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Kraszewski A, Argentieri E, Harris K, Toresdahl B, Drakos M, Hillstrom H, Allen A, Nwawka OK. Association Between Patellar Tendon Abnormality and Land-Jump Biomechanics in Male Collegiate Basketball Players During the Preseason. Orthop J Sports Med 2024; 12:23259671241242008. [PMID: 38686323 PMCID: PMC11057346 DOI: 10.1177/23259671241242008] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 05/02/2024] Open
Abstract
Background Patellar tendinopathy is a degenerative condition that predominantly affects jumping athletes. Symptoms may be subtle or nonexistent at preseason, but structural abnormalities may be present. Assessing patellar tendon abnormality (PTA) through magnetic resonance imaging (MRI) and ultrasound (US) and classifying symptoms using the Victorian Institute for Sport Assessment-Patellar tendon (VISA-P) may provide useful insights if combined with biomechanics measurements. Purpose To (1) assess whether land-jump biomechanical patterns are associated with clinically pertinent PTA as seen on imaging and through VISA-P scores and (2) model the contributing risk and accuracy of biomechanics to classify PTA and symptomatic observations. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 26 National Collegiate Athletic Association Division I and II male basketball players (n = 52 limbs) were recruited during the preseason. We collected VISA-P scores, bilateral PTA through US and MRI morphology measurements, and bilateral 3-dimensional lower extremity kinematics and kinetics measurements from a land-jump test from an 18-inch-high (45.7-cm-high) box. Statistically, each limb was treated independently. The association of biomechanics with PTA and symptoms (VISA-P score <80) was tested with multivariate models and post hoc tests. Logistic regression modeled relative risk and accuracy of biomechanical variables to classify PTA and symptomatic limbs. Results There were 19 to 24 limbs with PTA depending on US and MRI measurements. Differences in hip and knee kinematic strategies and ground-reaction loads were associated with PTA and symptomatic limbs. Peak landing vertical ground-reaction force was significantly decreased (169 ± 26 vs 195 ± 29 %body weight; P = .001), and maximum hip flexion velocity was significantly increased (416 ± 74 vs 343 ± 94 deg/s; P = .005) in limbs with versus without PTA on imaging. Knee flexion at the initial contact was decreased in symptomatic versus healthy limbs (17°± 5° vs 21°± 5°, respectively; P = .045). Regression models classified PTA limbs and symptomatic limbs with 71.2% to 86.5% accuracy. Hip and knee maximum flexion velocity and vertical ground-reaction force variables were most common across models observing clinically pertinent PTA. Conclusion Our findings suggested that functional kinematic and kinetic biomechanical strategies at the hip and knee were associated with PTA, identified on imaging, and symptomatic limbs.
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Affiliation(s)
| | - Erin Argentieri
- University of California–Berkeley, Berkeley, California, USA
| | - Kindred Harris
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | | | - Mark Drakos
- Hospital for Special Surgery, New York, New York, USA
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Kenechi Nwawka O, Cha N, Ko LM, LaSala VR. Visibility of Prevertebral Soft Tissues in the Neck Using Ultrasonography: A Feasibility Study. Int J Spine Surg 2023; 17:824-827. [PMID: 37813455 PMCID: PMC10753337 DOI: 10.14444/8546] [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] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE To aid emergent diagnosis of postoperative retropharyngeal hematoma in anterior cervical spine surgery patients, this study investigates ultrasonography's potential role by evaluating the visibility of retropharyngeal and prevertebral soft tissues in the neck using ultrasound and potential correlations with body habitus. METHODS The visibility of the anterior vertebral bodies and the prevertebral soft tissues in both sides of the neck was recorded and analyzed with 95% CI using the Wilson method. Body mass index, neck circumference, and neck length were measured. A point-biserial correlation was performed to compare body habitus with visibility of vertebrae and prevertebral tissues. RESULTS Longus colli muscle and C3 to C6 were successfully visualized in all 10 (100%) cases on both sides. C2 was only visible in 6 (60%) on both sides. C7 was visible in 9 (90%) on the right and 7 (70%) on the left. The esophagus was visible in 7 (70%) on the right and 10 (100%) on the left. There was a significant negative correlation with neck circumference and C2 visibility on the right side, r(8) = -0.76, P = 0.011. CONCLUSIONS Ultrasonography was successful in visualizing prevertebral tissues, with a trend of obstructed visibility with wider and longer necks. CLINICAL RELEVANCE Ultrasonography has potential to aid early detection of postoperative retropharyngeal hematoma after cervical spine surgery. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Noah Cha
