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PubMed1997

Frozen shoulder: correlation between the response to physical therapy and follow-up shoulder arthrography.

OBJECTIVE: To study the correlation between improvement of shoulder motion and shoulder joint space capacity determinated by arthrography. DESIGN: Case series. SETTING: General community hospital. PATIENTS: Twelve patients with clinically diagnosed frozen shoulder without rotator cuff tear. All subjects were divided as "primary" and "secondary" according to spontaneous onset or not, and "acute" or "chronic" depending on whether duration of disease was less than 2 months or longer. INTERVENTIONS: Outpatient rehabilitation programs, including physical modalities, exercise intervention, and regular weekly outpatient clinic follow-up. MAIN OUTCOME MEASURES: Shoulder range of motion (ROM) and joint space capacity in shoulder arthrography. RESULTS: In acute patients, the joint space capacity increased significantly after treatment (t = 2.82; p < .05). Increased joint space capacity was most significantly correlated with improvement in external rotation (r = .77, p < .05), followed by abduction (r = .43, p > .05), but was poorly correlated with flexion and internal rotation. In chronic patients, both primary and secondary groups, there was no obvious joint space capacity increase despite significant shoulder motion improvement. Follow-up arthrograms showed the reappearance and/or enlargement of the axillary recess and smoother capular margins in all the patients except one chronic case (disease duration for 1 year). These findings were more obvious in acute than in chronic patients. CONCLUSIONS: For frozen shoulder, generally described as "adhesive capsulitis," the adhesion was reversible in the acute stage. The increase of joint space capacity was significant and was correlated with improvement of external rotation. In chronic patients, ROM restoration occurred independent of change in joint space capacity, which increased slightly. The stretching of other contracted soft tissues around the shoulder, in addition to the adhesive capsule, may contribute to the recovery of chronic frozen shoulder.

Acute Disease↗
PubMed1998

Wrist arthrography today.

In recent years, wrist arthrography has been criticized for having low sensitivity and low specificity. This largely has been due to widely varying and less than rigorous technique and the reliance on criteria for abnormality that are now known to be invalid. Other criticisms have included the length of time needed to perform a three-compartment arthrogram with or without comparison to the contralateral side and the radiation dose to the patient. It is our belief, however, that with the use of the patient's history, symptoms and physical examination to develop a focused examination strategy, and with the use of digital equipment, the examination can be performed quickly and with minimal radiation dose to the patient. In order to improve the accuracy of arthrography, the radiologist must abandon the concept that simply identifying a communicating defect between the carpal compartments is a criterion for abnormality. He or she must utilize a meticulous approach to determine the site of communication to evaluate the features of the defects in order to determine the significance of the defect. As more is learned about the nature of traumatic and attritional defects and with further technologic advancements in cross-sectional imaging and three-dimensional rendering, it is quite possible that arthrographic imaging of the wrist will experience a resurgence of interest in the evaluation of posttraumatic wrist pain, avoiding the fate of such examinations as pneumoencephalography and oral cholecystography as many have predicted.

Arthrography↗
PubMed1998

MR arthrography of the ankle.

Injuries to the lateral ankle ligaments are extremely common. Many patients with acute injuries to the lateral ligament complex develop chronic ankle instability that requires surgical intervention. MR arthrography of the ankle plays a valuable role in identifying those patients who are most at risk for the development of chronic instability. MR arthrography of the ankle also aids in preoperative planning and in differentiating among other entities that can present as ankle instability.

Ankle Injuries↗
PubMedDate not supplied

Arthrography.

Arthrography is being performed more often, probably due to its recognition by radiologists and orthopedists as a useful diagnostic aid. Many recent advances in technique have helped to increase diagnostic accuracy and it has earned wider acceptance. The fundamentals of arthrography are fairly well known and covered in the literature. This monograph attempts to bring together practical points considered to be relevant to the arthrographer. The subjects covered for each joint are self-explanatory; the local anatomy, the technique involved and interpretation of the results are discussed from the purely medical and technical point of view and films are provided as a technical guide.

Ankle Joint↗
PubMed1996

Wrist arthrography versus arthroscopy: a comparative study of 150 cases.

