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PubMed2002

Effect of arthrocentesis on TMJ disturbance of mouth closure with loud clicking: a preliminary study.

The objective of this study was to evaluate the short-term effect of arthrocentesis on temporomandibular joint disturbance of mouth closure with loud clicking compared to the effect of one-time pumping into the joint space previous to arthrography. Twenty-one consecutive patients (22 joints) with loud clicking during mouth closure were enrolled. All were unable to smoothly close the mouth without effort. Eleven patients (12 joints) were examined using magnetic resonance imaging (MRI) to determine disk position. They then underwent arthrocentesis. Ten patients (10 joints) underwent arthrography alone as controls. Six months later, changes in clicking and temporomandibular joint movement were analyzed and the disk position was re-examined. There was improvement of mouth closing and clicking occurred in nine joints from the arthrocentesis group and two joints from the control group, with a significant difference between the two groups. Arthrocentesis may be indicated for patients with temporomandibular joint dysfunction and loud clicking when mouth closing.

Adolescent↗
PubMed1986

Arthroscintigraphic evaluation of the painful total hip prosthesis.

Arthroscintigraphy was performed in 19 patients with a painful total hip prosthesis by injecting both Tc-99m sulfur colloid and iodinated radiographic contrast material intra-articularly. Scintigraphic and radiographic results correlated exactly in 15 patients, with one false-negative scintigram, one false-positive scintigram, and one false-negative arthrogram. One patient was evaluated by scintigraphy alone. Although arthroscintigraphy is potentially more sensitive than conventional arthrography in the detection of femoral component loosening, acetabular component loosening cannot be evaluated by scintigraphy alone. A combination of scintigraphy and conventional arthrography appears to be the most accurate imaging method in the evaluation of hip prosthesis loosening.

Arthrography↗
PubMed2003

The proximal tibiofibular joint: an anatomic study.

In the first stage of the current study, 14 fresh specimens from above-the-knee amputations were examined by magnetic resonance imaging arthrography. In the second part of the study, these amputation specimens and 38 embalmed knees from cadavers were dissected. The types of the joint and insertion of the biceps femoris tendon and the other structures were observed. Of 14 fresh specimens from above-the-knee amputations examined by magnetic resonance imaging arthrography, nine had a clear communication between the proximal tibiofibular joint and the knee. It was difficult to distinguish the anterior tibiofibular ligament in 30 specimens as a separate band because it was fused intimately with the biceps femoris tendon. Of these specimens, 24 had an oblique type of joint. Because of this communication, the proximal tibiofibular joint might be construed as the fourth compartment of the knee to explain subtle knee problems.

Amputation, Surgical↗
PubMedDate not supplied

Arthrographic diagnosis of elbow injuries in children.

A prospective study was established to evaluate the value of arthrography in children with a variety of elbow injuries. Thirty-six arthrograms were performed on children with an average age of 3.8 years at an average of 20 h from the time of injury. The diagnosis made on the basis of standard radiographs was confirmed for 17 patients, and the initial diagnosis was altered for seven (19%). More important was that the treatment of these seven patients was altered by the arthrographic findings. Six of these seven were candidates for surgical management until arthrographic evaluation indicated a different diagnosis or that they could be treated nonoperatively. Elbow arthrography is recommended in skeletally immature patients whose diagnosis is in doubt. This technique is particularly helpful in humeral condylar fractures.

Arthrography↗
PubMed2000

Returning to the bedside: using the history and physical examination to identify rotator cuff tears.

