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PubMed1994

The relevance of ligament tears or perforations in the diagnosis of wrist pain: an arthrographic study.

This study was designed to assess the clinical significance of arthrographic abnormalities in the ligaments of a painful wrist. This was accomplished by means of comparison arthrography of the asymptomatic wrist. Fifty-six consecutive patients with unilateral wrist pain underwent selective bilateral arthrography to assess interruptions of continuity of the triangular fibrocartilage, lunotriquetral, and scapholunate ligaments. The prevalence of bilaterally symmetric lesions was high. In patients with ligament defects in the symptomatic wrist, 88% of defects near the radial attachment of the triangular fibrocartilage, 59% of lunotriquetral defects, and 57% of scapholunate defects were bilateral. Furthermore, physical examination was not predictive of specific ligament defects. This study raises questions concerning the relevance of interrupted ligaments in the diagnosis of wrist pain.

Adolescent↗
PubMed1987

The rotator cuff tear: MR evaluation.

Magnetic resonance imaging (MRI) is evolving as a particularly valuable diagnostic procedure in the evaluation of musculoskeletal pathology. To assess the role of MRI as applied to the shoulder, we examined eight normal volunteers, six patients with seven arthrographically proven rotator cuff tears and two patients with impingement symptomatology but with negative double contrast conventional and computed tomographic arthrography. The studies were performed on a 1-Tesla magnet operating at 0.5 Tesla. Coronal T1-weighted images were obtained in all cases and coronal spin density and T2-weighted pulse sequences were employed in two cases. In the normal individuals, the supraspinatus muscle and tendon could be consistently demonstrated. The proximal humeral marrow, the superior glenoid labrum, and the acromioclavicular joint could also be examined. Findings in patients with rotator cuff tears included: (1) hypointense gap within the supraspinatus muscle-tendon complex on T1-weighted sequences, (2) absence of a demonstrable supraspinatus tendon with narrowing of the subacromial space secondary to elevation of the humeral head, and (3) increased signal within the supraspinatus tendon on T2-weighted images. In the patients with impingement syndrome and negative arthrography, MR demonstrated elevation of the supraspinatus tendon with subacromial impingement in one case and a normal supraspinatus tendon in the other. Impingement on the coracoacroaminal arch causes progressive fibrosis, atrophy, and eventual tear of the rotator cuff. The potential applications of MRI relative to the shoulder include assessment of tendon retraction in patients with supraspinatus tears and noninvasive evaluation of patients with impingement syndrome, permitting etiologic determinations, hopefully before irreversible tendon injury has occurred.

Arthrography↗
PubMedDate not supplied

Internal derangement of the temporomandibular joint: radiologic staging with clinical, surgical, and pathologic correlation.

The radiologic findings from 60 patients with 86 internally deranged temporomandibular joints (TMJ) upon whom sequential imaging procedures had been performed over a period of two months to ten years were analyzed and correlated with clinical, surgical (72 joints), and pathological observations. Internal derangement of the TMJ disc (meniscus) and osseous structures was found to be an irreversible and progressive disorder with characteristic stages. Internal derangements of the TMJ were divided into early (stage one), intermediate (stages two and three) and late stage (stages four and five) categories based upon radiologic findings obtained with radiography, lateral TMJ tomography and either two compartment arthrography or high field, surface coil MR. After sequential imaging studies, each patient and 72 deranged joints underwent surgical joint exploration and meniscectomy because of progressive joint disease and clinical disability. Surgically removed tissues underwent routine histological evaluation. Surgical and pathologic observations included disc displacement, deformity, hyalination, myxomatous degeneration, perforation of the disc attachments, capsular adhesions, synovitis and mandibular condyle lesions including osteochondritis dissecans (OCD), avascular necrosis (AVN), osseous remodeling and degenerative arthritis. There was excellent correlation between imaging studies and surgical observations. Internal derangement of the TMJ is an irreversible, generally progressive disorder which may be staged and followed with radiography, tomography and either two-compartment arthrography or high field, surface coil MR.

Adolescent↗
PubMed1992

Ultrasound scanning for the diagnosis of meniscal lesions of the knee joint.

We report on the efficacy of ultrasound scanning as a noninvasive method of the preoperative diagnosis of meniscal lesions of the knee joint, using the 7.5-Hz head of a real-time scanner. In studies on cadaveric knee joints we found a high efficacy in diagnosing meniscal lesions using ultrasound. Comparative clinical studies on 51 patients who had undergone preoperative ultrasound scanning showed a strong correlation of ultrasound diagnosis with intraoperative findings. Arthrography was performed in 24 of the 51 patients, yet ultrasound studies proved to be more effective than arthrography in diagnosing meniscal lesions. Consequently, we believe that ultrasonic scanning as a noninvasive method of diagnosis is more helpful in identifying meniscal lesions of the knee joint.

