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Wille CM, Hurley SA, Schmida E, Lee K, Kijowski R, Heiderscheit BC. Diffusion tensor imaging of hamstring muscles after acute strain injury and throughout recovery in collegiate athletes. Skeletal Radiol 2024; 53:1369-1379. [PMID: 38267763 DOI: 10.1007/s00256-024-04587-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To identify the region of interest (ROI) to represent injury and observe between-limb diffusion tensor imaging (DTI) microstructural differences in muscle following hamstring strain injury. MATERIALS AND METHODS Participants who sustained a hamstring strain injury prospectively underwent 3T-MRI of bilateral thighs using T1, T2, and diffusion-weighted imaging at time of injury (TOI), return to sport (RTS), and 12 weeks after RTS (12wks). ROIs were using the hyperintense region on a T2-weighted sequence: edema, focused edema, and primary muscle injured excluding edema (no edema). Linear mixed-effects models were used to compare diffusion parameters between ROIs and timepoints and limbs and timepoints. RESULTS Twenty-four participants (29 injuries) were included. A significant ROI-by-timepoint interaction was detected for all diffusivity measures. The edema and focused edema ROIs demonstrated increased diffusion at TOI compared to RTS for all diffusivity measures (p-values < 0.006), except λ1 (p-values = 0.058-0.12), and compared to 12wks (p-values < 0.02). In the no edema ROI, differences in diffusivity measures were not observed (p-values > 0.82). At TOI, no edema ROI diffusivity measures were lower than the edema ROI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.69). A significant limb-by-timepoint interaction was detected for all diffusivity measures with increased diffusion in the involved limb at TOI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.42). Significant differences in fractional anisotropy over time or between limbs were not detected. CONCLUSION Hyperintensity on T2-weighted imaging used to define the injured region holds promise in describing muscle microstructure following hamstring strain injury by demonstrating between-limb differences at TOI but not at follow-up timepoints.
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Affiliation(s)
- Christa M Wille
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 6136 UW Medical Foundation Centennial Bldg, 1685 Highland Ave, Madison, WI, 53705, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Samuel A Hurley
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Elizabeth Schmida
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 6136 UW Medical Foundation Centennial Bldg, 1685 Highland Ave, Madison, WI, 53705, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Kenneth Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Richard Kijowski
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Bryan C Heiderscheit
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 6136 UW Medical Foundation Centennial Bldg, 1685 Highland Ave, Madison, WI, 53705, USA.
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA.
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Lazarczuk SL, Collings TJ, Hams AH, Timmins RG, Opar DA, Edwards S, Shield AJ, Barrett RS, Bourne MN. Biceps femoris long head muscle and aponeurosis geometry in males with and without a history of hamstring strain injury. Scand J Med Sci Sports 2024; 34:e14619. [PMID: 38572910 DOI: 10.1111/sms.14619] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/04/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Hamstring strain injuries (HSIs) commonly affect the proximal biceps femoris long head (BFlh) musculotendinous junction. Biomechanical modeling suggests narrow proximal BFlh aponeuroses and large muscle-to-aponeurosis width ratios increase localized tissue strains and presumably risk of HSI. This study aimed to determine if BFlh muscle and proximal aponeurosis geometry differed between limbs with and without a history of HSI. METHODS Twenty-six recreationally active males with (n = 13) and without (n = 13) a history of unilateral HSI in the last 24 months underwent magnetic resonance imaging of both thighs. BFlh muscle and proximal aponeurosis cross-sectional areas, length, volume, and interface area between muscle and aponeurosis were extracted. Previously injured limbs were compared to uninjured contralateral and control limbs for discrete variables and ratios, and along the relative length of tissues using statistical parametric mapping. RESULTS Previously injured limbs displayed significantly smaller muscle-to-aponeurosis volume ratios (p = 0.029, Wilcoxon effect size (ES) = 0.43) and larger proximal BFlh aponeurosis volumes (p = 0.019, ES = 0.46) than control limbs with no history of HSI. No significant differences were found between previously injured and uninjured contralateral limbs for any outcome measure (p = 0.216-1.000, ES = 0.01-0.36). CONCLUSIONS Aponeurosis geometry differed between limbs with and without a history of HSI. The significantly larger BFlh proximal aponeuroses and smaller muscle-to-aponeurosis volume ratios in previously injured limbs could alter the strain experienced in muscle adjacent to the musculotendinous junction during active lengthening. Future research is required to determine if geometric differences influence the risk of re-injury and whether they can be altered via targeted training.
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Affiliation(s)
- Stephanie L Lazarczuk
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Tyler J Collings
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Andrea H Hams
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ryan G Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
| | - David A Opar
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Suzi Edwards
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- School of Environmental and Life Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Anthony J Shield
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rod S Barrett
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Matthew N Bourne
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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B Nielsen L, B Svensson R, U Fredskild N, H Mertz K, Magnusson SP, Kjaer M, Bayer ML. Chronic changes in muscle architecture and aponeurosis structure following calf muscle strain injuries. Scand J Med Sci Sports 2023; 33:2585-2597. [PMID: 37621063 DOI: 10.1111/sms.14472] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/02/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Muscle strain injuries in the human calf muscles are frequent sports injuries with high recurrence. Potential structural and functional changes in the medial head of the musculus gastrocnemius (GM) and the associated aponeurosis are not well documented. PURPOSE To test whether a GM muscle strain injury affects muscle fascicle length, pennation angle, and the morphology of the deep aponeurosis at rest and during muscle contraction long time after the injury. Additionally, electromyography (EMG) of the GM and the soleus muscle during a unilateral heel rise was measured in the injured and uninjured calf. METHODS GM fascicle length, pennation angle, and aponeurosis thickness was analyzed on dynamic ultrasonography (US) recordings in 10 participants with a chronic calf strain. In addition, US images taken across the distal portion and mid-belly of the GM were analyzed at three different ankle positions. EMG recordings were obtained during a unilateral heel rise. RESULTS The pennation angle of the injured distal GM was significantly larger compared to the uninjured GM in the contracted, but not the relaxed state. Pennation angle increased more in the injured compared to the uninjured GM during contraction. Fascicle length was shorter in the most distal portion of the injured GM. Fascicles at the distal portion of the injured GM showed a pronounced curvilinear shape as the muscle contracted and the aponeurosis was enlarged in the injured compared to the uninjured GM. The ratio between GM and soleus EMG activity showed a significantly higher relative soleus activity in the injured compared to the healthy calf. CONCLUSION The greater change in pennation angle and curvilinear fascicle shape during contraction suggest that a long-term consequence after a muscle strain injury is that some muscle fibers at the distal GM are not actively engaged. The significantly enlarged aponeurosis indicates a substantial and long-lasting connective tissue involvement following strain injuries.
