Small Joint Effusion Research Articles

Prevalence of Transient Osteoporosis of the Hip Among Patients Presenting With Hip Pain in a Major Tertiary Hospital in Saudi Arabia.

Transient osteoporosis of the hip, or acute bone marrow edema syndrome, is a rare condition characterized by a decrease in bone mineral density of the proximal femur, which resolves with conservative management over 6-24 months. At presentation, the patient complains of sudden onset of localized pain in the hip, which is aggravated by weight-bearing. However, the prevalence and risk factors for this condition are still unclear. Objective: This study aims to identify the prevalence of transient osteoporosis of the hip among patients who present with hip pain and underwent magnetic resonance imaging of the hip. This is a retrospective investigation that involved collecting data from patients' records in a tertiary hospital in Saudi Arabia. Included candidates were patients who presented with hip pain, had an MRI done between 2016 and 2019 inclusive, and were older than 14 years. The collected data involved the age and gender of patients, the hip's affected side, and the diagnosis. Data analysis was executed through SPSS version 26 (IBM Corp., Armonk, NY). Three hundred and fourteen patients matched our inclusion criteria. The prevalence of transient osteoporosis of the hip was 2.5%. All of them were males and half were above 40 years, 50% had pain in the left side, and 75% had a small joint effusion. The femoral head was the most affected part of the joint in patients with transient osteoporosis of the hip. Among our patients, the most common cause of hip pain was gluteus medius tendonitis (12.9%), where 33.1% of patients with hip pain had normal examination and investigations, and 15.2% had more than one condition. Risk factors for transient osteoporosis of the hip are pain in the left hip joint (p-value=0.023) and an age between 41 and 50 years (p-value=0.012). The prevalence of transient osteoporosis of the hip is low, yet it requires confirmation by studies with a more robust design. Males older than 40 years and left-side hip pain are at higher risk.

003 Juvenile idiopathic arthritis: a series of 22 cases

Abstract Introduction Juvenile Idiopathic Arthritis (JIA) is a group of conditions in which the first sign of the disease appears before the child's 16th birthday. The common feature is the presence of at least one arthritis of > 6 weeks’ duration with no recognized aetiology. JIA affect approximately one child in 5000 before the age of 16. Materials and Methods This is a retrospective study of 22 cases of juvenile idiopathic arthritis from the department of pediatrics at the Mohammed VI University Hospital in Oujda seen over a period of four years and 7 months (January 2014 to August 2018). Results The patients were 10 girls and 12 boys aged from 1 to 13 years. The hospital frequency of this disease was 0.49%, six clinical forms of onset were seen: 8(36%) had systemic onset JIA, 5(23%) had Oligoarticular JIA, 2(9%) had rheumatoid positive polyarticular JIA, 3(14%) had rheumatoid negative polyarticular JIA, 2(9%) had enthesitis related arthritis, and 2(9%) had undifferentiated arthritis. The diagnosis was based on clinical, biological, radiological and evolutionary elements. The biologic inflammatory syndrome was present in almost all patients in our series. Anti-nuclear antibodies were positive in two cases of polyarticular JIA and rheumatoid factor was positive in 10% of our patients. 25% had radiological features: one patient was classified as Steinbrocker stage I and the second with systemic JIA as stage III. Two other patients with oligoarticular JIA had small joint effusion and fixed flexion deformities. The treatment was with non-steroidal anti-inflammatory drugs, corticosteroids, salicylates and disease modifying anti-rheumatic drugs which were methotrexate in 47% of cases, and biotherapy in 9% of them. Outcome was favorable in most of the patients, but 31% developed complications which were: growth retardation (2), joint deformities (1), and iatrogenic complications of medical treatment (4). The variability of the outcome reflects the extreme heterogeneity of clinical forms of JIA. Conclusion The treatment of a child with JIA cannot be conceived outside of a multidisciplinary pediatric team. The treatment includes medication and measures to maintain a good functional state of the joints, notably rehabilitation and surgery. The biotherapies have revolutionized the therapeutic approach to JIA, with a notable effect of these new molecules, particularly anti TNF, anti-IL 1 and anti-IL 6.