Arthrography↗
PubMed2006

Imaging of ulnar-sided wrist pain.

Ulnar-sided wrist pain has long been a diagnostic problem, partly because of the complex anatomy and many possible causes of pain in this region. This article discusses anatomy, pathophysiology, and imaging appearance of the more common causes, including tears of the triangular fibrocartilage complex, disorders of the distal radioulnar joint, tears of the lunotriquetral ligament, disorders of the extensor carpi ulnaris tendon, disorders of the pisotriquetral joint, the impingement and impaction syndromes, and ulnar wrist masses. Along with clinical history and physical examination, imaging is important in evaluation of ulnar-sided wrist pain. Conventional radiographs, conventional arthrography, CT, MRI, and MR arthrography are useful modalities that are often used in concert to help guide diagnosis and treatment.

Arthralgia↗
PubMed2005

Imaging the post-operative meniscus.

Considerable developments have occurred in meniscal surgery, and consequently in the imaging of post-operative menisci, over the last 15 years. A drive to preserve meniscal physiologic function for as long as possible, in order to delay osteoarthrosis, has resulted in limited partial meniscectomies, meniscal repairs and meniscal transplants. Each of these techniques affects the imaging appearance of the meniscus, reducing the accuracy of conventional MRI in predicting recurrent tears. The specificity of conventional MRI can be improved by employing at least two T2-weighted sequences, but this still leaves a shortfall in sensitivity. In an attempt to increase the diagnostic accuracy of cross-sectional imaging, MR arthrography (MRA) and CT arthrography (CTA), have been applied to the post-operative meniscus. Sensitivities and specificities for these two techniques approach 90% in predicting recurrent meniscal tears. In the setting of clinical symptoms and gross meniscal deficiency, meniscal allografts are being transplanted with increasing frequency. In these transplants meniscal degeneration, fragmentation and separation are common findings, but the role of imaging in the management of these patients has not yet been well defined. This review explores the imaging techniques available for the evaluation of the post-operative meniscus, their strengths and weaknesses, and the reasons that they may find a place in a rational strategy for imaging of the symptomatic post-operative knee.

Arthrography↗
PubMed1990

Baker's cyst simulating deep vein thrombosis.

Phlebography is frequently requested to confirm or exclude deep venous thrombosis in patients presenting with a painful, swollen calf or leg. We have noted a small proportion of those with negative phlebograms to have compression or lateral deviation of the popliteal vein. These patients were submitted to contrast arthrography. Eighty per cent of this selected group were found to have dissecting or ruptured Baker's cysts; almost a third of these were dissections upwards into the thigh. A positive diagnosis in these patients is important as management differs from deep vein thrombosis. The optimum diagnostic strategy in patients with a swollen, painful leg is firstly to perform ultrasound of the femoral vein and popliteal fossa to exclude obvious thrombus or ruptured Baker's cyst. If this examination is negative, or a Baker's cyst is shown with no evidence of rupture, phlebography should be performed to exclude calf vein thrombosis. If this examination is negative, but a Baker's cyst is present, or deviation or compression of the popliteal vein is detected, contrast arthrography is suggested to look for rupture of the cyst.

Adult↗
PubMed1998

Diagnostic imaging of osteochondrosis.

This article includes imaging of the glenohumeral (shoulder), elbow, stifle, and tarsal joints. The imaging modalities discussed are survey radiography, contrast arthrography, linear tomography, ultrasound, computed tomography, scintigraphy and magnetic resonance. Survey radiography is the first choice imaging modality for diagnosing osteochondrosis dissecans in dogs. In cases where survey radiography fail to demonstrate a lesion other modalities such as scintigraphy, linear tomography, computed tomography, and magnetic resonance may be helpful. Survey radiography, contrast arthrography, computed tomography, and magnetic resonance may also provide additional information contributing to early diagnosis and treatment.

Animals↗
PubMed1991

Contrast radiography of equine joints, tendon sheaths, and draining tracts.

Arthrography, tenography, and fistulography (or sinography) can provide additional information about the soft-tissue components of joints, tendon sheaths, and draining tracts, respectively. Arthrography is a valuable aid in the diagnosis of synovial masses, such as villonodular synovitis, and osteochondrosis. Tenography is particularly useful in evaluating chronic tendon sheath distention. Fistulography is an effective means of identifying acute traumatic damage to synovial structures and determining the cause and extent of draining tracts.

