Shoulder Imaging Research Articles

Relationship between SLAP Lesions and Shoulder Joint Capsule Thickness: An MR Arthrographic Study.

Background and Objectives: This study aimed to evaluate the relationship between SLAP lesions and the shoulder joint capsule thickness via MR arthrography. Understanding the relationship between SLAP lesions and the joint capsule thickness is important because an increased capsule thickness may indicate chronic inflammation and contribute to persistent pain and dysfunction. These findings have significant clinical implications for the diagnosis, management, and treatment strategies of shoulder joint pathologies. Materials and Methods: We retrospectively analyzed the MR arthrography results of 78 patients who underwent shoulder imaging at Düzce University Medical Faculty between October 2021 and November 2024. The study included patients diagnosed with SLAP lesions and compared them with a control group without such pathology. Data on joint capsule thickness at the level of the axillary recess, SLAP lesion type, cuff pathology, and demographic information were collected and analyzed. Results: The study included 32 patients with SLAP lesions and 46 control subjects. The mean age of the patients was 44.75 ± 14.18 years, whereas the control group had a mean age of 38.76 ± 13 years. The patient group presented a significantly greater mean anterior capsule thickness (3.13 ± 1.28 mm vs. 1.72 ± 0.7 mm, p = 0.0001), posterior capsule thickness (3.35 ± 1.32 mm vs. 1.95 ± 1.06 mm, p = 0.0001), and maximum capsule thickness (3.6 ± 1.32 mm vs. 2.06 ± 1.01 mm, p = 0.0001) in the axillary recess. SLAP type 2 lesions were the most common type (43.76%) in the patient group. Conclusions: This study revealed a significant association between SLAP lesions and an increased shoulder joint capsule thickness. These findings suggest that MR arthrography is an effective tool for assessing the joint capsule changes associated with labral tears, contributing to the better diagnosis and management of shoulder joint pathologies in clinical practice.

Trans-axillary sonography in the ABER (ABduction and External Rotation) position: a window to the subscapularis, teres major and latissimus dorsi.

Shoulder ultrasound is a key tool used by musculoskeletal practitioners to diagnose and treat a variety of upper girdle diseases. While magnetic resonance imaging is the cornerstone of shoulder imaging, sonography is readily available, practical and superior in its ability for dynamic assessment of musculoskeletal pathologies. The subscapularis, teres major and latissimus dorsi muscles are commonly involved in a myriad of pathology including myofascial pain and spasticity. There is scarce literature on the assessment of these muscles for diagnostic and therapeutic purposes. Conventional approaches to shoulder ultrasound have not included a dedicated assessment of the subscapularis muscle due to its inherent anatomical location deep to the scapular blade which blocks sound wave penetration. We describe an approach to visualizing the subscapularis muscle as a short addition to the established shoulder sonography format, which also permits assessment of both the latissimus dorsi and teres major muscles, which are important muscles for shoulder spasticity. The patient is imaged in a semi-recumbent position with the arms elevated above and behind the head in the ABduction and External Rotation (ABER) position. The relative ease of positioning and sonographic access to the musculature coupled with the potential for assessment and intervention makes this approach extremely desirable to the musculoskeletal practitioner looking to diagnose or treat muscle belly pathologies of the subscapularis, teres major or latissimus dorsi.

Diagnostic Comparison of Ultrasound and Magnetic Resonance Imaging in Detecting Rotator Cuff Tears: A Study Conducted in the Population of Vijayapura.

Injuries to the shoulder and restricted range of motion often lead to decreased work productivity, increased use of medical resources, and impaired quality of life.The most frequent cause of shoulder discomfort and dysfunction is a disease related to the rotator cuff, such as bursitis, degenerative tears, and calcific tendinosis. This study evaluates ultrasonography's diagnostic efficacy in relation to magnetic resonance imaging (MRI). Prospective research was conducted at a hospital to compare MRI and ultrasonography for shoulder cases involving rotator cuff injuries. There were 53 patients in the sample. Those who presented with pain and dysfunction in the shoulder were given both an MRI and an ultrasound (USG). Comparing the results of the MRI and USG allowed for the calculation of the diagnostic tests' accuracy, sensitivity, specificity, and positive and negative predictive values. The results of the study demonstrated a substantial agreement (p value <0.05) between the identification of rotator cuff tears by MRI and USG shoulder imaging. With a total accuracy of 88.6%, the sensitivity and specificity of identifying rotator cuff tears were 91.2% and 81.8%, respectively. With similar sensitivity and specificity, MRIand USG are useful diagnostic techniques for rotator cuff injuries. USG is a great screening alternative due to its cost-effectiveness, noninvasiveness, and easy accessibility. However, when it comes to identifying the anatomical regions that need surgical repair, MRI is superior.