A Soccer Fan’s Pain In The Elbow

HISTORY: A 35-year-old right-hand dominant male soccer fan presents with 3 days of acute right elbow pain. He began to experience progressive right lateral elbow pain while clapping exuberantly during a Seattle Sounders come from behind victory. He could recall no other trauma or inciting event. He had noticed some mild elbow soreness a few days preceding acute onset of pain. He endorsed elbow warmth and swelling as well as severe pain with any movement. He denied numbness, tingling, chills, fevers, fatigue, malaise. No prior history of rheumatic disease or gout. An x-ray obtained prior to presentation to our clinic showed small elbow joint effusion which the radiologist noted was suspicious for occult radial head fracture. PHYSICAL EXAMINATION: Swelling of right elbow with mild erythema. Decreased passive and active range of motion with elbow flexion, elbow extension, pronation, and supination. Tenderness to palpation overlying radial head as well as to olecranon bursa. Resisted wrist extension reproduced symptoms. Neurovascular exam was normal. DIFFERENTIAL DIAGNOSIS: 1. Occult radial head fracture 2. Lateral epicondylitis 3. Radial tunnel syndrome 4. Septic arthritis 5. Inflammatory arthropathy TEST AND RESULTS: X-ray: A small joint effusion suspicious for occult radial head fracture was noted. Ultrasound: Large elbow joint effusion tracking from the radiocapitellar joint deep to the triceps tendon insertion posteriorly. Common extensor tendon was intact. No swelling of the radial nerve visualized. Joint Aspiration: Joint aspiration revealed initially bloody then cloudy fluid. No organisms on gram stain or culture. Cell count revealed inflammatory joint aspirate containing over 50,000 WBCs of which 95% were neutrophils. Intracellular monosodium urate crystals were identified. FINAL WORKING DIAGNOSIS: Acute gout flare of right elbow TREATMENT AND OUTCOMES: Radiocapitellar joint steroid injection was performed due to ongoing pain despite oral NSAID use. Elbow pain resolved approximately 1 week after the injection. Dietary considerations were discussed. Patient advised to discuss uric acid lowering agents with PCP.

Clinical utility of accelerated MAVRIC-SL with robust-PCA compared to conventional MAVRIC-SL in evaluation of total hip arthroplasties.

To compare the diagnostic performance of a conventional metal artifact suppression sequence MAVRIC-SL (multi-acquisition variable-resonance image combination selective) and a novel 2.6-fold faster sequence employing robust principal component analysis (RPCA), in the MR evaluation of hip implants at 3T. Thirty-six total hip implants in 25 patients were scanned at 3T using a conventional MAVRIC-SL proton density-weighted sequence and an RPCA MAVRIC-SL proton density-weighted sequence. Comparison was made of image quality, geometric distortion, visualization around acetabular and femoral components, and conspicuity of abnormal imaging findings using the Wilcoxon signed-rank test and a non-inferiority test. Abnormal findings were correlated with subsequent clinical management and intraoperative findings if the patient underwent subsequent surgery. Mean scores for conventional MAVRIC-SL were better than RPCA MAVRIC-SL for all qualitative parameters (p < 0.05), although the probability of RPCA MAVRIC-SL being clinically useful was non-inferior to conventional MAVRIC-SL (within our accepted 10% difference, p < 0.05), except for visualization around the acetabular component. Abnormal imaging findings were seen in 25 hips, and either equally visible or visible but less conspicuous on RPCA MAVRIC-SL in 21 out of 25 cases. In 4 cases, a small joint effusion was queried on MAVRIC-SL but not RPCA MAVRIC-SL, but the presence or absence of a small effusion did not affect subsequent clinical management and patient outcome. While the overall image quality is reduced, RPCA MAVRIC-SL allows for significantly reduced scan time and maintains almost equal diagnostic performance.

Self-assessment

A 10 year old Caucasian girl is referred by her General practitioner to the paediatric ambulatory unit with an 8 week history of persistent swelling and redness of her left knee. There is no history of trauma or recent foreign travel. There are no other systemic symptoms except she feels tired sometimes. She complains of intermittent pain lasting for up to a week. There is no family history of note. General examination was unremarkable except for minimal pallor. She walks with an antalgic gait, and her left knee is red and swollen with restricted movements and a small joint effusion. There is no leg length discrepancy.