OBJECTIVES: To determine the value of elements of the bedside history and physical examination in predicting arthrography results in older patients with suspected rotator cuff tear (RCT). DESIGN: Retrospective chart review SETTING: Orthopedic practice limited to disorders of the shoulder PARTICIPANTS: 448 consecutive patients with suspected RCT referred for arthrography over a 4-year period MAIN OUTCOME MEASURE: Presence of partial or complete RCT on arthrogram RESULTS: 301 patients (67.2%) had evidence of complete or partial RCT. Clinical findings in the univariate analysis most closely associated with rotator cuff tear included infra- and supraspinatus atrophy (P < .001), weakness with either elevation (P < .001) or external rotation (P < .001), arc of pain (P = .004), and impingement sign (P = .01). Stepwise logistic regression based on a derivation dataset (n = 191) showed that weakness with external rotation (Adjusted Odds Ratio (AOR) 6.96 (3.09, 13.03)), age > or = 65 (AOR 4.05(2.47, 16.07)), and night pain (AOR 2.61 (1.004, 7.39)) best predicted the presence of RCT. A five-point scoring system developed from this model was applied in the remaining patient sample (n = 216) to test validity. No significant differences in performance were noted using ROC curve comparison. Using likelihood ratios, a clinical score = 4 was superior in predicting RCT to the diagnostic prediction of an expert clinician. This score had specificity equivalent to magnetic resonance imaging or ultrasonography in diagnosis of RCT. CONCLUSIONS: The presence of three simple features in the history and physical examination of the shoulder can identify RCT efficiently. This approach offers a valuable strategy to diagnosis at the bedside without compromising sensitivity or specificity.

Aged↗
PubMed1992

Evaluation of articular cartilage: radiographic and cross-sectional imaging techniques.

Many diagnostic modalities may be used to evaluate articular cartilage. Plain radiography remains the preferred initial study for cartilage evaluation, although even specialized views such as weight-bearing, tunnel, and flexion lateral projections are insensitive in the detection of early cartilage loss. Compared with newer modalities, conventional arthrography has limited capacity for the assessment of cartilage. Computed tomography performed after intraarticular injection of contrast material (ie, CT arthrography) has improved accuracy but is essentially limited to the axial plane. Magnetic resonance (MR) imaging, with its superb soft-tissue contrast and multiplanar capabilities, has shown promise in depicting articular cartilage. Cartilage is best depicted when an "arthrogram effect" is present, achieved with T2-weighted spin-echo imaging, with some gradient-echo pulse sequences, and when intraarticular contrast material is used. If performed with such techniques, MR imaging is the method of choice for evaluating specific cartilage loss, osteochondritis dissecans, and other osteochondral abnormalities.

Arthrography↗
PubMed1986

Temporomandibular joint: correlation between single-contrast videoarthrography and postmortem morphology.

Arthrography of the temporomandibular joint is widely performed in clinical practice. The diagnostic accuracy of this technique has not been systematically evaluated. Therefore, findings from transcranial single-contrast, lower-compartment videoarthrography of 58 temporomandibular joint autopsy specimens were correlated with postmortem morphology. Arthrographic diagnosis of disk position and perforation was confirmed in 47 joints (81%). Misinterpretations were made in 11 joints; nine concerned disk position and two concerned perforation. Analysis of the misinterpretations revealed that inability of arthrography to allow differentiation of lateral from medial resulted in four false-negative diagnoses and one false-positive diagnosis. Variation of joint anatomy with disk deformation resulted in four false-positive diagnoses of anterior disk position. The number of false diagnoses in clinical practice might be reduced if transcranial single-contrast, lower-compartment videoarthrography is followed by multilayer arthrotomography in cases with an unclear diagnosis.

Adult↗
PubMed1987

The normal temporomandibular joint: MR and arthrographic correlation.

Magnetic resonance (MR) images of 28 normal temporomandibular joints were obtained and correlated with respective arthrograms. There was a spectrum in the configuration and thickness of normal articular menisci. The anterior band varied from thin with a flat inferior margin to thick with a bulbous, convex inferior margin. The anatomic configuration of the meniscus as seen with MR correlated directly with normal variations of the anterior recess seen with arthrography. Concavity of the superior aspect of the anterior recess as seen on arthrography was caused by a thick, bulbous anterior band of the meniscus, whereas a flat anterior recess resulted from a thin anterior band without a convex inferior margin. This study emphasizes that the appearance of a concave anterior recess on static arthrograms is not necessarily due to a displaced meniscus.

Adult↗
PubMed1988

Adhesive capsulitis of the wrist: arthrographic diagnosis.

