About dynamic msk imaging modalities in the study of post-traumatic metacarpal fracture
Acute 4th metacarpal spiroid fracture of a professional football goalkeeper; first diagnosis was made directly on pitch with an ultrasound examination. Plain radiographs and Mri exam were performed just one hour after trauma.
One month after surgical fixation the fracture is studied with dynamic US, Mri and Cone-Beam CT imaging. The US and MR dynamic evaluations, show a regular tendon sliding over the fixation devices.
No metal-induced artifacts were seen, allowing a perfect visualization of the implanted devices.
Cone-Beam CT Sagittal (left) and Coronal (right) reconstructions.
The study was completed with dynamic Mri (0.3 Tesla) and Cone-Beam CT scans, performed with active flexion-extension of carpal-metacarpal joint structures.
about dynamic ultrasound and mri evaluation of partial patellar tendon tear
Today I show you the case of a partial tear at proximal insertion of the patellar tendon in a professional football player. The patient refears pain during flexion-extension at inferior patellar pole; hystory of repetitive trauma as usual in football players.
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.
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.
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.
Two months after a peroneal fracture the x-rays show a regular healing but the patient feels pain: why?
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.
Axial T2w (left) and Stir (right) mri sequences of the same patient (0.3 Tesla).
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.
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.