Multimodality imaging of chronic tophaceous gout

The diagnosis of gout is usually based on clinical presentation and laboratory findings. Imaging plays a role in the assessment and grading of articular damage related to chronic, long-standing disease, which is characterized by granulomatous synovitis, tophi, and erosions. Multimodality imaging of chronic tophaceous gout may be useful in clinical practice for a variety of purposes, including assessment of disease-related anatomical changes and monitoring of articular and soft-tissue lesions over time, especially in response to urate-lowering therapy. Radiography remains the primary imaging technique. Ultrasonography may detect monosodium urate crystals on cartilage, is helpful to assess small joint effusion, to guide to joint aspiration, and to evaluate the volume of tophi. Computed tomography is considered to be more sensitive than plain radiography in the detection and evaluation of cortical bone erosions associated with tophi. MRI represents the only imaging modality which provides visualization of bone marrow oedema associated with erosions and may be useful to characterize and distinguish tophi from other soft tissue nodules.

Acute Knee Injury in a Soccer Player

HISTORY: A fifteen year old female high school soccer player presented to a sports medicine clinic with a 2 day history of right knee pain. During a soccer game, she was tripped up over another player's feet going for the ball suffering a valgus injury to her right knee. Patient reported feeling a pop with immediate pain. She limped off of the field but had been using crutches and knee immobilizer at time of presentation. She complained of swelling and worsening pain with weight-bearing or knee flexion. She denied radiation of her pain, numbness or tingling. Medical HISTORY: Negative for previous knee injury or surgery. Positive for ankle sprain PHYSICAL EXAM: Right knee: Small joint effusion with tenderness to palpation over course of MCL primarily proximal and midportion as well as over lateral femoral condyle. Negative patellar apprehension test. Range of motion limited in flexion to 90 degrees. Patient able to achieve full extension. There was no laxity with valgus and varus stress at 0 degrees. At 30 degrees had guarding and laxity (1+) with valgus stress. stable to varus stress. Guarded with lachman exam without firm endpoint. Negative posterior drawer. Pain with McMurray's test without catch or clunk, localized deep in knee. Full range of motion at ankle, 2+ distal pulses, sensation intact to light touch in LE. DIFFERENTIAL DIAGNOSIS: 1. ACL injury 2. Patellar Dislocation 3. Bone Bruise 4. Occult Fracture 5. Meniscus Injury 6. MCL sprain TESTS AND RESULTS: Plain films: 3 views right knee: no acute fracture MRI right knee: non- displaced Salter-Harris IV fracture of the distal femur. Grade 2 sprain of the superficial medial collateral ligament and patellofemoral ligament at the femoral attachment. Bone marrow contusion pattern suggesting a pivot shift injury with intact ACL. Working Diagnosis: MCL sprain with non-displaced Salter IV femur fracture Treatment: 1. 6 weeks nonweightbearing in TROM with progressive return to weightbearing activities. 2.Locked in extension for 4 weeks, unlocked TROM for 2 weeks 3. Physical therapy: Initially comprised of straight leg raises, quadriceps sets and range of motion modalities. At 4 weeks, therapy was advanced to progressive weightbearing activities. At 6 weeks, patient was transitioned to sport specific modalities and agility training. Outcome: Gradual return to soccer play in 10 weeks

Spectrum of magnetic resonance imaging appearances of juvenile temporomandibular joints (tmj) in non-rheumatic children

Temporomandibular joints (TMJ) are frequently involved in children with juvenile idiopathic arthritis (JIA), and gadolinium-enhanced magnetic resonance imaging (MRI) is the only modality for an early diagnosis. However, only very few data exist on the appearance of contrast-enhanced MRI of normal juvenile TMJ. To define the spectrum of normal MRI findings of juvenile TMJ, and to assess a possible overlap with findings typical for active synovitis in JIA. 96 children (192 TMJ), 51 boys and 45 girls with a median age of 7.8 years (range 3-13 years), underwent a head MRI. The presence of autoimmune disease, including JIA, was excluded via chart history, available laboratory findings, and the absence of known typical pathological MRI changes (degree of synovial enhancement, hyperintense signal on T2-weighted images in the synovia or bone marrow, and morphologic changes of the mandibular condyle) of the TMJ affected by JIA. In 90 (94%) children, the TMJ showed no MRI abnormalities compatible with arthritis. In three children (3%), the only abnormal MRI finding was a small bilateral joint effusion. A further three children (3%) had a mild synovial enhancement seen on both axial and coronal MR planes in one child and only in the axial plane in the other two children. Signal hyperintensity on T2-weighted images and other corresponding characteristics of TMJ inflammation were lacking in all these six patients. The vast majority of juvenile TMJ in non-rheumatic children shows no MRI abnormalities. Exceptions, including a discrete enhancement of the synovial membrane (3%) or small joint effusions (3%), can occur in a minority of patients, but none of them are accompanied by other signs of inflammation or morphological changes of the TMJ.