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Affiliation(s)
- Louise B Nielsen
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rene B Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels U Fredskild
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kenneth H Mertz
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Physical Therapy, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Monika L Bayer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Miranda FC, Kihara EN, Prado MP, Rosemberg LA, Santos DDCB, Taneja AK. Acute ankle injuries: association between sprain severity and ancillary findings. Einstein (Sao Paulo) 2023; 21:eAO0162. [PMID: 37820199 PMCID: PMC10519667 DOI: 10.31744/einstein_journal/2023ao0162] [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: 05/05/2022] [Accepted: 02/07/2023] [Indexed: 10/13/2023] Open
Abstract
Miranda et al. reported a correlation between the significance of injuries to osseous, chondral, tendon, and ligamentous tissues in participants with low-grade versus high-grade acute ankle sprains. They demonstrated that participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of structural abnormalities compared to those with low-grade sprains. Special attention should be paid to acute ankle sprains in emergency settings to avoid failure in detecting severe injuries that could lead to chronic pain, impairment, or instability. Participants presenting acute ankle sprains (<15 days) were divided into low-grade versus high-grade sprain,according to the presence of a complete tear in at least one component of lateral ligament complex. High-grade ankle sprains group presented increased rates of medial malleolus bone bruise, deltoid ligament tears,extensor retinaculum lesions, and articular effusion. The calcaneonavicular distance was statistically shorter in patients with high-grade sprains (median, 3.0mm) when compared to those with low-grade sprains (median, 4.0mm) Objective: To correlate the significance of osseous, chondral, tendon, and ligamentous injuries with anatomical variations in low-grade versus high-grade acute ankle sprains. METHODS We retrospectively identified the magnetic resonance imaging findings of acute ankle sprains (<15 days). Participants with a history of previous sprains, arthritis, tumors, infections, or inflammatory conditions were excluded. Images were independently evaluated by two musculoskeletal radiologists and assessed for osseous, chondral, tendon, and ligamentous injuries and anatomical variations. Participants were divided into low-grade versus high-grade sprain groups, according to the presence of a complete tear in at least one component of the lateral ligament complex. RESULTS The final study group comprised 100 magnetic resonance images (mean age, 36 years), the majority of males (54%), the right ankle (52%), and a mean sprain duration of 5 days. Participants with high-grade sprains presented with increased rates of medial malleolus edema (p<0.001), moderate and large articular effusions (p=0.041), and shorter calcaneonavicular distance (p=0.008). Complete tears of the anterior talofibular ligament and calcaneofibular ligaments were observed in 100% and 51.2% of the participants in the High-Grade Group, respectively. The deltoid ligament complex was partially torn in this group (55.8% versus 8.8%, p<0.001). Extensor tendon retinaculum lesions occurred significantly more frequently in this group (41.9%) compared to the overall study population (23%) (p<0.001). CONCLUSION Participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of medial malleolus edema, deltoid complex partial tears, extensor retinaculum lesions, and articular effusion.
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Affiliation(s)
- Frederico Celestino Miranda
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Eduardo Noda Kihara
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Marcelo Pires Prado
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Laercio Alberto Rosemberg
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Atul Kumar Taneja
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Musculoskeletal Radiology DivisionDepartment of RadiologyUT Southwestern Medical CenterDallasTXUSA Musculoskeletal Radiology Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA.
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Herscovici D, Scaduto JM. The LISFRANC JUT: A physical finding of subtle LISFRANC injuries. Injury 2021; 52:1038-1041. [PMID: 33413925 DOI: 10.1016/j.injury.2020.12.026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/01/2020] [Accepted: 12/23/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Low-energy Lisfranc injuries are uncommon and are often misdiagnosed as sprains. This results in a delay for the definitive treatment. The aim of this study is to discuss the physical finding of a midfoot "jut," that can be used to help diagnose subtle Lisfranc injuries, in patients who present with persistent midfoot pain after low-energy trauma. PATIENTS AND METHODS Between January 2015 through December 2019, patients previously diagnosed with a sprain, who were at least six weeks after their original injury, and presented with midfoot pain, were identified. All had a bony prominence on the medial border of the first tarsometatarsal joint, defined as a "jut", which produced pain. Standing radiographs demonstrated subluxation of the tarsometatarsal joint(s). RESULTS Seven patients (5 females/2 males) presented as isolated injuries, with a mean age of 40.4 years. Mechanisms of injury were five falls, one from a sporting event, and one twisting injury. Time to diagnosis, from their date of injury, averaged 9.9 weeks. All underwent fixation. Follow-up averaged 13.7 months. At final follow-up none of the patients developed surgical site infections, wound dehiscence, loosening of implants, loss of reductions or a recurrence of the "jut". None of the patients demonstrated arthrosis and only one patient had a broken screw and declined further surgical intervention. DISCUSSION AND CONCLUSIONS Patients presenting with a history of low-energy trauma, a diagnosis of sprain, continued complaint of foot pain, and a "jut" on the medial border of the midfoot, should be evaluated for a subtle Lisfranc injury.
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Chang KV, Wu WT, Özçakar L. An Overlooked Cause of Posterior Knee Pain: Ultrasound Imaging and Guided Injection for Proximal Lateral Gastrocnemius Tendon Sprain. Med Ultrason 2020; 22:377-378. [PMID: 32898208 DOI: 10.11152/mu-2610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Proximal lateral gastrocnemius tendon injury is an overlooked cause of posterior knee pain. As the proximal gastrocnemius tendon attaches on the distal femur; its pain is more deeply located and can also be aggravated by flexion of the affected knee. In the present report, sonopalpation showed that the painful tendon appeared to have lost its fibrillary pattern and become thickened and hypoechoic as well. Under the diagnosis of proximal gastrocnemius tendon sprain, the ultrasound guided dextrose injection was performed and the pain was totally relieved.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine Hacettepe University Medical School, Ankara, Turkey.
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Girdwood M, West L, Connell D, Brukner P. Contact-Related Strain of Quadratus Femoris, Obturator Externus, and Inferior Gemellus in an Australian Football Player: A Case Report. J Sport Rehabil 2019; 28:887-890. [PMID: 30747560 DOI: 10.1123/jsr.2018-0279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/04/2018] [Accepted: 12/28/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Muscle injuries of the hip stabilizers are considered rare in sport. OBJECTIVE This report presents a previously unreported case of a contact injury resulting in acute strain of quadratus femoris, obturator externus, and inferior gemellus in an amateur Australian rules football player. DESIGN Level 4-case report. CASE PRESENTATION A player was tackled ipsilateral to the injured leg, while in hip flexion in a lunged position. The case describes the diagnostic process, initial management, and return to play for this athlete. RESULTS Following rehabilitation, the player was able to return to sport at 8 weeks without ongoing issues. CONCLUSIONS A literature search for sports-related contact injuries to either muscle returned only one result. All other documented cases of injury to these muscle groups are confined to noncontact mechanisms or delayed presentations. Despite conventional teaching, the action of the deep external rotators of the hip appears to be positionally dependent. Knowledge of this type of injury and mechanism may be useful for future clinical reasoning and differential diagnosis in patients with this type of presentation.
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Lee YY, Yang TH, Huang CC, Huang YC, Chen PC, Hsu CH, Wang LY, Chou WY. Ultrasonography has high positive predictive value for medial epicondyle lesions among adolescent baseball players. Knee Surg Sports Traumatol Arthrosc 2019; 27:3261-3268. [PMID: 30284010 DOI: 10.1007/s00167-018-5178-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/31/2018] [Accepted: 09/20/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Only few studies have investigated medial epicondyle (MEC) lesions, particularly in the 12-18 age group. To the best of our knowledge, no study has compared ultrasonography (US), radiography and magnetic resonance imaging (MRI) in detecting MEC lesions. The aims of this study were to examine the value of US for detecting MEC lesions and to investigate correlations among diagnostic tools. METHODS A prospective, comparative study was performed. Young baseball players from southern Taiwan were recruited, and basic characteristics, as well as passive range of motion (pROM) of the upper extremities, were recorded. Screening US was performed to identify MEC lesions, and players with MEC lesions received follow-up plain radiography and MRI. RESULTS A total of 299 young baseball players were screened using US, and 28 of 299 players with possible MEC lesions were identified with a positive predictive value (PPV) of 88% according to MRI findings. The MEC lesions were primarily comprised of unfused ossicles and bony fragmentation. Other diagnoses, including UCL strain and medial epicondylitis, were also found by MRI in players with abnormal US screening results. The pROM of shoulder external rotation (ER) of the throwing hand was significantly reduced in players with MEC lesions (p = 0.006). CONCLUSIONS Bony cortical discontinuity or fragmentation over the MEC warrants further research, and US provides good PPV for types of MEC lesions. Decreased shoulder ER may relate to MEC lesions and should be taken into consideration. The use of US may facilitate early detection and intervention. LEVEL OF EVIDENCE IV, Cross-sectional study.
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Affiliation(s)
- Yan-Yuh Lee
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China
| | - Tsung-Hsun Yang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China
| | - Chung-Cheng Huang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China
| | - Chia-Hao Hsu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China.
| | - Wen-Yi Chou
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China.
- Medical Mechatronic Engineering Program, Cheng Shiu University, Kaohsiung, Taiwan, Republic of China.
