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PubMed1991

Pathological changes of hyperphonated cat vocal folds.

To investigate the pathological changes of hyperphonated vocal folds 15 cats were used and over-cry was induced by mechanical stimuli. The longest experiment time was 15 weeks. All of the larynges were taken and the vocal folds were examined grossly and microscopically. The results were as follows: 1) liquid exudate accumulation beneath the epithelium developed in all of the experimental animals; 2) thickening of the epithelium was noticed in cats which had hyperphonated for more than 4 weeks; 3) acute laryngitis occurred in three cats.

Acute Disease↗
PubMed2002

Overuse and sports-related injuries of the ankle and hind foot: MR imaging findings.

Professional and recreational sporting activities have increased substantially in recent years and have led to a rise in the number of sports-related and overuse injuries. Magnetic resonance (MR) imaging has become an important tool for evaluating the lower leg for providing the necessary information for patient management and rehabilitation following this injury. The purpose of this essay is to give an overview of the MR findings of common overuse injuries and sports-related injuries to the bones and soft-tissue structures of the hind foot and ankle.

Ankle Injuries↗
PubMed1997

Imaging of the hand: degeneration, impingement and overuse.

Degenerative and overuse diseases as well as impingement syndromes of the hand are illustrated and discussed in this review article. Osteoarthritis of the interphalangeal joints as described by Heberden and Bouchard is a ubiquitous articular disease often associated with synovitis and erosive joint destruction. Osteoarthritis of the trapeziometacarpal joint is classified into four stages for proper indication of operation. Overuse can result in stenosing tenosynovitis around the wrist and in synovitis with or without impingement of the flexor or extensor tendons of the digitis or ruptures of the annular and cruciform pulleys. Although diagnosis of these entities is usually made by history and clinical investigation, ultrasound and MRI can be helpful tools in imaging of these diseases. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are the characteristic degeneration pattern of the wrist and represent the degeneration mechanisms in scapholunate insufficiency and nonunion of the scaphoid. SLAC wrist is a gradual degeneration classified in three stages and found in posttraumatic scapholunate rupture, calcium pyrophosphate dehydrate deposition disease (CPPD), rheumatoid arthritis, neuropathic diseases, trauma, and beta 2-microglobulin associated amyloid deposition. Ulna impaction syndrome is increasingly recognized as a cause of ulnar sided pain and exhibits a characteristic MRI appearance.

Cumulative Trauma Disorders↗
PubMed1997

Imaging of tendons--adaptation, degeneration, rupture.

Tendon imaging is mainly performed with ultrasonography (US) and magnetic resonance imaging (MRI) and has been improved within the last years because of technical advancements and a better understanding of tendon pathology. Several concepts concerning the etiology and the course of tendon diseases have influenced image interpretation and vice versa. Adaptive mechanisms within the tendon tissue against stress can be observed mainly on histologic specimens and not macroscopically or with in-vivo imaging. Degeneration may occur in the form of tendinitis, peritendinitis, enthesitis, or myotendinal junction abnormality. Distinct imaging findings exist for most of these forms. Many concepts that have been developed to explain tendon degeneration have been applied on virtually all tendons in the human body. They can be grouped into those which focus on hypovascularization, on biomechanical overload, and on degeneration secondary to other underlying disease. Tendon rupture seems, in many cases, to be the final stage of tendinitis. From this point of view, imaging may be used to predict the risk of tendon rupture together with other intrinsic and with extrinsic parameters. These considerations result in the concept of the "vulnerable zone" and of the "critical phase" in which tendon ruptures may predominantly occur.

Adaptation, Physiological↗
PubMed1997

Magnetic resonance imaging of the elbow.

Magnetic resonance imaging (MRI) provides useful information regarding the elbow joint. Many abnormalities seen in the elbow are a result of trauma, often from sports such as baseball and tennis. Elbow problems are frequently related to the medial tension-lateral compression phenomenon where repeated valgus stress produces flexor-pronator strain, ulnar collateral ligament sprain, ulnar traction spurring, and ulnar neuropathy. The lateral compression causes osteochondritis dissecans of the capitellum and radial head, degenerative arthritis, and loose bodies. Other elbow abnormalities seen on MRI include radial collateral ligament injuries, biceps and triceps tendon injuries, other nerve entrapment syndromes, loose bodies, osseous and soft tissue trauma, arthritis, and masses, including bursae.