Case 2: A teenage boy with epistaxis

A previously well 15-year-old boy presented to the emergency room with a three-month history of intermittent epistaxis, hemoptysis, intermittent low-grade fevers, cough and weight loss. The history began three months before presentation; while he had been participating in ultimate fighting, he was punched in the nose and developed a significant episode of epistaxis. Following this, he developed several more episodes of epistaxis and hemoptysis requiring cautery on three occasions in a community emergency department. During this period, a chest x-ray was performed that was reported as normal. Two months before admission, he developed right-sided otalgia, pharyngitis, and facial pain and tenderness. A computed tomography of his sinuses showed right maxillary sinusitis. A computed tomography of the chest was reported as normal. One month before presentation, his cough worsened. He developed dyspnea, hoarseness and gingival bleeding. The patient’s family doctor had referred him to a local otolaryngologist who had performed sinus lavage, septoplasty for septal perforation and placed tympanostomy tubes 10 days before admission. On review of his systems, the patient disclosed orthopnea, past arthralgia in the right thumb interphalangeal joint and right knee, vertigo and anorexia. He believed that the majority of his 14 kg weight loss had occurred over the past month. He denied any other sites of bleeding, recent travel or sick contacts. His medical history was significant for a two-year history of intermittent recurrent sinusitis treated with antibiotics, multiple tympanostomy tubes for frequent childhood otitis media and mild asthma. His family history was unremarkable. His physical examination revealed an unwell, but nontoxic-appearing boy, who was lying in bed (with the head of the bed tilted at 45 degrees) and breathing shallowly and sweating. His vital signs revealed a temperature of 36.8°C, heart rate of 90 beats/min, respiratory rate of 18 breaths/min, blood pressure of 120/70 mmHg and an oxygen saturation of 95% on room air. His weight was 64 kg, and his height was 172 cm. Head and neck examination revealed friable and bloody gums, and bloody crusts in the nares, but was otherwise normal. On respiratory examination, he had laboured breathing and breathlessness with hoarse speech, inspiratory and expiratory stridor, decreased air entry to the bases of the lungs bilaterally and a prolonged expiratory phase. No wheezes or crackles were audible. The remainder of the examination was unremarkable. On later consultation with the rheumatology consultant, he was found to have small joint effusions of the right thumb interphalangeal joint and the right knee. Initial laboratory studies included a normal complete blood count, electrolytes, blood urea nitrogen, creatinine and coagulation screen. The erythrocyte sedimentation rate was elevated at 40 mm/h. Additional imaging and bloodwork revealed the diagnosis.

Anterior Thigh Pain in a Collegiate Basketball Player

HISTORY: A 21 year old college student was playing basketball when he sustained an injury to his right thigh. He jumped up for a rebound and when he landed, he felt a pop and experienced pain over his right anterior thigh. He was unable to continue playing. He developed ecchymosis over the injured site. The pain was gradually improving when he sought medical attention four weeks later. He had not yet returned to playing basketball. He denied any numbness, tingling, or paresthesias. He denied low back pain or knee pain. By the time of his follow-up examination five weeks later, he had resumed playing basketball. He denied any further pain, however he occasionally experienced weakness and instability of his right knee. PHYSICAL EXAM: On initial examination, he was ambulating with a normal gait. He had no gross deformity or atrophy, no palpable tenderness or defect over his quadriceps muscle, and no appreciable soft tissue swelling or ecchymosis. He had no pain to active quadriceps resistance. Knee and hip range of motion were normal with no pain to resistive testing. Distal neurovascular exam was intact. On follow-up examination he had a grossly visible and palpable deformity over the anterior proximal thigh with tightening of quadriceps/VMO. The deformity was soft, non-tender and mobile. DIFFERENTIAL DIAGNOSIS: Quadriceps strain/rupture Hematoma Sarcoma Myositis Deep venous thrombosis TEST AND RESULTS: MRI right thigh: Myofascial muscular strain involving the rcctus femoris with suspicion for a tear of the tendon. A fluid component was seen around the inferior portion of the muscle extending down along the course of the expected tendon. MRI right knee: Small joint effusion. Extensor mechanism at level of the knee was intact. Equivocal findings for sprain of anterior cruciate ligament. FINAL WORKING DIAGNOSIS: Rectus femoris tendon tear TREATMENT AND OUTCOMES: Non-operative management with supervised physical therapy. Returned to playing basketball less than 4 weeks post injury.

