Diagnosis Of Soft Tissue Injuries Research Articles

Retrospective evaluation and review of approaches for nonspecific lameness in dogs presented to an emergency service (2013-2014): 134 cases.

This retrospective study aimed to characterize and evaluate the emergency approach, diagnosis, management, treatment, and follow-up of nonspecific canine lameness cases. Retrospective case series from September 25, 2013 to September 25, 2014. The study was conducted at an urban university teaching hospital. A consecutive sample of dogs presenting to the emergency service with nonspecific lameness in the designated timeframe was used to identify 134 cases. Owners were contacted to participate in the follow-up survey; dogs that died prior to data collection were excluded from the survey. Medical records were reviewed for lameness localization, etiology of lameness, diagnostics obtained, medications prescribed, and owner recommendations. Based on review of the medical records, the lameness localization, presumptive source of lameness (joint, soft tissue, neurological, or bone), diagnostics obtained, medications prescribed, and owner recommendations were recorded. Survey data included duration of lameness, perceived response to treatment, and activity level. Definitive diagnoses were not assigned in 88.8% of lameness cases. A presumptive diagnosis of soft tissue injury was assigned in 45.3% of cases. Single limb lameness was more prevalent than multiple limb lameness. Owners whose dogs were treated with medication were significantly more likely to report that the lameness resolved (P=0.049). Dogs with injury localized to ≥1 of the joints were significantly less likely to have resolution of lameness (P=0.037). Treatment recommendations were predominantly pain control and activity restriction. Nonspecific lameness represents approximately 4% of canine urban emergency cases. Highlighting the points of clinical care considerations in understanding the etiology of lameness in dogs represents an opportunity for improved patient care and growth in emergency referral and follow-up.

Tui-na Therapy for Shoulder Pain in a Young Great Dane

A 9-month-old male Great Dane developed acute non-weight bearing lameness of the right front leg after he slipped and fell while playing. A tentative diagnosis of soft tissue injury of the shoulder was made. The recommended conventional medical treatment of oral analgesics was declined by the owner who instead opted for traditional Chinese veterinary medicine (TCVM) therapy. The TCVM treatment included dry needle acupuncture (DNAP), Chinese herbal medicine (CHM) and Tui-na with improvement noted after the first TCVM session. In addition to Tui-na used during the TCVM sessions, simple techniques were taught to the owner to administer at home to support improvement and mobility recovery. The dog began using the leg again on the day after the first treatment, without the use of analgesics. After 2 weeks of TCVM therapy, the young dog was able to walk and run without evidence of lameness in the right front leg. This case highlights the benefit of augmenting TCVM therapy with Tui-na, particularly to manage acute soft tissue musculoskeletal injuries in dogs.

Role of High Resolution Ultrasound and Magnetic Resonance Imaging in Traumatic Soft Tissue Injuries of the Wrist and Hand

Abstract Aim of the Work To assess the role of ultrasound in the diagnosis of traumatic soft tissue injuries of hand and wrist. Patients and Method This study includes 30 patients with a mean age of 42.17 years ±9, all with history of traumatic soft tissue injuries in hand and wrist, all patients underwent ultrasound and MRI. The U/S&MRI diagnostic criteria of each patient were analyzed, compared and correlated with clinical diagnosis/ or operative findings . Results A comparison of the sensitivity of US versus MRI was done by correlating the final diagnosis of each modality with clinical diagnosis and/or operative findings. In general as regard all types of soft tissue injuries we found that, in correlation with clinical diagnosis US gives (93.3% sensitivity), while MRI gives (73.3% sensitivity). US & MRI result shows agreement in detection of all types of post traumatic soft tissue injuries except in chronic tendinopathy, tendon fibrosis ,and chronic tendon tear heals by fibrosis we found no agreement between them (in which ultrasound can diagnose them, while MRI couldn’t detect them). Conclusion Ultrasound shows higher sensitivity in diagnosis of soft tissue injuries of hand and wrist than MRI, as compared to operative findings and /or clinical data.