Preoperative imaging predicts coracoid graft size and restoration of the glenoid track in Latarjet procedures

BackgroundGlenoid bone grafting procedures are often utilized to address glenoid bone loss in patients with recurrent shoulder instability. The purpose of this study was to determine if preoperative advanced imaging can accurately predict coracoid graft size and conversion of off-track to on-track Hill-Sachs lesions in patients undergoing Latarjet procedures. MethodsPatients who underwent Latarjet procedure for shoulder instability at a single institution from 2012-2020 with pre- and postoperative advanced shoulder imaging (computerized tomography (CT) or magnetic resonance imaging (MRI) scans) were retrospectively reviewed. Glenoid diameter, HS interval (HSI), and measurements of the coracoid length, depth, and height were measured on preoperative imaging. Glenoid track (GT), percent glenoid bone loss, predicted restoration of glenoid track, and the difference between HSI and GT (ΔHSI-GT) were calculated. ResultsSeventeen patients with a mean age of 25± 9 years met inclusion criteria. Average glenoid bone loss preoperatively was 24± 7% and average HSI was 27 ± 5mm. The Latarjet procedure reconstructed 116 ± 8% of the native glenoid, and 104 ± 8% of the predicted diameter. Of the 15 patients that had off-track lesions preoperatively, 11 were successfully converted to on-track lesions (73%). The 4 persistent off-track lesions had a significantly higher HSI (32 ± 2 mm vs. 26 ± 4 mm, p=0.002). Preoperative measurements accurately predicted postoperative glenoid track status in 94% of cases. At a mean follow-up of 2 years, there was no significant difference in recurrence rate or rate of revision stabilization procedures between patients with on-track versus persistent off-track humeral lesions. ConclusionPreoperative advanced imaging measurements can accurately predict whether an off-track Hill-Sachs can be converted to on-track after Latarjet procedure, further enhancing shoulder stability.

Deep learning-based reconstruction enhances image quality and improves diagnosis in magnetic resonance imaging of the shoulder joint.

Accelerated magnetic resonance imaging sequences reconstructed using the vendor-provided Recon deep learning algorithm (DL-MRI) were found to be more likely than conventional magnetic resonance imaging (MRI) sequences to detect subacromial (SbA) bursal thickening. However, the extent of this thickening was not extensively explored. This study aimed to compare the image quality of DL-MRI with conventional MRI sequences reconstructed via conventional pipelines (Conventional-MRI) for shoulder examinations and evaluate the effectiveness of DL-MRI in accurately demonstrating the degree of SbA bursal and subcoracoid (SC) bursal thickening. This prospective cross-sectional study enrolled 41 patients with chronic shoulder pain who underwent 3-T MRI (including both Conventional-MRI and accelerated MRI sequences) of the shoulder between December 2022 and April 2023. Each protocol consisted of oblique axial, coronal, and sagittal images, including proton density-weighted imaging (PDWI) with fat suppression (FS) and oblique coronal T1-weighted imaging (T1WI) with FS. The image quality and degree of artifacts were assessed using a 5-point Likert scale for both Conventional-MRI and DL-MRI. Additionally, the degree of SbA and SC bursal thickening, as well as the relative signal-to-noise ratio (rSNR) and relative contrast-to-noise ratio (rCNR) were analyzed using the paired Wilcoxon test. Statistical significance was defined as P<0.05. The utilization of accelerated sequences resulted in a remarkable 54.7% reduction in total scan time. Overall, DL-MRI exhibited superior image quality scores and fewer artifacts compared to Conventional-MRI. Specifically, DL-MRI demonstrated significantly higher measurements of SC bursal thickenings in the oblique sagittal PDWI sequence compared to Conventional-MRI [3.92 (2.83, 5.82) vs. 3.74 (2.92, 5.96) mm, P=0.028]. Moreover, DL-MRI exhibited higher detection of SbA bursal thickenings in the oblique coronal PDWI sequence [2.61 (1.85, 3.46) vs. 2.48 (1.84, 3.25) mm], with a notable trend towards significant differences (P=0.071). Furthermore, the rSNRs of the muscle in DL-MRI images were significantly higher than those in Conventional-MRI images across most sequences (P<0.001). However, the rSNRs of bone on Conventional-MRI of oblique axial and oblique coronal PDWI sequences showed adverse results [oblique axial: 1.000 (1.000, 1.000) vs. 0.444 (0.367, 0.523); and oblique coronal: 1.000 (1.000, 1.000) vs. 0.460 (0.387, 0.631); all P<0.001]. Additionally, all DL-MRI images exhibited significantly greater rSNRs and rCNRs compared to accelerated MRI sequences reconstructed using traditional pipelines (P<0.001). In conclusion, the utilization of DL-MRI enhances image quality and improves diagnostic capabilities, making it a promising alternative to Conventional-MRI for shoulder imaging.