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Lydia M Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Vincent R LaSala
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA
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3
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Jardon M, Nguyen J, Casaletto E, Ko L, Wolff A, Daluiski A, Nwawka OK. Utilization of shear wave elastography to quantify and predict response to upper extremity botulinum toxin injections in patients with cerebral palsy: A pilot study. Clin Neurol Neurosurg 2023; 230:107798. [PMID: 37236005 DOI: 10.1016/j.clineuro.2023.107798] [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: 01/15/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Shear wave elastography (SWE) was used to quantify change in upper extremity muscle stiffness in patients with unilateral spastic cerebral palsy (USCP) following botulinum toxin A (BTX-A) therapy. We hypothesized that SWE measures would decrease following ultrasound-guided BTX-A injection, and correlate with functional improvement. METHODS SWE measures of BTX-A treated muscles were recorded immediately pre-injection, and at 1-, 3- and 6-months post-injection. At the same timepoints, functional assessment was performed using the Modified Ashworth Scale (MAS), and passive and active range of motion (PROM and AROM) measures. Correlation of SWE with MAS, PROM and AROM, as well as the relationship between change in SWE and change in MAS, PROM and AROM was determined using Spearman's rank correlation coefficient and generalized estimating equation modeling. RESULTS 16 muscles were injected and longitudinally assessed. SWE and MAS scores decreased following BTX-A injection (p = 0.030 and 0.004, respectively), reflecting decreased quantitative and qualitative muscle stiffness. Decreased SWE reached statistical significance at 1- and 3-months, and 1-, 3- and 6-months for MAS. When comparing relative change in SWE to relative change in AROM, larger change in SWE strongly correlated with positive change in AROM (p-value range:<0.001-0.057). BTX-A responders also demonstrated lower baseline SWE (1.4 m/s) vs. non-responders (1.9 m/s), p = 0.035. CONCLUSION Ultrasound-guided BTX-A injections in patients with USCP resulted in decreased quantitative and qualitative muscle stiffness. Strong correlation between change in SWE and AROM, as well as the significant difference in baseline SWE for BTX-A responders and non-responders, suggests SWE may provide a useful tool to predict and monitor BTX-A response.
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Affiliation(s)
- Meghan Jardon
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Joseph Nguyen
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, NY, USA
| | - Emily Casaletto
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Lydia Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Aviva Wolff
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Aaron Daluiski
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
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4
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Nwawka OK, Desai R, Ko LM, Chong CCW, Jacobson JM, Endo Y. Sonographic Assessment of Hand Injuries: Diagnostic Accuracy and Review of Pathology. HSS J 2023; 19:22-31. [PMID: 36776511 PMCID: PMC9837401 DOI: 10.1177/15563316221129578] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/05/2022] [Indexed: 02/14/2023]
Abstract
Background: The high soft-tissue contrast of magnetic resonance imaging (MRI) makes it useful for evaluation of hand injuries, but its limitations include cost, imaging artifacts, and patient claustrophobia. Ultrasound is readily available, fast, noninvasive, and radiation free, but its utility for the evaluation of hand soft-tissue injury and pathology is less well known. Purpose: We sought to examine the accuracy of ultrasound for the evaluation of hand injury at a single institution. Methods: We queried a radiology information system for ultrasound cases between 2014 and 2020 at a tertiary care institution using the keyword "hand" and injury terms. We performed a retrospective chart review of cases found according to the type of injury detected on ultrasound. To evaluate the diagnostic accuracy of ultrasound in hand injury and pathology, we recorded postimaging clinical diagnoses and surgical findings. Results: We found 154 patients who underwent ultrasound for hand injuries and had confirmed surgical diagnosis and/or robust clinical follow-up. Tendon injury was the most commonly diagnosed condition on ultrasound (70/154); others detected were retained foreign body (31), mass (21), ligamentous injury (9), pulley injury (8), nerve injury (11), and traumatic arthropathy (4). Ultrasound correctly characterized hand injury in 150/154 cases (97.4%) based on surgical and/or clinical follow-up. Ultrasound failed to diagnose 3 cases of partial tendon tear and 1 case of digital nerve injury. Conclusion: In this retrospective, single-institution review, ultrasound was found to be highly accurate in the detection of soft tissue hand injury and pathology, demonstrating a high concordance rate with surgical and clinical findings. Further study is warranted.