ROLE OF MRI IN EVALUATION OF ANTERIOR CRUCIATE LIGAMENT TEAR

Magnetic resonance imaging being a most advanced and non-invasive imaging modality is a gold standard imaging modality in the diagnosis of soft tissue injuries including the injuries of ligament and tendons because of its three dimensional approach. Almost there are 360 joints in human body with the help of which we can move from one place to other, among them knee joint is the largest joint. It is a synovial joint of hinge variety which mainly allows flexion and extension. Knee joint is supported by a huge network of ligaments and tendons which provide a great strength and flexibility to the knee joint. Anterior and posterior cruciate ligament are the important stabilizing ligaments of the knee joint these two ligaments connects the tibia with femur. Injury or torn to them can cause a critical clinical conditions to the patients suffering from that injury. Injury to anterior cruciate ligament is more frequent as compare to other ligamentous injuries of the knee. Injury to ACL occurs mostly by sudden change in direction so because of which it affects the people who take part in different types of sports like basketball, soccer, baseball skiing. Female athletes are at higher risk of having ACL tear as compare to males. ACL tear should be treated properly because injury to it can cause a serious clinical conditions like it can cause the immobilization of the subject until it is treated properly. For the accurate treatment there should be most advanced and highly sensitive diagnostic approach which aids in the addition of accurate information regarding the location, grading and the condition of ACL tear either there is complete or partial tear. Magnetic resonance imaging modality can diagnosis ACL tears with a high accuracy with the help of specific protocols which are more sensitive to soft tissue injuries. Keywords : ANTERIOR CRUCIATE, LIGAMENT TEAR DOI: 10.7176/JHMN/93-10 Publication date: September 30 th 2021

Bone Tumours of the Talus: 18-Year Cohort of Patients With Rare Osteoid Lesions.

BackgroundBone tumours of the talus are a rare cause of ankle pain. This study aims to provide additional clinical clarity regarding the presentation and management of a minimally researched topic.MethodsSixteen patients were diagnosed with bone tumour of the talus between 2002 and 2020 following referral for ankle pain. Symptoms, diagnosis, and management were retrospectively reviewed. Patients were actively followed up until consistently symptom-free and consenting to discharge (mean of 2.9 years). An open appointment was offered to all patients to reattend the unit if symptoms recurred.ResultsThe most common diagnosis was osteoid osteoma/osteoblastoma (nine patients), chondroblastoma (four patients), a giant cell tumour of bone, a chondral lesion in Ollier’s disease and a rare metastatic renal cancer case. The mean age of onset was 29 years. Thirteen patients experienced ankle pain without a clear precipitating cause. Night pain was less common in osteoid osteoma/osteoblastoma than usually observed in the literature. The mean delay in diagnosis was two years, often due to an incorrect diagnosis of soft tissue injury. Plain radiographs are insufficient to identify most lesions.Ten patients underwent computed tomography (CT)-guided radiofrequency ablation and five patients had open surgical curettage. Ollier’s disease was managed with orthotics. The five cases of recurrence across four patients were managed operatively.ConclusionsPatients are usually young and healthy with benign disease, but talus tumours can cause significant functional impairment. Unexplained ankle pain should be extensively examined and be further investigated with magnetic resonance imaging (MRI) and CT scanning to avoid missing these rare tumours.

Clinical profile of patients with forearm and hand injuries at tertiary care institute of Bhuj, Kutch

Background and Aim: Hand and forearm injuries, however small or large they may be do have a significant impact on the society in terms of cost of treatment and hospital stay and costs of lost production. A further loss occurs in terms of an increased time off work due to need for rehabilitation and in some cases due to the permanent loss or impairment of function of the hand. Material and Methods: The study was conducted in the Department of Surgery, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, over the period of 12 months. Total 150 Subjects were recruited from patients presenting in emergency/surgery OPD, with a primary diagnosis of soft tissue injuries in the forearm and the hand. A complete history of patients and detailed examination of patients was performed after obtaining the written informed consent of the patients. The findings were recorded and evaluated in following terms. Time since injury on admission, first aid/intervention done outside, mode of injury, detailed clinical examination in the form of general examination and systemic examination. Local examination which included details like the limb involved, examination of the would including its dimensions, neurovascular status, involvement of the tendons, any fracture of the underlying bones and involvement of joint. Results: Out of 150 subjects 128 (85.3%) were males while 22 (14.6%) were females. Maximum cases were of crush injuries accounting for 50% of the subjects (75 subjects). Lacerated wounds made up for 27.3% subjects (41 subjects). Associated involvement of the joint was seen in 55 subjects (36.6%), whereas 95 subjects (63.3%) did not have any involvement of the joints. Neurovascular injury was seen in only 29 subjects (19.3%). Conclusion: Among all those attended, the male gender had a higher prevalence. Hand and forearm injuries are more common in males and in the age group of 20 to 40 years leading to loss of productive working days causing a significant financial burden on the society. Hand and forearm injuries range from isolated soft tissue injuries to those associated with bony and neurovascular involvement.

