Dorsal Scapholunate Ligament Tear

about dynamic mri and ultrasound examination of carpal instability

In my previous post Dynamic Evaluation of Dorsal Scapholunate Ligament I showed the usefulness of both ultrasound and Mri dynamic evaluation in the study of this important ligament structure. Today I want to show you the dorsal scapholunate ligament (SL) tear in a patient that came to my observation after a regular healing of post-traumatic scaphoid fracture.

SL Tear

Coronal Stir (left) and T1w (right)  Mri scans (0.3 Tesla): correct visualization with no artifacts of post-surgical treatment with scaphoid screw. Tear of the dorsal scapholunate ligament is evident (red arrow).

For the appropriate treatment is crucial to see also the dynamic behaviour of this kind of injuries. I always perform both ultrasound and Mri dynamic evaluation in these cases.

The dynamic ultrasound exam shows the post-traumatic carpal instability; dorsal SL tear is evident, togheter with the scapholunate dissociation and DISI picture.

For the correct ultrasound scanning please see my previous post Dynamic Evaluation of Dorsal Scapholunate Ligament.

The Dynamic Mri evaluation (0.3 Tesla) during flexion-extension and ulnar-radial deviation confirms the clinical picture, better defining all the pathologic findings. The radiology technician plays a crucial role for this kind of examination, explaining to the patient the correct wrist movement during the Mri acquisitions.

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Peroneal Fracture Monitoring

about ultrasound monitoring of peroneal fracture

Two months after a peroneal fracture the x-rays show a regular healing but the patient feels pain: why?

Peroneal Fracture Healing

I suggest you to always use both ultrasound and Mri imaging to better evaluate the correct healing of the fracture.

In this professional football player is also evident a gross perilesional edema involving the peroneal muscles togheter with the peroneal neurovascular bundle.

Peroneal Fracture Mri

Axial T2w (left) and Stir (right) mri sequences of the same patient (0.3 Tesla).

Peroneal Fracture Mri2

Sagittal Stir (left) and T2w (right) Mri sequences (0.3 Tesla); the perilesional edema along the course of peroneal neurovascular bundle is evident.

The dynamic ultrasound exam allows to better appreciate all the structures involved in this pathological picture; just a little reminder: high sensibility but 0% specificity of the ultrasound imaging in the study of cortical bone.

 

 

Athletic Pubalgia

about ultrasound findings of athletic pubalgia

The pubic symphysis region has a complex anatomy and biomechanics, with large number of potential sources of groin pain and different types or sites of injury that can be present in the same patient.

Today I want to show you the usefulness of the rectus abdominis-adductor longus tendon dynamic ultrasound examination. I always suggest to have a direct visualization of both these important structures that work togheter as antagonists of one another during rotation and extension from the waist.

Professional soccer player with groin pain: the Mri exam shows gross irregularity of the pubic symphysis cortical bone, with cleft sign alongside the right pubic body (arrow) and a partial strain and chronic tendinopathy of the right adductor longus tendon.

athletic-pubalgia

Coronal Pdw Spair (left) and T1w (right) Mri scans (1.5 Tesla).

Same findings are present in this patient at the pubic attachment of right rectus abdominis tendon.

rectus-abdominis

Sagittal (left) and Coronal (right) Pdw spair Mri scans (1.5 tesla).

Ultrasound dynamic examination with active muscle contraction is crucial in this kind of injuries.

In this patient a Spigelian hernia was also detected during provocative  Valsalva maneuvers over linea semilunaris.