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Affiliation(s)
- O. Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Ravi Desai
- Lehigh Valley Health Network, Allentown, PA, USA
| | - Lydia M. Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Colin Chun Wai Chong
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Department of Radiology, Macquarie University Hospital, NSW, Australia
- Department of Radiology, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | | | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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Fort NM, Victoria C, Ko L, Wolfe SW, Lee SK, Nwawka OK. High resolution ultrasound for the evaluation of radial nerve pathology adjacent to metallic hardware. J Orthop Res 2022; 40:2557-2564. [PMID: 35088459 DOI: 10.1002/jor.25278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 02/04/2023]
Abstract
Accurate localization and characterization of peripheral nerve injuries adjacent to metallic hardware is difficult with magnetic resonance imaging (MRI) due to susceptibility artifact. This study sought to present the use of high-resolution ultrasound (US) in accurate characterization of radial nerve injury adjacent to metallic hardware, using findings at the time of operative exploration as confirmation of the US assessment. A retrospective chart review of cases with clinically identified radial nerve injuries evaluated by the high-resolution US was performed from January 2015 through December 2019. Preoperative clinical data, US reports, MRI reports, electrodiagnostic (EDx) reports, and operative reports were reviewed for each case. Preoperative US correctly characterized the affected nerve component, type, and location of injury in all 13 cases (100%), when correlated with intraoperative findings. Nerve injury was directly adjacent to metallic hardware in 12 cases (92%). Out of the seven cases evaluated by both US and MRI, US correctly accurately diagnosed radial nerve injuries in all cases, whereas MRI accurately diagnosed in four cases (57%). In 3/7 cases (43%) MRI was nondiagnostic due to susceptibility artifact. MRI evaluation of the nerve was limited to some degree by metallic artifact in 6/7 cases (85%).
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Affiliation(s)
- Nicholas M Fort
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - Christian Victoria
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - Lydia Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - Steve K Lee
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
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Nwawka OK, Tischler B, Lin B, Ko L, Schneider R, Miller TT. Utility of lavage in addition to native fluid collection during fluoroscopically guided joint aspiration in infection diagnosis. J Orthop Res 2021; 39:1884-1888. [PMID: 33251626 DOI: 10.1002/jor.24929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
Image-guided prosthetic joint aspirations have been criticized in the literature as having poor sensitivity and specificity. Native fluid is typically analyzed for the presence of infection. Joint lavage during fluoroscopically guided aspiration of prosthetic joints is not routinely performed, and the lavage aspirate is not typically analyzed unless native fluid could not be aspirated for culture. This study aims to determine if concordance of culture results from native fluid and an additional joint lavage sample improves sensitivity and specificity in the diagnosis of prosthetic joint infection by fluoroscopically guided joint aspiration. A retrospective review of the fluoroscopically guided joint aspirations at our institution between December 2007 and December 2009 was performed. Data collected from the electronic medical record included culture results for both native fluid and lavage aspirate, histopathology results, final clinical diagnosis, as well as clinical/surgical management. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio for infection were calculated for the following culture analysis scenarios: native fluid alone; lavage aspirate alone; native fluid; and lavage aspirate. Five hundred sixty-three aspirations, mostly prosthetic joints, were identified in the reviewed time period, of which 397 were sent for both native fluid and lavage aspirate analysis. Concordance between positive culture results from native fluid and joint lavage aspirate markedly increased the likelihood ratio for infection from 23.8 to 138.7 and improved specificity and PPV of fluoroscopically guided joint aspiration, with similar sensitivity and NPV to that of native fluid culture alone.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA.,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Brian Tischler
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Lydia Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Robert Schneider
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA.,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA.,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, New York, USA
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Nwawka OK, Gutierrez N, Lin B, Ko LM, Miller TT. Quantitative assessment of change in upper extremity muscle stiffness following fluid injection using shear wave elastography. Skeletal Radiol 2021; 50:1455-1460. [PMID: 33108511 DOI: 10.1007/s00256-020-03648-w] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantitatively assess changes in muscle stiffness following intramuscular saline injection using shear wave elastography (SWE). MATERIALS AND METHODS Thirty muscles (lateral deltoid (LD), biceps brachii (BB), brachialis, pronator teres (PT), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU)) from fresh-frozen cadaveric specimens were injected with saline under ultrasound guidance. Pre- and post-injection muscle thickness (MT) (mm) and SWE (kPa) measurements were recorded. RESULTS All muscles demonstrated a decrease in the mean SWE value post-injection, with the largest differences ± standard error noted in the LD (14.76 ± 3.55 kPa, p = 0.021) and brachialis muscles (12.02 ± 2.51 kPa, p = 0.013). Muscle thickness increased following injection, although the degree of changes poorly correlated with the change in SWE. CONCLUSION In summary, following intramuscular injection of saline injection, a decrease in upper extremity muscle stiffness is detected using SWE. It is important to note that if performing a longitudinal assessment of muscle stiffness after intramuscular injection, saline will likely contribute to a decrease in muscle stiffness in the immediate post-injection time period.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA. .,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, NY, USA.
| | - Nicholas Gutierrez
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA
| | - Lydia M Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA.,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, NY, USA
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Nwawka OK, Katzen JT. COVID-19 narratives from the New York Roentgen Society. Clin Imaging 2021; 74:173. [PMID: 33451813 PMCID: PMC8851673 DOI: 10.1016/j.clinimag.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022]
Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA.