Management of patients with forearm and hand injuries

Background: Injuries to the hand and the forearm, particularly crush injuries have always been a major challenge to even the best of surgeons, whether it is a major case of a mangled hand by a high pressure injury or even a small case as an injury to the tip of the finger by getting squashed in a closing door. Any injuries in the forearm and the hand requires a very meticulous and thoughtful approach towards coverage with the aim of maximal restoration of function as well aesthetic appearance.Methods: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over the period of 12 months. Subjects were recruited from patients presenting in emergency/surgery OPD, HIMS, Dehradun with a primary diagnosis of soft tissue injuries in the forearm and the hand. A total of 114 patients were included in the study.Results: 39.5% (45 patients) were treated with combined modalities, including debridement, grafting & flap coverage. 14.1% (16 patients) required some form of orthopaedics intervention. 21.1% (24 patients) needed neurovascular or tendon repair surgery. 37.7% (43 patients) faced some sort of early or late complications. Conclusions: Proper assessment and management of complex injuries of hand and forearm is mandatory for a good functional and aesthetic outcome.

Clinical profile of patients with forearm and hand injuries

Background: Hand injuries are among the most frequent injuries, constituting between 6.6% and 28.6% of all injuries. Hand and forearm injuries, however small or large they may be do have a significant impact on the society in terms of cost of treatment, hospital stay and costs of lost production and hence the importance of this study.Methods: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over the period of 12 months. Subjects were recruited from patients presenting in emergency/surgery OPD, HIMS, Dehradun with a primary diagnosis of soft tissue injuries in the forearm and the hand. A total of 114 patients were included in the study.Results: Overall mean age of the subjects in our study was 28.21±15.71. The highest incidence was in the age group of (20-40) years i.e. 62 (54.30%). Male to female ratio in our study was 6.6:1. Maximum injuries occurred as workplace and industrial injuries. This contributed to 34.2% (39 subjects) of overall injuries. 50% patients had crush injuries while lacerations, burn and avulsion were other form of injuries. 43 patients had bone and joint involvement,16 patients had neurovascular injuries and 20 patients had tendon injuries. Conclusions: Hand and forearm injuries are more common in males and in the age group of 20 to 40 years leading to loss of productive working days causing a significant financial burden on the society.

Application of MRI in diagnosis of transient dislocation of patella

To explore the diagnostic value of MRI in the transient dislocation of the patella. The DR and MRI data of 35 patients with acute patellar transient dislocation from January 2015 to December 2017 were retrospectively analyzed, including 12 males and 23 females, ranging in age from 10 to 23 years old, with an average of 17 years old. The differences between DR and MRI diagnosis and surgical or discharge diagnosis were compared, and the difference between them in diagnosis of knee anatomical position, bone injury, signs and soft tissue injury were compared. The R statistical software WiLcoxon signed rank test (WiLcoxon signed rank test) was used for statistical analysis. All 35 MRI findings were completely consistent with postoperative or discharge diagnosis. According to MRI, 7 cases of high patella and 7 cases of patella subluxation were diagnosed. According to DR, 7 cases of high patella and 0 cases of patella subluxation were diagnosed. Fourteen dislocations were diagnosed by MRI and 7 dislocations were diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of abnormal position of patella(v=10, P<0.05). Total 112 cases of bone injuries were diagnosed by MRI, and 0 was diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of bone injuries(v=16, P<0.05). Total 43 cases of soft tissue injuries were diagnosed by MRI, and 0 was diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of soft tissue injuries (v=21, P<0.05). Total 35 cases of hydrops of the knee joint were diagnosed by MRI, and 30 were diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of hydrops of the knee joint(v=32, P>0.05). MRI is superior to DR in the diagnosis of acute temporal bone dislocation. MRI should be used as the first choice for imaging diagnosis of acute temporal bone dislocation. It can avoid missed diagnosis and misdiagnosis.

