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Becciolini M, Bonacchi G, Stella SM, Tamborrini G. Intermittent flexor hallucis longus dislocation: ultrasound findings. J Ultrasound 2024:10.1007/s40477-024-00880-1. [PMID: 38602647 DOI: 10.1007/s40477-024-00880-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/12/2024] [Indexed: 04/12/2024] Open
Abstract
We report a case of intermittent dislocation of the flexor hallucis longus at its passage in the retro-malleolar area, related to a post-traumatic detachment of the retrotalar pulley from the medial tubercle of the talus. High-resolution ultrasound depicted the anterior dislocation of the tendon during dynamic stress, by asking the patient to flex his hallux against the examiner resistance, with the ankle in slight dorsiflexion. The tendon normally relocated after the dynamic maneuver. Tendon dislocation was associated with a painful snap.
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Affiliation(s)
- Marco Becciolini
- Misericordia di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy.
- Scuola Siumb di Ecografia Muscoloscheletrica, Pisa, Italy.
| | - Giovanni Bonacchi
- Misericordia di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy
- Scuola Siumb di Ecografia Muscoloscheletrica, Pisa, Italy
| | | | - Giorgio Tamborrini
- Swiss Ultrasound Center, Institute of Rheumatology, Basel, Switzerland
- Clinic for Rheumatology, University Hospital of Basel, Basel, Switzerland
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Forien M, Ebstein E, Léger B, Benattar L, Dieudé P, Ottaviani S. Ankle retinacula abnormalities as features of psoriatic arthritis: An ultrasound study. Joint Bone Spine 2024; 91:105649. [PMID: 37797828 DOI: 10.1016/j.jbspin.2023.105649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To compare the ultrasonography (US) assessment of the retinacula of ankles in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). METHODS This cross-sectional study included RA or PsA patients with ankle pain and healthy controls. The following US features were recorded: presence of synovitis, tenosynovitis and abnormalities of two retinacula (the superior peroneal retinaculum [SPR] and the flexor retinaculum [FR] evaluated in mode B and power Doppler). RESULTS Among the 80 included patients, 37 (46%) and 23 (29%) had RA and PsA; 20 (25%) patients were healthy controls. The FR was thicker in PsA than RA ankles 0.96±0.39 vs. 0.64±0.15, P<0.001 with no difference between RA patients and HCs. Other FR abnormalities such as hypoechogenicity, PD positivity or periostosis were more frequent in PsA than RA patients, P<0.001. On receiver-operating-characteristic curve analysis, a cut-off of 1mm FR thickness provided a sensitivity of 49% and specificity of 97% for the diagnosis of PsA. Overall, 39 and 3% of PsA and RA ankles exhibited retinaculitis of FR (thickness≥1mm with hypervascularization or hypoechogenicity). The two disease groups did not differ in the evaluation of SPR. CONCLUSIONS US abnormalities of FR were more frequent in PsA than RA and appeared to be specific for PsA. US assessment of FR might be useful to distinguish RA and PsA.
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Affiliation(s)
- Marine Forien
- Rheumatology Department, DMU Locomotion, Bichat Hospital (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France.
| | - Esther Ebstein
- Rheumatology Department, DMU Locomotion, Bichat Hospital (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - Bastien Léger
- Rheumatology Department, DMU Locomotion, Bichat Hospital (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - Leslie Benattar
- Rheumatology Department, DMU Locomotion, Bichat Hospital (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - Philippe Dieudé
- Rheumatology Department, DMU Locomotion, Bichat Hospital (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - Sébastien Ottaviani
- Rheumatology Department, DMU Locomotion, Bichat Hospital (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
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Kim YH, Chai JW, Kim DH, Kim HJ, Seo J. A problem-based approach in musculoskeletal ultrasonography: heel pain in adults. Ultrasonography 2021; 41:34-52. [PMID: 34674456 PMCID: PMC8696136 DOI: 10.14366/usg.21069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Musculoskeletal ultrasonography (US) has unique advantages, such as excellent spatial resolution for superficial structures, the capability for dynamic imaging, and the ability for direct correlation and provocation of symptoms. For these reasons, US is increasingly used to evaluate problems in small joints, such as the foot and ankle. However, it is almost impossible to evaluate every anatomic structure within a limited time. Therefore, US examinations can be faster and more efficient if radiologists know where to look and image patients with typical symptoms. In this review, common etiologies of heel pain are discussed in a problem-based manner. Knowing the common pain sources and being familiar with their US findings will help radiologists to perform accurate and effective US examinations.