| | - Janine T Katzen
- Weill Cornell Imaging, NewYork Presbyterian Hospital, USA; Weill Cornell Medical College of Cornell University, New York, NY, USA
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Johnson CC, Zusstone E, Miller TT, Nwawka OK, Lee SK, Wolfe SW. Clinical tests for assessing the presence and quality of the palmaris longus tendon: diagnostic accuracy of examination compared with ultrasound. J Hand Surg Eur Vol 2020; 45:292-298. [PMID: 31847681 DOI: 10.1177/1753193419895160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Various clinical tests are used to evaluate the palmaris longus tendon, but their accuracy is unknown. We assessed the accuracy of clinical tests (Schaeffer's, Thompson's, Mishra-I, Mishra-II) against ultrasound as the reference standard. We hypothesized that Schaeffer's was most accurate and that examination can reliably assess the palmaris longus tendon's length. Ninety-six wrists were examined clinically and evaluated with ultrasound by radiologists who were blinded to examination results. We calculated diagnostic accuracy and agreement between length measurements. Sensitivity values were as follows: Schaeffer's 94%, Mishra-I 100%, Mishra-II 100%, Thompson's 72%. Specificity values were as follows: Schaeffer's 94%, Mishra-I 83%, Mishra-II 89%, Thompson's 91%. Intraclass correlation coefficient between palmaris longus tendon length measurement on examination and ultrasound was 0.54. Schaeffer's test accurately detected this tendon with >90% sensitivity and specificity, but clinical examination less reliably measured palmaris longus tendon length. Ultrasound may be a useful adjunct to assess potential graft length preoperatively. Level of evidence: I.
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Affiliation(s)
| | | | | | | | - Steve K Lee
- Hospital for Special Surgery, New York, NY, USA
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Sneag DB, Arányi Z, Zusstone EM, Feinberg JH, Queler SC, Nwawka OK, Lee SK, Wolfe SW. Fascicular constrictions above elbow typify anterior interosseous nerve syndrome. Muscle Nerve 2019; 61:301-310. [DOI: 10.1002/mus.26768] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Darryl B. Sneag
- Department of Radiology and ImagingHospital for Special Surgery New York New York
| | | | | | - Joseph H. Feinberg
- Department of Physiatry, Sports MedicineHospital for Special Surgery New York New York
| | - Sophie C. Queler
- Department of Radiology and ImagingHospital for Special Surgery New York New York
| | - O. Kenechi Nwawka
- Department of Radiology and ImagingHospital for Special Surgery New York New York
| | - Steve K. Lee
- Department of Orthopedic Surgery, Hand, and Upper ExtremityHospital for Special Surgery New York New York
| | - Scott W. Wolfe
- Department of Orthopedic Surgery, Hand, and Upper ExtremityHospital for Special Surgery New York New York
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Casaletto E, Lin B, Wolfe SW, Lee SK, Sneag DB, Feinberg JH, Nwawka OK. Ultrasound imaging of nerves in the neck: Correlation with MRI, EMG, and clinical findings. Neurol Clin Pract 2019; 10:415-421. [PMID: 33299669 DOI: 10.1212/cpj.0000000000000767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/25/2019] [Indexed: 01/15/2023]
Abstract
Objective We evaluated the performance of ultrasound in the detection of neuropathy of the suprascapular nerve (SSN), long thoracic nerve (LTN), spinal accessory nerve (SAN), and phrenic nerve and compared this performance with MRI. Methods A retrospective review of 56 patients who had undergone ultrasound imaging of the SSN, LTN, SAN, and phrenic nerve was performed. Diagnoses made by ultrasound, MRI, EMG reports, and clinical and operative notes were recorded. Results Ultrasound was successful in visualizing nerves in the neck in the overwhelming majority of cases. Sonographic findings were typically in agreement with MRI and clinical findings. Conclusion Ultrasound is effective in the visualization and diagnostic evaluation of the SSN, LTN, SAN, and phrenic nerve. Classification of evidence This study provides Class IV evidence that ultrasound can effectively visualize and diagnose neuropathy of the SSN, LTN, SAN, and phrenic nerve in the neck.