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Bullock SA, Allen GM, Watson MS, Wilson DJ. Predicting poor outcome from simple ankle injuries: a prospective cohort study. Br J Radiol 2018; 91:20170213. [PMID: 29076746 PMCID: PMC5966200 DOI: 10.1259/bjr.20170213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/07/2017] [Accepted: 10/23/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Sprained ankles are common and when there are no signs or evidence of a fracture, conventional management is conservative. At present, there are no clinical markers to identify those that may develop persisting instability and disability that would require rehabilitation or surgery. OBJECTIVES To investigate the nature and extent of soft tissue ankle injuries, and to consider whether the anatomical severity of injury can predict functional outcome. METHODS Patients attending a local Accident and Emergency Department in Oxford with an acute ankle injury with no clinical requirement for radiographs, or where radiographs were normal, were invited into the study. Within 5 days, patients underwent a diagnostic ultrasound examination, a cone beam CT study and a disability assessment. Ultrasound and physiotherapy assessments were repeated at 3 and 6 months. RESULTS 100 patients were recruited and grouped based upon injuries. 58 had simple ankle injuries, 21 complex, 19 had significant fractures and 2 were excluded from further follow up analysis. There were no clinically significant differences in pain, disability or functional outcomes between the groups at all points of the study. CONCLUSION Medium to long term clinical outcomes were not solely determined by the severity of injury. Some patients with simple injuries were seen to have ongoing problems, whereas some with complex injuries recovered completely in a shorter period. Advances in knowledge: The severity of an ankle injury determined by radiological imaging does not necessarily dictate the severity of a patient's symptoms and the trajectory of their recovery.
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Wang EH, Loftus WK, Bird SJ, Sampson MJ. Ring finger lumbrical origin strain: a case series with imaging findings. Skeletal Radiol 2016; 45:1729-1734. [PMID: 27717977 DOI: 10.1007/s00256-016-2483-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/21/2016] [Revised: 08/25/2016] [Accepted: 09/05/2016] [Indexed: 02/02/2023]
Abstract
Lumbrical strain is a relatively unknown hand injury. We report four cases of lumbrical origin strain involving the ring finger flexor tendons. Three patients sustained the injury during rock climbing and one while working with a jackhammer. In all cases, circumferential fluid around the flexor tendons of the ring finger was demonstrated on MRI and/or ultrasound at the distal palmar level at the "bare area," which is normally devoid of a synovial sheath. There is a paucity of information in the literature regarding this injury and its specific imaging features. Lack of awareness of this injury renders accurate diagnosis difficult.
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Affiliation(s)
- Edward H Wang
- The Queen Elizabeth Hospital, Adelaide, SA, Australia.
| | | | | | - Matthew J Sampson
- Benson Radiology, Adelaide, SA, Australia
- Repatriation General Hospital, Adelaide, SA, Australia
- Flinders University, Adelaide, SA, Australia
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Martella I, Azzali E, Milanese G, Praticò FE, Ruggirello M, Trunfio V, Parziale R, Corrado M, Della Casa G, Capasso R, De Filippo M. MRI in acute ligamentous injuries of the ankle. Acta Biomed 2016; 87 Suppl 3:13-19. [PMID: 27467862] [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] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/25/2016] [Indexed: 06/06/2023]
Abstract
Ankle sprains are the most common lower limb injuries and affect more frequently young athletes; imaging is needed for an accurate diagnosis of such traumatic injuries. The purpose of this review is to analyse the magnetic resonance (MR) findings of both normal and pathological ankle's ligaments; indeed, MRI is the gold standard for the diagnosis of acute traumatic injuries and is useful for differentiation of the causes of ankle instability as well as for pre-operative planning.
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Affiliation(s)
- Ilenia Martella
- Department of Surgical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Parma, Italy.
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12
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Affiliation(s)
- John T Machin
- Department of Trauma and Orthopaedics, Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK.
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13
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Abstract
Injuries to muscle in the elite athlete are common and may be responsible for prolonged periods of loss of competitive activity. The implications for the athlete and his/her coach and team may be catastrophic if the injury occurs at a critical time in the athlete's diary. Imaging now plays a crucial role in diagnosis, prognostication and management of athletes with muscle injuries. This article discusses the methods available to clinicians and radiologists that are used to assess skeletal muscle injury. The spectrum of muscle injuries sustained in the elite athlete population is both discussed and illustrated.
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Affiliation(s)
- J C Lee
- Department of Radiology, Chelsea and Westminster Hospital, London, UK.
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14
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Charles J, Valenti L, Miller G. Sprains and strains. Aust Fam Physician 2012; 41:171. [PMID: 22574350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
From April 2010 to March 2011 in BEACH (Bettering the Evaluation and Care of Health), sprains and strains were managed at a rate of 14 per 1000 encounters, suggesting an average 1.7 million sprain/strain patient-doctor encounters nationally per year.
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Affiliation(s)
- Janice Charles
- Family Medicine Research Centre, University of Sydney, New South Wales
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15
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Tan SW, Ng SW, Tan SH, Teoh LC. Arthroscopic debridement of intercarpal ligament and triangular fibrocartilage complex tears. Singapore Med J 2012; 53:188-191. [PMID: 22434293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Wrist arthroscopy has evolved since its inception to become an essential diagnostic and therapeutic tool for the management of various wrist disorders. Our study aimed to examine the outcomes of arthroscopic debridement in the treatment of scapholunate (SL), lunotriquetral (LT) and triangular fibrocartilage complex (TFCC) tears. METHODS We conducted a retrospective review of 68 consecutive wrist arthroscopies performed at our institution between January 2000 and July 2005. All the patients complained of wrist pain, which often interfered with their daily activities, work or sports. A standard arthroscopic technique was employed in all. Any intercarpal ligament or TFCC tears found were debrided. RESULTS There were 42 patients with TFCC tears, 58 with SL tears and 49 with LT tears. At a mean follow-up time of 16.6 months, 85.3% of the patients reported an improvement in symptoms and 27.9% had improved range of motion. Grip strength improved by 11.8%. All except two patients returned to their original activities. Outcome following arthroscopic debridement was determined using the Mayo Modified Wrist Score. Based on the postoperative wrist scores of 47 patients, 24 were rated excellent, 17 good, four fair and two poor. By comparing the pre- and postoperative wrist scores of 31 patients, we were able to demonstrate significant improvement in patients who underwent wrist arthroscopies. CONCLUSION Our study demonstrated that there is a definite role for arthroscopic debridement in the management of SL, LT and TFCC tears.
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Affiliation(s)
- S W Tan
- Department of Hand Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
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16
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Lange B, Wessel LM. [Sprain of the ankle]. MMW Fortschr Med 2011; 153:41-42. [PMID: 22165343] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Bettina Lange
- Klinik für Kinderchirurgie der Univ.-Medizin Mannheim
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17
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Chow AHL, Morrison WB. Imaging of hip injuries in dancers. J Dance Med Sci 2011; 15:160-172. [PMID: 22687656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Dancers are quite prone to injuries in the hip region. Imaging plays a key role in evaluation of the pain resulting from such injuries, as proximity of structures and cross-innervation can result in a clinical dilemma regarding the specific injury, and thus origin of the pain generator. Advanced imaging techniques, including MRI, ultrasound, and multidetector CT, are becoming increasingly important in the workup of injuries in athletes, yet radiographs remain an essential component. This article presents a variety of injuries in the hip and groin region that may be seen in dancers and discusses the utility of basic and advanced imaging modalities.
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18
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Nazarian LN. Musculoskeletal ultrasound: applications in the hip. J Dance Med Sci 2011; 15:173-176. [PMID: 22687657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article illustrates how ultrasound (US) can be useful in the evaluation of painful hips. For an experienced examiner using high quality equipment, US is the imaging test of choice for tendon abnormalities, hernias, bursitis, and dynamic abnormalities such as extra-articular snapping hip. Ultrasound is also useful in screening for hip effusions and guiding diagnostic and therapeutic interventions. Ultrasound has a complementary role to magnetic resonance imaging (MRI) for labral pathology, although MRI or MR arthrography is preferable for most intra-articular pathologies. It is better tolerated, less expensive, and more readily available than MRI, and as US technology continues to improve, its role in hip imaging should grow.