Trustworthy deep learning framework for the detection of abnormalities in X-ray shoulder images.

Musculoskeletal conditions affect an estimated 1.7 billion people worldwide, causing intense pain and disability. These conditions lead to 30 million emergency room visits yearly, and the numbers are only increasing. However, diagnosing musculoskeletal issues can be challenging, especially in emergencies where quick decisions are necessary. Deep learning (DL) has shown promise in various medical applications. However, previous methods had poor performance and a lack of transparency in detecting shoulder abnormalities on X-ray images due to a lack of training data and better representation of features. This often resulted in overfitting, poor generalisation, and potential bias in decision-making. To address these issues, a new trustworthy DL framework has been proposed to detect shoulder abnormalities (such as fractures, deformities, and arthritis) using X-ray images. The framework consists of two parts: same-domain transfer learning (TL) to mitigate imageNet mismatch and feature fusion to reduce error rates and improve trust in the final result. Same-domain TL involves training pre-trained models on a large number of labelled X-ray images from various body parts and fine-tuning them on the target dataset of shoulder X-ray images. Feature fusion combines the extracted features with seven DL models to train several ML classifiers. The proposed framework achieved an excellent accuracy rate of 99.2%, F1Score of 99.2%, and Cohen's kappa of 98.5%. Furthermore, the accuracy of the results was validated using three visualisation tools, including gradient-based class activation heat map (Grad CAM), activation visualisation, and locally interpretable model-independent explanations (LIME). The proposed framework outperformed previous DL methods and three orthopaedic surgeons invited to classify the test set, who obtained an average accuracy of 79.1%. The proposed framework has proven effective and robust, improving generalisation and increasing trust in the final results.

Comparison of 3D Gradient-Echo Versus 2D Sequences for Assessing Shoulder Joint Image Quality in MRI.

Background: Three-dimensional gradient-echo (3D-GRE) sequences provide isotropic or nearly isotropic 3D images, leading to better visualization of smaller structures, compared to two-dimensional (2D) sequences. The aim of this study was to prospectively compare 2D and 3D-GRE sequences in terms of key imaging metrics, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), glenohumeral joint space, image quality, artifacts, and acquisition time in shoulder joint images, using 1.5-T MRI scanner. Methods: Thirty-five normal volunteers with no history of shoulder disorders prospectively underwent a shoulder MRI examination with conventional 2D sequences, including T 1- and T 2-weighted fast spin echo (T1/T2w FSE) as well as proton density-weighted FSE with fat saturation (PD-FS) followed by 3D-GRE sequences including VIBE, TRUEFISP, DESS, and MEDIC techniques. Two independent reviewers assessed all images of the shoulder joints. Pearson correlation coefficient and intra-RR were used for reliability test. Results: Among 3D-GRE sequences, TRUEFISP showed significantly the best CNR between cartilage-bone (31.37 ± 2.57, p < 0.05) and cartilage-muscle (13.51 ± 1.14, p < 0.05). TRUEFISP also showed the highest SNR for cartilage (41.65 ± 2.19, p < 0.01) and muscle (26.71 ± 0.79, p < 0.05). Furthermore, 3D-GRE sequences showed significantly higher image quality, compared to 2D sequences (p < 0.001). Moreover, the acquisition time of the 3D-GRE sequences was considerably shorter than the total acquisition time of PD-FS sequences in three orientations (p < 0.01). Conclusions: 3D-GRE sequences provide superior image quality and efficiency for evaluating articular joints, particularly in shoulder imaging. The TRUEFISP technique offers the best contrast and signal quality, making it a valuable tool in clinical practice.