Animals↗
PubMed1994

Arthroscopically assisted rotator cuff repair: correlation of functional results with integrity of the cuff.

Thirty-three patients (35 full-thickness rotator cuff tears) who underwent arthroscopically assisted mini open repair between June 1987 and January 1990 were evaluated for shoulder function and cuff integrity. The study population was composed of 19 women and 14 men with an average age of 63 years (range 35-76) and an average follow-up of 3.7 years (range 2.5-5.1). Functional results were obtained using the UCLA Shoulder Rating Scale. Integrity of the rotator cuff was established by shoulder arthrography at a minimum 2 years postoperatively. UCLA Shoulder Rating Scale showed 86% good/excellent results with 92% patient satisfaction. The shoulder arthrography showed 12 (34%) full-thickness tears, seven (20%) partial tears, and 16 (46%) no tears. The size of the arthrographic defect correlated well with the size of the intraoperative tear. Seventy percent of the large tears had follow-up full-thickness defects and 80% of the small tears had no defect. Eighty percent and 88% good/excellent functional results were achieved in patients with full-thickness defects and no defects, respectively, without significant differences. The size of the tear at the time of the repair is a major determinant of the integrity of the cuff after repair. The integrity of the cuff at follow-up does not determine the functional outcome of the operated shoulder.

Adult↗
PubMed1996

CT scans and arthro-CT scans.

The study of the cartilage is relatively easy with modern imaging. If the interpretation of MRI cartilage remains difficult arthro-CT images are easy to obtain. Arthro-CT is much preferable to simple arthrography. These two steps are in fact complementary: the global study of the joint is made with arthrography while the accurate assessment of cartilage is obtained with thin CT native slices acquired in an adapted plane and completed with reformatted images. The detection of small lesions, such as a faint thinning of the cartilage, or a focal fissure is only possible with a long and meticulous examination. The pathological value of the images still depends on the clinical examination, because of the high incidence of asymptomatic chondromalacia in elderly patients. The assessment of the cartilage overlying osteochondritis or osteochondral fractures is of particular clinical interest. The detection of post-traumatic cartilaginous lesions may also be valuable in medicolegal problems.

Arthrography↗
PubMed1997

The diagnostic value of ultrasonography to determine the temporomandibular joint disk position.

OBJECTIVE: Temporomandibular joint (TMJ) arthrography and magnetic resonance imaging are the imaging techniques of choice in patients presenting with signs and symptoms of TMJ disorders suggesting soft tissue pathosis. With the disadvantage of arthrography as an invasive procedure and magnetic resonance imaging posing a problem in clinical availability and cost, the purpose of this study was to determine whether ultrasonography could be used to assess the presence or absence of disk displacement in patients with TMJ disorders. STUDY DESIGN: In 17 patients, 100 TMJ positions were investigated by static and dynamic ultrasonography to analyze the disk-condyle relationship. To compare the respective findings with those of a diagnostic method offering high accuracy, coronal and sagittal magnetic resonance imaging was carried out immediately afterwards. RESULTS: With static ultrasonography showing a sensitivity of 0.41 and a specificity of 0.70 and dynamic ultrasonography a sensitivity of 0.31 and a specificity of 0.95, the data revealed that static and dynamic ultrasonography are marginal in detecting the presence of disk displacement, but dynamic ultrasonography is sensitive in detecting the absence of disk displacement. However, with a positive predictive value of 0.61 and a negative predictive value of 0.51 for static ultrasonography, and a positive predictive value of 0.88 and a negative predictive value of 0.55 for the dynamic technique, the results indicate that both modalities are insufficient in establishing a correct diagnosis for the presence or absence of disk displacement. CONCLUSION: In view of the fact that dynamic ultrasonography proved to be a reliable diagnostic aid for the detection of normal disk position, the results of this study should be of further interest and encourage research in its potential uses and diagnostic capabilities.

Adolescent↗
PubMed2005

[Diagnosis of lunotriquetral instability].

