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At least 433 records · Page 24Linked to original sources
PubMed1999

Subscapularis tendon tears: detection and grading at MR arthrography.

PURPOSE: To assess diagnostic accuracy in the detection and grading of subscapularis tendon lesions at magnetic resonance (MR) arthrography. MATERIALS AND METHODS: MR arthrograms in 50 consecutive patients (29 with normal subscapularis tendons, 11 with a lesion in the cranial quarter, seven with a major tear but not complete detachment, three with complete detachment) with arthroscopic or surgical confirmation were evaluated independently by two radiologists. Diagnosis was established on findings from transverse and/or parasagittal images. RESULTS: With transverse images alone, sensitivity was 95%/100% (reader 1/reader 2); specificity was 55%/62%. With parasagittal images alone, sensitivity was 91%/91%; specificity was 76%/90%. With combined images, sensitivity was 91%/91%; specificity was 86%/79%. Interobserver agreement was substantial (kappa = 0.67). Forty-one of 50 (82%) grades for subscapularis abnormalities matched at MR imaging and surgery; nine mismatches differed by only one degree. Several signs were specific (90%-100%) but insensitive (29%-62%); these included leakage of contrast material onto the lesser tuberosity, fatty degeneration of the subscapularis muscle, and abnormality in the course of the long biceps tendon (luxation, subluxation). CONCLUSION: MR arthrography is accurate in the detection and grading of subscapularis tendon lesions. Specificity of findings on transverse images for this diagnosis can be improved by including indirect signs and findings on parasagittal images.

Adult↗
PubMedDate not supplied

Aids to successful shoulder arthrography performed with a fluoroscopically guided anterior approach.

One method for performing effective shoulder arthrography with a fluoroscopically guided anterior approach is described. The technique can ensure success while injury to the cartilaginous labrum is avoided, which is essential when arthrography is performed in conjunction with magnetic resonance (MR) imaging. The key features of the technique include supine positioning of the patient with the shoulder in external rotation, marking the skin just lateral to the humeral head cortex, inserting the needle perpendicular to the fluoroscopy beam, testing the injection with an anesthetic agent, and confirming intraarticular needle placement with iodinated contrast material. The procedure can be followed by an injection of dilute gadolinium solution for subsequent MR imaging. Proper patient and needle positioning as well as accurate confirmation of intraarticular needle placement are critical to a successful and atraumatic shoulder arthrographic examination.

Adolescent↗
PubMedDate not supplied

MR imaging and MR arthrography of the postoperative shoulder: spectrum of normal and abnormal findings.

The postoperative shoulder may be evaluated with various imaging modalities, including radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging, each of which has advantages and disadvantages. For optimal soft-tissue visualization, MR imaging and MR arthrography are widely used. Several factors, however, may decrease the accuracy of MR imaging in the evaluation of the postoperative shoulder. These factors include surgical distortions of native anatomy, changes in the signal intensity of tissues, and image degradation caused by metallic artifacts. To maximize the accuracy of MR imaging, the radiologist must select the most appropriate pulse sequences and techniques for the given anatomic structure and the suspected postoperative condition. To avoid magnetic susceptibility artifacts at MR imaging, inversion recovery may be used instead of fat saturation, and fast spin-echo sequences may be used instead of conventional spin-echo sequences or gradient-echo sequences. MR arthrography is most useful for optimal delineation of the rotator cuff, capsulolabral structures, and tendon defects. To achieve accurate image interpretation, the radiologist must be familiar with the arthroscopic and the open surgical techniques currently used to repair internal derangements of the glenohumeral joint, as well as with the typical imaging findings in each postoperative situation.

Arthrography↗
PubMedDate not supplied

Computed tomography (CT) arthrography of shoulder instabilities in athletes.

Sixty professional and recreational athletes underwent CT arthrography of the shoulder for evaluation of suspected shoulder joint derangement. These athletes, 46 males and 14 females ranging in age from 15 to 60 years (mean, 32 years), all had persistent pain that interfered with their sports activity and was resistant to conservative treatment. Seventeen patients had shoulder instability based on clinical manifestations and CT arthrographic findings. An additional five patients, also based on clinical manifestations and CT arthrographic findings, were considered to have an unobtrusive degree of anterior joint laxity. Patients with anterior instability (20 cases) all had an anteroinferior tear or detachment of the glenoid labrum, as well as some violation of the insertion of the joint capsule onto the scapula. Those with posterior instability (two cases) had a combination of labral and capsular tears. Two other major patterns of labral tears, both unaffiliated with shoulder instability, were identified. These included total or partial detachment of superior segments of the labrum, and anterior labral tears at the midglenoid level. Moreover, various degrees of labral attenuation (or, less often, enlargement), osteophyte formation, and alterations in articular cartilage were observed. Surgical correlation was obtained in 25 patients, with 95% accuracy of CT arthrographic findings. CT arthrography is a minimally invasive and highly accurate technique for investigation of glenohumeral derangement. Specifically, the extent of pathologic changes associated with instability can be determined and differentiated from other intraarticular causes of incapacity, such as labral tears caused by throwing, or degenerative changes.