Image features of herniation pit of the femoral neck

Objeetive To evaluate imaging appearances of herniation pit of the femoral neck.Methods We retrospectively analyzed the X-ray,CT and MRI findings of 9 patients with herniation pit of the femoral neck.All nine patients were male with the age ranging from 21 to 73 years.They had pain in the hip from two months to two years duration.Results The bilateral hips were affected in six patients,the right hips in the other 3 patients.Of the nine patients,X-ray plain films(2 cases),CT scanning(6 cases),and MR scanning(5 cases)were performed.The size of the lesions ranged from 0.5 cm×0.6 cm to 1.0 cm×1.5 cm,located in the anterosuperior portion of the femoral neck(n=7)or anteroinferior portion(n=2).X-ray plain films showed an osteolytic lesion surrounded by a sclerotic rim.CT scanning showed the lesion just below the cortex of the femoral neck surrounded by a rim of sclerosis or associated with a small cortical break in two patients.MR scanning showed low signal intensity in five patients on T1WI and high signal intensity surrounded by a rim of low signal intensity(n=3)or low signal intensity(n=2)on T2WI,and high signal intensity on fat suppression MR image.A small joint effusion was observed in two cases on T2WI.Conclusion The CT and MRI findings of herniation pit of the femoral neck are characteristic,it is useful in defining the diagnosis of the herniation pit of the femoral neck. Key words: Femoral neck; Bone diseases; Diagnostic imaging

Inflammatory arthritis-like and other MR findings in wrists of asymptomatic subjects

To describe magnetic resonance (MR) imaging findings in the wrists of asymptomatic subjects that might be confused with pathologic findings. MR examination of the dominant wrist was performed in 30 asymptomatic volunteers aged 22-49 years using pre-contrast and post-contrast sequences in the coronal and axial planes. The bases of the metacarpals, the carpus and the distal radius and ulna were evaluated by two musculoskeletal radiologists for lesions, notches, blood vessels and synovial enhancement. There were 24 bright osseous lesions (erosions, intraosseous ganglia, oedema or cysts) in 14 subjects. Intraosseous blood vessels were seen in all but one wrist examined, most commonly in the capitate and lunate bones. Enhancement was present in 26 of 27 notches identified at the base of the second metacarpal and less commonly in the capitate, hamate and triquetral notches. A small joint effusion was present in 14 subjects. Joint or soft-tissue enhancement was identified in 16 wrists. Many MR abnormalities and variants may be detected in the wrists of asymptomatic subjects. Many of these could be confused with pathologic findings usually associated with inflammatory arthritis.

An Unusual Case of Knee Pain

Osteomyelitis of the patella is a rare disease, which primarily affects the pediatric population. We present a case of hematogenous osteomyelitis of the patella with secondary development of septic arthritis of the knee. There is often a delay in diagnosis, as illustrated by our case report, due to the rarity of the condition and nonspecific presentation. There is usually no history of trauma. Focal tenderness over the patella is the most helpful clinical sign. A small joint effusion may be present which is usually sterile and reactionary due to inflammation of the patella. Treatment of osteomyelitis of the patella is similar to treatment of osteomyelitis in other areas. Function and range of motion of the knee usually returns to normal after completion of treatment. A delay in diagnosis may lead to progression of disease and complications such as septic arthritis of the knee.

Vertical Medial Malleolar Fracture in a Collegiate Soccer Player With Tibia Varus