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Affiliation(s)
- Emily Casaletto
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Bin Lin
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Scott W Wolfe
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Steve K Lee
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Darryl B Sneag
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Joseph H Feinberg
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - O Kenechi Nwawka
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
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Weinstock-Zlotnick G, Lin B, Nwawka OK. Clinical Assessments of Hand Function in First Carpometacarpal Osteoarthritis Do Not Appear to Correlate with Radiographic Findings. HSS J 2019; 15:269-275. [PMID: 31624483 PMCID: PMC6778263 DOI: 10.1007/s11420-019-09705-y] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thumb carpometacarpal (first CMC) osteoarthritis (OA), a degenerative process affecting hand use, is typically assessed by clinical examination and radiographs. This assessment determines treatment, but it may not reflect functional limitations. QUESTIONS/PURPOSES We aimed to explore the relationship between measures of hand function and radiographs in individuals with and without first CMC OA. METHODS We designed a cross-sectional, observational pilot study, enrolling five patients with first CMC OA (nine thumbs with modified Eaton-Littler grades ranging from 1 to 4, using retrospective radiographic data) and nine healthy controls. They underwent evaluation of hand function using four patient-reported outcome measures (PROMs)-the Patient-Specific Functional Scale (PSFS); the Patient-Rated Wrist/Hand Evaluation (PRWHE); the Disabilities of the Arm, Shoulder, and Hand (DASH); and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH)-and one performance measure, the Arthritis Hand Function Test (AHFT). Spearman's ρ with 95% subject clustered bootstrapped confidence intervals was calculated to assess for correlations between radiographic findings and measures of hand function. RESULTS Only the DASH work score showed strong positive correlation with radiographic OA grade, with PSFS, PRWHE, M-SACRAH, and AHFT scores demonstrating low to moderate correlations. Notable differences were found between patients and control subjects in median scores of the DASH, PSFS, PRWHE, and M-SACRAH, as well as in the grip, pinch, and button scores of the AHFT. CONCLUSION While only the DASH work score strongly correlated with radiographic grade of first CMC OA, several measures detected considerable differences in functional hand use between patients and control subjects. The findings of this pilot study suggest that hand function scores be considered in addition to radiographs when determining severity of first CMC OA. The findings can also inform the design of a larger, powered study.
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Affiliation(s)
| | - Bin Lin
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - O. Kenechi Nwawka
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Nwawka OK, Casaletto E, Wolfe SW, Feinberg JH. Ultrasound imaging of brachial plexus trauma in gunshot injury. Muscle Nerve 2019; 59:707-711. [PMID: 30847944 DOI: 10.1002/mus.26461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/18/2018] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Brachial plexus trauma related to gunshot (GS) injury requires early examination and characterization to ensure appropriate treatment. Magnetic resonance imaging (MRI) may be contraindicated when there are metal fragments in a patient's body. Ultrasound (US) may present an alternative to imaging GS-related brachial plexus injury. METHODS Three patients with GS-related brachial plexus injury who underwent US imaging evaluation at our institution were identified. A retrospective review of the patients' medical records was performed. RESULTS US characterization of nerve abnormalities after GS injury to the brachial plexus was in agreement with electrodiagnostic and intraoperative findings. DISCUSSION Information from the US reports was useful in preparation for brachial plexus reconstruction surgery. As such, US has unique utility when MRI cannot be performed. US imaging can provide useful characterization of the brachial plexus after GS injury when performed by an experienced operator. Muscle Nerve 59:707-711, 2019.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, New York, 10021, USA
| | - Emily Casaletto
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, New York, 10021, USA
| | - Scott W Wolfe
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, New York 10021, USA
| | - Joseph H Feinberg
- Department of Physiatry, Hospital for Special Surgery, 535 E 70th Street, New York, New York 10021, USA
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Affiliation(s)
| | | | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G Potter
- Sports Health Associate Editor for Imaging, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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Johnson CC, Vutescu ES, Miller TT, Nwawka OK, Lee SK, Wolfe SW. Ultrasound determination of presence, length and diameter of the palmaris longus tendon. J Hand Surg Eur Vol 2018; 43:948-953. [PMID: 29879859 DOI: 10.1177/1753193418778990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Inadvertent median nerve harvest is a devastating complication of palmaris longus harvest. Accurate assessment of palmaris longus presence and dimensions preoperatively would minimize this risk and assure safe harvest. We hypothesized that ultrasound would accurately predict palmaris longus presence, length and diameter. Seventeen cadaveric forearms were studied using a LOGIQ-E9 ultrasound. Two radiologists assessed palmaris longus presence and dimensions. Each wrist was explored, and the tendon was harvested and measured. Inter-rater reliability and agreement between measurements was assessed. The palmaris longus was present in 13 of 17 forearms. Both radiologists correctly identified the tendon and its absence (sensitivity and specificity, 100%). Ultrasound assessment of palmaris longus dimensions significantly correlated with surgical measurements. Intraclass correlation coefficient between radiologists was 0.97. We conclude that ultrasound can determine palmaris longus presence and dimensions with excellent accuracy and inter-observer reliability. Ultrasound is useful for preoperative evaluation of the palmaris longus and its use will increase patient safety.