Arm Injuries↗
PubMed1997

Overload syndromes of the peritalar region.

INTRODUCTION: The purpose of this study was to identify the diagnostic possibilities of the different diagnostic techniques in the evaluation of the pathological conditions affecting the peritalar region. MATERIALS AND METHODS: Between September 1995 and December 1996, 58 patients, with a painful syndrome at peritalar level were submitted to MRI, which was performed using a 'dedicated system' consisting of 0.2 and 0.5 T equipment. Spin-Echo T1-weighted and Gradient-Echo T2-weighted sequences were used on sagittal, coronal and axial planes, with slice thickness of 3-5 mm. Conventional radiography was previously performed in all patients, while 18 of them underwent CT. Surgery or arthroscopy was performed in 22 cases. 36 patients underwent clinical follow-up associated with conventional radiography in six cases, MRI in 11 and to both of them in six patients. RESULTS: After arthroscopy and surgery, an involvement of the tibio-talar joint was found (one pathogenic synovial plica, three meniscoid syndrome and 12 anterior impingement) in 16 patients. Concerning the subtalar joint, surgical examination revealed a cellulo-adipostis of the sinus tarsi in two patients, while in three cases osteochondral damage of the subtalar joint was identified. In the last patient, degenerative changes of the posterior tibial tendon associated with osteochondral pathology of the talo-navicular joint were found. MRI findings agreed with the surgical and arthroscopic ones in all patients except for the synovial plica; in this case, the MRI was negative. Follow-up performed on 36 patients revealed 12 tibio-talar joint, 17 subtalar joint and 7 talo-navicular joint pathological conditions. DISCUSSION: Concerning the tibio-talar joint, MRI findings were confirmed by arthroscopy in all cases of anterior impingement. Magnetic resonance (MR), due to its capability in detecting osteochondral damage and identifying osteophyte sites, results in the best imaging method for evaluating this condition. Meniscoid syndrome is easily detected by MRI only in the presence of sufficient scar tissue, while conventional radiography reveals the calcific stage. In sinus tarsi syndrome, the ligamentous damage associated with sero-hemorrhagic effusion at fatty tissue level may lead to a 'chopping' effect on the nerve endings: this condition is well demonstrated by MRI. In all cases of osteochondral alterations affecting both the subtalar and talo-navicular joint, it has been possible to obtain correct diagnosis with MRI, which also depicted well the tenosynovitis of the posterior tibial tendon. In cases of stress fracture of the navicular bone, both CT and MRI demonstrated the lesions well, even when, in the early phases, conventional radiography produced a negative result. In conclusion, MRI may be considered the choice method in the study of different pathological alterations affecting the peritalar region, also providing detailed information useful for a therapeutic approach.

Adult↗
PubMed1998

Children's sports injuries.

Sports injuries in children are common. They range from very serious and even, occasionally, fatal accidents, to trivial sprains and bruises. Sports medicine is a burgeoning field. Parallel with this there has been an increased understanding of the radiology of these lesions. Lesions in the immature skeleton differ greatly to those in the mature skeleton. This review describes the most frequent sports injuries in children.

Athletic Injuries↗
PubMed1997

Overuse of hyaline cartilage and imaging.

Traumatic injury to joints may involve articular cartilage alone or result in osteochondral fractures which may impair mechanical properties of articular cartilage. Injuries of articular cartilage alone with visible tissue disruption and osteochondral fractures are now visualized by MRI which is the only modality for direct non-invasive visualization of articular cartilage. Three-dimensional T1-weighted gradient-echo sequences with fat-suppression provide high accuracy in the detection of cartilage surface defects. Fast spin echo imaging with heavy T2-weighting demonstrates cartilage defects in the presence of joint effusion accurately too, but minimal slice thickness in 2D-imaging is limited. For correct staging of osteochondral fractures, which determines further therapy, intraarticular administration of contrast media may be necessary. Repetitive direct blunt trauma or high-energy joint loading can cause cartilage damage without visible tissue disruption. To demonstrate this early stage of chondral injury special techniques and agents are necessary. These include diffusion weighted imaging, measurements of magnetization transfer as a function of collagen concentration, proton density mapping to plot the distribution of water in hyaline cartilage and sodium imaging to visualize ions bound to proteoglycans or intraarticular application of Mangan selectively bound to proteoglycans. Although promising techniques, they are still experimental. With recent developments of repair of cartilage defects by cartilage grafts, osteochondral autografts and transplantation, MRI becomes the method of choice in the noninvasive evaluation of injured articular cartilage and follow-up studies.