HISTORY: 18 yo male collegiate soccer player with history of nondisplaced, isolated, vertical medial malleolar fracture treated conservatively with short leg nonweightbearing cast for 3 weeks followed by walking boot for 3 more weeks. 6 week radiographs showed interval healing and no change in alignment, and he returned to full activity after achieving full range of motion with physical therapy. He was asymptomatic until 7 months after initial injury when during a soccer game he felt a pop and developed medial ankle pain after landing flat on his previously injured ankle. He presented to our clinic for evaluation. PHYSICAL EXAMINATION: Mild swelling without ecchymosis over medial ankle. Small joint effusion palpable. Medial pain with attemped weight bearing. Tender to palpation 3cm above medial malleolus. No fibular or syndesmotic tenderness. Mildly tender over deltoid and posterior tibial tendon. Nontender over lateral ligaments. Negative lower extremity squeeze test. Normal Thompson's test. No pain with calcaneal squeeze or palpation over navicular, cuboid, or fifth metatarsal base. Normal neurovascular exam distally in his foot. Tibia varus alignment. DIFFERENTIAL DIAGNOSIS: Medial malleolar fracture Deltoid ligament sprain Avulsion fracture medial malleolus Posterior tibial tendon strain or subluxation Syndesmotic sprain Talar dome fracture. TEST AND RESULTS: Radiographs of ankle showed no displacement but increased lucency through callous formation from previous fracture. No widening of ankle mortise. No talar dome lesions. No other fractures. FINAL WORKING DIAGNOSIS: Nondisplaced fracture through previous fibrous union of vertical medial malleolar fracture. TREATMENT AND OUTCOMES: Patient underwent operative plate fixation with bone grafting of medial malleolar fracture. Current literature supports conservative management for isolated, nondisplaced, medial malleolar fractures (Richter, Orthopade 1999;28(6), Thordarson, Physician and Sportsmedicine 1996;24(9)). This case is very similar to that of a well known professional basketball player who underwent 4 surgeries and missed most of two seasons for a similar fracture. In these cases, it is hypothesized that the tibia varus alignment contributed to the vertical orientation of the fracture, incomplete healing, and subsequent reinjury. Anatomic alignment should be considered in management decisions for vertical medial malleolar fractures. Patients with tibia varus alignment may have a higher rate of complications and may need longer immobilization or initial operative fixation for these types of fractures.

Return To Sports After A Contact Knee Injury In An Elite Female Soccer Player

HISTORY A 17 - year - old female soccer athlete sustained a contact injury to her right knee when she collided with an opposing defender. The athlete recalled falling to the turf after her knee hyperextended as a result of the impact. She had to be helped off the field and was unable to return to competition. Her chief complaints on the sidelines were pain in the distal thigh as well as tingling or numbness just below the knee. Upon presentation in the emergency room, she was diagnosed with a right knee sprain, given a knee immobilizer, and instructed to follow-up with her orthopaedic surgeon. PHYSICAL EXAMINATION On initial presentation to the orthopaedist, 3 days post injury, the patient showed trace effusion of the right knee and was able to bear weight fully with a slight hyperextension gait pattern. Her chief complaints were intermittent posterior knee pain, medial knee pain, swelling and weakness. Significant findings included a positive posterior drawer and a positive valgus stress test at 30 degrees of knee flexion. She rated her knee pain 6/10 on a Visual Analog Scale. DIFFERENTIAL DIAGNOSIS Posteromedial rotary instability Medial meniscus tear Tibial plateau fracture TEST AND RESULTS X-rays showed no acute bony changes MRI revealed an intermediate to high grade MCL sprain and a high grade PCL sprain. MRI revealed a small contusion of the anterolateral tibial plateau with small joint effusion. MRI confirmed the ACL was intact. FINAL WORKING DIAGNOSIS Grade III PCL sprain and Grade II MCL sprain. TREATMENT AND OUTCOMES Conservative treatment started 1 week post injury with activity modification, hinged knee bracing, quadriceps isometric leg lifting and NSAIDs. Home exercise instruction for stationary biking began 3 weeks post injury. Physical therapy emphasizing strength and neuromusuclar control training started at 4 weeks post injury. PCL had tightened up to Grade I+ and MCL demonstrated only residual laxity by 6 weeks post-injury. Dynamic neuromuscular training and speed training started 6 weeks post injury with functional PCL brace support. Returned to sports 2 months post injury after demonstrating no neuromuscular deficits with a single leg hop for distance, a box drop vertical jump, and cutting maneuvers.

The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion.