Early Clinical Efficacy of Small Incision Reduction and Superior Closed Pin Fixation of Goss-Ideberg Type III Glenoid Fractures using X-ray and CT Scan.

Imaging techniques such as X-rays and 3D Computed Tomography (CT) are used to diagnose and evaluate a patient's shoulder before and after surgery. Identifying the kind, location, and severity of a shoulder fracture helps surgeons choose the right treatment and surgery. The study examines the effectiveness of small incision reduction and superior closure pinning in treating Ideberg type III glenoid fractures identified by X-ray and CT scans. From October 2017 to June 2022, 40 patients with Ideberg type III glenoid fractures underwent mini-incision reduction and superior closed pinning fixation using the Anterior (AA) and Posterior (PA) approaches. Pre- and post-surgery shoulder scores and imaging data were analyzed. Outpatient review and shoulder anteroposterior radiographs were collected at 1, 3, 6, and 12 months after surgery. We assessed shoulder joint function using the American Shoulder and Elbow Society (ASES) shoulder score, VAS score, Constant-Murley Shoulder Outcome (Constant) score, and DASH score. A total of 40 patients were monitored for 14-16 months, averaging 15.2 ± 0.3 months. All fractures were healed between 14-25 weeks from X-rays, averaging 17.6 ± 5.4 weeks. Both the AA and PA groups had similar shoulder score changes. However, the AA group did better. In all cases, ASES shoulder scores were outstanding at 80%. Radiographs demonstratedno traumatic arthritis or internal fixation failure consequences like screw loosening or breakage. It was concluded that Ideberg type III glenoid fracture reduction with an anterior small incision and superior closed pinning hollow lag screw internal fixation could be successful.

Patient experiences of rotator cuff-related shoulder pain and their views on diagnostic shoulder imaging: a qualitative study

Purpose To explore patient experiences of rotator cuff-related shoulder pain, and their views on the role and value of diagnostic shoulder imaging. Materials and methods Semi-structured interviews were conducted with 20 patients with shoulder pain exploring the impact and management of their shoulder condition, reasons for and experiences of diagnostic imaging, and feelings about and responses to diagnostic imaging findings. Framework analysis was used to analyse the dataset. Results Five themes were identified [1]: Lived experience and beliefs about pain and movement [2]; Contextualisation of imaging findings by health professionals is more important than the imaging report [3]; Factors influencing whether and when to have imaging [4]; Imaging can identify the actual problem and guide treatment; and [5] Treatment responses and treatment decision making. Conclusion Patients commonly believe imaging is needed to formulate a diagnosis. There was minimal concern about potential indirect harms that could arise (e.g., inappropriate diagnosis leading to unnecessary treatments). The context of the diagnostic imaging reports (i.e., what needed to be done) was perceived as more important than the exact meaning of the imaging findings. Patients felt that the diagnostic imaging confirmed their existing biomedical beliefs, and these beliefs were not challenged by their healthcare professionals.

Fully automatic system to detect and segment the proximal femur in pelvic radiographic images for Legg-Calvé-Perthes disease.

This study aimed to develop a method using computer vision techniques to accurately detect and delineate the proximal femur in radiographs of Legg-Calvé-Perthes disease (LCPD) patients. Currently, evaluating femoral head deformity, a crucial predictor of LCPD outcomes, relies on unreliable categorical and qualitative classifications. To address this limitation, we employed the pretrained object detection model YOLOv5 to detect the proximal femur on over 2000 radiographs, including images of shoulders and chests, to enhance robustness and generalizability. Subsequently, we utilized the U-Net convolutional neural network architecture for image segmentation of the proximal femur in more than 800 manually annotated images of stage IV LCPD. The results demonstrate outstanding performance, with the object detection model achieving high accuracy (mean average precision of 0.99) and the segmentation model attaining an accuracy score of 91%, dice coefficient of 0.75, and binary IoU score of 0.85 on the held-out test set. The proposed fully automatic proximal femur detection and segmentation system offers a promising approach to accurately detect and delineate the proximal femoral bone contour in radiographic images, which is essential for further image analysis in LCPD patients.Clinical significance: This study highlights the potential of computer vision techniques for enhancing the reliability ofLegg-Calvé-Perthes diseasestaging and outcome prediction.