Persistent pain and decreased range of motion are disabling complications of wrist trauma. Between 1978 and 1986, in ten patients with persistent pain following trauma, arthrography depicted changes characteristic of adhesive capsulitis. Adhesive capsulitis has been described in the shoulder, hip, and ankle, but little mention has been made of this entity in other joints. Confirmation of this diagnosis requires arthrography, since there are no characteristic findings on plain radiographs. Typical arthrographic findings include decreased capacity, small volar and styloid recesses, and adhesions preventing complete opacification of the joint. The arthrographic diagnosis allows proper institution of appropriate therapy.

Adult↗
PubMed1991

Meniscal tears: MR and arthrographic findings after arthroscopic repair.

Magnetic resonance (MR) imaging was performed on 29 previously repaired menisci and one conservatively treated meniscus (total, 30 menisci). Intermediate- and T1-weighted MR sequences revealed persistent signal intensity extending to an articular surface (grade 3 signal intensity) in 27 of the 30 menisci. On T2-weighted images, seven of the 30 menisci were found to contain unequivocally higher signal intensity, defined by a full-thickness defect (grade 3 signal intensity involving two articular surfaces) increasing in signal intensity to a level equivalent to that of joint fluid. The MR imaging and arthrographic appearances of 23 of the 30 menisci were compared. Arthrographic examination revealed partial or complete healing in 13 menisci and tears in 10. The presence of grade 3 signal intensity on intermediate- and T1-weighted MR images did not reliably predict a tear seen at arthrography. Unequivocally higher signal intensity on T2-weighted images is a useful sign in the prediction of a persistent meniscal tear (sensitivity, 60%; specificity, 92%; P less than .02). Since presence of grade 3 signal intensity on intermediate- and T1-weighted images does not reliably predict a tear and unequivocal T2 increase in intensity has a sensitivity of only 60%, arthrography should be considered for assessment of the symptomatic, previously repaired meniscus.

Adult↗
PubMed1999

Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees.

PURPOSE: To define magnetic resonance (MR) imaging findings in patients with the iliotibial band friction syndrome (ITBFS) and to correlate these findings with anatomic features defined at magnetic resonance (MR) arthrography in cadavers. MATERIALS AND METHODS: The anatomic relationship of the iliotibial tract (ITT) to the lateral recesses of the knee joint and the lateral femoral epicondyle was investigated with MR arthrography at full extension and at 30 degrees and 60 degrees of knee flexion in six cadaveric knees. Seventeen MR imaging studies in 16 patients with ITBFS were evaluated. RESULTS: In the cadaveric study, no interference of the lateral synovial recess with the lateral femoral epicondyle at full extension and at 30 degrees and 60 degrees of knee flexion was observed. In all specimens, correlation of MR images with macroscopic and microscopic sections revealed no primary bursa between the lateral femoral epicondyle and the ITT. In clinical studies, MR imaging findings of poorly defined signal intensity abnormalities or circumscribed fluid collections were located in a compartmentlike space confined laterally by the ITT and medially by the meniscocapsular junction, the lateral collateral ligament, and the lateral femoral epicondyle. CONCLUSION: MR imaging accurately depicts the compartmentlike distribution of signal intensity abnormalities in patients with ITBFS.

Adolescent↗
PubMed1989

Clinical vs. arthrographic diagnosis of TMJ internal derangement.

Internal derangements of the temporomandibular joint (TMJ) have gained increased recognition as a potential source of pain and dysfunction of the masticatory system. The objective of this study was to evaluate the reliability of clinicians in predicting an arthrographic diagnosis of articular disc position in a typical patient population presenting for TMJ arthrographic evaluation. Two clinicians utilized a brief history, clinical examination (including evaluation of mandibular movement and TMJ auscultation), and tomographic TMJ imaging in evaluating 60 patients. The radiologist subsequently performed the arthrographic procedures on 102 TMJs (18 unilateral and 42 bilateral). Diagnostic agreement was determined for all possible diagnostic categories including: normal disc position, TMJ internal derangement with reduction, TMJ internal derangement without reduction/acute, TMJ internal derangement without reduction/chronic, and osteoarthrosis. The significance of the diagnostic agreement between the clinicians and arthrography was evaluated with a Kappa Statistical Test, which showed good reliability. For epidemiological studies, it was concluded that clinical and tomographic evaluation would provide sufficient reliability for determination of the presence and stage of TMJ internal derangement. However, in a specific clinical situation, a difficult diagnostic problem may require the use of arthrography, depending on the impact of the diagnosis on subsequent treatment decisions.