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Affiliation(s)
| | | | | | | | - Steve K Lee
- Hospital for Special Surgery, New York, NY, USA
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16
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Endo Y, Nwawka OK, Smith S, Burket JC. Tarsometatarsal joint communication during fluoroscopy-guided therapeutic joint injections and relationship with patient age and degree of osteoarthritis. Skeletal Radiol 2018; 47:271-277. [PMID: 29116343 DOI: 10.1007/s00256-017-2806-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/03/2017] [Accepted: 10/19/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although the tarsometatarsal joints are separated into three distinct synovial compartments, communications between adjacent compartments are often noted during image-guided injections. This study aims to determine whether abnormal inter-compartment tarsometatarsal joint communication is associated with patient age or degree of tarsometatarsal osteoarthritis. MATERIALS AND METHODS One hundred forty tarsometatarsal injections were retrospectively reviewed by two radiologists. Extent of inter-compartment communication and degree of osteoarthritis were independently scored. Univariate and multivariable analyses were performed to assess whether the presence of and number of abnormal joint communications were related to age and degree of osteoarthritis. RESULTS Forty out of 140 tarsometatarsal joints showed abnormal communication with a separate synovial compartment, and 3 of the 40 showed abnormal communication with two separate compartments. On univariate analysis, higher grade osteoarthritis (p < 0.001) and older age (p = 0.014) were associated with an increased likelihood of abnormal inter-compartment tarsometatarsal communication and a greater number of these abnormal communications. On multivariate analysis, the degree of osteoarthritis remained a significant predictor of the presence of (p < 0.001) and number of (p < 0.001) abnormal communications, while the association of age was not statistically significant. There was significant correlation between age and degree of osteoarthritis (p < 0.001). CONCLUSION Higher grade osteoarthritis increases the likelihood of abnormal inter-compartment tarsometatarsal joint communication and is associated with a greater number of abnormal communications. Diagnostic injection to localize a symptomatic tarsometatarsal joint may be less reliable in the setting of advanced osteoarthritis.
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Affiliation(s)
- Yoshimi Endo
- Radiology and Imaging, Hospital for Special Surgery, New York, NY, 10021, USA.
| | - O Kenechi Nwawka
- Radiology and Imaging, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Shrita Smith
- Radiology and Imaging, Hospital for Special Surgery, New York, NY, 10021, USA
- Coordinated Health, Allentown, PA, 18104, USA
| | - Jayme C Burket
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, 94063, USA
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Nwawka OK, Meyer R, Miller TT. Ultrasound-Guided Subgluteal Sciatic Nerve Perineural Injection: Report on Safety and Efficacy at a Single Institution. J Ultrasound Med 2017; 36:2319-2324. [PMID: 28593710 DOI: 10.1002/jum.14271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/09/2017] [Accepted: 02/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To determine the safety and efficacy of ultrasound (US)-guided subgluteal sciatic nerve injections. METHODS A retrospective chart review of US-guided subgluteal sciatic nerve injections at our institution was performed. RESULTS Of 221 US-guided subgluteal sciatic nerve injections, 100% achieved technical success, with no postprocedure complications. Sixty-eight percent of patients with follow-up reported symptom relief. Most patients with no relief had suboptimal preprocedure screening. CONCLUSIONS With appropriate screening, our technique of US-guided subgluteal sciatic nerve injection is safe and effective.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Russell Meyer
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medical College of Cornell University, New York, New York, USA
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Nwawka OK, Miller TT, Jawetz ST, Saboeiro GR. Ultrasound-guided perineural injection for nerve blockade: Does a single-sided injection produce circumferential nerve coverage? J Clin Ultrasound 2016; 44:465-469. [PMID: 27155542 DOI: 10.1002/jcu.22364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/01/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE Our current clinical technique for sonographic-guided perineural injection consists of two-sided perineural needle placement to obtain circumferential distribution of the injectate. This study aimed to determine if a single-side needle position will produce circumferential nerve coverage. METHODS Fresh-frozen cadaveric specimens were used for this study. In six upper extremities, a needle was positioned along the deep surface of median, radial, and ulnar nerves in the carpal tunnel, radial tunnel, and cubital tunnel, respectively, and 2 ml of contrast was injected for each nerve. In three pelvic specimens, a needle was positioned deep to the sciatic nerves bilaterally, and 5 ml of contrast was injected. An additional four median nerve injections were performed using superficial surface needle position. The specimens then underwent CT scanning to assess the distribution of the perineural contrast medium. RESULTS One hundred percent of the radial, ulnar, and sciatic nerves demonstrated circumferential distribution on CT. Only 50% of the median nerve injections with the needle placed deep to the nerve produced circumferential coverage, whereas 100% of median nerves injected with the needle between the nerve and retinaculum demonstrated circumferential coverage. The average length of spread of perineural injectate was 11.6 cm in the upper extremity and 10.3 cm for the sciatic nerves. CONCLUSIONS Using clinical volumes of fluid, needle positioning at the deep surface of upper extremity and sciatic nerves was sufficient to produce circumferential coating of the nerve, except in the carpal tunnel, where placement of the needle between the nerve and flexor retinaculum is recommended. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:465-469, 2016.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York.
