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 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.
Today a show you the case of a young football player that came to my observation for a persistent pain on his postero-medial compartment of the leg; as you can see from the dynamic ultrasound examination, a gross irregularity of the cortical tibial surface was evident with intense periostal hypervascularity.
The tibia is the most common site of a stress fracture in the lower body, especially in young athletes. Don’t forget that sensibility of the ultrasound scan with bone-like structures is 100% but 0% specificity. The integration with other imaging modalities is always needed; Mri exam is essential.
Sagittal Stir-3D Shark-T1w Mri scans 0.3 Tesla (from left to right)
Axial Stir (left) and T2w (right) Mri scans (0.3 Tesla); intense periostal reaction is evident.
With plain radiograph positive findings may take months to appear; don’t be surprised if during the first few weeks after the onset of symptoms, x-rays of the damaged area may look normal; not in this case….
Plain radiographs of the same patient: acute phase (left) and two months after (right).
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?
During a standard wrist ultrasound exam, it might happen to find a bifid median nerve. According to literature it has an incidence of ~3% and may be accompanied by an accessory artery, the persistent median artery of the forearm, which lies in between the two nerve bundles.
Axial ultrasound and T2w Mri scan (0.3 Tesla)
Especially in case of carpal tunnel release it is essential that this particular anatomy be mentioned in your report in order to avoid iatrogenic injuries. Mri scan togheter with dynamic ultrasound examination and electromyography are the best choice for the evaluation of peripheral neuropathies.