An unusual cause of limp

A 38-year-old male re-presented to the ED five days after being discharged with a diagnosis of soft tissue injury to the left knee. Re-attendance was prompted by increased inability to weightbear and loss of joint function. The patient limped into the department and was asked to lie supine for examination. Even a cursory visual examination revealed marked infra-patellar swelling with a loss of contour and definition to this aspect of the joint. Pain was not a significant part of the presentation being scored at 2/10 at worst. The patient was an otherwise active adult who had become frustrated by his inability to indulge in any sort of sporting activity since discharge. After visiting the gym that morning he had been advised by one of the staff to re-attend as there was a possibility that he may have a more significant injury than previously diagnosed.

A numerical method to detect soft tissue injuries from tissue displacements

A method is introduced to detect soft tissue injuries from internal measurements of displacements taken while a quasi-static load is applied to the tissue. We aimed to quantify and improve reliability of the diagnosis of soft tissue injuries with quasi-static ultrasound elastography. Our method consists of (i) building a model of displacements in healthy tissues and (ii) characterizing injured tissue for how displacements estimated in this tissue differed from the model. The model was built by applying principal component analysis to a data-set of displacements in healthy tissues. A Monte Carlo simulation of Finite Element models was performed to test our method. Our method could detect injuries quantitatively (area under ROC curves equal to with no displacement noise, with noise and with noise) and provided maps with significantly higher contrast-to-noise ratios between damaged and healthy regions than maps provided by current methods, either strain-based and modulus-based ().

Repeatability and accuracy of a non-invasive method of measuring internal and external rotation of the tibia

The ability to quantify rotational laxity of the knee would increase understanding of functional rotatory instability, identify the best treatment methods for soft tissue injury, and have a role in diagnosis of soft tissue injury. This study aimed to report the reliability, repeatability and precision of a non-invasive adaptation of image-free navigation technology by comparing with a validated invasive system used for computer-assisted surgery. Twelve cadaveric lower limbs were tested with a commercial image-free navigation system using passive trackers secured by bone screws. They were then tested a non-invasive fabric-strap system. Manual application of torque was used consistent with clinical examination to rotate the tibia to the end of internal rotation and external rotation range. Measurements were taken at 10° intervals from full extension to 90° flexion, and protocol was repeated twice using each system. Intraclass correlation coefficient (ICC) was used to reflect reliability of measurements. At each flexion interval, coefficient of repeatability (CR) was calculated for each system, and limits of agreement (LOA) were used to reflect agreement between the systems. The results for internal and external rotation were combined throughout flexion: ICC invasive; 0.94 (0.86-0.99), non-invasive; 0.92 (0.7-0.99), CR invasive; 2.4° (1.3-4.8°), non-invasive; 3.5° (1.8-6.6), LOA; 8.2° (4.3-13.5). Non-invasive optical tracker fixation gives improved agreement with a validated method of measurement compared with devices measuring tibial rotation by foot position. This system gives the added possibility of dynamic, weight-bearing testing in the clinically important range of 0°-30° knee flexion without the need for any limb restraint.