- Weill Cornell Medical College of Cornell University, New York, New York.
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
- Weill Cornell Medical College of Cornell University, New York, New York
| | - Shari T Jawetz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
- Weill Cornell Medical College of Cornell University, New York, New York
| | - Gregory R Saboeiro
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
- Weill Cornell Medical College of Cornell University, New York, New York
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Abstract
CONTEXT Musculoskeletal ultrasound (US) research is expanding due to increased clinical utility of sonography. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Ultrasound is widely applied in musculoskeletal imaging and sports medicine. The real-time capabilities and favorable cost profile of US make it ideal for use in diagnosis of musculoskeletal conditions. The enthusiasm for the use of US in musculoskeletal imaging has led to an increase in US research to broaden its applications. CONCLUSION Several recent advances have been made in conventional and novel US imaging techniques, quantitative US imaging, and US-guided interventions. STRENGTH OF RECOMMENDATIONS TAXONOMY SORT C.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York Weill Cornell Medical College of Cornell University, New York, New York
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Abstract
Granulomatous diseases have a varied etiology that includes autoimmune, infectious, idiopathic, and hereditary causes. The unifying factor in these diseases is the formation of granulomas, which histologically are mononuclear inflammatory cells or macrophages surrounded by lymphocytes. Granulomatous diseases often have systemic manifestations that affect organs throughout the body. Granulomatous diseases with head and neck manifestations include granulomatosis with polyangiitis, Churg-Strauss syndrome, Behçet disease, chronic granulomatous disease, and sarcoidosis. Infectious causes include tuberculosis, cat-scratch disease, syphilis, leprosy, actinomycosis, rhinoscleroma, and fungal infections. In the head and neck, granulomatous disease may affect the orbits, sinonasal cavities, salivary glands, aerodigestive tract, temporal bone, or skull base. Imaging findings include sinonasal opacification, ocular and other soft-tissue masses, osseous erosion, airway narrowing, lymphadenopathy, and salivary gland infiltration. Vascular involvement may also be evident, with displacement, narrowing, or occlusion of arteries and veins. Some radiologic findings of granulomatous processes have a considerable overlap with findings of malignancy, and a radiologic differential diagnosis inclusive of both is critical to avoid incorrect clinical treatment. Without the benefit of a prior clinical diagnosis, laboratory findings, or suggestive clinical signs and symptoms, granulomatous diseases may be difficult to differentiate radiologically. Although individual granulomatous diseases may have overlapping findings at imaging, certain radiologic findings should prompt the inclusion of granulomatous diseases in the differential diagnosis, thus facilitating appropriate clinical management.
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Affiliation(s)
- O Kenechi Nwawka
- From the Departments of Radiology (O.K.N., R.N., A.F., O.S.) and Otolaryngology-Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, Boston, MA 02118
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Nwawka OK, Schneider R, Bansal M, Mintz DN, Lane J. Membranous lipodystrophy: skeletal findings on CT and MRI. Skeletal Radiol 2014; 43:1449-55. [PMID: 24777445 DOI: 10.1007/s00256-014-1887-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/03/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
Abstract
Membranous lipodystrophy, also known as Nasu-Hakola disease, is a rare hereditary condition with manifestations in the nervous and skeletal systems. The radiographic appearance of skeletal lesions has been well described in the literature. However, CT and MRI findings of lesions in the bone have not been documented to date. This report describes the radiographic, CT, MRI, and histopathologic skeletal findings in a case of membranous lipodystrophy. With corroborative pathologic findings, a diagnosis of membranous lipodystrophy on imaging allows for appropriate clinical management of disease manifestations.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA,
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Abstract
BACKGROUND Magnetic resonance (MR) imaging evaluation of the painful failed shoulder arthroplasty is a useful imaging modality due to advancements in metal artifact reduction techniques, which allow assessment of the integrity of the supporting soft-tissue envelope and the implant. QUESTIONS/PURPOSES The focus of this pictorial review is to illustrate the benefits of MR imaging, whether used alone or as an adjunct to other imaging modalities, in aiding the clinician in the complex decision making process. METHODS A PubMed (MEDLINE) search focusing on the complications and imaging assessment of shoulder arthroplasty was performed. Articles were selected for review based on their pertinence to the aforementioned topics. RESULTS We discuss the ability of MR imaging to identify why a patient's arthroplasty may have failed. Specific causes including component loosening and implant failure, rotator cuff and deltoid integrity, infection, subtle fractures, and nerve pathology are reviewed, with illustrative sample images. CONCLUSION MRI is a valuable tool in the assessment for pathology in the shoulder following arthroplasty.
