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Grey scale ultrasonography and arthrography in evaluation of popliteal cysts.

Ultrasonography will reliably detect popliteal cysts of clinically significant size and improvements in ultrasound imaging have enhanced the value of ultrasound in relation to arthrography in the assessment of cyst rupture. Forty-eight knees in 25 patients suspected of having a popliteal cyst were examined by ultrasonography followed immediately by arthrography. Popliteal cysts were demonstrated in 40% (19/48) by ultrasound and in 46% (22/48) by arthrogram. Arthrography detected small cysts not seen with ultrasound, but altrasonic scanning showed cysts which did not fill on arthrography. A ruptured cyst or deep venous thrombosis was suspected in 10 patients. Rupture was confirmed in two patients by arthrography, in both of whom soft tissue changes and attenuation of the distal margin of the cysts were shown by ultrasound.

Cysts

Findings at arthroscopy and arthrography in knee injuries.

The diagnostic accuracy of arthroscopy and arthrography was investigated. A total of 135 patients were examined by the two methods. All were operated on and 90 of them were analyzed in detail, the X-ray examinations being done at this hospital. In 82 patients arthroscopy gave correct information. In eight (9 per cent) the diagnosis was incorrect, in most cases a rupture of the posterior horn of the medial meniscus being overlooked. Arthrography gave accurate preoperative information in 52 patients, but in 38 (42 per cent) the diagnosis was inaccurate. This difference in correlation with the operation findings between arthroscopy and arthrography was highly significant (P less than 0.001), and it is concluded that endoscopy gives more complete and more useful preoperative information than arthrography. Arthrography, however, remains a valuable diagnostic tool, as arthroscopy cannot be performed in every patient with knee symptoms.

Adolescent

[Arthrography of the wrist: procedures and normal results (author's transl)].

The results of 31 opaque arthrographies of the wrist carried out under two different circumstances are reported. --In a first group the investigation was made immediately after or within a longer period following injury to the wrist or forearm. The results supply information to the surgeon on the condition of the triangular ligament in dislocation and partial dislocations of the inferior radioulnar joint, caused by an architectural fault in the radius after trauma (fracture of the head, diaphysis, or lower extremity). Simple reduction of the radius, without intervention on the inferior radio-ulnar joint, provides an excellent functional result when the triangular ligament is simply stretched. When it is torn (sprains, dislocation locally or at a distance) results are not very convincing in spite of the many possible procedures available. Arthrography easily reveals the presence of a reflex dystrophy complicating the injury. Both the radiological and clinical signs give characteristic pictures of the condition. --This examination is still only used infrequently for the diagnosis of chronic inflammatory rheumatic diseases. The arthrographic images appear very early, however, and are characteristic of an inflammatory synovial lesion. Examinations were carried out mainly for evaluation before therapy, surgical in the case of a synovectomy, medical for a chemical or isotopic synovial treatment. Arthrography in a acutely inflammed joint is followed by an injection of corticoid, sometimes associated with a local antibiotic. This rapidly relieves the patient and prevents worsening of the acute inflammatory process. Arthrography of the wrist is a simple, painless, rapidly performed examination. There has never been a failure, any incident, or accident. It appears to be the only direct exploratory procedure for this joint. A precise anatomical evaluation can be made from the image which gives a true picture of the different anatomical structures.

Adrenal Cortex Hormones

Correlations of arthrography with arthroscopy.

Arthrography and arthroscopy were compared on a prospective basis in 100 consecutive and unselected knees, all in patients who underwent arthrography, arthroscopy, and surgery. Arthroscopy was found to be more accurate than arthrography in the diagnosis of medial and lateral meniscus and anterior cruciate ligament lesions. Because of its easy availability and relatively low cost, arthrography continues to be a useful extension of the physical examination of the knee, serving as a further diagnostic screening technique. However, arthroscopy is recommended in all patients prior to surgery because it provides more complete and more accurate delineation of intra-articular lesions.

Cartilage, Articular

Arthrography of the hip in the diagnosis of postoperative painful conditions after total hip replacement.

Arthrography of the artificial hip joint was performed postoperatively in 29 patients with pain after total hip replacement. In 23 cases the arthrographic findings were checked by operation and corresponded in 91%. In two arthrographies which did not give reliable results sinuses outside the thigh or a large pseudocapsule prevented a satisfactory performance of the arthrography. The unoperated patients had only mild discomfort or were considered a high risk for reoperation; they were treated with physiotherapy and medication. As a result of this investigation arthrography can be regarded as a highly reliable method of diagnosing the various causes of pains in the hip after total hip replacement.