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Affiliation(s)
- Levon N Nazarian
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107-5244, USA.
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19
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Lentell G, Desch RJ, Tracz SM, Nyberg LM. Self-stress vs manual stress in talar tilt radiography. Radiol Technol 2010; 82:14-21. [PMID: 20826597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Radiographic study following inversion ankle sprain commonly is used to determine the presence of anatomic laxity across the talocrural joint. PURPOSE To compare the degree of talar tilt derived from a radiographic ankle stress exam under 2 conditions: self-stress vs manual stress applied by the clinician. METHODS Twenty-four subjects seeking medical care following ankle sprain underwent talar tilt stress exams of both ankles. The involved ankle was imaged with self-stress by use of a strap and with the clinician providing manual stress during the imaging exam. Mean talar tilt for the self-stress method was 2.2 degrees, compared with 5.9 degrees for the manual stress method (P < .001). RESULTS Significantly greater and clinically meaningful differences in talar tilt angle were found when manual stress was provided by the clinician. To avoid false negative findings of anatomic laxity in stress talar tilt studies at the ankle, a standardized procedure in which the clinician provides manual stress may be necessary.
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Gremeaux V, Coudreuse JM, Collado H, Cohen M, Bensoussan L, Fondarai J, Champsaur P, Viton JM, Delarque A. Comparative study of clinical and ultrasonographic evaluation of lateral collateral ligament sprains of the ankle. J Sports Med Phys Fitness 2009; 49:285-291. [PMID: 19861934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM Clinical examination is sometimes insufficient to assess the severity of lateral collateral ligament (LCL) sprain of the ankle, making it difficult to choose the most appropriate treatment. The aim of this study was to compare the assessment of clinical signs and the ultrasonographic findings in recent LCL sprain of the ankle. METHODS This was a retrospective cross-sectional study. Spearman's rank correlation test and multiple regression analysis were used to assess correlations between clinical signs and type of ligament injury. Fisher's linear discriminant analysis was used to determine most contributive signs in ligament tear diagnosis. RESULTS No single clinical sign was correlated with the severity of ligament injury as revealed by ultrasonography in the 34 patients analyzed. Careful assessment of all the usual clinical signs of severity seems to better guide the diagnosis of the presence or absence of ligament tearing. CONCLUSIONS These results confirm the lack of correlation between clinical examination and the anatomic injury in distension or partial tearing of the anterior talofibular ligament. They raise questions about the usefulness of clinical classifications and suggest a broadening of the indications for ultrasonographic exam in ambiguous situations, particularly for athletes showing few signs of severe injury, in order to ensure optimal treatment and a faster recovery.
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Affiliation(s)
- V Gremeaux
- Pòle Rééducation Réadaptation, CHU de Dijon, 23 rue Gaffarel, BP 77908 F-21079 Dijon cedex, France.
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21
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Polzer H, Ockert B, Grote S, Volkering C, Mutschler W, Kanz KG. [Ankle sprain--who needs X-ray?]. MMW Fortschr Med 2009; 151:48-49. [PMID: 19739551] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- H Polzer
- Chirurgische Klinik und Poliklinik, Klinikum der Universität München.
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22
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Cutilli T, Corbacelli A. Mandibular condylar fractures and acute atlanto-axial subluxation Part 2 A physiopathological factor for the cervical spine sprain. Minerva Stomatol 2009; 58:199-208. [PMID: 19436249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM The aim of this study was to analyze the physiopathology of the acute cervical injure in the event of mandibular condylar fractures. METHODS As in the Part 1, 25 non-consecutive cases of condylar mandibular fractures (16 males and 9 females, mean age: 22.96/range 14-36 years) observed and treated in the Maxillofacial Surgery Department of the University of L'Aquila, have been studied. Types of fractures examined included: unilateral: 19 cases (solitary: 12; associated with other mandibular fractures: 7, homolateral: 2); bilateral: 6 cases (equivalent: 2, not equivalent: 4). A control group was constituted of 10 patients, 5 males and 5 females, aged from 19 to 24 years (mean range: 21.6) suffering from acute isolated cervical distorsion (whiplash). The study has been performed by means of the analysis of X-ray and computed tomography (CT)-CT/3D of the mandibular condylar regions, the occipital-atlanto-axial structures and the cervical region. RESULTS In all the patients the following constant alterations that link up with these fractures have been observed: the rotation of atlas, the atlanto-axial subluxation and the derangement of the occipital-atlanto-epistropheal joint, homolateral to the side of the mandibular condylar fracture. The cervical spine shows the constant loss of physiological lordosis with hinge between C3 and C4. In the whiplash, as the authors have been able to assess in the control group, there are no alterations of occipital-atlanto-axial joint and the kinetic vector is placed on the longitudinal plane. In the mandibular condylar fractures the kinetic mechanism is completely different regarding the whiplash. The point of entry is the chin and the kinetic vector is oriented down-up, sometimes oblique in the opposite side. Subsequently the kinetic force is transmitted throughout the mandibular structure and causes the condylar or bicondylar fracture. The kinetic vector is placed before on the vertical plane, then on the horizontal plane and later on the vertical plane. Therefore the dynamics of the crash cannot cause the swaying of the head as in the whiplash. Indeed in the mandibular condylar fractures the authors have observed the cervical distortion with the loss of lordosis on the sagittal plane without whiplash and also a constant derangement of the cranio-cervical joint and the atlanto-axial subluxation. CONCLUSIONS These results allow to delineate a different physiopathological mechanism: in the event of mandibular condylar fractures, the sprain of the cervical spine seems to be caused by the acute atlanto-axial subluxation.
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Affiliation(s)
- T Cutilli
- Department of Maxillofacial Surgery, University of L'Aquila School of Medicine, Italy.
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Imade S, Takao M, Miyamoto W, Nishi H, Uchio Y. Leg anterior compartment syndrome following ankle arthroscopy after Maisonneuve fracture. Arthroscopy 2009; 25:215-8. [PMID: 19171284 DOI: 10.1016/j.arthro.2007.08.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [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: 07/19/2007] [Revised: 08/10/2007] [Accepted: 08/10/2007] [Indexed: 02/02/2023]
Abstract
We report a case of leg anterior compartment syndrome following ankle arthroscopy after Maisonneuve fracture. A 21-year-old football player sprained his left ankle. Plain radiography of his left ankle showed a lateral dislocation of the talus without obvious fractures. Plain radiography of his left lower extremity showed a spiral fracture of the proximal fibula approximately one third distal to the fibular head. According to these findings, we diagnosed this fracture as a Maisonneuve fracture and treated it by ankle arthroscopy and drilling of the talar osteochondral injury followed by arthroscopic ankle visualization during syndesmosis screw fixation. Six hours after surgery, the patient complained of pain in the lower extremity. We diagnosed acute compartment syndrome and performed emergent fasciotomy. One year after surgery, he was able to fully participate in athletic activities. We consider ankle arthroscopy to be available for the treatment of ankle fracture with the suspected complication of an intra-articular disorder such as a Maisonneuve fracture. However, with this type of ankle fracture, there is a higher potential risk of acute compartment syndrome developing than with other types of ankle fractures. Therefore we suggest that surgeons guard against this complication.
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Affiliation(s)
- Shinji Imade
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Shimane, Japan.
