Psoriatic Arthritis of the Elbow

About chronic synovitis of the elbow in a patient with psoriatic arthritis.

Sometimes patients come to our attention without a specific clinical history, referring just joint pain.

In case of this joint swelling and gross chronic synovitis always think to a rheumatic disorder. Remember that on MRI, psoriatic synovitis appears indistinguishable from that of rheumatoid arthritis. According to the EULAR (European League Against Rheumatism) recommendations – “A definitive diagnosis of rheumatic diseases can be made by assessing the medical history, by performing a physical examination or ordering specific laboratory tests and undertaking imaging investigations”.

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Coronal Ge Stir (left) and T1W Mri scans (0.3 Tesla).

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Coronal GeStir (left) and Sagittal T2w (right) Mri scans (0.3 Tesla). A gross synovitis with pseudonodular distension of the bicipitoradialis bursa is evident.

The Mri examination shows diffuse irregularity of the cortical bone surfaces and entheseal region of tendons and ligaments, with distension of adjacent bursae by fluid collection. All of these findings are well depicted on ultrasound exam.

This patient also suffered for a painful synovial impingement along the course of the posterior interosseous nerve at Frohse’s arcade, best seen with the dynamic ultrasound examination.

With the elastosonography exam you can discriminate the real fluid quote of this chronic synovitis.

Avoid joint aspiration in this kind of situations: it’s like putting a needle into the marmalade! 

Take home message? Keep calm and call a rheumatologist.

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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?

 

Medial Collateral Ligament Tear

This is the case of a professional football player with a  grade 2 injury of the medial collateral ligament; high signal and partial disruption of the ligament is seen on Mri exam. The study is completed by dynamic ultrasound and elastosonography evaluation;  in this picture the elastosonography signal works like a “contrast agent”, with the red color that depicts the real extent of the ligament tear.

Have you ever tried to change the point of view of your ultrasound images? Takea look at the picture below, in which both Mri and ultrasound images have the same angle orientation.

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Coronal T2w mri scan (0.3 Tesla) and ultrasound exam of the same patient.

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Medial collateral ligament tear: from grade 1 to grade 3. T2w coronal Mri scans (0.3 Tesla).