Hip Joint

Upper extremity arthrography.

Arthrography is a proven and well-established diagnostic aid in the evaluation and treatment of lesions in several joints; it provides useful information in the treatment of shoulder and wrist lesions. The procedure can be used whenever the cause of shoulder pain is in doubt. Arthrography of the shoulder can aid in the diagnosis of a variety of lesions: rotator cuff tear, subluxation of the shoulder, recurrent dislocation, subluxation and tear of the biceps tendon, the frozen shoulder, anterior capsular derangements, and combinations of these abnormalities. Arthrography has occasional, but definite use in the wrist, particularly in recurrent ganglion, painful ganglion on the flexor aspect of the wrist, and in the evaluation of the post-traumatic wrist with unexplained pain.

Adult

A study of ankle instability utilizing ankle arthrography.

A preclinical and clinical study of ankle arthrography for chronic ankle instability was performed. In the first study, ankle arthrograms were done on 50 cadaver ankles to demonstrate the limits of the normal ankle joint, and it was demonstrated that contrast in tendon sheaths is not a sign of a torn ankle ligament. The second study consisted of investigating ten cases of chronic ankle instability utilizing ankle arthrography. It was concluded that ankle arthrography is helpful in diagnosing torn ankle ligaments if all remaining investigative procedures are negative. A positive ankle arthrogram is proof that a torn capsule and ligament has occurred. However, in this small series a negative a negative arthrogram and a normal talar tilt was still associated with a torn ligament of the ankle.

Adolescent

[The importance of the combination of the special x-ray with the arthrography in congenital displacement of the hip (author's transl)].

Arthrography is an important method of diagnosis of congenital displacement of the hip. It reveals the interposition of the soft tissue and the correctness of the position of the femur after a reduction of the hip joint. Arthrography only in a anterior posterior position cannot always demonstrate the real relationship between the femur and the pelvis. An x-ray of the arthrography in 45 degrees oblique position (Foramen obturatorium position) can reveal the situation.

Child

Precision in the diagnosis of meniscal lesions: a comparison of clinical evaluation, arthrography, and arthroscopy.

We assessed the accuracy of clinical evaluation, arthrography, and arthroscopy in the diagnosis of meniscal lesions in fifty knees in which arthrotomy was performed for disabling symptoms after evaluation by these three methods. At surgery, forty-seven menisci were removed, of which forty-four were abnormal and three were normal. In three patients with normal menisci, loose bodies were found in two and the exploration was negative in one. In the forty-four knees with a meniscal lesion, a correct diagnosis was made clinically forty time, arthrographically thirty-nine times, and arthroscopically thirty-two times. Most errors occurred in the knees with posterior horn lesions of the medial meniscus. Clinical diagnosis was least accurate for lesions of the lateral meniscus (four missed) and arthroscopy was least accurate for lesions of the posterior horn of the medial meniscus (ten missed). Arthrography appeared to provide collateral evidence of lesions not seen directly. Based on this study it was concluded that even with negative findings by arthroscopy and arthrography it still may be necessary occasionally to remove a meniscus on the basis of the clinical evaluation.

Adult

Color subtraction arthrography in the diagnosis of component loosening in hip arthroplasty.

While component loosening in arthroplasty of the hip joint may not always be associated with pain, the painful total hip arthroplasty frequently can be shown to be associated with loosening of one or both components. The application of color subtraction techniques to routine arthrography of the hip has greatly increased the authors' accuracy in identifying component loosening in the painful total hip. The technique and its method of application are described in this preliminary report. Several examples of its use are presented. The authors have found this technique to be a useful adjunct to routine arthrography of the hip in selected instances. It has improved overall diagnostic accuracy and is more rapid and less costly than standard photographic subtraction techniques.

Arthrography

[Arthrography in humeroscapular peri-arthritis].