Adolescent↗
PubMedDate not supplied

Arthrography, clinical examination, and stress radiograph in the diagnosis of acute injury to the lateral ligaments of the ankle.

We examined 188 consecutive patients, each of whom had an acute ankle sprain, using clinical stability assessment, stress radiographs, and arthrography to compare the reliability of these methods used in diagnosing lateral ligament ruptures of the ankle. Sixty-six of the ankles were treated operatively. Arthrography accurately detected ligament damage in all of the patients with this injury and revealed the extent of the injury in about 85%, whereas clinical examination and stress radiographs detected only about half of the injuries. The injuries and the results of these two methods were often controversial, as our study will show.

Acute Disease↗
PubMed1989

Double-contrast computed tomographic arthrography of the shoulder joint.

Dislocation of the shoulder joint can cause post-traumatic injury to certain anatomical structures, which may lead to recurrent dislocation. The operative visualization of some of these abnormalities may be difficult and their identification preoperatively allows selection of the appropriate surgical approach and avoids the necessity for lengthy surgery. Fifty-one patients with a history of recurrent dislocation, single dislocation or suspected recurrent subluxation as a cause of pain were examined over a 3-year period by double-contrast computed tomographic (CT) arthrography. Thirty-five patients had a demonstrable abnormality and 13 were considered suitable for surgical intervention on radiological criteria. A further 12 patients were advised to have surgery on a combination of clinical and radiological grounds. Eleven of these have so far had surgery, eight of which required an arthrotomy and the CT findings have been confirmed in all these cases. The results of CT arthrography in the patients examined are reported and the technique, normal anatomy and pathological findings are described. The technique is suggested as the imaging method of choice in recurrent dislocation.

Adolescent↗
PubMed1991

Air aspiration after double-contrast knee arthrography: a worthwhile exercise?

A prospective study following double-contrast knee arthrography was undertaken to compare pain and discomfort experienced at the conclusion of the procedure and for 7 days afterwards. The patients were divided into two groups. Half had the air aspirated at the end of the examination and the other half did not. Twice as many patients in the aspirated group were totally asymptomatic (48% compared with 22%); however, by 7 days after the procedure the numbers of asymptomatic patients were similar in the two groups (64% and 63%, respectively). Thus our conclusion is that air aspiration after double-contrast knee arthrography does reduce short-term morbidity.

Air↗
PubMed1994

The value of shoulder distension arthrography with intraarticular injection of steroid and local anaesthetic: a follow-up study.

A series of 51 patients, seen in Leicester, with "frozen shoulder", and referred for arthrographic examination, were assessed both before and after distension arthrography, using air and a low-osmolar contrast media combined with a steroid and local anaesthetic injection. 38 attended for further assessment at up to 6 months later. 16 patients were found to have a rotator cuff tear. There was no significant change in the mean range of active movement in the patients with rotator cuff tears, but symptomatic improvement ensued in 44% of cases. In those found to have no rotator cuff tear, and external rotation of less than 35 degrees, a significant improvement in range of movement was seen. While those with less limitation of external rotation showed no change in their range of movement, they did experience symptomatic improvement in 73% of cases. We conclude that shoulder distension arthrography, with steroid and local anaesthetic injection, may be of symptomatic benefit in patients with frozen shoulder and without a rotator cuff tear, while only those with external rotation of less than 35 degrees are likely to improve their range of motion.

Adult↗
PubMed2004

Single air contrast arthrography for temporomandibular joint disorder using limited cone beam computed tomography for dental use.

MRI has the problem of artefacts caused by metal or body motion and is also incompatible for patients with claustrophobia. Arthrography is invasive and involves the risk of perforation or allergy to a contrast medium. This report discusses a patient with temporomandibular joint (TMJ) disorder who required soft tissue imaging of the TMJ. As she had claustrophobia and a reaction to iodine, air contrast arthrography and pumping manipulation therapy using limited cone beam computed tomography for dental use (3DX) was performed. We conclude that the 3DX examination method used in the study is practical as a diagnostic procedure and thus recommend this method to be used for patients with TMJ disorder in the presence of iodine contraindication.

Air↗
PubMed1997

Intraoperative arthrography and the Ilizarov technique. Role in the correction of paediatric deformity and leg lengthening.