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24
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Molinari A, Stolley M, Amendola A. High ankle sprains (syndesmotic) in athletes: diagnostic challenges and review of the literature. Iowa Orthop J 2009; 29:130-138. [PMID: 19742102 PMCID: PMC2723709] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- A Molinari
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Sports Medicine Center,
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25
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Liu XS, Bevill G, Keaveny TM, Sajda P, Guo XE. Micromechanical analyses of vertebral trabecular bone based on individual trabeculae segmentation of plates and rods. J Biomech 2008; 42:249-56. [PMID: 19101672 DOI: 10.1016/j.jbiomech.2008.10.035] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 10/29/2008] [Accepted: 10/29/2008] [Indexed: 11/17/2022]
Abstract
Trabecular plates play an important role in determining elastic moduli of trabecular bone. However, the relative contribution of trabecular plates and rods to strength behavior is still not clear. In this study, individual trabeculae segmentation (ITS) and nonlinear finite element (FE) analyses were used to evaluate the roles of trabecular types and orientations in the failure initiation and progression in human vertebral trabecular bone. Fifteen human vertebral trabecular bone samples were imaged using micro computed tomography (microCT), and segmented using ITS into individual plates and rods by orientation (longitudinal, oblique, and transverse). Nonlinear FE analysis was conducted to perform a compression simulation for each sample up to 1% apparent strain. The apparent and relative trabecular number and tissue fraction of failed trabecular plates and rods were recorded during loading and data were stratified by trabecular orientation. More trabecular rods (both in number and tissue fraction) failed at the initiation of compression (0.1-0.2% apparent strain) while more plates failed around the apparent yield point (>0.7% apparent strain). A significant correlation between plate bone volume fraction (pBV/TV) and apparent yield strength was found (r(2)=0.85). From 0.3% to 1% apparent strain, significantly more longitudinal trabecular plate and transverse rod failed than other types of trabeculae. While failure initiates at rods and rods fail disproportionally to their number, plates contribute significantly to the apparent yield strength because of their larger number and tissue volume. The relative failed number and tissue fraction at apparent yield point indicate homogeneous local failure in plates and rods of different orientations.
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Affiliation(s)
- X Sherry Liu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, Mail Code 8904, 1210 Amsterdam Avenue, New York, NY 10027, USA.
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26
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Robins RH. Injuries of the metacarpophalangeal joints. Hand 2008; 3:159-63. [PMID: 5127924 PMCID: PMC2529137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
BACKGROUND Grade III syndesmosis sprains are usually treated with internal fixation. Limited information is available on early weightbearing and early return to activity after operative treatment for grade III syndesmosis sprains. HYPOTHESIS Treatment of grade III syndesmosis sprains in intercollegiate athletes with internal fixation, early range of motion, and early weightbearing can lead to rapid return to sport with minimal complications and no ankle problems in midterm follow-up. STUDY DESIGN Case series; Level of evidence, 4. METHODS We evaluated a consecutive series of intercollegiate athletes treated operatively with 4.5-mm cortical screw fixation for grade III syndesmosis sprains. At 1 week after surgery, patients were allowed to begin range of motion exercises, progressive weightbearing, and gradually return to full activity as tolerated. Outcome measures included time to return to full activity and, at final follow-up, the Sports Ankle Rating System scores. RESULTS Six male intercollegiate college athletes met the inclusion criteria for this study. The average time for return to full activity was 41 days (range, 32-48 days). There were no intraoperative complications or complications when resuming in-season sport activities with the screw in place. One screw broke during removal. At an average follow-up of 34.3 months, using the Sports Ankle Rating System, the average clinical rating score was 96.2, the average quality-of-life measure was 96.7, and the average single assessment numeric evaluation was 95.3. Radiographs at final follow-up showed no mortise widening or lateral talar subluxation. Two patients had mild degenerative changes on lateral radiographs with anterior tibial osteophytes. CONCLUSIONS In selective cases, athletes can return to full activity as early as 6 weeks after internal fixation of grade III syndesmosis sprains.
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Affiliation(s)
- Dean C Taylor
- Department of Surgery, Division of Orthopaedic Surgery, Box 3615, Duke University Medical Center, Durham, NC 27710, USA.
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28
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Abstract
UNLABELLED The purpose of the study was to investigate the relationship between the intensity of unrestrained weight bearing after a non-fracture injury (e.g. sprain), and the development of osteoarthropathic deformities of the foot (Charcot foot) in patients with diabetic neuropathy. METHODS 34 diabetic patients (14 Type 1, 20 Type 2) with foot bone injuries were studied in retrospect. At onset of injury symptoms (e.g. foot swelling), 32 of 34 feet displayed unremarkable X-ray, but pathologic MR imaging (e.g. bone marrow edema along the Lisfranc and/or the Chopart joint). Cumulative load forces after the onset of symptoms until treatment by total contact cast (TCC) were estimated using the product of body weight and number of weeks of ambulation (kg x week) as a surrogate. Feet were classified in 3 groups according to the degree of foot deformities found at the start of treatment with TCC: Feet without deformities (group A, n=16), feet with minor deformities (partially reduced plantar arch (group B, n=6) and feet with major deformities (collapsed plantar arch, group C, n=12) RESULTS Feet in group A had been exposed to 262 (95% CI 135-390) kg x week, compared to 974 (95% CI 342-1606) in group B, and to 2348 (95% CI 1265-3430) kg x week in group C (p<0.05 between groups), indicative of a dose-response relationship between weight-bearing and progressive foot deformities. Destruction along the Lisfranc joint was observed in 2/16 feet in group A, versus 18/18 feet in group B and C combined (p<0.001). In group A, the undeformed feet were healed without major deformities (except for 2 non-compliant patients), whereas in group B and C feet remained as deformed as they were at TCC application. CONCLUSION Unrestrained weight-bearing of injured foot bones and joints of more than 400 kg x week (equivalent to 8 weeks of normal walking by a person of 50 kg body weight) prompts Charcot deformities, with disintegration of the Lisfranc joint. Early off-loading by TCC treatment allows healing without deformities.
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Affiliation(s)
- R Kimmerle
- Practice of Endocrinology and Diabetes, Düsseldorf.
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29
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Hawkes NC, Flemming DJ, Ho VB. Radiology corner. Answer to last month's radiology case and image: Subtle lisfranc injury: low energy midfoot sprain. Mil Med 2007; 172:xii-xiii. [PMID: 17937370] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Nathan C Hawkes
- School of Medicine (NCH) and Dept. of Radiology and Radiological Sciences (DJF, VBH), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA
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30
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Genovese EA, Callegari L, Combi F, Leonardi A, Angeretti MG, Benazzo F, D'Angelo F, Fugazzola C. Contrast enhanced ultrasound with second generation contrast agent for the follow-up of lower-extremity muscle-strain-repairing processes in professional athletes. Radiol Med 2007; 112:740-50. [PMID: 17657416 DOI: 10.1007/s11547-007-0177-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2006] [Accepted: 12/26/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE In literature, ultrasonographic potentials in traumatic muscle lesions have been codified, whereas the data about this method utility in follow-up are dissonant. The purpose of this work is to evaluate a second-generation ultrasound (US) contrast agent rule for the professional athletes' distractive lesions. MATERIALS AND METHODS Twenty professional athletes (18 men and two women, aged between 18 and 34 years) affected by different muscle lesions were examined. All the patients were evaluated within 48 h of the trauma by US device Esaote Technos MPX with a high-frequency linear probe. The examinations were carried out with and without contrast agent after 20, 40 and 60 days after the trauma; second-generation contrast agent was used (SonoVue). RESULTS In all athletes (nine first-grade lesions, 11 second-grade lesions), by using contrast agent intravenous injection done after 20 days, the appearance of contrast spots affecting part or all the lesioned area were observed. During the follow-up, after 40 days. the contrast spots widened to include the entire scar area, with haemorrhagic residual in three cases. After 60 days, in no case was a liquid haemorrhagic collection still present, and we found an important reduction of extension of vascular spots and US intensity and their total disappearance in seven cases. CONCLUSIONS US with a second-generation contrast agent, thanks to the neoangiogenesis identification, allows recognition, individuation and monitoring the repair processes in the muscle lesion and allows estimation of when athletes can return to competitive activity. This fact obviously reduces both relapses and complications.
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Affiliation(s)
- E A Genovese
- Cattedra di Radiologia, Università dell'Insubria-Ospedale di Circolo, Fond. Macchi, Via Borri 57, I-21100 Varese, Italy.