“Rice bodies” symptoms on magnetic resonance imaging of the shoulder in a patient with rheumatoid arthritis

The “rice bodies” symptom on magnetic resonance imaging of the shoulder joint in patients with rheumatoid arthritis is a rare but specific finding characterized by the presence of multiple small, round, rice-grain-like structures in the synovial fluid of the joint, synovial pouches, or sheaths. The etiology of the “rice bodies” is still not fully understood. They are suggested as the result of microinfarcts of the synovial membrane in patients with rheumatoid arthritis or other inflammatory joint diseases. Clinically, the “rice bodies” symptom may cause pain, but not in every case. Among radiological diagnostic methods, magnetic resonance imaging is the leading method for the detection of rice bodies. This article presents a clinical case of “rice bodies” symptoms diagnosed by magnetic resonance imaging in a patient with a long history of rheumatoid arthritis who presented with a painless enlargement in the left shoulder. Computed tomography and magnetic resonance imaging of the left shoulder could detect “rice bodies” as a manifestation of an underlying disease and determine further treatment techniques.

Appropriate intradeltoid muscle needle penetration depth in vaccine administration: an MRI study in Thailand.

The objective of this study was to evaluate the appropriate vaccination needle penetration depth into the deltoid muscle to avoid injection-site complications from an inappropriate injection depth and/or injection site in the Thai population. This was a retrospective study using axial proton density-weighted images of MRI shoulders at the level of 2 fingerbreadths below the acromion process to measure the combined thickness of the skin, subcutaneous fat pad and deltoid muscle to evaluate the percentage of injections into the deltoid muscle with various needle penetration depths. There were 509 MRI shoulder images of 222 males and 287 females (265 right shoulders and 244 left shoulders). The average body mass index and age were 24.54 ± 3.54 kg/m2 and 64.81 ± 10.20 years, respectively. Using a needle penetration depth of 12.7 mm (0.5 inches) achieved 100% of injections into the deltoid muscle. We recommend advancing the entire length of a 0.5-inch needle perpendicular to the skin at 2 fingerbreadths below the acromion process for adult intradeltoid vaccinations. This approach ensures optimal vaccine delivery and minimizes the risk of injection-related injuries.

Concordance of shoulder symptoms and imaging findings: a protocol for the Finnish Imaging of Shoulder (FIMAGE) study

IntroductionShoulder pain is a substantial medical and socioeconomic problem in most societies, affecting the ability to work or carry out leisure time activities as well as subsequently influencing physical and...

Native Glenoid Depth and Hill-Sachs Lesion Morphology in Traumatic Anterior Shoulder Instability

Background: Although Hill-Sachs lesions (HSLs) are assumed to be influenced by glenoid characteristics in the context of bipolar bone loss, little is known about how glenoid concavity influences HSL morphology. Purpose: To investigate the relationship between the native glenoid depth and HSL morphological characteristics. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Computed tomography images of bilateral shoulders from 151 consecutive patients with traumatic unilateral anterior shoulder instability were retrospectively reviewed. Patients were categorized into flat (<1 mm), moderate (1-2 mm), and deep (>2 mm) groups based on the native glenoid depth measured from the contralateral unaffected shoulder. The HSL morphological characteristics included size (depth, width, length, and volume), location (medial, superior, and inferior extent), and orientation (rim and center angle). The glenoid characteristics included diameter, depth, version, and bone loss. The patient, glenoid, and HSL morphological characteristics were compared among the 3 depth groups. Subsequently, the independent predictors of some critical HSL morphological characteristics were determined using multivariate stepwise regression. Results: After exclusion of 55 patients, a total of 96 patients were enrolled and classified into the flat group (n = 31), moderate group (n = 35), and deep group (n = 30). Compared with those in the flat group, patients in the deep group were more likely to have dislocation (38.7% vs 93.3%; P = .009) at the primary instability and had a significantly larger number of dislocations (1.1 ± 1.0 vs 2.2 ± 1.8; P = .010); moreover, patients in the deep group had significantly deeper, wider, larger volume, more medialized HSLs and higher incidences of off-track HSLs (all P≤ .025). No significant differences were detected among the 3 groups in HSL length, vertical position, and orientation (all P≥ .064). After adjustment for various radiological and patient factors in the multivariate regression model, native glenoid depth remained the strongest independent predictor for HSL depth (β = 0.346; P < .001), width (β = 0.262; P = .009), volume (β = 0.331; P = .001), and medialization (β = −0.297; P = .003). Conclusion: The current study sheds light on the association between native glenoid depth and the morphology of HSLs in traumatic anterior shoulder instability. Native glenoid depth was independently and positively associated with HSL depth, width, volume, and medialization. Patients with deeper native glenoids were more likely to have off-track HSLs and thus require more attention in the process of diagnosis and treatment.

