, age and nerve distribution of fibrolipomatous hamartoma. DESIGN: A computer search was performed of the term fibrolipomatous hamartoma through the musculoskeletal section MR imaging results at our institution from June 7, 1996 to January 21, 1998 followed by a search of the terms lipomatous hamartoma, median nerve, surrounding fat, increased fatty signal, coaxial, and neuroma. MR images and medical files were retrospectively reviewed by two experienced musculoskeletal radiologists for imaging characteristics, nerve and age distribution as well as for history of trauma. In addition three consultation cases from outside institutions were added for determination of image characteristics. RESULTS: Ten fibrolipomatous hamartomas were identified: eight in the median nerve, one in the ulnar nerve and one in the sciatic nerve. Mean age was 32.3 years (range 4-75 years, SD 21 years). Imaging characteristics were serpiginous low-intensity structures representing thickened nerve fascicles, surrounded by evenly distributed fat, high signal intensity on T1-weighted sequences and low signal intensity on T2-weighted sequences. The amount of fat varied; however, distribution in eight cases (80%) was predominantly between nerve fibers rather than surrounding them peripherally. All had a coaxial-cable-like appearance on axial planes and a spaghetti-like appearance on coronal planes that was not seen in any other type of median nerve abnormality imaged during the study period. CONCLUSION: The MR imaging characteristics of fibrolipomatous hamartoma are pathognomonic, obviating the need for biopsy for diagnosis.

Adult↗
PubMed1999

The MR imaging features of the posterior intermalleolar ligament in patients with posterior impingement syndrome of the ankle.

OBJECTIVE: To describe the MR imaging features of the posterior intermalleolar ligament (IML) in patients with posterior impingement syndrome (PIS) of the ankle. DESIGN AND PATIENTS: Three patients (one male and two females, 13-25 years of age) are presented. Each patient presented clinically with symptoms of PIS of the ankle. Plain film examination was negative for a structural cause of the PIS in all patients. MR images were obtained with a 1.5 T scanner using an extremity coil. Clinical data and, in one patient, findings at ankle arthroscopy, were correlated with the results of MR imaging. RESULTS: Ankle MR images from the three patients with a clinical diagnosis of PIS are presented. Findings in all patients included: (1) absence of another structural cause of the PIS (i.e., an os trigonum, trigonal process, fracture, loose bodies, etc.), (2) identification of the IML as a structure discrete from the posterior talofibular and tibiofibular ligaments, and (3) prominence of the IML as indicated by (a) identification of the IML in three different imaging planes, and (b) a caliber of the IML comparable to that of the conventional posterior ankle ligaments visualized in the same imaging plane. Arthroscopic resection of a meniscoid IML resulted in resolution of the PIS in one of the patients presented. CONCLUSIONS: MR imaging is an effective means of investigating the IML as a potential cause of PIS. The identification of a prominent IML in the absence of another structural cause of PIS indicates that impingement of the IML is the most likely cause of PIS.

Adolescent↗