Ultrasonography-Guided Injection for Quadriceps Fat Pad Edema: Preliminary Report of a Six-Month Clinical and Radiological Follow-Up

Purpose: To investigate efficacy and safety of ultrasonography-guided local corticosteroid and anesthetic injection followed by physical therapy for the management of quadriceps fat pad (QFP) edema. Materials and Methods: We prospectively evaluated 1671 knee MRI examinations in 1542 patients for QFP edema with mass effect, which was present in 109 (6.5%) knees. Participants were assigned into injection and therapy groups (both received the same physical therapy program). Injection group was first treated with ultrasonography-guided QFP injection of 1 mL corticosteroid and 1 mL local anesthetic agent. Patients were evaluated at baseline and 1-, 2-, 6-month follow-up for pain using static and dynamic visual analogue scale (VAS), suprapatellar tenderness, and QFP edema on MRI. Results: Final sample size consisted of 19 knees (injection group, 10; therapy group, 9) in 17 patients. An overall improvement was detected in both groups between baseline and final assessments. The injection group fared better than the therapy group in static VAS scores (3.33 ± 1.70 versus 0.56 ± 1.33), while there was no such difference for dynamic VAS. Incidence of suprapatellar tenderness decreased in both groups, statistically significantly in the injection group (from 100% to 0%). Pain reduction was greater in the injection group at the first month (88.9% – 90% good response versus 50% – 66.7% good response, static-dynamic VAS scoring, respectively), whereas there was no such superiority at the sixth month. No severe adverse events were identified. Conclusion: Ultrasonography-guided local injection followed by physical therapy is safe in the management of QFP edema; however, it is not superior to stand-alone physical therapy program in the long term

Magnetic Resonance Imaging (Mri) of Snapping Scapula in a 10-Year-Old Boy

Background Snapping scapula syndrome, also known as scapulothoracic crepitus or bursitis, is a manifestation of a mechanical abnormality of the scapulothoracic joint. In addition to characteristic findings on physical examination, magnetic resonance imaging (MRI) exquisitely reveals soft tissue changes such as muscle edema and scapulothoracic bursitis. Case Report We present a case of a 10-year-old boy who had snapping scapula syndrome of the right scapula that was associated with edema of the serratus anterior muscle at the scapulothoracic interface and with scapulothoracic, specifically supraserratus, bursitis on MRI. Conclusions MRI in snapping scapula syndrome, which is a clinical diagnosis, exquisitely reveals soft tissue changes such as muscle edema and scapulothoracic bursitis. Such soft tissue findings of snapping scapula syndrome need to be kept in mind while evaluating routine shoulder and/or scapular region MRI, especially in the absence of relevant clinical information at the time of the imaging study.PubMedScopu

Intramuscular Chondroid Lipoma: Magnetic Resonance Imaging Diagnosis by 'Fat Ring Sign'

Background: Chondroid lipoma is an extremely rare variant of benign lipomatous lesions that is composed of lipoblasts, mature fat, and chondroid matrix. Although benign lipomatous lesions are the most common soft tissue tumors and imaging findings are often pathognomonic, there have been few reports describing the imaging features of chondroid lipoma. Case Report: We present magnetic resonance imaging (MRI) findings of a pelvic intramuscular chondroid lipoma in a 59 year-old man and describe a "fat ring sign" that may be useful to diagnose this rare tumor radiologically. Conclusion: Magnetic resonance imaging findings of a chondroid lipoma may be heterogenous according to the distribution of the fatty and chondroid tissue. However, in the presence of "fat ring sign," radiologists should consider a diagnosis of chondroid lipoma preoperatively.WoSScopu