Cartilage, Articular↗
PubMed1998

Joint impingement syndrome: clinical features.

Joint impingement is a painful syndrome caused by the friction of joint tissues, which is both the cause and the effect of altered joint biomechanics. From the anatomical and clinical viewpoints, these syndromes are classified as bone impingement, soft tissue impingement and entrapment neuropathy, depending on what joint portion impinges on the others. We considered the most important impingement syndromes of the upper and the lower limbs from the clinical viewpoint. As for the upper limb, supraspinatus impingement is a frequent cause of shoulder pain in both athletes and the normal population; the painful subacromial arch is a typical sign of the rotator cuff impingement syndrome and of outlet and non-outlet impingement as well. As for the elbow, we considered both medial and lateral impingement. The carpal tunnel syndrome is the most common peripheral entrapment neuropathy of the upper limb; it is caused by compression of the median nerve at the wrist. We considered the main causes of carpal tunnel narrowing and the relative clinical findings. As for the lower limb, we considered the iliotibial band friction syndrome, which is the most common overuse syndrome of the knee and the ankle impingement syndrome. The latter includes anterolateral impingement (with chronic anterolateral and lateral pain and ankle instability), sinus tarsi impingement, anterior impingement (with pain during foot dorsiflection and posterior impingement. The tarsal tunnel syndrome is the most important ankle entrapment neuropathy causing burn pain and paresthesias in the toes and sole of the foot.

Cumulative Trauma Disorders↗
PubMed1998

Sports injuries in the pelvis and hip: diagnostic imaging.

We discuss the role of imaging techniques in examining the athletes with sports injuries involving the pelvis and the hip. Pelvis and hip pain is of difficult clinical clarification because of the various athletic injuries which may affect the bone or soft tissues at different anatomic sites. Moreover, the symptoms of pelvis and hip injuries are similar in most cases and they are often diffuse and atypical. Diagnostic imaging can play an essential role because treatment success depends on a correct diagnosis and these techniques can actually differentiate the most frequent causes of pelvis and hip sports injuries such as groin strain, osteitis pubis, ischial intersection syndrome, snapping hip, stress fractures, hernias and avulsion fractures. Finally, we discuss the role of magnetic resonance imaging in detecting the causes of hip pain other than sports injuries, such as avascular necrosis, reflex sympathetic dystrophy syndrome, herniation pit, acetabular labrum injuries. To conclude, diagnostic imaging techniques currently permit the direct and noninvasive depiction of pelvis and hip conditions. Particularly, magnetic resonance imaging is very helpful in detecting injury site, extent and characteristics; it can also predict the time period an athlete will be disabled and help define the best treatment planning.

Athletic Injuries↗
PubMed1998

Ankle impingement syndromes.

The ankle impingement syndrome is a frequent condition in both athletes and the normal population. We investigated this painful syndrome from both a clinical and a diagnostic viewpoint. Depending on what ankle tissue impinges on the other, it is possible to distinguish bone impingement, soft tissue impingement and peripheral nerve entrapment. For each of these pathologic conditions we investigated the diagnostic role of conventional radiography, Computed Tomography and Magnetic Resonance Imaging. The evidence of osteophytes, exostosis and presence of the os trigonum on plain films make clinical diagnosis easy in both anterior and posterior bone impingement. CT can provide useful information about the component of the posterior ankle. MRI always adds important information about chondral or subchondral bone injuries, synovial reaction and adjacent soft tissue involvement. The anterolateral impingement syndrome is caused by repeated injuries in plantar flexion and ankle intrarotation. MRI well detects the meniscoid injury thanks to high contrast sequences; it can also distinguish this syndrome from painful chondral and/or bony lesions at this level. MRI is also the method of choice to study sinus tarsi impingement, especially thanks to fat suppression sequences which increase MR diagnostic capabilities in this important anatomic area. Deep peroneal nerve entrapment, the medial plantar nerve entrapment syndrome and the tarsal tunnel syndrome are the most important entrapment neuropathies of the ankle. US and MRI are very useful to study the tendon and soft tissue abnormalities causing the anterior tarsal tunnel syndrome. CT and particularly MRI can easily detect many pathologic conditions causing the medial plantar nerve entrapment and the tarsal tunnel syndromes.