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Affiliation(s)
- Yong Hee Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jin Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jiwoon Seo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Becciolini M, Pivec C, Riegler G. Ultrasound Imaging of the Deep Peroneal Nerve. J Ultrasound Med 2021; 40:821-838. [PMID: 32881065 DOI: 10.1002/jum.15455] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/14/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Abstract
Ultrasound is considered an excellent imaging modality to evaluate the nerves of the limbs. The deep peroneal nerve (DPN) is one of the terminal branches of the common peroneal nerve. The DPN may be affected by various disorders, which may be clinically challenging to show. This Pictorial Essay reviews the normal ultrasound anatomy of the DPN and presents disorders that may involve the nerve and its main branches along its course, from proximal to distal.
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Affiliation(s)
- Marco Becciolini
- Misericordia di Pistoia, Pistoia, Italy
- Scuola Siumb di Ecografia Muscolo-Scheletrica, Pisa, Italy
| | | | - Georg Riegler
- Private Ultrasound Center Graz, Lassnitzhoehe, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
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Becciolini M, Bonacchi G, Stella SM, Galletti S, Ricci V. High ankle sprain: sonographic demonstration of a posterior inferior tibiofibular ligament avulsion. J Ultrasound 2020; 23:431-433. [PMID: 32248412 DOI: 10.1007/s40477-020-00455-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/23/2020] [Indexed: 12/26/2022] Open
Abstract
Syndesmotic injuries, also referred as high ankle sprains, may cause significant ankle instability and chronic pain. Ultrasound (US) is a well-proven imaging modality to evaluate the ligaments of the ankle, due to its high spatial resolution and the possibility to perform dynamic examinations. However, considering the syndesmosis complex, the sonographic appearance of the posterior inferior tibiofibular ligament (PITFL) is not well described in the pertinent literature and, to the best of our knowledge, we found no report of PITFL avulsion demonstrated at US, as in the case presented.
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Affiliation(s)
- Marco Becciolini
- Misericordia Di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy. .,Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Pisa, Italy.
| | - Giovanni Bonacchi
- Misericordia Di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy.,Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Pisa, Italy
| | - Salvatore Massimo Stella
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Pisa, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Bologna, Italy
| | - Vincenzo Ricci
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Bologna, Italy.,Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
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Hung CY, Chang KV, Mezian K, Naňka O, Wu WT, Hsu PC, Özçakar L. Advanced Ankle and Foot Sonoanatomy: Imaging Beyond the Basics. Diagnostics (Basel) 2020; 10:E160. [PMID: 32183398 DOI: 10.3390/diagnostics10030160] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/16/2022] Open
Abstract
Ankle/foot pain is a common complaint encountered in clinical practice. Currently, due to the complex anatomy, the diagnosis and management of the underlying musculoskeletal disorders are extremely challenging. Nowadays, high-resolution ultrasound has emerged as the first-line tool to evaluate musculoskeletal disorders. There have been several existing protocols describing the fundamental sonoanatomy of ankle/foot joints. However, there are certain anatomic structures (e.g., Lisfranc ligament complex or Baxter nerve) which are also clinically important. As they are rarely elaborated in the available literature, a comprehensive review is necessary. In this regard, the present article aims to brief the regional anatomy, illustrate the scanning techniques, and emphasize the clinical relevance of the ankle/foot region.
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Tamborrini G, Bianchi S. [Ultrasound of the Foot (Adapted According to SGUM Guidelines)]. Praxis (Bern 1994) 2020; 109:1074-1084. [PMID: 33050813 DOI: 10.1024/1661-8157/a003541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ultrasound of the Foot (Adapted According to SGUM Guidelines) Abstract. This review paper explains the simplified ultrasound anatomy of the foot including the ankle, midfoot and the toes. The adapted basic standard planes are described in detail according to SGUM guidelines and illustrated with a selection of high-resolution ultrasound images. A profound knowledge of the sonographic anatomy is essential for the detection of pathologies.
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Affiliation(s)
- Giorgio Tamborrini
- UZR® - Schweizer Ultraschallzentrum und Institut für Rheumatologie, Basel
- Rheumatologie, Universitätsspital Basel, Basel
| | - Stefano Bianchi
- CIM SA, Cabinet d'imagerie médicale, Genf
- Division de la radiologie, Hôpitaux Universitaires de Genève, Genf
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