Biomedical subjects
W W Gibbon
Publications and source records attributed to W W Gibbon.
Distribution of sonographically detected tendon abnormalities in patients with a clinical diagnosis of chronic achilles tendinosis.
PURPOSE: We conducted a retrospective study of the distribution of sonographically detected abnormalities in the heels of patients who had a clinical diagnosis of Achilles tendinosis. METHODS: One hundred eighteen symptomatic heels in 73 patients who had a clinical diagnosis of chronic Achilles tendinosis were examined over a 12-month period by the same experienced sonologist. The distribution of altered tendon architecture and features suggesting retrocalcaneal bursitis or Achilles paratendinosis were evaluated. RESULTS: Sonograms of 118 symptomatic heels demonstrated that 96 (81%) had abnormalities confined to the proximal two thirds of the Achilles tendon, 9 (8%) had abnormalities in the distal third alone, and 13 (11%) had abnormalities at both sites. Of the 109 heels with proximal two-third Achilles tendon disease, 99 (91%) had medial tendon involvement; 22 of the 99 showed diffuse tendon changes. Lateral tendon segment changes were seen in 22 (19%) of the 118 symptomatic heels. No lateral tendon segment was involved in isolation. Of the 22 heels with distal third abnormalities, 14 (64%) had sonographic evidence of Achilles paratendinitis, and 13 (59%) had sonographic evidence of Achilles tendinosis. Eighteen of the 22 had sonographic evidence of retrocalcaneal bursitis. In all cases of distal third tendinosis, the deep surface of the tendon was primarily involved. In the heels with both proximal and distal changes, superficial segment involvement of the mid-Achilles tendon was present. CONCLUSIONS: Sonography provides information that helps to accurately diagnose clinical Achilles tendinopathy and may help to determine the biomechanical processes involved in the injury.
The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography.
OBJECTIVE: The ability to make an early, accurate diagnosis of rheumatoid arthritis (RA) has become increasingly important with the availability of new, expensive, and targeted therapies. However, plain radiography, the traditional method of detecting the characteristic bone erosions and an important adjunct in establishing a diagnosis of RA, is known to be insensitive. This study compared sonography, a modern imaging technique, with conventional radiography for the detection of erosions in the metacarpophalangeal (MCP) joints of patients with RA. METHODS: One hundred RA patients (including 40 with early disease) underwent posteroanterior radiography and sonography of the MCP joints of the dominant hand. Twenty asymptomatic control subjects also underwent sonography. Erosion sites were recorded and subsequently compared using each modality. Magnetic resonance imaging (MRI) was performed on the second MCP joint in 25 patients with early RA to confirm the pathologic specificity of sonographic erosions. Intraobserver reliability of sonography readings was assessed using video recordings of 55 MCP joint scans of RA patients, and interobserver reliability was assessed by comparing 160 MCP joint scans performed sequentially by 2 independent observers. RESULTS: Sonography detected 127 definite erosions in 56 of 100 RA patients, compared with radiographic detection of 32 erosions (26 [81%] of which coincided with sonographic erosions) in 17 of 100 patients (P < 0.0001). In early disease, sonography detected 6.5-fold more erosions than did radiography, in 7.5-fold the number of patients. In late disease, these differences were 3.4-fold and 2.7-fold, respectively. On MRI, all sonographic erosions not visible on radiography (n = 12) corresponded by site to MRI abnormalities. The Cohen-kappa values for intra- and interobserver reliability of sonography were 0.75 and 0.76, respectively. CONCLUSION: Sonography is a reliable technique that detects more erosions than radiography, especially in early RA. Sonographic erosions not seen on radiography corresponded to MRI bone abnormalities. This technology has potential in the management of patients with early RA/inflammatory arthritis and is likely to have major implications for the future practice of rheumatology.
Postgraduate medical education: methodology.
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Ultrasound of the plantar aponeurosis (fascia).
OBJECTIVE: To assess the plantar aponeurosis origin (plantar fascia) using high-resolution ultrasound. DESIGN: The sonographic appearance of the plantar fascia in asymptomatic volunteers was compared with the appearance in: (1) clinical idiopathic plantar fasciitis, (2) inflammatory arthropathy without clinically active plantar fasciitis and (3) Achilles tendon or ankle ligament injury. Patients. There were 48 asymptomatic volunteers (96 heels), 190 patients with idiopathic plantar fasciitis (297 heels), 35 with rheumatoid factor negative spondyloarthropathy (70 heels), 17 with rheumatoid arthritis (34 heels), 62 with clinical Achilles tendinitis (93 heels) and 17 with instability secondary to previous ankle ligament injury (17 heels). RESULTS: Compared with the asymptomatic volunteers, the symptomatic plantar aponeurosis demonstrated significant thickening in patients with clinically unilateral (P<0.001) and bilateral (P<0.001) idiopathic plantar fasciitis as well as in patients with spondyloarthropathy (P<0.001). However, the plantar aponeurosis on the asymptomatic side in patients with unilateral idiopathic plantar fasciitis (P<0.2), rheumatoid arthritis (P<0.2) and ankle injury (P<0.1) demonstrated no significant thickening. In patients with idiopathic plantar fasciitis, abnormal plantar aponeurosis echogenicity was seen in 78% and subcalcaneal bone spurs in 24%. Peritendinous edema was present in 5% of all symptomatic heels, subcalcaneal bone erosion in 4% and intratendinous calcification in 3% of heels. Retrocalcaneal bursitis was present in 7% of patients with idiopathic plantar fasciitis, 40% with spondyloarthropathy and 19% with rheumatoid arthritis. CONCLUSION: Ultrasound allows confirmation of the clinical diagnosis in plantar fasciitis and may provide information as to its etiology.