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Abstract
Ankle sprains are among the most common athletic injuries and represent a significant source of persistent pain and disability. Despite the high incidence of ankle sprains in athletes, syndesmosis injuries have historically been underdiagnosed, and assessment in terms of severity and optimal treatment has not been determined. More recently, a heightened awareness in sports medicine has resulted in more frequent diagnoses of syndesmosis injuries. However, there is a low level of evidence and a paucity of literature on this topic compared with lateral ankle sprains. As a result, no clear guidelines are available to help the clinician assess the severity of injury, choose an imaging modality to visualize the injury, make a decision in terms of operative versus nonoperative treatment, or decide when the athlete may return to play. Increased knowledge and understanding of these injuries by clinicians and researchers are essential to improve the prevention, diagnosis, and treatment of this significant condition. This review will discuss the anatomy, mechanism of injury, diagnosis, and treatment of syndesmosis sprains of the ankle while identifying controversies in management and topics for future research.
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Affiliation(s)
- Glenn N Williams
- Graduate Program in Physical Therapy and Rehabilitation Science, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
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32
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Abstract
Acromioclavicular (AC) sprains can be graded in 3 to 6 different types according to Tossy or Rockwell, respectively. In mild sprains (Tossy and Rockwell I), movements in the AC joint are minimal, because the coraco-clavicular ligaments are intact. In these patients, stress radiography is usually normal, and sonographic examination at rest can be normal as well, showing minimal or no displacement between the 2 extremities of the bones. We present a simple dynamic maneuver to enhance the diagnosis of these mild sprains known as the cross-arm maneuver, in which the hand is placed on the opposite shoulder. The dynamic sonographic examination during this maneuver clearly shows abnormal movements in the clavicle's extremity, which "falls down" to the acromion in the cross-arm position and is raised and pulled from the acromion at rest. The maneuver is very easy to perform and may be useful when a mild AC joint sprain is suspected.
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Affiliation(s)
- Philippe Peetrons
- Hôpitaux IRIS sud, Centre hospitalier Molière-Longchamp 142, rue Marconi, 1190 Brussels, Belgium
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Guillodo Y, Riban P, Guennoc X, Dubrana F, Saraux A. Usefulness of ultrasonographic detection of talocrural effusion in ankle sprains. J Ultrasound Med 2007; 26:831-6. [PMID: 17526615 DOI: 10.7863/jum.2007.26.6.831] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Ankle sprain severity is difficult to assess initially in the emergency department, yet it governs treatment decisions. Ultrasonography readily shows fluid present in the talocrural joint, which is difficult to assess by physical examination. The purpose of this study was to evaluate the prevalence of ultrasonographic talocrural joint effusion in moderate and severe ankle sprains and to determine the cause of effusions by magnetic resonance imaging (MRI). METHODS Consecutive patients 18 to 55 years of age with moderate and severe ankle sprains within the previous 48 hours were included if they had no history of abnormalities in the same ankle within the last 12 months. When ultrasonography with the ankle in the neutral position showed talocrural effusion, MRI was performed within 8 days. RESULTS Of the 110 patients (83 men and 27 women; mean age, 24.2 years), 40 (36.4%; 95% confidence interval, 27.6%-46.1%) had joint effusion on ultrasonography and MRI. In 39 of these 40 patients, MRI visualized damage to the anterior talofibular ligament (positive predictive value, 97.5%; 95% confidence interval, 85.3%-99.9%), accompanied in 5 (12.8%) cases by damage to the calcaneofibular ligament. In 14 (35%) cases, MRI showed cartilage damage or bony contusion. CONCLUSIONS Talocrural effusion on ultrasonography may identify patients with severe ankle sprains. Magnetic resonance imaging should be performed in patients with talocrural effusion. Further work is needed to evaluate the usefulness of MRI in acute ankle sprains without talocrural effusion.
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Affiliation(s)
- Yannick Guillodo
- Service d'Orthopédie-Traumatologie et Urgences Chirurgicales, Centre Hospitalier Universitaire Cavale Blanche, Brest, France
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Imade S, Takao M, Nishi H, Uchio Y. Unusual malleolar fracture of the ankle with talocalcaneal coalition treated by arthroscopy-assisted reduction and percutaneous fixation. Arch Orthop Trauma Surg 2007; 127:277-80. [PMID: 16871393 DOI: 10.1007/s00402-006-0196-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Indexed: 11/27/2022]
Affiliation(s)
- Shinji Imade
- Department of Orthopaedic Surgery, Shimane University School of Medicine, 89-1, Enya, Izumo, Shimane, Japan.
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35
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Saliou G, Kocheida M, Vernois J, Bonnaire B, Lehmann P, Vanden Abeel B, Boulu G, Le Blanche AF, Vallée JN. [Ankle and foot sprains: conventional radiography aspects]. ACTA ACUST UNITED AC 2007; 88:541-7. [PMID: 17464252 DOI: 10.1016/s0221-0363(07)89853-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Emergency departments frequently encounter pathology resulting from injury to the foot and ankle, with approximately 6000 case per day in France. In an ankle sprain, 85% of the lesions involve the lateral collateral ligament. Many other, much rarer, types of lesion with different therapeutic consequences can present, however. Interpretation of the initial conventional radiographs is vital to establishing the type lesion and to proposing adapted and rapid treatment. The objective of this article is to review the various osteoarticular and ligament injuries encountered in the foot and the ankle.
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Affiliation(s)
- G Saliou
- Service de radiologie A, CHU Nord, place Victor Pauchet, 80054 Amiens cedex 1, France.
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Abstract
BACKGROUND Chronic ankle instability (CAI) is a common orthopaedic entity in sport. Although other risk factors have been studied extensively, little is known about how it is influenced by the osseous joint configuration. AIM To study the effect of osseous ankle configuration on CAI. DESIGN Case-control study, level III. SETTING Radiological examination with measurement of lateral x rays by an independent radiologist using a digital DICOM/PACS system. PATIENTS A group of 52 patients who had had at least three recurrent sprains was compared with an age-matched and sex-matched control group of 52 healthy subjects. MAIN OUTCOME MEASURES The radius of the talar surface, the tibial coverage of the talus (tibiotalar sector) and the height of the talar body were measured. RESULTS The talar radius was found to be larger in patients with CAI (21.2 (2.4) mm) than in controls (17.7 (1.9) mm; p<0.001, power >95%). The tibiotalar sector, representing the tibial coverage of the talus, was smaller in patients with CAI (80 degrees (5.1 degrees )) than in controls (88.4 degrees (7.2 degrees ); p<0.001, power >95%). No significant difference was observed in the height of the talar body between patients with CAI (28.8 (2.6) mm) and controls (27.5 (4.0) mm; p = 0.055). CONCLUSION CAI is associated with an unstable osseous joint configuration characterised by a larger radius of the talus and a smaller tibiotalar sector. There is evidence that a higher talus might also play some part, particularly in women.
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Affiliation(s)
- Arno Frigg
- Orthopaedic Department, Musculoskeletal Care Centre, University Hospital of Basel, Basel, Switzerland.
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Hubbard TJ, Hertel J. Anterior positional fault of the fibula after sub-acute lateral ankle sprains. ACTA ACUST UNITED AC 2006; 13:63-7. [PMID: 17188923 DOI: 10.1016/j.math.2006.09.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/05/2006] [Accepted: 08/26/2006] [Indexed: 12/26/2022]
Abstract
Recent evidence has suggested a positional fault of the fibula exists in chronically unstable ankles. However, there has been little research examining positional faults after a sub-acute lateral ankle sprain (LAS). Our purpose was to measure the position of the distal fibula in relation to the distal tibia in subjects with sub-acute LASs and to determine if there is a relationship between the amount of swelling and fibular position. Eleven subjects with a unilateral sub-acute LAS and 11 healthy controls participated. The Wilcoxon signed rank test revealed a significant (p=0.008) difference within the ankles of the injured group. The sprained ankles had a mean fibular position of 14.2+3.4 mm and were positioned significantly more anteriorly than the contralateral uninjured ankles (17.0+3.2 mm). The Mann-Whitney test revealed a significant difference (p=0.045) between the sprained ankle and the side-matched limbs of the controls (16.8+2.3) Pearson product moment correlations revealed a strong positive correlation between fibular position and swelling (r=0.793, p=0.004). Those ankles with more swelling had the most anteriorly positioned fibulae. The fibulae in sub-acutely sprained ankles appear to be positioned more anteriorly compared to the contralateral ankles. This positional fault may be maintained acutely by swelling.