Adolescent↗
PubMed1993

Reliability and validity of imaging diagnosis of temporomandibular joint disorder.

The purpose of this article is to review reliability and validity of imaging diagnosis of temporomandibular joint disorders. Plain-film and tomography are basic imaging techniques for assessment of the temporomandibular joint. These can be used for evaluation of osseous disease and as a baseline for follow-up. In patients with symptoms from the joint, plain-film and tomography are rarely definitive, and evaluation of the soft tissues is frequently necessary. Arthrography, computed tomography, and magnetic resonance imaging have all been used for evaluation of the soft-tissue components of the joints. Accuracy studies of these techniques have demonstrated the highest diagnostic accuracy for magnetic resonance imaging. Arthrography is relatively insensitive for detection of medial and lateral displacements. Magnetic resonance imaging accurately depicts both hard and soft tissues, and this technique is emerging as the prime diagnostic imaging technique in patients presenting with clinical signs and symptoms of a disorder of the temporomandibular joint. The most frequent findings when patients with clinical symptoms of temporomandibular joint disorders are "imaged" are different forms of disc displacement and degenerative joint disease. Studies have demonstrated a high prevalence of different forms of disc displacement in patients, although these abnormalities are also seen in some asymptomatic volunteers. Future research should further refine imaging techniques to come closer to an understanding of the association between morphologic alterations and patient symptoms.

Arthrography↗
PubMed1991

Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases.

Traumatic rupture of the tendon of the subscapularis muscle was documented as an isolated lesion in the shoulders of 16 men. The injury was caused either by forceful hyperextension or external rotation of the adducted arm. The patients complained of anterior shoulder pain and weakness of the arm when it was used above and below the shoulder level. They did not experience shoulder instability. The injured shoulders exhibited increased external rotation and decreased strength of internal rotation. A simple clinical manoeuvre called the 'lift-off test', reliably diagnosed or excluded clinically relevant rupture of the subscapularis tendon. Confirmation of the clinical diagnosis was best achieved by ultrasonography or MRI, but arthrography or CT arthrography were also useful. Surgical exploration confirmed the diagnosis in every case. Repair of the ruptured tendon was technically demanding and required good exposure to identify and protect the axillary nerve.

Adult↗
PubMed1994

Ultrasonographic evaluation of the elbow in infants and young children after suspected trauma.

Fractures and epiphyseal injuries in the region of the elbow are uncommon in infants and young children, but they can be very difficult to diagnose and delineate accurately. In addition to plain radiography, invasive or costly procedures such as arthrography and magnetic resonance imaging traditionally have been used to evaluate these injuries. We used high-resolution real-time ultrasonography to evaluate a suspected injury of the elbow in seven infants and one ten-year-old child. Three of the infants had a physeal separation, two had a supracondylar fracture, and two had no skeletal injury. The child had an avulsion fracture of the lateral epicondyle of the humerus and an effusion in the joint. The ultrasonographic findings were confirmed by arthrography in three patients, by open reduction in one, and by follow-up radiographs in all. None of the ultrasonographic studies were performed with the patient under general anesthesia. Ultrasonography, a readily available, non-invasive technique, can be used to evaluate the unossified epiphysis about the elbow of infants and young children; to demonstrate dislocations, fractures, and physeal separations; to identify a hinge of soft tissue at the site of a fracture; to identify interposition of soft tissue between fracture fragments; and to aid in the planning of closed and open reductions.

Arthrography↗
PubMed1988

MR imaging diagnosis of rotator cuff tears.

