Seminars in musculoskeletal radiology
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Traumatic injuries are the leading cause of death in adults < 45 years of age. Musculoskeletal trauma accounts for a substantial number of injuries in patients sustaining polytrauma. The diagnostic work-up of those patients is challenging, complex, and requires a structured and interdisciplinary workflow. ⋯ In this context, CT angiography facilitates the detection of coexisting vascular injuries after trauma of the skeleton. In addition, recent technologies (e.g., dual-energy CT) provide promising applications such as metal artifact reduction. This article summarizes the basic principles of interdisciplinary management of polytrauma patients, reviews recent advances of CT technology that have enabled comprehensive trauma imaging, provides appropriate scan protocols, and discusses the radiologic evaluation of musculoskeletal findings.
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Pain around the greater trochanter is still a common clinical problem that may be secondary to a variety of either intra-articular or periarticular pathologies. Gluteal tendon pathologies are one of the primary causes of greater trochanteric pain, with attrition of the fasciae latae against the gluteus medius and minimus tendons, and the trochanteric bursa being possible causes. Key sonographic findings of gluteal tendinopathy, bursitis, and differential diagnosis are described in this overview. Clinical diagnosis and treatment of greater trochanteric pain syndrome is still challenging; therefore ultrasound is helpful to localize the origin of pain, determine underlying pathology, and, based on these findings, to guide local aspiration and/or injection in cases of tendinopathy and/or bursitis.
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Ultrasound (US) provides excellent delineation of tendons and ligaments in the foot and ankle and provides real-time visualization of a needle during interventions, yielding greater accuracy and efficacy than the traditional blind approach using anatomical landmarks. For this reason, US is rapidly gaining acceptance as the preferred modality for guiding interventions in the foot and ankle where the anatomy is complex, neurovascular structures should be identified, and precise technique is demanded. In the foot and ankle, US is especially useful to guide tendon sheath, bursal, and Achilles paratenon injections, Morton neuroma injections, plantar fascial injections, and joint aspirations and injections.
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Semin Musculoskelet Radiol · Sep 2012
ReviewMR imaging of the shoulder: first dislocation versus chronic instability.
Traumatic dislocation of the shoulder is a frequent injury in the young and active population. An acute shoulder dislocation often denotes a onetime traumatic episode, whereas chronic shoulder instability indicates multiple recurrent dislocations. ⋯ In this article, we describe the underlying biomechanics of glenohumeral stability as well as the imaging features and treatment options of shoulder dislocation. A review of current literature is presented, aimed to shed light about the potential role of imaging in distinguishing first dislocation versus chronic instability.
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Ulnar-sided wrist pain is one of the most common symptoms in athletes of baseball, racket sports, golf, and wrestling where there is frequent use of the hands as well as in soccer and running, where hand use is minimal. Compared with all wrist injuries, ulnar-sided wrist injury is a relatively serious condition for athletes because it plays an important role in performing a strong grip and in the rotation of the forearm. Ulnar-sided wrist pain in athletes can be related to acute trauma or chronic overuse. ⋯ Repetitive mechanical stresses to tendons, ligaments, and the joint structures can lead to tendinitis or osteoarthrosis. Diagnosis of the ulnar-sided wrist pain is challenging both for hand surgeons and radiologists because of the small and complex anatomy. In the present article, we discuss mechanisms of wrist injury, sports-specific ulnar-sided wrist injuries, and the differential diagnosis of ulnar-sided wrist pain.