One hundred fifty patients with suspected wrist ligamentous injuries were studied with both triple injection wrist arthrography and arthroscopy. The diagnoses obtained by these two techniques were compared to determine the differences between these two modalities. All the patients in this study had both the clinical diagnosis of ligamentous injuries of the wrist and normal findings on x-ray films. Intercarpal abnormalities were found in 106 patients (71%) at wrist arthrography and in 136 patients (91%) at arthroscopy. There was only 42% agreement (63 patients) between the arthrographic and arthroscopic diagnoses. Eighty-seven patients (58%) had alterations of their arthrographic diagnoses following arthroscopy. For patients with normal arthrographic findings (44 patients), 88% underwent arthroscopy because there was insufficient correlation between the physical examination findings and the arthroscopic findings. Out of the 44 patients with normal arthrographic findings, 35 patients (80% of the subgroup) had injuries found at arthroscopy. Over half of the patients had alterations in their arthrographic diagnoses following arthroscopy. In a patient with suspected ligamentous injury of the wrist, wrist arthroscopy may be the most efficient method in arriving at a definitive diagnosis.

Adolescent↗
PubMed1996

Aspiration arthrography of the hip joint. Its uses and limitations in revision hip surgery.

Seventy-one patients undergoing revision hip surgery over a 5-year period from 1988 to 1993 had aspiration arthrography of the hip as a preoperative investigation. Sixteen hips were found to be infected at operation. Preoperative aspiration yielded positive cultures in 11 of these 16 hips. There was identical correlation between the organisms isolated on aspiration and during surgery. There were 5 false positive cultures from the aspirates of the remaining 55 noninfected hips. All of the hips from which a true positive culture was obtained had either clinical or radiologic evidence suggestive of infection. Aspiration arthrography does not have a major role to play as a routine investigation prior to all revision hip surgery. It is recommended that its use be reserved for those hips in which there is either clinical, hematologic, or radiologic evidence of infection.

Adult↗
PubMedDate not supplied

Bipositional MR imaging vs arthrography for the evaluation of femoral head sphericity and containment in Legg-Calvé-Perthes disease.

Eleven hips of 10 patients with Legg-Calvé-Perthes disease (LCPD) were examined by arthrography and magnetic resonance (MR) imaging. Arthrogram and MR images were obtained with the hips in neutral position and in 20 degrees flexion-abduction and internal rotation. Modified arthrographic index (AI) was used for the evaluation of sphericity and acetabulum head index (AHI) was used for the assessment of containment. According to AI, there is no significant difference between the arthrograms and coronal MR imaging, but the difference between the coronal and sagittal MR imaging was significant. There was no statistical difference between the arthrograms and MR measurements in terms of AHI. Anterior flattening of the femoral head and the effect of hip flexion in the containment at the sagittal plane could be demonstrated clearly in sagittal MR imaging. Even if there was significant flattening in coronal plane, the sphericity of the head was preserved in the sagittal plane. Bipositional MR imaging is comparable to arthrography for the demonstration of sphericity and containment of the femoral head in both coronal and sagittal planes in LCPD.

Arthrography↗
PubMed1987

Normal and abnormal temporomandibular joints: quantitative evaluation of inferior joint space arthrography.

Arthrography has been shown to provide important diagnostic information in patients with temporomandibular joint (TMJ) dysfunction. In this study, 60 arthrograms on totally asymptomatic patients and 64 arthrograms on symptomatic patients were evaluated. Quantitative evaluation of inferior joint space arthrography was performed with the help of a computer digitizing morphometry program. Results indicate a significant difference in the areas of the anterior and posterior recesses between normal and abnormal joints in the closed-mouth position. Differences between the 2 groups also exist in linear measurements of the anterior recess. This data further defines important diagnostic criteria in the arthrographic evaluation of both the normal and abnormal TMJ.

Adolescent↗
PubMed1987

Significance of arthrography and computed tomography in the assessment of internal derangement of the temporomandibular joint.

Arthrography was performed on 56 joints of 47 patients presenting with symptoms of pain and dysfunction of the temporomandibular joint. The diagnosis could be confirmed in 53 joints. In addition, there was evidence of 13 perforations and 7 joints with adhesions. In 51 of the affected joints, computed tomography (CT) was also performed to compare both methods. The same CT procedure was performed on 12 joints of patients without any joint problem. Almost consistently (88%), an arthrographically anteriorly dislocated disc was detectable in the axial CT scans. 92% of the healthy joints showed normal soft tissue structures. For CT visualization of a displaced disc sagittal reformations or primary sagittal scans are not necessary. Confirmation of possible perforations or adhesions cannot be made by CT. Comparing the advantages and disadvantages, arthrography must still be regarded as superior to CT. In some cases, however, CT is a valuable tool in assessing an internal derangement.