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Affiliation(s)
- Tricia J Hubbard
- Department of Kinesiology, University of North Carolina, 9201 University City Blvd., Charlotte, NC 28223, USA.
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Abstract
OBJECTIVE The study attempted to evaluate the value of ultrasonography in determining the therapeutic strategy for patients with osseous injuries caused by ankle sprains. DESIGN A 10-MHz compact linear-array ultrasound transducer was used to assess patients with inversion ankle sprains. Eleven female and 12 male patients who had fractures detected by sonograms were included in the study. All 23 patients underwent radiographic examination for identification of fractures. Bone scintigraphy was performed for those who had negative x-ray findings. RESULTS Eighteen patients had distal fibular tip fractures, three patients had the fifth metatarsal base fractures, one patient had a talar neck fracture, and one patient had a navicular fracture. These fractures were all detected by ultrasonography and then proved even by radiography or by bone scans. All the 23 patients had anterior talofibular ligament injuries. Among these patients, 11 had anterior ankle-joint recess effusion, and two had additional anterioinferior tibiofibular ligament injuries. Six weeks of immobilization with the ankle fracture brace was prescribed for all the patients after the identification of fractures. Their ankle pain symptoms soon improved. CONCLUSIONS Ultrasonography is valuable in evaluating tiny foot and ankle fractures and coexistent soft tissue injuries. It can guide the treatment for patients with osseous injuries caused by ankle sprains.
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Affiliation(s)
- Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Affiliation(s)
- T J Gemmill
- Division of Companion Animal Sciences, Institute of Comparative Medicine, University of Glasgow Veterinary School, Bearsden Road, Glasgow G61 1QH, Scotland, UK
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Simanovsky N, Hiller N, Leibner E, Simanovsky N. Sonographic detection of radiographically occult fractures in paediatric ankle injuries. Pediatr Radiol 2005; 35:1062-5. [PMID: 16047141 DOI: 10.1007/s00247-005-1536-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [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: 04/18/2005] [Revised: 05/21/2005] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND In some paediatric ankle injuries, the clinical picture is suggestive of a fracture despite negative three-view radiographs. OBJECTIVE To determine the effectiveness of high-resolution US to differentiate radiographically occult fractures from sprains. MATERIALS AND METHODS During a 12-month period, children aged 5-13 years who had sustained an acute ankle injury suspicious of a fracture on clinical examination, but with negative radiography, were referred for high-resolution US. Follow-up radiographs were obtained after 2-3 weeks. RESULTS A total of 20 children were examined. In 13, US did not reveal a fracture; small fractures were detected in 7. All patients with negative US studies had negative follow-up radiographs. In six patients with positive US the follow-up radiographs demonstrated a periosteal reaction. In one child in whom a fracture line identified by US was in the depth of the lateral malleolus, the follow-up radiograph demonstrated an area of increased bone density. CONCLUSIONS US is effective for the detection of radiographically silent fractures of the paediatric ankle. It may be used as an adjunct to radiography in clinically suspicious, but radiographically negative ankle injuries.
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Affiliation(s)
- Natalia Simanovsky
- Department of Radiology, Hadassah University Hospital, Mount Scopus, P.O. Box 24035, Jerusalem 91120, Israel.
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Beynnon BD, Webb G, Huber BM, Pappas CN, Renström P, Haugh LD. Radiographic measurement of anterior talar translation in the ankle: determination of the most reliable method. Clin Biomech (Bristol, Avon) 2005; 20:301-6. [PMID: 15698703 DOI: 10.1016/j.clinbiomech.2004.11.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [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: 11/25/2003] [Accepted: 11/18/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although most would agree that stress radiography is an important research tool to evaluate the integrity of the ankle ligaments in studies of chronic ankle instability, there is little agreement with regard to the best technique to make these measurements. The primary objective of this study was to establish the most reliable method for measuring anterior displacement of the talus relative to the tibia using stress radiographs of the ankle. This information is necessary to standardize radiographic evaluation of injured ankles and for biomechanical studies of the ankle joint, but has never been investigated. METHODS This study examined the reliability of four available methods by measuring the intra-observer repeatability and inter-observer reproducibility of three different investigators. Lateral radiographs were obtained while the ankle was supported in the Telos device with the joint unloaded, and then with a 150 N anterior directed load applied to the calcaneus. At two separate time intervals, the radiographs were read by three different observers using four measurement techniques. For each technique, the measurement of the unloaded ankle was subtracted from the loaded ankle to obtain anterior talar translation. FINDINGS The method that measured the shortest distance between the posterior lip of the distal tibia and the talar dome (designated Method I in the current series) was significantly more reproducible between readers and within readers across repeated measurements than the other methods tested. INTERPRETATION Based on the findings from this study, it can be concluded that measurement of the distance between the posterior lip of the distal tibia and the talar dome is the method of choice to characterize the position of the talus relative to the tibia in stress radiography. In order to standardize the radiographic evaluation of ankle injuries, this method should be the one employed to measure anterior talar translation.
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Affiliation(s)
- Bruce D Beynnon
- Department of Orthopaedics and Rehabilitation, McClure Musculoskeletal Research Center, University of Vermont, Burlington, VT 05405, USA.
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Golec E, Nowak S, de Lubicz-Jaworowski M. [Chronic instability talocrural joint after tibiofibular syndesmosis traumatic injures]. Chir Narzadow Ruchu Ortop Pol 2005; 70:255-9. [PMID: 16521524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The authors present long term results of treatment for traumatic injuries of the tibiofibular syndesmosis being a part of crural fractures considering the chronic talocrural joint instability. It presents different operational methods of treatment evaluating simultaneously the effect this method has on regaining the functional efficiency of the operated joint. The evaluation of the talocrural joint anterior stability is performed according to my own method and lateral and medial stability is based on Zwipp's method. The clinical material of 1997-2004 year are 62 cases, 40 male (64.5%) and 22 female (35.5%) treated operatively because of ankle fractures in which performed stabilization of injured tibio-fibular syndesmosis. Average time of study is 6 month. Obtained outcomes of observation permit to make assertion that traumatic damage of tibio-fibular syndesmosis during ankle fractures demand anatomical alignment and effective stabilization of fragments and reconstruction of ligaments. Inveterate ankle sprain cause rotation talocrural joint instability.
