Subluxating Ulnar Nerve at the Elbow

about ultrasound findings of post-traumatic ulnar nerve subluxation

This is the case of a direct blow to a flexed elbow. The X-ray and Mri exams show a condylar fracture of the humerus, with a partial cortical bone detachment; a gross joint capsule distension is also evident.

Elbow Mri-xray

Coronal Xbone-T1w Mri scan (0.3 Tesla) and Plain Radiography.

Condylar Fracture

Coronal Stir (left) and T1w (right) Mri scans of the same patient (0.3 Tesla).

Why ultrasound in this case? Because after 1 month the patient feels pain on the posterior-medial aspect of the elbow, especially during the flexion-extension active movement, with distal pain irradiation to the forearm.

The dynamic ultrasound exam better depicts the clinical picture of a post-traumatic ulnar nerve subluxation at the sulcus ulnaris, togheter with a gross joint synovitis.

Ulnar Nerve Inflammation

Axial T2w (left) and Stir (right) Mri scans of the same patient (0.3 Tesla).

Advertisements

Medial Gastrocnemius Rupture

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 Mri

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.

Bipartite Hallux Sesamoid Injury

about dynamic ultrasound and MRi findings of post-traumatic injury of a medial bipartite hallux sesamoid bone

Today I show you the injury of a medial bipartite hallux sesamoid bone in a professional football player; extremely painful after trauma, it takes time to heal.

Sesamoid

Standard X-Ray exam after trauma.

Medial Bipartite Sesamoid MRI

Sagittal (left) and Coronal (right) Ge-Stir Mri sequences (0.3 Tesla); bone marrow edema of the medial sesamoid is evident.

I always perform also the dynamic evaluation, both with ultrasound and Mri exams.

 

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.

 

 

Sartorius Tendon Injury

About sartorius tendon injuries in adolescents.

14 years-old male soccer player presents with right hip pain after kicking. The site of referred higher pain is located on the anterior-superior iliac spine.

The dynamic ultrasound exam shows a partial strain of the sartorius tendon bone attachment, togheter with a gross irregularity of the cortical bone surface, a common finding in young patients; power-doppler evaluation defines the typical post-traumatic hypervascularity.

In these cases I always suggest to perform also the Mri exam for the correct diagnosis and clinical management.

Ultrasound imaging is not enough: what’s about the osteochondral involvment?

antero-superior-iliac-spine

Axial (left) and Sagittal Pdw-Spair Mri scans (1.5 Tesla).

The partial tear of sartorius tendon with associated marrow and soft tissue edema is evident. Apophyseal injuries to the hip and pelvis are quite frequent in skeletally immature individuals playing football. Combining ultrasound and Mri imaging modalities is the gold standard, especially beacuse radiographs may be interpreted as negative also in case of non-displaced fractures.

If you are a “pure sonographer” or a physiotherapist don’t forget to talk with a radiologist about these kind of injuries.

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.

gradient_echo_stir___3__and_spin_echo_t1___2_

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?