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.
About dynamic ultrasound and Mri study of Haglund’s syndrome
Pain at the back of the heel is the clinical presentation of Haglund’s syndrome; Achilles tendinophaty, bony enlargement on posterosuperior aspect of calcaneum and retrocalcaneus bursitis are the main characteristics of this painful syndrome, also associated with calcaneal spurs. Repetitive impingement microtraumas lead to Achilles tendon degeneration.
I always perform both ultrasound and Mri examinations; direct visualization of the impingement syndrome allows to better estimate the tendon damages and all associated painful conditions, such as the retrocalcaneal bursitis.
Don’t forget to take a look at the Kager’s fat padtriangle; on ultrasound exam its echogenicity need to be the same or inferior than Achilles tendon appearance.
In this patient hyperechogenicity of Kager’s triangle is evident, due to its chronic involvement in the inflammatory process.
From left to right: Sagittal T1w – Xbone T1w and Ge Stir Mri sequences of the same patient (0.3 Tesla).
The Mri exam also shows a stress fracture of the posterosuperior corner of the calcaneus.
In a previous post I showed you my daily routine in studying patellar tendon degeneration and how crucial is to combine all the imaging modalities for a better treatment strategies.
It’s not easy to study post-surgical outcomes of a tendon with the Mri evaluation; lots of artifacts and calcfications doesn’t allow a clear visualization of tendon’s fibres.
Sagittal T1w (left) and GeStir (right) of patellar tendon degeneration 10 years after surgery reconstruction; red arrows indicate the site of pain.
This is the case of a patient that ten years after surgical reconstruction of the patellar tendon, starts to feel pain. Is it possible to “see” the pain? Gross tendon degeneration is evident but, only with ultrasound examination I can better depict the hypervascularity of the tendon in the site of referred pain and the relationship between patellar tendon and Hoffa’s fat pad, its well known “biomechanical attenuator”.
But I also asked to myself: what’s behind this tendon degeneration? Dynamic Mri study gave me the answer: a scarce patellar mobility during active flexion-extension movements was evident.
Less patellar mobility means more stress for the tendon. Isn’t it?
Dynamic Mri exam is crucial in many situations; in a previous post I have shown a dynamic Mri study of patellofemoral impingement with patella alta.
Take a look at this patient in which the suspected patella baja is well studied during flexion-extension active movements.
The Insall-Salvati Index (ISI) and its modified version are used the same way on Mri studies as on plain radiographs.
Rember that in case of true patella baja, the patella remains engaged within the trochlear groove in full knee extension. The dynamic examination allows to appreciate the direct visualization of patellar and trochlear allignment for a more objective measurement, together with the others modalities. In this patient the dynamic examination shows a correct patellar positioning during active extension.