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Affiliation(s)
- Edward Golec
- Klinika Chirurgii Urazowej i Ortopedii z Oddziałem Neurochirurgii i Rehabilitacji 5 Wojskowego Szpitala Klinicznego z Poliklinika, Samodzielny Publiczny Zakład Opieki Zdrowotnej w Krakowie
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Hedström M. ["Sprained ankle" gives emergency room physicians headache. The Ottawa method gives guidelines for x-ray examination]. Lakartidningen 2004; 101:3407-8. [PMID: 15560655] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Connell DA, Schneider-Kolsky ME, Hoving JL, Malara F, Buchbinder R, Koulouris G, Burke F, Bass C. Longitudinal Study Comparing Sonographic and MRI Assessments of Acute and Healing Hamstring Injuries. AJR Am J Roentgenol 2004; 183:975-84. [PMID: 15385289 DOI: 10.2214/ajr.183.4.1830975] [Citation(s) in RCA: 246] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE We compared sonography and MRI for assessing hamstring injuries in professional football players (Australian football) 3 days, 2 weeks, and 6 weeks after an injury and identified imaging characteristics at baseline that may be useful in predicting the time needed for return to competition. MATERIALS AND METHODS Sixty men who are professional football players presented with suspected acute hamstring strain underwent sonography and MRI within 3 days of injury; those who were injured returned 2 and 6 weeks later for follow-up MRI and sonography. Two radiologists interpreted either the MR images or the sonograms and were blinded to the results of the other technique. The following six parameters were measured at each assessment: the muscle injured, the site of injury within the muscle, the longitudinal injury length (expressed in millimeters), the cross-sectional injured area (expressed as a percentage), and the presence of interand intramuscular hematoma. RESULTS At baseline, MRI identified abnormalities in 42 (70.0%) of 60 patients, whereas sonography found abnormalities in 45 (75%) of 60. At 2 weeks, 29 (59.2%) of 49 scans showed abnormalities on MRI and 25 (51.0%) of 49 showed abnormalities on sonograms. Of those players who were injured at baseline, 15 (35.7%) of 42 and 10 (22.2%) of 45 still showed abnormal results on scans at 6 weeks on MRI and sonography, respectively. However, all but one player had returned to competition. The biceps femoris was the most commonly injured muscle and the musculotendinous junction was the most common site of injury. Injuries appeared significantly larger on MRI than on sonography at all time points. Our analysis showed that at baseline, the longitudinal length of hamstring tear on MRI had the highest statistical correlation with recovery (r = 0.58, p < 0.0001) and was the best radiologic predictor for return to competition. CONCLUSION Sonography is as useful as MRI in depicting acute hamstring injuries and because of lower costs may be the preferred imaging technique. However, MRI is more sensitive for follow-up imaging of healing injuries. The longitudinal length of the strain as measured on MRI is a strong predictor for the amount of time needed until an athlete can return to competition.
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Affiliation(s)
- David A Connell
- Department of Medical Imaging, Victoria House Hospital, 316 Malvern Rd., Prahran 3181, Australia
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45
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Abstract
Injuries of the toes and sesamoids of the first metatarsophalangeal joint comprise a wide spectrum of traumatic entities. Despite the fact that a majority of lesions may well respond to nonsurgical treatment and exhibit an excellent prognosis, appropriate clinical and imaging analysis is mandatory to select those injuries that require specific therapeutic and surgical measures to avoid long-term sequelae of functional disability.
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Affiliation(s)
- Thomas Mittlmeier
- Chirurgische Klinik und Poliklinik der Universität Rostock, Abteilung für Unfall-und Wiederherstellungschirurgie, Germany.
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46
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Spahn G. The ankle meter: an instrument for evaluation of anterior talar drawer in ankle sprain. Knee Surg Sports Traumatol Arthrosc 2004; 12:338-42. [PMID: 15088082 DOI: 10.1007/s00167-003-0477-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 05/03/2003] [Accepted: 10/27/2003] [Indexed: 11/30/2022]
Abstract
The aim of this study was to work out a clinical test which is possible to measure the anterior talar drawer (ATD) in patients after ankle sprain. The instrument for evaluation was called "ankle meter". The instrument consists of two plastic scales (heal scale and tibia scale). The instrument allows quantifying the results of the anterior drawing test. A total of 38 persons (16 men, 22 women) were available as control group. The persons were 28.8+/-10.1 years old. No proband had any ankle problems in his history. A total of 45 patients (25 males, 20 females) suffering from ankle sprain were included in the study. In these patients stress radiography (147.1 N) was performed to measure the ATD. In control group the clinical measured ATD was 1.7+/-1.3 mm. Measurement for detect the interobserver validity did not detect significant differences. The ATD of the joint after ankle sprain was significantly higher (8.9+/-4.3 mm). The difference between healthy and injured ankle in case of an ankle sprain was 7.4+/-4.2 mm. There was a significant correlation between clinical and radiological measured ATD (R=0.91). The results suggest that it is possible to measure the ATD exactly. The values of the clinical ATD measurement showed a good correlation with the results of stress radiography. Diligent clinical examination in combination with this special test are after this experiences sufficient to classify the severity of injury after ankle sprain.
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Affiliation(s)
- Gunter Spahn
- Clinic of Arthroscopy and Joint Surgery Eisenach, Sophienstrasse 16, 99817 Eisenach, Germany.
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Poh ACC, Peh WCG. Clinics in diagnostic imaging (95). Os trigonum. Singapore Med J 2004; 45:140-4. [PMID: 15029419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 19-year-old boy presented to the Accident and Emergency Department after sustaining trauma to his left ankle and foot while playing soccer. The radiograph of his left ankle showed a well-corticated triangular fragment of bone posterior to the left talus, typical of an os trigonum. This accessory bone was initially mistaken for a fracture fragment and a plaster cast was applied. The term, do not touch lesion, has been coined to describe this group of benign bony entities which may be classified into three broad categories, namely: normal variants, lesions that are real but obviously benign, and lesions that are related to degenerative disease. The importance of recognising the characteristic radiographical appearances of these entities is emphasised, as the need for further imaging or diagnostic tests can usually be avoided.
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Affiliation(s)
- A C C Poh
- Department of Diagnostic Radiology, Changi General Hospital, Singapore 529889
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48
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Flusser G. Ankle sprain: CT appearance. Isr Med Assoc J 2004; 6:121. [PMID: 14986476] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Gideon Flusser
- Department of Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel.
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49
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Abstract
BACKGROUND Specific anatomic variations of the ankle mortise may predispose people to ankle sprains. HYPOTHESIS There is a correlation between a higher malleolar index (posteriorly positioned fibula) and incidence of ankle sprain. STUDY DESIGN Prospective case control study. METHODS We compared the malleolar index (transverse plane of the talus) on computerized axial tomographic images of 61 patients with ankle sprain with that of 101 normal controls. A positive number for the malleolar index meant that the lateral malleolus was posterior to the plane of the medial malleolus. A negative number meant that the lateral malleolus was actually anterior to the plane of the medial malleolus. RESULTS The average malleolar index of the patients with ankle sprain was +11.5 degrees with a standard deviation of 7 degrees. Malleolar relationships varied from -6 degrees to +39 degrees, a range of 45 degrees. The average malleolar index in the control group was +5.85 degrees with a standard deviation of 4.9 degrees, which varied from -8 degrees to +16 degrees. However, there was no correlation between recurrence of sprains and malleolar index values. CONCLUSION Patients with an ankle sprain were more likely to have a posteriorly positioned fibula, possibly predisposing them to ankle sprain.
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Affiliation(s)
- Osman Tugrul Eren
- First Department of Orthopaedic Surgery, Sisli Etfal Research and Training Hospital, Istanbul, Turkey
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50
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Abstract
OBJECTIVE To evaluate the imaging findings following acute hamstring injury. DESIGN AND PATIENTS We retrospectively reviewed the imaging findings of hamstring muscle complex (HMC) strain in 170 patients referred to our institution over a 3-year period. A total of 179 injuries to the HMC were demonstrated in 170 patients (154 male, 16 female, mean age 28.2 years). The mean duration of symptoms was 4.7 days (range 1-10 days). MR imaging was performed in 97 cases and sonography in 102 cases (both modalities were performed in 20 examinations). Attention was directed to the frequency of muscle involvement, the location of the injury within the muscle-tendon unit, the extent of the injury and discriminating avulsion from muscle injury. RESULTS AND CONCLUSIONS Twenty-one patients had proximal tendon injury, with sixteen avulsions and five partial tears. Sixteen of these patients had surgical confirmation of hamstring avulsion from the ischial tuberosity (14 conjoint, 2 biceps femoris alone) and all were reliably diagnosed with MR imaging (16/16), but less so with sonography (7/12). Four distal tendon avulsions were also observed (three semitendinosus, one biceps femoris). With respect to muscle injury, the biceps femoris was most commonly injured (124/154). Semimembranosus was an uncommon muscle injury (21/154) and semitendinosus rare (9/154). Imaging can discriminate a hamstring tendon avulsion from musculotendinous strain and helps identify which patients necessitate surgical management as opposed to conservative treatment.
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Affiliation(s)
- George Koulouris
- Department of Radiology, St Francis X Cabrini, Wattletree Rd, 3144, Malvern, Victoria, Australia
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