Patellar Tendon Tear

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.

Patellar Tendon Tear

Sagittal Xbone T1w (left) and T1w TSE (right) Mri scan (o.3 Tesla)

The Mri exam shows a partial tear of the patellar tendon proximal insertion. In these kind of injury I always need a dynamic ultrasound exam, both in clino and orthostatic position.

The partial tear is better depicted with the dynamic ultrasound evaluation; the dynamic Mri is also useful to appreciate the tendon relationship with the patella.

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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.

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.

Lateral Meniscus Cyst

about ultrasound appearance of lateral meniscus cyst degeneration

In my previous post Meniscal Cyst I showed the ultrasound appearance of a medial meniscus cyst, together with a suspected meniscal tear. Today I present the case of a young football player that came to my observation one year after a lateral collateral partial strain injury. As you certainly know peripheral attachments of the lateral meniscus are more lax than on the medial side, permitting greater mobility of the lateral meniscus.

lateral-meniscus-cyst

The dynamic ultrasound exam allows to appreciate a gross meniscal fissuring, with a meniscal cyst and partial extrusion; no alterations were seen along the course of the lateral collateral ligament.

Meniscus extrusion is usually associated with meniscal degeneration and tears, so it is crucial to always perform also the Mri examination.

lateral-meniscus

Coronal T2w (left) and Axial T2w (right) Mri scans (0.3 Tesla). The meniscal cyst and degeneration are evident.

lateral-meniscus-complex-tear

Coronal T2w (left) and Axial T2w (right) Mri scans (0.3 Tesla). Complex tear of the lateral meniscus.

 

Biceps Femoris Fibrosis

about ultrasound monitoring of muscle injury remodelling phase

In my recent post Ultrasound Muscle Injuries Monitoring I showed the importance of the dynamic ultrasound and elastosonography exam in the study of the granulation tissue at the site of injury during the rehabilitation program.

Today I want to remind you to take care about muscle also after the final phases of remodeling (3–6 months after trauma), in which maturation of the regenerating fibers into a functional contractile unit takes place.

remodelling

Axial (left) and Coronal (right) Mri scans of a late left biceps femoris injury evaluation (1.5 Tesla).

In these cases the Mri exam is less sensistive than ultrasound imaging; don’t forget to always perform both imaging modalities.

fibrosis

The patient suspected a reinjury in the same site of a previous trauma; first evaluation was made with an ultraportable device.

The power-doppler exam togheter with the elastosonography evaluation, show an incomplete scar maturation.

Soleus Myotendinous Junction Injury

About aponeurotic medial insertion injury of the soleus muscle.

Knowing the anatomy and biomechanics of the gastrocnemius-soleus complex – or triceps surae – is crucial for an understanding of the etiology and treatment of all its possible injuries. Today I want to show you a painful partial lesion at the aponeurotic medial insertion of the soleus muscle in a professional soccer player.

One month after a soleus injury, a patient suffered for pain and discomfort at the distal soleus myotendinous junction; first examination was made with an ultraportable device directly on the pitch during a daily training session. A partial injury of the aponeurotic medial insertion was evident, togheter with muscle perilesional edema.

soleus-injury

Sagittal Ultrasound comparative examination of the medial soleus myotendinous junction; normal findings on the right side.

soleus-medial-insertion

Sagittal GeStir (left) and Coronal T2w Mri scans of the same patient (0.3 Tesla).

fse_t2__2__and_fse_t2__4_

Axial (left) and Sagittal (right) T2w Mri scans (0.3 Tesla).

With the dynamic ultrasound examination is better appreciated also an inflammation along the course of the posterior tibial nerve.

Also in this case the elastosonography evaluation works like a “contrast agent” well depicting the lesional area.

You can find further information about the complex anatomy of the triceps surae in this interesting scientific paper: Anatomy of the Triceps Surae: A Pictorial Essay