The purpose of our study was twofold: to better understand the relationship between medial meniscal extrusion (MME) and degenerative joint disease (DJD), and to determine whether a relationship exists between MME and medial meniscal root (MMR) pathology, radial tear and joint effusion. Two hundred and five consecutive MR imaging examinations of the knee were prospectively evaluated, regardless of indication, for the presence and degree of MME, medial compartment marginal osteophytes, medial compartment articular cartilage loss, joint effusion, medial meniscal tear and MMR pathology. MME >or=3 mm was considered abnormal. All studies were performed using a 1.5 T GE Signa MR unit with a quadrature knee coil. The standard protocol included oblique sagittal, coronal and axial imaging. We found a strong association ( P<0.0001) between >or=3 mm MME and medial joint line osteophytosis (77%), medial compartment articular cartilage loss (69%), MMR pathology (64%) and radial tear (58%) when compared with knees without these findings. Fifty-one percent of cases with a moderate/large joint effusion had <3 mm MME. We found that 20% (31/155) of patients with minimal or no evidence of DJD had >or=3 mm MME. Of this group, 62% (19/31) had either MMR pathology and/or radial tear, 13% (4/31) had joint effusion as their only abnormality and 6% (2/31) had a normal examination (other than the presence of MME). The remaining 19% consisted of three cases of different types of meniscal tear and three cases of small joint effusions but no other detectable pathology. MME >or=3 mm is strongly associated with DJD, MMR pathology and radial tear. A significant number of cases with no or minimal evidence of DJD (20%) had >or=3 mm MME, suggesting that MME precedes, rather than follows, the development of DJD. We also found that joint effusion was not strongly associated with >or=3 mm MME.

MR imaging of transient osteoporosis

目的 分析暂时性骨质疏松的MR表现.方法回顾性复习8例暂时性骨质疏松的MR表现.8例均行常规MR轴面和冠状面T1、T2WI.8例中男5例,女3例,年龄范围12～70岁.3例女性患病时均不在妊娠期.结果双侧髋部病变7例,左肩部病变1例.于T1WI呈低信号8例;T2WI呈正常信号2例,中-高信号3例,高信号3例.这种骨髓水肿征象涉及髋臼1例、股骨头5例,T2WI示双侧髋关节少量关节渗液.结论MRI有利于明确暂时性骨质疏松的诊断、病变部位和范围。

Musculoskeletal-Chronic Left Knee Pain in a High School Athlete Competing in Football and Basketball

0109 HISTORY: A 15 year-old high school basketball and football player presents with complaint of intermittent left knee pain for 3 months. One week prior to presentation, the athlete notes that while running and cutting in football practice he “felt something pop in his left knee during contact drills.” After this episode, the patient describes acute swelling over his left knee, occasional “locking” of the knee, and has had to reduce his activities to non-contact drills due to the increased pain with his left knee. The pain presently is located over “the front, inside part of my knee.” Denies any 'giving out' of the knee when ambulating, and has no difficulty ascending or descending stairs. PHYSICAL EXAM: On examination, atrophy of the left thigh over vastus medialis (left thigh girth 2 cm smaller in diameter). Tenderness over medial femoral condyle and anteromedial aspect of knee. Small joint effusion was noted over the left knee. Normal range of motion, no other areas of point tenderness over patella, patellar tendon, or tibial tubercle, and normal patellar tracking with negative apprehension test. No point tenderness over medial or lateral joint lines. Negative Lachman's, posterior drawer, valgus and varus stress testing. Negative McMurray's test. Wilson's test negative. Tanner stage 4. DIFFERENTIAL DIAGNOSIS: Osteochondritis Dissecans of the Knee Stress Fracture of the Knee Medial Meniscal injury Medial Collateral Ligament Sprain Patellar subluxation Tibial Plateau fracture Idiopathic Anterior Knee pain (patellofemoral knee syndrome) TESTS AND RESULTS: Left Knee plain radiographs – Partial loose body defect of lateral part of medial femoral. FINAL/WORKING DIAGNOSIS: Osteochondritis Dissecans of the Left Knee TREATMENT AND OUTCOMES: Restriction of all athletic competition and placed on non-weight bearing status via crutches. Two fragments were fixed into position using Acutrak screws followed by chondroplasty. Athlete was placed into immobilizing brace and advised to follow up on a monthly basis to determine weight bearing status via physical examination and follow up radiographs. Follow up radiographs from his first visit showed good approximation of osteochondral body in situ by Acutrak screws. Due to the osteochondral body in situ, patient will likely be non-weight bearing for 8–12 weeks with avoidance of pivoting. For the first 4 weeks, the patient was advised to start range-of-motion exercises with extension and flexion only. Following this, he will start quadriceps strengthening and rehabilitation of left knee. The athlete will likely return to sports in 3–4 months from surgery with graded progression of activity.