Thirty-one symptomatic patients were studied with MR imaging to evaluate the sensitivity and specificity of shoulder MR in the diagnosis of rotator cuff tears. Correlative studies included arthroscopy in 19 patients and arthrography in 12 patients. Images were obtained on either a 0.5- or 1.5-T Philips superconducting magnet using spin-echo pulse sequences (650-850/30 [TR, TE], 2000/30, 100) with 5-mm slices oriented in an oblique coronal plane perpendicular to the glenohumeral joint. The MR studies were initially interpreted without knowledge of the results of other diagnostic procedures. The MR diagnosis of cuff tear was made when irregularity, discontinuity, and increased signal were identified in the rotator cuff. MR images showed tears in 10 patients (32%) and were negative for tear in 21 patients (68%). MR correlated with arthroscopy and arthrography in 17 of 18 normal patients, in eight of 10 patients with complete tears, and in one of three patients with partial tears. For complete rotator cuff tears, the sensitivity, specificity, and accuracy were 80%, 94%, and 89%, respectively. For all tears (partial and complete), the sensitivity, specificity, and accuracy were 69%, 94%, and 84%, respectively. These data suggest that MR imaging is an accurate procedure for the diagnosis of complete rotator cuff tears. The number of partial tears (three) in this series is too small to evaluate the value of MR imaging in the diagnosis of partial tears.

Adult↗
PubMed1990

Rotator cuff tears: diagnosis with sonography.

The purpose of this study was to determine the accuracy of sonography in the detection of rotator cuff tears. Eighty-one patients were referred by orthopedic specialists because of a clinical suspicion of rotator cuff tear. The standards of comparison were arthrography in 79 cases and surgery in two cases. The sonographic technique used was based on a review of the literature and experience gained by scanning normal subjects. The sonographic criteria for the diagnosis of a complete rotator cuff tear were a focal defect in the cuff or complete absence or nonvisualization of the cuff. All sonograms were interpreted prospectively without knowledge of arthrographic or surgical results. With arthrography as the standard of comparison for the diagnosis of rotator cuff tear, sonographic results included 15 true-positives, 52 true-negatives, eight false-negatives, and four false-positives. With surgery as the standard of comparison, the results were one true-positive and one true-negative sonogram. The sensitivity of sonography in detecting rotator cuff tear was 0.67, the specificity was 0.93, and the accuracy was 0.85. Our study found lower sensitivity and accuracy results for shoulder sonography than have been previously reported.

Arthrography↗
PubMed2002

Wooden foreign bodies: imaging appearance.

OBJECTIVE: The purpose of this study was to identify the characteristic imaging features of wooden foreign bodies. MATERIALS AND METHODS: The imaging studies of 12 patients with surgically confirmed wooden foreign bodies were retrospectively reviewed. The study group consisted of seven females and five males, 10-65 years old (mean age, 36 years). All patients underwent radiography. Nine patients were evaluated with sonography, eight with MR imaging, three with CT, and one with CT arthrography. Gadolinium-enhanced MR imaging was performed in six patients. Three patients presented with a draining sinus and nine with painful swelling. Only three patients presented with a history of penetrating injury. RESULTS: Lesions were located in the foot (n = 4), hand (n = 3), thigh (n = 2), calf (n = 2), and elbow (n = 1). Radiographs failed to reveal the retained foreign bodies in all patients. With MR imaging, wooden foreign bodies displayed a variable signal intensity that was equal to or less than that of skeletal muscle on both T1- and T2-weighted images. MR imaging showed the surrounding inflammatory response in all patients. CT showed the retained wood as linear cylindric foci of increased attenuation. Wood was highly echogenic and revealed pronounced acoustic shadowing on sonography. Arthrography in one patient showed an associated reactive synovitis. CONCLUSION: The imaging appearance of wooden foreign bodies is variable; however, imaging can be quite specific, and when taken in the appropriate clinical setting, the imaging should reliably suggest the diagnosis. Sonography is frequently underused but proved most useful for the evaluation of retained wooden foreign bodies.

Adolescent↗