We performed intraoperative arthrography of the knee in 12 children with congenital short femur, Blount's disease or Ollier's disease in whom the Ilizarov technique was used for correction of deformity, leg lengthening or both. In each case, arthrography revealed a joint surface considerably different from that assumed from plain radiographs, and resulted in a change in the placement of our reference wires before application of the frame. This gave significant improvement in the mechanical axis obtained at the time of removal of the frame. The technique is safe, cheap and easy to perform. It is a useful adjunct to the application of the Ilizarov frame when used for complex lengthening and correction of deformity in the leg.

Arthrography↗
PubMed1997

Treatment of developmental dislocation of the hip in children after walking age. Indications from two-directional arthrography.

We treated 120 children between the ages of 12 and 31 months with 137 developmental dislocations of the hip and reviewed them at a mean follow-up of 14 years. We had used two-directional arthrography of all hips before reduction to evaluate the anterior, superior, and posterior portions of the limbus. Of the 137 hips, 64 had no interposed limbus in the AP view of the arthrogram, but 45 of these had an interposed anterior or posterior portion of the limbus. The hips with good stability and no interposed limbus in either AP or lateral arthrograms had excellent results by closed methods; in the other cases the results were less satisfactory. Our findings suggest that hips suitable for management by closed reduction can be identified by two-directional arthrography. Hips shown to have an interposed limbus are best managed by open reduction.

Age Distribution↗
PubMed2001

Arthrography for reduction of a fracture of the radial neck in a child with a non-ossified radial epiphysis.

A fracture of the neck of the radius when the head is not ossified can be difficult to assess and treat. In a four-year-old child we suspected from the radiographs that there was an O'Brien type-III injury after trauma. Partial manual reduction of the non-ossified radial head was completed using the Métaizeau technique of intramedullary Kirschner (K-) wiring aided by intraoperative arthrography. The child had a full range of movement at the elbow and wrist when reviewed 11 weeks after the injury, three weeks after removal of the K-wire. We suggest that intraoperative arthrography is a useful complement to the Métaizeau technique for successful reduction of fractures of the radial neck in the presence of a non-ossified radial head.

Arthrography↗
PubMed1995

Arthrography of the wrist. Assessment of the integrity of the ligaments in young asymptomatic adults.

Fifty-two asymptomatic adults who were between twenty and thirty-five years old had arthrography of the wrist with use of a single injection into the radiocarpal joint. The purpose of the study was to evaluate the integrity of the triangular fibrocartilage, the scapholunate ligament, and the lunotriquetral ligament. Contrast medium was injected under fluoroscopic guidance, and posteroanterior and lateral radiographs of the wrist were made after the subjects had performed exercises of the wrist. No patient who had a history of trauma to the wrist, pain in the wrist, or inflammatory arthritis was included in the study. All of the subjects had an examination of both upper extremities that included measurement of the active motion of the wrist with a goniometer, strength-testing with a Jamar dynamometer, ballottement and testing for impingement, and palpation for tenderness. Plain radiographs were evaluated, and the ulnar variance was recorded. The arthrograms revealed an abnormal communication of the contrast medium in fourteen wrists (27 per cent), and four of the fourteen had multiple areas of communication. The abnormal communication was through the triangular fibrocartilage alone in six wrists, the scapholunate ligament alone in two wrists, the lunotriquetral ligament alone in two wrists, and in more than one of these areas in four wrists. A positive arthrogram was associated with a greater positive ulnar variance. All of the subjects had symmetrical motion of the wrists and grip strength, and none of them had tenderness in the wrist. There were no complications related to the arthrography. Perforation of a ligament in the wrist is common in young asymptomatic adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Direct arthrography of the pisotriquetral joint.

OBJECTIVE: The purpose of this study was to describe and evaluate a simple and safe procedure for direct arthrography of and steroid injection into the pisotriquetral joint. CONCLUSION: Direct pisotriquetral arthrography using a medial approach is an effective and easy-to-perform technique for injection of steroids.

Adult↗
PubMed1991

Unidirectional joint communications in wrist arthrography: an evaluation of 250 cases.

Although arthrographically demonstrable communications between various compartments of the wrist occur in older persons without symptoms, similar communications in younger persons may indicate clinically significant posttraumatic ligament tears and other pathologic processes. However, detection of communications varies depending on the arthrographic technique used. It has been claimed that if triple-compartment arthrography is not used in all patients, clinically significant unidirectional ligament tears may be overlooked. We determined the frequency and distribution of unidirectional intercompartmental communications, using a modification of techniques described in the literature. Separate injections of contrast material were made in sequence into the midcarpal, distal radioulnar, and radiocarpal joints of 250 consecutive patients. We found 38 unidirectional communications (17 lunotriquetral, nine scapholunate, three radial capsular, one ulnar capsular, six combined sites, and two indeterminate sites) between the midcarpal and radiocarpal joints. Nine unidirectional communications between the radiocarpal and distal radioulnar joints were found. Comparison of these results with the frequency and direction of unidirectional communications reported by others suggests that demonstration of communications depends on specific technical factors, such as which joint is injected first, the amount of contrast material used, and the delay between injections. This dependence on technical factors raises questions about the value of routine three-compartment wrist arthrography.

