about monitoring stress injury of the talar dome with dynamic MRI and CBCT exam
Today I present you the clinical picture of a medial talar bone edema and spongious impaction of an elite runner; I’d like to remind you that a bone bruise is a subchondral osseous fracture of the cancellous microarchitecture with accompanied local hemorrhage and edema, so less indication for ultrasound imaging in this case. Yes, with ultrasound we can perfectly see the cortical irregularity but nothing about the definitive staging of the disease, so don’t forget: MRI is the method of choice (Stress Fracture in Runners).
Three months after the study was completed with Cone-Beam Ct scan; try to identify risk factors and training errors predisposing to stress fractures is mandatory.
I always use the dynamic MRI-CBCT examination before the return to activity.
About diagnostic imaging of postoperative complication of anterior cruciate ligament (ACL) reconstruction.
This is the case of a patient the came to my observation for a palpable mass into the anterior-medial pretibial region, two years after ACL reconstruction.
Tunnel cyst formation is a rare complication after ACL reconstruction, usually occurring 1-5 years post-operatively, which may occasionally be symptomatic. The ultrasound exam in this case is not enough. The study is completed with MRI and Cone-Beam CT examination.
Why Cone-Beam CT? Same diagnostic capability of total-body CT but low radiation dose!
The computed tomography dose index (CTDI) is a commonly used radiation exposure index in X-ray computed tomography (CT); in this case 4,74 mGy was the value detected. 16.98 mGy is the estimated absorbed dose by using a total-body CT scan for the same examination.
about ultrasound and mri findings of vastus lateralis injury
This is the case of a young rugby player presenting an high degree strain of the vastus lateralis muscle at its proximal insertion, togheter with an aponeurotic fascial injury on the subcutaneous lateral side.
I always suggest to perform both the Mri and ultrasound investigations; with the Mri exam it is evident the bone marrow edema, due to the avulsion injury at the intertrochanteric line, suspected during the clinical evaluation but impossible to see on ultrasound exam.
Coronal (left) and Sagittal (right) PD-Fs Mri scans (1.5 Tesla).
Axial PD-Fs Mri scan (1.5 Tesla). The bone marrow edema and the avulsion injury are evident.
about the correct ultrasound scanning techinchs to find the ulnar erve at the sulcus ulnaris
Have you seen my recent post “Subluxating Ulnar Nerve at the Elbow”? If yes, you may find also interesting how to locate the ulnar nerve at the sulcus ulnaris and the specific ultrasound scans. Use your own elbow to practice or try to ask to a friend or collegue to “share” their anatomy; in other words… Practice is the mother of skills!
In the video below you can find everything needed for your training, so enjoy the video and if you have any questions don’t hesitate to contact me.
about ultrasound findings of post-traumatic ulnar nerve subluxation
This is the case of a direct blow to a flexed elbow. The X-ray and Mri exams show a condylarfracture of the humerus, with a partial cortical bone detachment; a gross joint capsule distension is also evident.
Coronal Xbone-T1w Mri scan (0.3 Tesla) and Plain Radiography.
Coronal Stir (left) and T1w (right) Mri scans of the same patient (0.3 Tesla).
Why ultrasound in this case? Because after 1 month the patient feels pain on the posterior-medial aspect of the elbow, especially during the flexion-extension active movement, with distal pain irradiation to the forearm.
The dynamic ultrasound exam better depicts the clinical picture of a post-traumatic ulnar nerve subluxation at the sulcus ulnaris, togheter with a gross joint synovitis.
Axial T2w (left) and Stir (right) Mri scans of the same patient (0.3 Tesla).
about ultrasound findings of complete detachment of medial gastrocnemius
In case of major traumas in the calf region, a reminder of its intrinsic anatomy is necessary; I suggest you to read an interesting paper in which all of the tirceps surae anatomical structures are perfectly depicted. https://www.ncbi.nlm.nih.gov/pubmed/25456712
Today I show you the case of a complete detachment of the medial gastrocnemius, togheter with the total rupture of the the so-called intramuscular aponeurosis of the soleus.
Axial T2w (left) and Stir (right) Mri scans (0.3 Tesla)
The Mri images show a gross fluid collection in the aponeurotic space between medial gastrocnemius and soleus muscle; I always perform the ultrasound dynamic examination, both in the acute phase and especially during resting period. The elastosonography study is also useful in the monitoring of the fluid collection evolution.
The elastosonography study is also useful in the monitoring of the fluid collection evolution.
about dynamic cone-beam ct imaging of TFCC wrist injury
It’s always difficult to combine clinical aspects and diagnostic imaging, approaching wrist joint pathology; in many circumstances the orthopaedic surgeon needs to directly visualize what’s happened during the joint motion, especially in a complex region such as the wrist.
I show you an example in which a complex tear of the triangular fibrocartilage complex (TFCC) is evident, togheter with a positive ulnar variance. TFCC is a complex of a fibrocartilaginous disk in association with several ligamentous structures, acting as a stabilizers of the distal radioulnar joint, and transmitting axial loading from carpus to the ulna.
Coronal T1w (left) and 3D SHARC (right) Mri scans (0.3 Tesla).
The dedicated Mri examination (0.3 Tesla), depicts the pathologic picture; the ulnar plus defines the reduction of the quadrilateral ulno-carpal space, and the consequent complex tear of the TFCC at its ulnar attachment; but what happens during the active movements? I usually perform also the dynamic evaluation, both with ultrasound and Mri exams. In this case the Cone-beam CT (CBCT) dynamic acquisitions give the answer.