Non-union of an intra-articular fracture of the sternum

We report the unique finding of a vertical fracture of thesternum extending into the sterno-clavicular (SC) joint whichresulted in a non-union. This was treated with open reduction andinternal fixation with bone grafting. To our knowledge this is thefirst report of a non-union of a traumatic vertical sternal fracture.Furthermore, we believe it is the first report of an intra-articularfracture of the sternal side of the SC joint.2. Case reportA 31 year old professional equestrian presented to the accidentand emergency (A&E) department with right shoulder, chest andpelvic pain having fallen from her horse. At the time of impact, herarm waselevatedaboveherrightshoulderbuttherewasnoreportof a direct injury to the chest. Radiographs of the pelvis were onlyperformed and revealed a fracture of the pubic ramus. The patientwas discharged with a further diagnosis of soft tissue injuries ofboth the right shoulder and chest.She subsequently represented to the A&E department twoweeks later with continuing right shoulder and chest pain. Aradiograph of the shoulder was performed but revealed no bonyabnormality. She was referred for physiotherapy and encouragedto mobilise.Six months following the initial injury, the patient presented tothe shoulderclinicwithgeneralisedshoulderpainwhichwasmostsevere over the SC joint. There was tenderness on palpation of theSC joint butno swellingwasapparent. Internal rotation,abductiongreater than 908 and adduction of the affected shoulder causedpain localised to the SC region. Plain radiographs of the sternumand SC joint revealed no bony abnormality. A MRI scan wasperformed which revealed a non-union of a vertical sternalfracture extending into the SC joint (Fig. 1).In view of the patient’s persistent level of symptoms and herhigh functional demands, it was felt that the only therapeuticoption was to proceed to an open reduction and internal fixationwith bone grafting of the non-union.The surgery was undertaken as a combined case by the seniorauthor and a consultant cardiothoracic surgeon. An incision wasmade from the medial end of the clavicle curving medially andinferiorly over the sternoclavicular joint and manubrium. Anobviousfracturenon-unionwasidentifiedrunningverticallydownfrom the base of the sternal articular surface of the manubrium(Fig. 2). This was exposed and curetted. Bone graft was harvestedfrom the ipsilateral iliac crest and inserted into the fracture. Thefracture was then was then fixed using two 4 mm, cannulated,partially threaded, cancellous screws. The entry points for thescrews were exposed by careful dissection down onto the lateraledge of the sternum with minimal disturbance to the overlyingligamentous structures(Fig.3).Goodcompressionwasobtainedatthe fracture.Post-operatively, the patient was immobilised in a sling for 4weeks and then began a graded rehabilitation programme. At 6months following surgery, the patient’s fracture had clinicallyunited. Bony union was confirmed on MRI (Fig. 4). She was painfree and had regained a full range of motion and had returned toher pre-injury level of activity.3. DiscussionTraumatic sternalfracturesaccountforbetween5and10%ofallthoracic injuries.

Wireless Diagnostics

Diagnosis of soft-tissue injuries (STIs) in occupational medicine using wireless technology will be cost effective and will improve the assessment outcomes. This article provides an overview of the design and clinical motivation for a novel system implementation using the sensing health with intelligence, modularity mobility and experimental reusability (Shimmer) platform.

Boolean-format biocatalytic processing of enzyme biomarkers for the diagnosis of soft tissue injury

The development of a novel enzyme logic sensing concept for the detection of soft tissue injury (STI) is reported. The new biocatalytic scheme employs creatine kinase (CK) and lactate dehydrogenase (LDH) as enzyme biomarker inputs to a biochemical cascade that mimics the operational functionality of a NAND Boolean logic gate. Under the optimal conditions, physiological and pathological levels of CK and LDH are detected optically and electrochemically by monitoring the level of reduced nicotinamide adenine dinucleotide (NADH) as an output of the logic gate. The latter technique employs a flexible carbon screen-printed electrode (SPE) to facilitate the on-site detection of STI. By establishing a pathologically meaningful threshold, relatively simple optical and amperometric assays tendered the diagnosis in a straightforward ‘True’/‘False’ digital format. Only the simultaneous presence of elevated levels of both enzyme inputs would thus trigger a positive diagnosis. Moreover, an interference investigation is performed that employs circulating levels of potential interferents. Such an enzyme cascade and enzymatically-processed biochemical information offer promise for point-of-care injury screening where a rapid determination of pathological situations is a prime consideration.

Does a trauma clinic help improve the diagnosis of soft tissue hand injuries?

