Weight Bearing Ultrasound Study of Patellar Tendon Degeneration.

About weight-bearing ultrasound study of patellar tendon.

Take a look at this clinical case in which the patient with a clear evidence of patella alta and lateral patellar compression syndrome, has a tendinopathy of the patellar tendon at its proximal insertion, with chronic anterior knee pain and instability.

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Sagittal T1w and Stir Mri sequences (0.3 tesla).

In orthostatism is most evident the increase of flow in vessels that are dilated because of inflammatory response.

This is the reason why I always perform the ultrasound examination both in clino and in orthostatism. Have you ever tried?

 

Ultrasound Muscle Injuries Monitoring

About using Ultrasound and Elastosonography imaging in the muscle injuries monitoring.

Deciding when the injured muscle can be remobilized is probably the most crucial decision in the recovery period after a trauma. The process of scar formation begins almost immediately following injury; immature scar tissue is susceptible to reinjury and the formation of granulation tissue at the site of injury needs to be monitored during the rehabilitation program.

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2nd degree strain of biceps femoris: ultrasound monitoring in a professional athlete; the two images appear quite similar.

The rehabilitation program is usually regulated with reduced activity until the scar reaches sufficient strength to bear the muscle contraction.

How to differentiate the tissue structural changes in the site of injury?

In my daily practice the elastosonography examination allows to distinguish normal from inadequate healing, working as a “contrast agent” in the site of scar formation.

Looking at the referral colour scale I remind you that red colour means softness and blue colour means hardness.

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Same patient studied with elastosonography examination.

15 days after the injury an immature granulation tissue is present (red color in the site of injury), while after 1 month  the scar seems to be progressing favorably (blue color is dominant).

In this case the difference between scar tissues elements is more evident with elastosonography than with standard B-mode ultrasound  examination. Power-doppler exam demonstrates the revascularization by ingrowing capillaries in the site of injury.

 As I showed in my previous post “Are Muscle Strains Hot?” a difference of temperature occurs between the site of injury and the peripheral tissues.

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Also in this patient the thermographic evaluation shows an altered temperature diffusion in the left injured tigh; this is another useful information about the progression of the injurious event.

Dupuytren Disease

About Mri and Ultrasound study of palmar fibromatosis of the hand.

This fibrosing hand disorder often leads to progressive and debilitating flexion contractures of the fingers. The diagnosis is made clinically but defining how much a fibrous nodule infiltrates a tendon is a keyelement in the diagnosis and treatment strategy, especially because recurrence after surgery is common.
For this reason I always perform both Mri and ultrasound examinations in my daily practice. Always.

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Sagittal (left) and Axial (right) T2w Mri scans (0.3 Tesla); red arrows indicate the fibrous nodule and flexor tendons.

The video below demonstrates the nodule traction on the underlying flexor tendons, resulting in flexion contractures of the digits (Dupuytren contractures).