Skeletal radiology
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Hourglass-like constriction neuropathy is a neurological condition caused by non-traumatic, non-compressive fascicular constrictions of one or more individual peripheral nerves. Based on clinical manifestations, it is very difficult to differentiate hourglass-like constriction neuropathy from idiopathic neuralgic amyotrophy. ⋯ Recently, high-resolution ultrasound or magnetic resonance neurography (MRN) have been introduced to detect focal hourglass-like constrictions of peripheral nerves in spontaneous nerve palsy. We present a series of three cases in which the suprascapular nerve was affected by hourglass-like constrictions, which were visualized by high-solution MRN, including a nerve-selective morphological MR pulse sequence with strong fat- and water-signal suppression.
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Image-guided percutaneous bone biopsy may be requested by clinicians to guide antibiotics management decisions in patients with extremity osteomyelitis. Much of the clinical literature describes a high rate of bone biopsy culture positivity in patients with osteomyelitis, but anecdotally biopsy is felt to be fairly low yield in many musculoskeletal radiology practices. The objective of the study is to determine the culture positivity rate and clinical utility of bone biopsy in guiding the management of patients with osteomyelitis. ⋯ Percutaneous bone biopsies may have a low rate of culture positivity, and even when positive, frequently do not have an impact on antibiotics choice. These data differ from much of the clinical literature, which describes a very high rate of culture positivity.
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Accurate identification of distal tibio-fibular syndesmotic injuries is essential to limit potential deleterious post-traumatic effects. To date, conventional radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) have shown limited utilization. This cadaver study evaluates the utility of weight-bearing CT scans on the assessment of incomplete and more complete syndesmotic injuries. ⋯ Torque application helps to diagnose incomplete syndesmotic injuries when using weight-bearing CT. The TFO may be useful for identifying incomplete syndesmotic injuries, whereas the MCS and TFCS predict more complete injuries.
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To describe and evaluate the outcome following shoulder manipulation under rotator interval block for the treatment of adhesive capsulitis. ⋯ Manipulation under general anaesthesia is a well-recognised treatment for adhesive capsulitis. We report that targeted ultrasound-guided injection of the rotator interval and manipulation of the shoulder under local anaesthetic blockade result in good outcomes in reducing shoulder pain and symptoms of adhesive capsulitis with low recurrence and complication rates.
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To examine the impact of the presence of facet tropism on the results of transforaminal epidural steroid injection for unilateral radicular pain induced by lumbar disc herniation. ⋯ Facet tropism correlates with less success of transforaminal epidural steroid injection; therefore, facet tropism may be a worthwhile measurement in a discussion with patients of the benefits of the procedure.