Adult↗
PubMed1996

Evaluation of selective wrist arthrography of contralateral asymptomatic wrists for symmetric ligamentous defects.

OBJECTIVE: The objective of this investigation was to study the role of selective wrist arthrography of the asymptomatic wrists of patients with unilateral wrist pain and the efficacy of three-compartment and selective-compartment injections of contrast medium into the asymptomatic wrist in demonstrating symmetric and asymmetric intercarpal ligament and triangular fibrocartilage communicating defects. SUBJECTS AND METHODS: Wrist arthrography with bilateral three-compartment injections was performed for 62 patients with unilateral wrist pain. The numbers of bilateral intercarpal ligament and triangular fibrocartilage communicating defects were recorded. The results obtained with three-compartment injections in each wrist of these patients were compared with those obtained with single-compartment injections. RESULTS: Bilateral three-compartment injections identified 110 communicating defects (59 in the symptomatic and 51 in the asymptomatic wrists). Midcarpal injections showed all 36 scapholunate and lunatotriquetral ligament defects that were also shown by three-compartment injections in asymptomatic wrists. However, only 26 (72%) of these 36 ligament defects were shown by radiocarpal injections. No single-compartment injection showed all triangular fibrocartilage defects that were shown by three-compartment injections. Ten bilateral symmetric triangular fibrocartilage communicating defects were shown by three-compartment injections. All 10 triangular fibrocartilage communicating defects in asymptomatic wrists were shown by radiocarpal injections. However, only five of the 10 triangular fibrocartilage communicating defects in asymptomatic wrists were shown by injection of the distal radioulnar joints. CONCLUSION: Selective midcarpal injection of an asymptomatic wrist showed all matching defects in that wrist when only intercarpal ligament defects were found in the symptomatic wrist. Similarly, selective radiocarpal injection of an asymptomatic wrist showed all matching defects of the triangular fibrocartilage in that wrist. In either situation, routine injection of all three compartments of the asymptomatic wrist should not be necessary.

Adolescent↗
PubMed1998

Ganglion cysts of the knee: articular communication revealed by delayed radiography and CT after arthrography.

OBJECTIVE: The diagnosis of ganglion cysts of articular origin may sometimes be uncertain when communication with the joint is not evident. Because we have observed that opacification of ganglion cysts revealed by arthrography can be significantly delayed, the purpose of this study was to determine retrospectively in 20 cases the time delay needed to show with arthrography a communication between the articular cavity and ganglion cysts of the knee. CONCLUSION: Arthrographic evidence of a communication between the articular cavity of the knee and communicating ganglion cysts requires delayed radiography performed at least 1 hr after intraarticular injection of contrast material. The best results are obtained with additional CT performed 1-2 hr after injection.

Adult↗
PubMed2000

MR arthrography of the labral capsular ligamentous complex in the shoulder: imaging variations and pitfalls.

OBJECTIVE: Using MR arthrography, we examined normal anatomy, anatomic variations, and pitfalls of imaging the labral capsular ligamentous complex in the asymptomatic shoulder. SUBJECTS AND METHODS: We obtained 108 MR arthrograms of the glenohumeral joint in 95 asymptomatic volunteers with axial (108 shoulders) and oblique coronal (56 shoulders) images. We examined labral shape, patterns of capsular insertion, presence or absence of glenohumeral ligaments, and pitfalls of imaging. Our patients were men (auxiliary policemen) between 19 and 24 years old (mean age, 21 years). RESULTS: The shapes of labra were triangular (anterior part, 64%; posterior part, 47%), round (17%; 33%), flat (2%; 17%), cleaved (11%; 1%), notched (3%; 0%), or absent (2%; 2%). Using the system of Mosely and Overgaard, the anterior capsular insertion was type 1 in 63% of shoulders, type 2 in 20%, and type 3 in 17%; the posterior capsular insertion was type 1 in 60% of shoulders, type 2 in 31%, and type 3 in 9%. The superior and inferior glenohumeral ligaments were present in 99% of shoulders, but the middle glenohumeral ligament was present in only 79%. We also detected many pitfalls of MR imaging in identifying findings such as the undercutting of the labrum by cartilage (32% of shoulders), prominent axillary folds (46%), sublabral holes (7%) or recesses (33%), Buford complexes (2%), and sulci between the biceps tendon and superior labrum (30%). CONCLUSION: Knowledge of normal anatomy and anatomic variations of the labral complex is important for the examination of the shoulder with MR arthrography.

Adult↗