BACKGROUND: Lunotriquetral dissociation with rupture of the lunotriquetral ligament and the radiolunotriquetral and the radiodorsal ligament is usually recognized late. Cinematography, arthrography, magnetic resonance imaging and arthroscopy are the diagnostic procedures. Treatment includes nonoperative methods in the case of incomplete lesions but also closed reposition with temporary LT arthrodesis and open ligament repair. In many cases, definitive LT arthrodesis may become necessary. It is the aim to develop a diagnostic algorithm on the base of retrospective analysed data. MATERIAL AND METHODS: From January 1998 to July 2003, 97 cinematographies of the wrist were performed, 22 with the question for a dynamic or static VISI deformity as a sign for lunotriquetral instability. This group of patients was analysed retrospectively to evaluate the diagnostic reliability. Based on these datas, a diagnostical algorithm was established for prospective investigations. RESULTS: The combination of cinematography, arthrography and magnetic resonance imaging suspected lunotriquetral instability in ten cases so that an arthroscopy was arranged. This way LT-lesions were verified in nine cases. The mean interval between accident and first contact with our institution was five months. CONCLUSIONS: The management of lunotriquetral injuries is complicated by the long time from trauma to definitive diagnosis. A combination of refined clinical and apparative investigations can lead to a reliable diagnosis.

Adolescent↗
PubMed1987

[Sonography of the meniscus and its lesions].

It is the considered opinion of the authors that meniscus sonography can largely replace arthrography. This opinion is based on their detailed examinations and studies. Sonographic visualisation of all lesions produced by a scalpel was demonstrated using knees of corpses. Even cracks having the fineness of a human hair were visualised by sonography. A comparison between sonographic and surgical findings in meniscus lesion yielded in 82 patients an agreement of 95.1%. In 47 patients it was possible to prove that sonography was more accurate than arthrography as far as diagnosis was concerned. A comparison of 94 sonographically and arthrographically established findings yielded agreement in 89% of the cases. Sonography is suitable for meniscus imaging especially on account of the good imaging reproducibility of meniscus morphology; through safe detection of a pathological process in the meniscus; through the safe presentation of lesions; through the accurate imaging of all parts of the meniscus; and, furthermore, through the invaluable advantage of noninvasiveness, freedom from pain and hazards; and, last but not least, rapid manipulation and unlimited repeatability.

Arthrography↗
PubMed1990

[Arthrographic imaging of ganglions of the hand].

In the genesis of ganglions synovial herniation is discussed with an existence of a valve mechanism which prevents the synovial fluid from returning into the joint space. Arthrography of the wrist was performed in 34 patients with suspicion of ganglions on the dorsal and volar aspect of the wrist. By injection of contrast medium in 6 cases directly into the ganglion no connection with the carpal joint cavity was seen. On the contrary, wrist arthrography with examination of the midcarpal and radiocarpal joint showed regularly a communication by a torturous narrow duct between the midcarpal joint and the dorsal ganglion and the radiocarpal joint and the volar ganglion. Other pathologic findings were seen, like tears of the scapholunate ligament and of the triangular fibrocartilage. The consequences for surgical therapy and conclusions for the aetiology of the ganglions are shown.

Adolescent↗
PubMedDate not supplied

[Sonographic diagnosis of anterior syndesmosis rupture].

In a prospective trial we evaluated the diagnostic value of ultrasound imaging in the diagnosis of injuries to the anterior syndesmosis of the ankle joint. In an initial series of 20 patients using a basic standard ultrasound machine (Siemens Sonoline SL 1 with a 7.5 MHz piece) and a simple dynamic testing protocol as described in this article we found a significant difference between the ultrasound result for the ruptured syndesmosis versus non rupture and a specificity similar to that of arthrography. We conclude that ultrasound imaging is a useful tool in the diagnosis of syndesmotic rupture. Given the statistical significance of these results we feel confident that-despite the small amount of patients of this series and after an individual learning curve-ultrasound will eventually replace arthrography as the standard of investigation for this type of injury.

Ankle Injuries↗
PubMedDate not supplied

Sonographic versus magnetic resonance arthrographic evaluation of full-thickness rotator cuff tears in millimeters.

Preoperative knowledge of full-thickness rotator cuff tear size is important in counseling patients because tear size affects the choice of surgical techniques and the functional outcome of surgery. Twenty-six shoulders of twenty-five consecutive patients were included in a prospective study that compared the preoperative accuracy of magnetic resonance arthrography and ultrasonography for tear size in millimeters with intraoperative findings. No significant differences were found between intraoperative, ultrasonographic, and magnetic resonance arthrographic data for the width of tears. Adoption of a "curved line measurement" for ultrasonographic evaluation of large tears eliminated the tendency of ultrasonography to underestimate tears greater than or equal to 35 mm in width. No significant differences were found between intraoperative, ultrasonographic, and magnetic resonancearthrographic data for retraction of tears. However, a limitation of ultrasonography to evaluate retractions of more than 30 mm was found. Therefore, ultrasound is of equal value for tears less than 30 mm, but magnetic resonance arthrography is more accurate for tears greater than 30 mm.

Adult↗