Magnetic resonance imaging of injuries in the child athlete.
Sports related injuries in children and adolescents are an increasingly frequent clinical problem. Soft tissue injury is relatively less common in children than in adults and radiographs suffice in most situations. However there are specific clinical circumstances where MR imaging is of value. We discuss and demonstrate a variety of acute and chronic sports related conditions where MR imaging has contributed to the diagnosis and management. Some conditions such as apophysitis, osteochondritis and chronic physeal injuries are unique to childhood while others including spondylysis and stress fractures are unusual conditions outside the context of sport in this age group.
Ultrasound in inflammatory disease.
US may be used effectively to diagnose and treat a wide range of musculoskeletal inflammatory conditions. It is likely that its usage will increase with regards to such conditions especially in the management of rheumatology clinic patients.
The sportsman's groin.
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The current status of ultrasonography in rheumatology.
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Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis.
OBJECTIVE: To assess the number and distribution of tendon microtears in asymptomatic controls and athletes with chronic Achilles tendinitis or partial thickness tears using high resolution ultrasound. METHODS: The mean number of microtears in three random tendon cross sections were recorded per tendon third in 19 asymptomatic volunteers, 16 athletes with symptomatic chronic Achilles tendinitis, and eight athletes with partial Achilles tendon rupture. RESULTS: Microtears were most numerous in the middle third section of the Achilles tendon. Some 67% of tendons in the control group had no microtears, and 28% showed a single microtear. Only 18% of the athletes with chronic Achilles tendinitis and none of the athletes with partial tendon rupture were without microtears in the middle third of their Achilles tendon. Of the tendons with chronic tendinitis, 13% had more than three microtears per section which increased to 87% in tendons exhibiting partial rupture. CONCLUSIONS: There appears to be an association between microtear formation and Achilles tendon rupture.
Groin pain in professional soccer players: a comparison of England and the rest of Western Europe.
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Diagnostic ultrasound in sports medicine.
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Ultrasonography in the diagnosis of chickenpox-related osteomyelitis.
Osteomyelitis is a recognized but uncommon complication of chickenpox. Very little published information is available regarding imaging of this condition, particularly regarding ultrasonographic appearances. We report two cases of young children who developed osteomyelitis after chickenpox infection in whom ultrasonography proved a valuable adjunct to clinical diagnosis. In both cases sonography demonstrated a subperiosteal abscess, confirming the diagnosis. Ultrasonography precisely defined the extent of the subperiosteal collection in order to guide surgical drainage. We believe ultrasonography to be a useful method of investigation in a child with limb or joint pain after chickenpox infection.
Diseases of the pubis and pubic symphysis: MR imaging appearances.
MR imaging may provide detailed information as to the precise nature of a wide range of abnormalities occurring in the pubic symphysis region. Conventional radiographs should, however, be performed initially because MR imaging is not always indicated and without complementary radiographs may result in erroneous diagnosis.
Chondromyxoid fibroma of the foot.
Chondromyxoid fibroma is a rare benign cartilaginous tumour seen most frequently around the knee in children and young adults. Up to 17% occur in the foot, where more aggressive appearances have been reported. Four cases of chondromyxoid fibroma in the forefoot are presented, demonstrating the wide range of radiological appearances of this primary tumour. Three of the four tumours recurred, one at 19 years after the surgery. These cases illustrate the need for thorough preoperative assessment to ensure complete surgical resection in an attempt to reduce the incidence of local recurrence.
Musculoskeletal ultrasound.
Ultrasound is an extremely useful and versatile method of assessing soft tissue abnormality in rheumatological conditions. It is best performed as an extension of clinical examination. Ultrasound has the advantage of not only being able to demonstrate abnormalities but also allows transducer compression of those abnormalities to see if it reproduces the patient's characteristic symptoms. It is likely to find even greater use in the clinical setting over future years. In the near future skeletal ultrasound should develop into an essential tool for the extension of physical examination in rheumatology practise. It hopefully will become as vital to a rheumatologist as echocardiography is to a cardiologist. This will however require clinicians to be prepared to undergo sufficient training in order to avoid diagnostic errors. Probably it will only be at that time, when skeletal ultrasound has become a fundamental part of rheumatological diagnosis, that its full potential will be realized.