Arthrography↗
PubMedDate not supplied

Distention arthrography in the treatment of adhesive capsulitis of the shoulder.

PURPOSE: Adhesive capsulitis involving the glenohumeral joint (frozen shoulder) is an insidious and painful condition that results in gradual loss of joint motion. Recovery is frequently prolonged despite multiple therapeutic maneuvers. The authors investigate the mechanism of action and the long-term clinical result of distention arthrography for the treatment of patients with frozen shoulder. PATIENTS AND METHODS: Sixteen patients with adhesive capsulitis of the shoulder were treated with therapeutic capsular distention by using intra-articular injection of a 30-mL mixture of lidocaine, corticosteroid, and contrast media immediately following diagnostic arthrography. RESULTS: Capsular disruption was demonstrated in all cases. Thirteen patients (80%) experienced immediate pain relief and increased shoulder mobility. This improvement was maintained over a follow-up interval of 6 months or more. Disruption occurred at the subscapular bursa in eight patients, the subacromial bursa in six, and the distal bicipital tendon sheath in two. These latter two patients had no pain relief. CONCLUSION: Arthrographic distention of the constricted capsule appears to be an excellent therapeutic intervention for achieving rapid symptomatic relief from adhesive capsulitis.

Arthrography↗
PubMedDate not supplied

Indicators of superior glenoid labral detachment on magnetic resonance imaging and computed tomography arthrography.

The magnetic resonance imaging and computed tomography arthrographic findings of 36 shoulders with arthroscopically diagnosed detachment of the superior labrum were compared with those of 40 shoulders with a normal superior labrum to detect any findings specific to the injury. In this study we defined a specific magnetic resonance imaging finding as the presence of a linear, high-to-intermediate intensity area between the superior labrum and the glenoid rim on oblique coronal T2-weighted images. We also defined a specific computed tomography arthrography finding as air entering between the superior labrum and the upper part of the glenoid surface. On the basis of these findings magnetic resonance imaging had a sensitivity of 41%, a specificity of 86%, and an accuracy of 63%, whereas computed tomography arthrography had a sensitivity of 45%, a specificity of 93%, and an accuracy of 73%. Thus both of these procedures were specific for these particular findings, but they were neither sensitive nor accurate.

Adolescent↗
PubMed2006

Hip MR arthrography and femoroacetabular impingement.

Hip pain is a common complaint among athletes of all ages. Advances in imaging and treatment are changing the paradigm of evaluation and management of hip pain. The role of abnormal femoral and acetabular morphology and lesions of the acetabular labrum and cartilage is increasingly recognized as being crucial in the development of degenerative change. In addition, femoroacetabular impingement is increasingly recognized as an etiologic factor in hip pain. This article discusses techniques of hip magnetic resonance (MR) arthrography, normal anatomy seen at hip MR arthrography, common intra-articular pathologies in patients with hip pain, and imaging findings of femoroacetabular impingement.

Acetabulum↗
PubMed1998

[Low-field MR arthrography of the shoulder: early results using an open 0.2T MR system].

PURPOSE: To assess the practicability and image quality of doing MR arthrography of the shoulder using a 0.2T system. PATIENTS AND METHOD: 60 patients (24 with chronic instability, 36 with impingement syndrome) were examined in an open 0.2T MR apparatus (Magnetom Open, Siemens). After the intra-articular injections of 15-20 ml of a 2 mmol Gd-DTPA solution, coronary STIR, T1-weighted, sagittal and axial T2*-weighted FLASH 2D sequences were performed. 21 patients subsequently underwent surgery. RESULTS: Image quality of the T1- and T2*-weighted FLASH 2D sequences was regarded as good or adequate and movement artifacts were minor or moderate. STIR sequences were statistically significantly worse in respect of image quality and movement artifacts (p < 0.001, p < 0.005). The sensitivity and specificity in the diagnosis of rotator cuff rupture as confirmed by surgery was 100% (labrum lesions 100%, 93%). Agreement in the diagnosis of rupture of the supraspinatus and infraspinatus tendons was 0.93 and 0.65. CONCLUSION: MR arthrography of the shoulder using an open 0.2 T MR system provides adequate information concerning the intra articular structures of the joint. The disadvantage is the prolonged duration of the examination with the risk of poor image quality resulting from movement artifacts.

Adult↗
PubMed1991

[The methods and place of digital subtraction arthrography of the hip in detecting endoprosthesis loosening].