Seven general radiography x-ray detectors with pixel sizes ranging from 175 to 76 μm: technical evaluation with the focus on orthopaedic imaging

Aim. Flat panel detectors with small pixel sizes general can potentially improve imaging performance in radiography applications requiring fine detail resolution. This study evaluated the imaging performance of seven detectors, covering a wide range of pixel sizes, in the frame of orthopaedic applications. Material and methods. Pixel sizes ranged from 175 (detector A175) to 76 μm (detector G76). Modulation transfer function (MTF) and detective quantum efficiency (DQE) were measured using International Electrotechnical Commission (IEC) RQA3 beam quality. Threshold contrast (C T) and a detectability index (d′) were measured at three air kerma/image levels. Rabbit shoulder images acquired at 60 kV, over five air kerma levels, were evaluated in a visual grading study for anatomical sharpness, image noise and overall diagnostic image quality by four radiologists. The detectors were compared to detector E124. Results. The 10% point of the MTF ranged from 3.21 to 4.80 mm−1, in going from detector A175 to detector G76. DQE(0.5 mm−1) measured at 2.38 μGy/image was 0.50 ± 0.05 for six detectors, but was higher for F100 at 0.62. High frequency DQE was superior for the smaller pixel detectors, however C T for 0.25 mm discs correlated best with DQE(0.5 mm−1). Correlation between C T and the detectability model was good (R 2 = 0.964). C T for 0.25 mm diameter discs was significantly higher for D150 and F100 compared to E124. The visual grading data revealed higher image quality ratings for detectors D125 and F100 compared to E124. An increase in air kerma was associated with improved perceived sharpness and overall quality score, independent of detector. Detectors B150, D125, F100 and G76, performed well in specific tests, however only F100 consistently outperformed the reference detector. Conclusion. Pixel size alone was not a reliable predictor of small detail detectability or even perceived sharpness in a visual grading analysis study.

Correlation of the depth, medial wall and opening angle of the bicipital groove and the dimensions of long head of the biceps tendon

Objectives: The aim of this study was to investigate the relationship between the morphological measurements of bicipital groove and long head of biceps tendon and determine the effect of age and gender on these measurements. Methods: The study included 110 patients (60 females, 50 males) aged 18–50 years, who underwent magnetic resonance imaging of the left shoulder between January and December 2020. The patients had stable biceps tendons, and did not have a rotator cuff tear. The bicipital groove morphology was evaluated based on depth, opening angle, medial wall angle and the biceps tendon morphology was assessed based on thickness (anteroposterior length) and width (transverse length). Results: There was no difference between the females and males in terms of age, opening angle and medial wall angle (p&gt;.05). The bicipital groove depth was lower in the females than in the males (p&lt;.001), while the biceps tendon was thicker in the males compared to the females (p&lt;.001). There was no correlation between age and the sizes of bicipital groove and the biceps tendon. A negative correlation was observed between the bicipital groove depth and opening angle (r=-0.55), and a positive correlation between medial wall angle (r=0.51), tendon thickness (r=0.50) and tendon width (r=0.34). Bicipital groove depth had a positive correlation with tendon thickness (r=0.54) in women and tendon width in men (r=0.28). Conclusion: The morphological measurements of bicipital groove and the biceps tendon showed correlations. There were also gender differences in these morphological measurements.