Soft tissue hand injuries represent a major part of the trauma workload in most plastic surgery units in the UK. It is therefore crucial that such injuries be appropriately assessed and managed, so as to reduce the risk of any potential complications. Also, inappropriate assessments may lead to unnecessary operations and their potential complications. In an attempt to improve its trauma service, the Plastic Surgery Unit at Frenchay Hospital has made several innovations to its service, one of which being the creation of a trauma clinic manned by a senior plastic registrar. The aim of our study was to assess the rate of negative exploration in soft tissue hand injuries and also to assess the impact that the trauma clinic will have on the diagnosis of soft tissue injuries. The pre- and post-operative diagnosis of 50 patients prospectively recruited from the pre- and post-trauma clinic were compared and analysed using the t test. The overall rate of negative exploration was 7% (8% pre-trauma clinic and 6% post-trauma clinic). The correct diagnosis was made in 68% in the pre-trauma clinic group and 74% in the post-trauma clinic group. Additional diagnoses were made in 24% and 20% of pre- and post-trauma groups, respectively. The seniority of the senior house officers also influenced the rate of accurate diagnosis.

Clinical diagnosis of soft tissue injuries to the knee by physiotherapists and orthopaedic surgeons: Is there a difference between the two professions?

Abstract The aim of this study was to compare the accuracy of clinical diagnosis made by trained physiotherapists and orthopaedic surgeons when seeing elective patients in the outpatient clinic. The method involved a retrospective analysis of 100 case notes of patients who had been seen in the orthopaedic outpatient department and consecutively scheduled for knee arthroscopies. Fifty patients were seen by a physiotherapist and 50 by the orthopaedic surgical team. The physiotherapist was able to make a 66% clinically accurate diagnosis compared with 82% by the doctors ( p = 0.07). Sensitivity was 90.7% for surgeons and 68.1% for physiotherapists, whereas specificity was shown to be 71.4% for surgeons and 66.6% for physiotherapists. The accuracy of clinical diagnosis by trained surgeons is better than that of physiotherapists, although not statistically significant. It is, therefore, justifiable to place patients on theatre lists based only on clinical examination by either physiotherapists or surgeons.

SONOGRAPHY OF THE SOFT TISSUE STRUCTURES OF THE CANINE TARSUS

Currently, there are no available anatomic descriptions of the soft tissue structures that are visible with ultrasound in the canine tarsus. Eight cadaver hindlimbs and 10 clinically normal dogs (15-37 kg) were examined with ultrasound to establish which structures could be visualized in normal dogs. The structures always identified included the long digital extensor tendon, the tibialis cranialis tendon, the joint space, and the three bellies of the extensor digitum brevis muscle on the cranial/dorsal aspect of the tarsus. The lateral digital extensor tendon and the peroneus longus tendon were identified as a single structure on the lateral aspect of the tarsus. The caudal/plantar approach allowed identification of the calcaneal tendon, the deep and superficial digital flexor tendons, the plantar ligament, and the lumbricales and interosseus muscles. The medial collateral ligament can be identified on the medial tarsus of larger dogs. This technique has proved useful in the diagnosis of soft tissue injuries of the canine tarsus, and clinical examples of tibialis cranialis tendinopathy, deep digital flexor tendinopathy, fibrosis surrounding the medial collateral ligament and extent of invasion of a tarsal hemangiosarcoma are described.

Summary of an evidence-based guideline on soft tissue injuries and related disorders – Part 1: Assessment

To provide a succinct summary of the diagnosis of soft tissue injuries to the shoulder for primary health care practitioners based on the New Zealand guideline. A multidisciplinary team developed the guideline by critically appraising and grading retrieved literature using the Graphic Appraisal Tool for Epidemiology (GATE). Recommendations were derived from resulting evidence tables. Diagnostic ultrasound is a valid tool for the diagnosis of a full thickness rotator cuff tear. If a significant tear is suspected, referral for diagnostic ultrasound is recommended. There is a paucity of evidence for the diagnosis of soft tissue shoulder injuries and most recommendations are based on the consensus of the guideline team. Assessment relies on thorough history-taking and physician examination with appropriate referral where there is evidence of serious damage or the diagnosis remains unclear.

Soft tissue injuries of the knee

The knee is a complex joint in which the bony contours, articular surface, ligaments and menisci all play crucial interacting roles to provide normal motion and function. The knee is a superficial joint, being easy to see, palpate and stress, and yet diagnosis of soft tissue injuries of the knee is often poor.