Ankle Injuries↗
PubMed1999

Medial tibial pain: a dynamic contrast-enhanced MRI study.

The purpose of this study was to compare the sensitivity of different magnetic resonance imaging (MRI) sequences to depict periosteal edema in patients with medial tibial pain. Additionally, we evaluated the ability of dynamic contrast-enhanced imaging (DCES) to depict possible temporal alterations in muscular perfusion within compartments of the leg. Fifteen patients with medial tibial pain were examined with MRI. T1-, T2-weighted, proton density axial images and dynamic and static phase post-contrast images were compared in ability to depict periosteal edema. STIR was used in seven cases to depict bone marrow edema. Images were analyzed to detect signs of compartment edema. Region-of-interest measurements in compartments were performed during DCES and compared with controls. In detecting periosteal edema, post-contrast T1-weighted images were better than spin echo T2-weighted and proton density images or STIR images, but STIR depicted the bone marrow edema best. DCES best demonstrated the gradually enhancing periostitis. Four subjects with severe periosteal edema had visually detectable pathologic enhancement during DCES in the deep posterior compartment of the leg. Percentage enhancement in the deep posterior compartment of the leg was greater in patients than in controls. The fast enhancement phase in the deep posterior compartment began slightly slower in patients than in controls, but it continued longer. We believe that periosteal edema in bone stress reaction can cause impairment of venous flow in the deep posterior compartment. MRI can depict both these conditions. In patients with medial tibial pain, MR imaging protocol should include axial STIR images (to depict bone pathology) with T1-weighted axial pre and post-contrast images, and dynamic contrast enhanced imaging to show periosteal edema and abnormal contrast enhancement within a compartment.

Adolescent↗
PubMed2003

Chronic repetitive reaching and grasping results in decreased motor performance and widespread tissue responses in a rat model of MSD.

This study investigated changes in motor skills and tissues of the upper extremity (UE) with regard to injury and inflammatory reactions resulting from performance of a voluntary forelimb repetitive reaching and grasping task in rats. Rats reached for food at a rate of 4 reaches/min, 2 h/day, and 3 days/week for up to 8 weeks during which reach rate, task duration and movement strategies were observed. UE tissues were collected bilaterally at weekly time points of 3-8 weeks and examined for morphological changes. Serum was tested for levels of interleukin-1alpha (IL-1) protein. The macrophage-specific antibody, ED1, was used to identify infiltrating macrophages and the ED2 antibody was used to identify resident macrophages. Rats were unable to maintain baseline reach rate in weeks 5 and 6 of task performance. Alternative patterns of movement emerged. Fraying of tendon fibrils was observed after 6 weeks in the mid-forelimb. After 4 weeks, a general elevation of ED1-IR macrophages were seen in all tissues examined bilaterally including the contralateral, uninvolved forelimb and hindlimbs. Significantly more resident macrophages were seen at 6 and 8 weeks in the reach limb. At 8 weeks, serum levels of IL-1alpha increased significantly above week 0. Our results demonstrate that performance of repetitive tasks elicits motor decrements, signs of injury and a cellular and tissue responses associated with inflammation.

Animals↗
PubMed2000

Hypothenar hammer syndrome: proposed etiology.