Settings and Indications of Ultrasound in Imaging of Shoulder, Foot, and Ankle

Ultrasonography is a well-established musculoskeletal imaging technique with a multitude of advantages when compared to other modalities. It provides great spatial resolution in the evaluation of superficial articular and peri-articular structures including tendons, ligaments, bursae, and nerves. Given that it is the only modality which allows dynamic assessment, it also plays a crucial role in diagnosing impingement, subluxation/dislocation, and instability. The purpose of this article is to review the settings and indications of US in the imaging of shoulder, foot, and ankle in particular. Relevant literature, predominantly in the form of peer-reviewed journal articles was obtained from the electronic databases such as PubMed and MEDLINE and reviewed in a structured manner. This was combined with background knowledge and expertise in this field.

Comparative evaluation of ultrasonography with magnetic resonance imaging in the diagnosis of shoulder ailments

Background: Shoulder pain encompasses a diverse array of pathologies and can affect as many as one quarter of the population depending on age and risk factors. It may be caused by problems with the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, or other soft tissues around the shoulder. Aims and Objectives: The main aim of the study is to compare the diagnostic accuracy of ultrasound (US) shoulder and magnetic resonance imaging (MRI) of the shoulder in the diagnosis of shoulder ailments. Materials and Methods: This is a comparative study done in Department of Radiology, Aarupadai Veedu Medical College and Hospital, Pondicherry. In total, 54 patients were included for ultrasonography (USG) and MRI examination of shoulder ailments. The statistical analysis was done using Statistical Package for the Social Sciences Version 21.0 statistical analysis software. Results: Subacromial-Subdeltoid Bursitis is the most common finding. US detects partial-thickness tears with a sensitivity of 63.3% and a specificity of 70.8% and full-thickness tears with a sensitivity of 80.0% and a specificity of 91.8%. Trauma was the etiology in only a few patients. MRI is more sensitive than USG in identifying labral and capsular pathologies. MRI is the most sensitive and specific modality for the establishment of shoulder pain. MRI is useful in cases in which the diagnosis is uncertain on USG. Conclusion: MRI is recommended as a secondary method since it provides more information about the extent of tendons and has a lower artifact risk.

La découverte d’une arthrose acromio-claviculaire est la norme sur les IRM après l’âge de 40 ans

BackgroundAcromioclavicular joint (AC) arthritis (A) is a common incidental finding on shoulder imaging. An improved knowledge of the age- and sex-specific prevalence (or base rate) of incidental ACA can inform diagnosis and treatment strategies for shoulder pain. HypothesisThere is no relationship between age or gender and the presence or severity of MRI findings consistent with osteoarthritis of the acromioclavicular joint. MethodsWe rated ACA on 475 MRIs from a database of patients who had MRIs for non-AC indications. The cohort consisted of 51% men, 49% women, and had an average age of 55. Bivariate analyses were used for analysis of age and sex-specific prevalence. ResultsThe prevalence of findings consistent with ACA on MRI for non-AC indications was 83%. The prevalence increased from 75% between ages 40 and 50 to 100% after age 70. Logistic regression demonstrated an association between age and ACA (Odds Ratio 2.89; 95% confidence interval [CI]=2.30 to 3.63; p=0.001). No difference was seen by sex (CHI-Square, 0.16; p=0.67). There was a positive correlation between age and ACA severity (Spearman's rho=0.43; p=0.000010). DiscussionThe observation that MRI evidence of ACA is the norm (75%) after age 40 and is universal with human aging (100% after age 70), makes it very difficult to discern ACA as a cause of shoulder symptoms. Given the near universal prevalence of radiological ACA, imaging cannot be used as a reference standard for diagnosis of symptomatic ACA based on symptoms and signs. Level of evidenceNot applicable.

MRI appearance of multiple displaced osteochondritis dissecans cartilage fragments in the bicipital tendon sheath of a juvenile dog

A 1-year-old Bernese Mountain dog presented with an acute onset of left thoracic limb lameness. Magnetic resonance imaging (MRI) of the left shoulder was performed, showing a subchondral bone defect in the caudomedial aspect of the humeral head. In addition, several round hypointense structures were visible in the biceps tendon sheath. A left shoulder arthroscopy was performed, which confirmed an osteochondritic lesion. Exploration of the biceps tendon sheath via a small open approach allowed retrieval of the fragments, which likely migrated from the joint. Histopathology confirmed the structures to be multiple osteochondritic fragments.