Degenerative changes in the shoulder joint affect the capsule much more frequently than might be expected and are not seen on a plain radiograph. Arthrography of the shoulder has become of increasing significance in view of modern surgical management. Arthrography is used particularly to demonstrate a tear of the rotator cuff (especially the supra spinatus and infra spinatus). It also shows other important abnormalities which cause pain on movement, such as adhesions, tight capsule and the formation of septa. The indications, technique and necessary records, as well as typical pathological findings, are demonstrated in forty shoulder arthrograms. Hemuro-scapular peri-arthritis is a collective term for complex, primarily degenerative or posttraumatic, changes including peri-articular calcification. Demonstration of calcification alone does not justify the radiological diagnosis of humeroscapular peri-arthritis.

Calcinosis

[Arthrography and ultrasound scanning for the detection of Baker cysts (author's transl)].

23 knee joints with clinical evidence of Baker's cysts have been studied in comparison by arthrography and ultrasound-scanning. In 20 knees, there was correlation between arthrographic and sonographic findings. In 3 cases, a positive sonogram was not confirmed by arthrography. Possible causes for faulty interpretation and differential diagnoses have been discussed. We prefer ultrasound scanning for the diagnosis in inflammatory and degenerative joint diseases because it is entirely harmless. In cases of traumatic Baker cysts the arthrogram may reveal an additional meniscal injury.

Adult

[Reliability of double-contrast arthrography in detection of cartilage lesions of the knee joint (author's transl)].

The present work evaluates the method of double-contrast arthrography. To this end, cartilage damage on femoral condyles and tibial joint surfaces was studied in 1566 retrospectively evaluated double-contrast arthrographies. Operation reports and histological results served as control. The results of our own experiments demonstrate that even isolated cartilage lesions as small as 1 mm in diameter can be visualized.

Adult

Arthrography of the knee.

Arthrography of the knee is becoming an integral part of the evaluation of the patient with a suspected internal derangement of the knee. The examination is relatively simple, and can be performed on out-patients with conventional radiographic equipment or a modified fluoroscope. Knee arthrography has been proven safe in a large series of patients. The technique is reliable, particularly in the diagnosis of meniscus lesions. The knee arthrogram is helpful to the orthopedic surgeon to confirm suspected abnormalities, to reveal unsuspected or multiple lesions, to exclude some conditions which could be confusing clinically, or to plan a surgical approach to the knee.

Cartilage Diseases

Double contrast knee arthrography in the evaluation of osteochondritis dissecans.

Double contrast knee arthrography is an invaluable adjunct in the evaluation of patients with osteochondritis dissecans. The cartilage overlying the osteochondritic defect can be evaluated and unsuspected meniscal pathology accurately diagnosed. In our series, there were three unsuspected medial meniscal tears, diagnosed by arthrography and confirmed at surgery. The location of the osteochondritic defect was atypical in all four of our female patients.

Adolescent

Arthrography as a method of diagnosing tear of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb ("gamekeeper's thumb").

Arthrography of the metacarpo-phalangeal (MP) joint of the thumb was performed on 47 thumbs. The normal arthrographic appearance shows a closed joint space, whereas leakage of contrast material indicates tear of the joint capsule with or without an associated tear of a stabilizing ligament. Arthrographic demonstration of the heads of the adductor pollicis muscle was found to be specific for tear of the ulnar collateral ligament (UCL) of the MP joint, a tear which is commonly responsible for its instability. Arthrography is suggested as a safe and accurate diagnostic examination for the early detection of tears of the UCL of the MP joint.

Adolescent

Arthrography of the ankle joint: problems in diagnosis of acute lateral ligament injuries.

Arthrography of the ankle joint is a reasonably accurate and helpful method of delineating the extent of injuries to the lateral ligament. Forty-six arthrograms were obtained following acute injuries, with 26 patients having operative evaluation. Eight false negative results were encountered, all in combination with fairly massive capsular tears. Although ankle arthrography in acute injuries is useful, it is not infallible. An explanation for the large number of false negative results is offered and additional suggestions are made about the technique of examination.

Acute Disease

Rupture of the quadriceps tendon: diagnosis by arthrography.

Arthrography revealed an abnormal tract of contrast agent dissecting from the suprapatellar bursa into the soft tissue anterior to the patella and downward to a level 9 cm beneath the tibial plateau in a patient with complete rupture of the quadriceps tendon. The bursal anatomy of the anterior portion of the knee is reviewed in relation to the capsule-forming structures of the quadriceps expansion. The use of knee arthrography for the assessment of quadriceps tendon injury is advocated.

Aged