Digital subtraction arthrography (DSAr) of the operated hip is presented and compared to nuclide bone scan and plain radiograph. Surgical proof was obtained in 47 patients. In the evaluation DSAr proved to be superior to nuclide bone scan and plain radiograph. DSAr had the best predictive value in the diagnosis of loosening of a prosthesis. In contrast to conventional arthrography there is a better differentiation between the contrast medium, the prosthesis, the acrylic cement and the bone by using DSAr. In addition DSAr presents the advantage of postprocessing, especially pixel shift.

Aged↗
PubMedDate not supplied

[Value of the plain roentgen image and arthrography in diagnosis of loosening of cemented hip endoprostheses].

Radiographic signs of suspected prosthetic hip component loosening were evaluated by comparing them with the intraoperative findings. In 59 surgical procedures for suspected loosening of cemented total hip prostheses preoperative radiographic signs of loosening in plain radiographs and radiographic arthrograms were compared with the intraoperative findings. Radiolucent lines between the interfaces prosthesis/cement and cement/bone in defined zones (Salvati et al. 1976, Gruen et al. 1979) were evaluated. For the acetabular component relevant radiolucent lines were observed only between the interface cement/bone. A radiolucent line > 2 mm in zone 1, > 1 mm in zone 2a, a fracture or a retroversion were shown to be reliable signs for loosening with a specificity of 92%, a sensitivity of 61% and a predictive value of 97% (p < 0.01). For the femoral component a radiolucent line at the cement/bone interface of > 1 mm in any of the single zones 2, 3, 6 or 7 and radiolucent lines of > 0 mm in the combined zones 1 + 2 + 6 + 7 proved to be reliable signs of loosening. At the cement/prosthesis interface of the femoral component a radiolucent line of any width in zone 6 and radiolucent lines in the combined zone 1 + 2 or 1 + 7 proved to be reliable signs for loosening as well as major defects within the cement. The above mentioned signs of femoral component loosening display a specificity of 79%, a sensitivity of 86% and a predictive value of 81% (p < 0.001). Arthrography may be useful as an additional diagnostic means for the acetabular component (7 out of 18 false negative results in the radiograms were true positive in the arthrography. Penetration of the contrast material through all 4 zones yields a specificity of 83%, a sensitivity of 48% and a predictive value of 90% with p > 0.05), whereas for the evaluation of the femoral component loosening the gain of information is marginal compared with plain radiographs (specificity 80%, sensitivity 69% and predictive value 78% with p < 0.01). Hip component loosening can be identified with the above mentioned signs even if there are no previous radiographs available.

Arthrography↗
PubMedDate not supplied

[Meniscus signals in vibration arthrography].

The technique of vibration arthrography (VAG) permits the non-invasive evaluation of internal derangements of the knee. Using the computer-assisted recording and analysis equipment which has previously been described, a major survey was conducted into the signal patterns present in subjects with symptomatic knee joints. Two hundred and forty-seven patients were examined, and all of these subsequently underwent arthroscopy. One hundred and seventy-two patients were demonstrated arthroscopically to have a meniscal lesion and 150 of these gave characteristic meniscal signals. This paper discusses the vibration signal patterns associated with the various types of meniscal tear and the effect of surgery on the meniscal signal. The overall accuracy of vibration arthrography in the diagnosis of meniscal pathology was 86%. In many cases, not only could the site of a meniscal tear be determined, but the type of tear could be diagnosed with reasonable accuracy.

Arthrography↗
PubMed1986

[Arthrography of the temporomandibular joint. Indications, technic and interpretation].

Articular dysfunction of the TMJ with anterior displacement of the disc ("internal derangement") is an entity which has been separated from other types of the "myofascial pain syndromes" and which can be treated conservatively or by surgery. Arthrography of the TMJ has contributed greatly to an understanding of normal and abnormal function and, in many cases, it can provide a diagnosis. On the basis of our experience with 80 investigations we discuss technical problems and the clinical indications. The indications for arthrography are in the pre-operative diagnosis, when clinical findings are uncertain, in order to demonstrate perforation, in order to confirm a suspected diagnosis and to assist in prosthetic treatment.

Arthrography↗
PubMed1985

[Inflammatory changes in shoulder arthrography].

Arthrography of the shoulder joint in so-called periarthritis humeroscapularis often shows nodular contrast defects, irregular defects in the bursa and contrast-filling of irregular lymphatics; these are characteristic signs of a synovitis. Arthrography can provide an exact diagnosis, not only in suspected post-traumatic rotator cuff, tears, but also in other painful conditions that limit movement. It is superior to CT in demonstrating inflammatory changes.

Arthrography↗