Musculoskeletal-Chronic Left Knee Pain in a High School Athlete Competing in Football and Basketball

0109 HISTORY: A 15 year-old high school basketball and football player presents with complaint of intermittent left knee pain for 3 months. One week prior to presentation, the athlete notes that while running and cutting in football practice he “felt something pop in his left knee during contact drills.” After this episode, the patient describes acute swelling over his left knee, occasional “locking” of the knee, and has had to reduce his activities to non-contact drills due to the increased pain with his left knee. The pain presently is located over “the front, inside part of my knee.” Denies any 'giving out' of the knee when ambulating, and has no difficulty ascending or descending stairs. PHYSICAL EXAM: On examination, atrophy of the left thigh over vastus medialis (left thigh girth 2 cm smaller in diameter). Tenderness over medial femoral condyle and anteromedial aspect of knee. Small joint effusion was noted over the left knee. Normal range of motion, no other areas of point tenderness over patella, patellar tendon, or tibial tubercle, and normal patellar tracking with negative apprehension test. No point tenderness over medial or lateral joint lines. Negative Lachman's, posterior drawer, valgus and varus stress testing. Negative McMurray's test. Wilson's test negative. Tanner stage 4. DIFFERENTIAL DIAGNOSIS: Osteochondritis Dissecans of the Knee Stress Fracture of the Knee Medial Meniscal injury Medial Collateral Ligament Sprain Patellar subluxation Tibial Plateau fracture Idiopathic Anterior Knee pain (patellofemoral knee syndrome) TESTS AND RESULTS: Left Knee plain radiographs – Partial loose body defect of lateral part of medial femoral. FINAL/WORKING DIAGNOSIS: Osteochondritis Dissecans of the Left Knee TREATMENT AND OUTCOMES: Restriction of all athletic competition and placed on non-weight bearing status via crutches. Two fragments were fixed into position using Acutrak screws followed by chondroplasty. Athlete was placed into immobilizing brace and advised to follow up on a monthly basis to determine weight bearing status via physical examination and follow up radiographs. Follow up radiographs from his first visit showed good approximation of osteochondral body in situ by Acutrak screws. Due to the osteochondral body in situ, patient will likely be non-weight bearing for 8–12 weeks with avoidance of pivoting. For the first 4 weeks, the patient was advised to start range-of-motion exercises with extension and flexion only. Following this, he will start quadriceps strengthening and rehabilitation of left knee. The athlete will likely return to sports in 3–4 months from surgery with graded progression of activity.

KNEE PAIN - WEIGHT LIFTER

HISTORY 35 year old male presented with right anteromedial knee pain that began following his routine weight training workout 8 days prior to presentation. Pain fairly constant. No alleviating factors. Symptoms worsened over past 8 days. He denied any trauma. He denied any previous history of knee pain. He denied swelling, instability, locking, or other mechanical symptoms. He denied constitutional symptoms. No history of crystalline-induced arthropathy. Alcohol intake <2 drinks per week. Denied use of anabolic-androgenic steroids. Works as a customs engineer which requires being on his feet most of the day. No family history of rheumatologic disease. PHYSICAL EXAMINATION Afebrile, Right knee with trace effusion. No erythema or warmth. Full extension; Flexion to 125 degrees; Maximal area of tenderness over the medial femoral condyle. No joint line tenderness. No ligamentous instability. Negative McMurray's. Negative patellar apprehension test. Normal gross neurologic and vascular exam. DIFFERENTIAL DIAGNOSIS Medial meniscal tear. Osteochondral or chondral defect. Avascular necrosis. Femoral stress fracture. Crystalline-induced arthropathy. Medial plica syndrome. Pes anserine bursitis. Saphenous neuritis. Loose body. Quadriceps tendon tear (partial). TEST AND RESULTS AP/LAT, notch and sunrise radiographs — small suprapatellar joint effusion; otherwise normal. - MRI — abnormal increased signal within the distal vastus lateralis; — intrameniscal abnormality within the posterior horns of the medial and lateral menisci, without tear, — small joint effusion - Patient declined arthrocentesis - Positive Tinel's test over the saphenous nerve - Diagnostic local lidocaine injection of the saphenous nerve near its exit from the adductor canal - complete resolution of symptoms. FINAL/WORKING DIAGNOSIS Saphenous neuritis (right medial knee). TREATMENT and OUTCOMES Patient with complete resolution of symptoms upon leaving the office. Failed to keep follow-up appointment. Patient was called 1 and 3 months after presentation and has been completely pain free. No nerologic complaints. Returned to all previous activities (work and weight lifting) without problems.