PURPOSE: Finger ischemia caused by embolic occlusion of digital arteries originating from the palmar ulnar artery in a person repetitively striking objects with the heel of the hand has been termed hypothenar hammer syndrome (HHS). Previous reports have attributed the arterial pathology to traumatic injury to normal vessels. A large experience leads us to hypothesize that HHS results from trauma to intrinsically abnormal arteries. METHODS: We reviewed the arteriography, histology, and clinical outcome of all patients treated for HHS in a university clinical research center study of hand ischemia, which prospectively enrolled more than 1300 subjects from 1971 to 1998. RESULTS: Twenty-one men had HHS. All had occupational (mechanic, carpenter, etc) or avocational (woodworker) exposure to repetitive palmar trauma. All patients underwent upper-extremity and hand arteriography, unilateral in eight patients (38%) and bilateral in 13 patients (62%). By means of arteriogram, multiple digital artery occlusions were shown in the symptomatic hand, with either segmental ulnar artery occlusion in the palm or characteristic "corkscrew" elongation, with alternating stenoses and ectasia. Similar changes in the contralateral asymptomatic (and less traumatized) hand were shown by means of 12 of 13 bilateral arteriograms (92%). Twenty-one operations, consisting of segmental ulnar artery excision in the palm and vein grafting, were performed on 19 patients. Histology was compatible with fibromuscular dysplasia with superimposed trauma. Patency of arterial repairs at 2 years was 84%. One patient (5%) required amputative debridement of necrotic finger tips. No other tissue loss occurred. There have been no recurrences of ischemia in patients with patent bypass grafts. CONCLUSION: To our knowledge, this is the largest reported group of HHS patients. The characteristic angiographic appearance, histologic findings, and striking incidence of bilateral abnormalities in patients with unilateral symptoms lead us to conclude that HHS occurs when persons with preexisting palmar ulnar artery fibrodysplasia experience repetitive palmar trauma. This revised theory for the etiology of HHS explains why HHS does not develop in most patients with repetitive palmar trauma.

Adult↗
PubMed2003

Controversies surrounding "misuse," "overuse," and "repetition" in musicians.

Medical opinion remains divided on the existence of a specific medical entity of nonspecific arm pain produced by repetition. Controversy also exists in the pathophysiology of certain painful, anatomically defined medical conditions in the hand and arm and the role of repetition, cumulative trauma, and microtrauma in the development of these conditions. The flaws in science and the language are examined in this article, as are the results of a survey of Australian music students in comparison with nonmusic students, questioning accepted wisdom on repetitive strain injuries.

Cumulative Trauma Disorders↗
PubMed2003

A search for the pathophysiology of the nonspecific "occupational overuse syndrome" in musicians.

The findings of this investigation have suggested a new theory to help explain the origin of activity-related pain. It proposes an as yet unrecognized physiologic process (the physiologic activity limitation process). When the intensity of an activity is greater than that appropriate for an individual's level of fitness for that activity, this process then generates unpleasant sensations, physiologic activity-related pain, the function of which is to limit that activity. The physiologic pain generated by this process will have pathways in common with pain caused by other protective mechanisms.

Algorithms↗
PubMed2004

Etiology and pathology.

Until the 1920s, TOS was believed to be a vascular condition caused by compression of the subclavian artery by a congenital anomaly, either a cervical rib or tight anterior scalen muscle. Today it is regarded primarily as a neurologic condition caused by neck trauma injuring and scarring the scalene muscles.

Congenital Abnormalities↗
PubMed2000

Effect of rest from running on overuse injuries in army basic training.

BACKGROUND: It has been hypothesized that a period of rest from running in the early weeks of basic military training will prevent stress fractures among recruits. DESIGN: Modification of running schedules in companies of Army recruits undergoing basic military training was assigned. SETTING/PARTICIPANTS: Six male training companies were enrolled and followed during their 8 weeks of basic military training at Fort Bliss, Texas, in summer/fall 1989. INTERVENTION: Intervention companies were asked to rest from running during the second, third, or fourth week of basic military training. MAIN OUTCOME MEASURES: Data were collected from questionnaires, anthropometric measurements, Army physical fitness tests, company training logs, and medical record abstraction of all clinic visits. RESULTS: Among the 1357 enrolled male recruits, there were 236 (17%) with overuse injury and 144 (11%) with traumatic injury, resulting in 535 clinic visits and 1927 training days lost. Stress fracture/reaction rates varied from 3 to 8 per 100 recruits among the intervention companies and 2 to 7 per 100 recruits among the non-intervention companies. Total injury rates were 18 to 35 per 100 recruits in the intervention companies and 18 to 29 per 100 recruits in the non-intervention companies. CONCLUSIONS: The study provided no evidence for a protective effect on overuse injuries of resting from running for 1 week early in basic military training. There was varied physical training among the companies, however, with variation of injury rates that likely related to factors other than the intervention.

Adolescent↗