Dr. Jeckyll and Mr. Frohse

‘Man is not truly one, but truly two’ – Robert Louis Stevenson’s Strange Case of Dr Jekyll and Mr Hyde

When I was studying the anatomy, I used to improve my memory combining the information I wanted to remember with a visual image, a sentence, or a word. The posterior  interosseous nerve is the continuation of the deep branch of the radial nerve; he passes beneath the Frohse’s arcade, a fibrous arch between the two heads of the supinator muscle. The deep branch of the radial nerve and his continuation… two sides of the same coin… In the same period I was reading the Stevenson’s novel, so easy for me to combine the duplicity of the nerve with the main character of the book.

A compressive entrapment of the posterior interosseous nerve is called Radial Tunnel Syndrome and the arcade of Frohse is the most common site of compression.

frohse etg-mri

Axial Ultrasound and T2w Mri scan (0.3 Tesla) of the Frohse’s arcade normal anatomy.

The early diagnosis of this pathological condition can be easily done with dynamic ultrasound examination; repeating all the clinical manouvres is possible to directly appreciate the nerve compression syndrome. First of all you need to know where the posterior  interosseous nerve is located and how it appears under normal conditions; I suggest you to perform the axial scan. Take a look at the video below and enjoy your study.

Are Muscle Strains Hot?

As consultant radiologist for the U.S. Palermo football team, I had a collaboration with the Medical Staff directed by DrCristian Francavilla; Stefano Gari is one of the physiotherapists. He’s working on an interesting project: to study muscular activity with a thermographic camera. 

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Me and Stefano Gari together with Dr. Francavilla and the goalkeeper Stefano Sorrentino during Sassuolo-Palermo match of last year “Serie A”season.

From Wikipedia, the free encyclopedia: “A thermographic camera (also called an infrared camera or thermal imaging camera) is a device that forms an image using infrared radiation, similar to a common camera that forms an image using visible light. Instead of the 400–700 nanometer range of the visible light camera, infrared cameras operate in wavelengths as long as 14,000 nm (14 µm). Their use is called thermography.

Stefano started from a physiological consideration: the inflammatory process increases local temperature; the classical signs of acute inflammation are pain, heat, redness, swelling and loss of function. In the first 24 hours after an injury, a great difference of temperature occurs between the site of injury and the peripheral tissues. Before making the standard radiological examinations, he began to take several thermographic pictures of the injured muscle and then tried to correlate with Mri imaging. The results? In such cases the comparison is incredible. 


2nd degree strain of gastrocnemius medial head – coronal stir mri study and thermography correlation

Thermographic camera never can be considered an alternative to others radiological examinations but a complementary study, especially during physiotherapy treatment follow-up of muscular strains, to better evaluate the progression to healing.


Thermographic pictures taken 24 hours (A) and 48 hours (B) after a strain injury of the right biceps femoris in a professional football player.


Coronal – Sagittal – Axial Stir Mri scans of the same patient performed two days after trauma.

Many colleagues often ask me what I think about the use of ultrasound exams immediately after a muscle trauma on the playground: is it useful? In my opinion the answer is no; too high the risk of underestimate a muscular lesion immediately after an injury. The perfect timing for a good ultrasound examination is about 48-72 hours after the trauma. Can the thermographic camera cover this time interval to have a pre-evaluation of the possible damages? I hope so; at this moment I find very interesting the possibility of monitoring the tissue changes during the physiotherapy treatments.

Come on Stefano, get down to it! I’m waiting for further studies!