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Affiliation(s)
- O. Kenechi Nwawka
- />Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Weill Cornell Medical College, New York, NY 10021 USA
| | - Gabrielle P. Konin
- />Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Weill Cornell Medical College, New York, NY 10021 USA
| | - Darryl B. Sneag
- />Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Weill Cornell Medical College, New York, NY 10021 USA
| | - Lawrence V. Gulotta
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Weill Cornell Medical College, New York, NY 10021 USA
| | - Hollis G. Potter
- />Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Weill Cornell Medical College, New York, NY 10021 USA
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Monaghan N, Nwawka OK, Wyss JF. Giant iliopsoas bursa presenting as a large pulsatile groin mass. PM R 2014; 6:857-9. [PMID: 24793654 DOI: 10.1016/j.pmrj.2014.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/15/2014] [Accepted: 04/19/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Niall Monaghan
- Department of Rehabilitation Medicine, New York Presbyterian Hospital, 91 Payson Avenue, Apt 5L, New York, NY 10034(∗).
| | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY(†)
| | - James F Wyss
- Department of Physiatry, Hospital for Special Surgery, New York, NY(‡)
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Nwawka OK, Kabutey NK, Locke CM, Castro-Aragon I, Kim D. Ultrasound-guided needle localization to aid foreign body removal in pediatric patients. J Foot Ankle Surg 2013; 53:67-70. [PMID: 24239426 DOI: 10.1053/j.jfas.2013.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Indexed: 02/03/2023]
Abstract
Patients with podiatric foreign body injury commonly present to the emergency department. Often, the foreign object cannot be easily located or removed, and radiographs are frequently obtained to aid in localization. In cases requiring tissue dissection to remove the foreign bodies, accurate localization is required for safe removal of small and difficult to visualize bodies. We present 2 pediatric cases in which an ultrasound-guided needle localization technique was used to facilitate successful removal of small, difficult to visualize foreign bodies from the plantar foot. Ultrasound-guided needle localization reduced the required incision length and depth and helped to minimize the risk of damage to surrounding tissue.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology, Boston Medical Center/Boston University Medical Center, Boston, MA.
| | - Nii-Kabu Kabutey
- Department of Radiology, Boston Medical Center/Boston University Medical Center, Boston, MA
| | - Christopher M Locke
- Department of Surgery, Boston Medical Center/Boston University Medical Center, Boston, MA
| | - Ilse Castro-Aragon
- Department of Radiology, Boston Medical Center/Boston University Medical Center, Boston, MA
| | - Ducksoo Kim
- Department of Radiology, Boston Medical Center/Boston University Medical Center, Boston, MA
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Nwawka OK, Hayashi D, Diaz LE, Goud AR, Arndt WF, Roemer FW, Malguria N, Guermazi A. Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Insights Imaging 2013; 4:581-93. [PMID: 24006205 PMCID: PMC3781258 DOI: 10.1007/s13244-013-0277-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/13/2013] [Accepted: 07/17/2013] [Indexed: 12/15/2022] Open
Abstract
Sesamoids and accessory ossicles seen in the foot vary widely in their prevalence and appearance. Occasionally, these bones may be associated with painful syndromes, due to various pathologies, including trauma, infection, inflammation, degeneration and others. However, symptomatic accessory and sesamoid bones are rare, and search for additional pathology should be performed. Although the clinical significance of these osseous structures is probably minor, clinicians very commonly ask about these bones, which may originate an unnecessary work-up. Therefore, knowledge of their presence and morphological variations is important to prevent misinterpreting them as fractures—a common error. Finally, it may be very difficult to distinguish between incidental variants and truly symptomatic ones. Radiological studies provide insight regarding the presence and pathology involving these bones. This review describes an overview of the anatomy of sesamoids and accessory ossicles in the foot, and provides a pictorial review of their pathological conditions, including trauma, sesamoiditis, osteomyelitis, osteoarthritis and pain syndromes. Radiological studies including radiography, ultrasound, scintigraphy, computed tomography (CT) and magnetic resonance imaging (MRI) provide useful information which should be used in concert with clinical findings to guide patient management. Teaching points • Sesamoids and accessory ossicles seen in the foot vary widely in their prevalence and appearance. • Pathology of these bones includes trauma, sesamoiditis, infection, osteoarthritis and pain syndromes. • Radiography, ultrasound, scintigraphy, CT and MRI provide information regarding the pathology of these bones.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA
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