Mri Of Lower Extremity Impingement And Friction Syndromes In Children

Although generally more common in adults, lower extremity impingement and friction syndromes are also observed in the pediatric age group. Encompassing femoroacetabular impingement, iliopsoas impingement, subspine impingement, and ischiofemoral impingement around the hip; patellar tendon-lateral femoral condyle friction syndrome; iliotibial band friction syndrome; and medial synovial plica syndrome in the knee as well as talocalcaneal impingement on the hindfoot, these syndromes frequently cause pain and may mimic other, and occasionally more ominous, conditions in children. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of musculoskeletal impingement and friction syndromes. Iliopsoas, subspine, and ischiofemoral impingements have been recently described, while some features of femoroacetabular and talocalcaneal impingements have recently gained increased relevance in the pediatric population. Fellowship-trained pediatric radiologists and radiologists with imaging workloads of exclusively or overwhelmingly pediatric patients (particularly those without a structured musculoskeletal imaging program as part of their imaging training) specifically need to be aware of these rare syndromes that mostly have quite characteristic imaging findings. This review highlights MRI features of lower extremity impingement and friction syndromes in children and provides updated pertinent pathophysiologic and clinical data.Wo

Ct Assessment Of Asymptomatic Hip Joints For The Background Of Femoroacetabular Impingement Morphology

PURPOSE The purposes of this study were to assess the presence of cam and pincer morphology in asymptomatic individuals with a negative femoroacetabular impingement test, and to determine and compare the ranges of alpha angle using two measurement methods. MATERIALS AND METHODS In total, 68 consecutive patients who underwent abdominopelvic computed tomography (CT) for reasons other than hip problems were the patient population. Patients who had a positive femoroacetabular impingement test were excluded. Alpha angle measurements from axial oblique (A(N)) and radial reformat-based images (A(R)) from the anterior through the superior portion of the femoral head-neck junction, as well as femoral head-neck offset, center-edge angle, acetabular version angle measurements, and acetabular crossover sign assessment, were made. RESULTS Overall prevalences of cam (increased alpha angle, decreased femoral head-neck offset) and pincer morphology (increased center-edge angle, decreased acetabular version) were 20.0%, 26.8%, 25.8%, and 10.2% of the hips, respectively. The mean A(R) ranged from 41.64 degrees +/- 4.23 degrees to 48.13 degrees +/- 4.63 degrees, whereas A(N) was 41.10 degrees +/- 4.44 degrees. The values of A(R) were higher than A(N), and the difference was statistically significant (P < 0.001). The highest A(R) values were measured on images from the anterosuperior section of femoral head-neck junction. CONCLUSION In asymptomatic subjects, higher alpha angle values were obtained from radial reformatted images, specifically from the anterosuperior portion of the femoral head-neck junction compared with the axial oblique CT images. Other measurements used for the assessment of cam and pincer morphology can also be beyond the ranges that are considered normal in the general population.WoSScopu

A Critical Overview of The Imaging Arm of The Asas Criteria For Diagnosing Axial Spondyloarthritis: What The Radiologist Should Know

The Assessment in SpondyloArthritis international Society (ASAS) defined new criteria in 2009 for the classification of axial spondyloaithritis (SpA) in patients with >= 3 months of back pain who were aged = 1 SpA features (such as inflammatory back pain, arthritis, heel enthesitis, uveitis, dactylitis, psoriasis, Crohn's disease/colitis, good response to non-steroidal anti-inflammatory drugs, family history for SpA, HLA-B27 positivity, or elevated C-reactive protein) is sufficient to make the diagnosis of axial SpA. A number of rules and pitfalls, however, are present in the diagnosis of active sacroiliitis on MRI. These points are highlighted in this review, and a potential shortcoming of the imaging arm of the ASAS criteria is addressed.WoSScopu

Ultrasonography-Guided Injection For Quadriceps Fat Pad Edema: Preliminary Report Of A Six-Month Clinical And Radiological Follow-Up

Purpose: To investigate efficacy and safety of ultrasonography-guided local corticosteroid and anesthetic injection followed by physical therapy for the management of quadriceps fat pad (QFP) edema. Materials and Methods: We prospectively evaluated 1671 knee MRI examinations in 1542 patients for QFP edema with mass effect, which was present in 109 (6.5%) knees. Participants were assigned into injection and therapy groups (both received the same physical therapy program). Injection group was first treated with ultrasonography-guided QFP injection of 1 mL corticosteroid and 1 mL local anesthetic agent. Patients were evaluated at baseline and 1-, 2-, 6-month follow-up for pain using static and dynamic visual analogue scale (VAS), suprapatellar tenderness, and QFP edema on MRI. Results: Final sample size consisted of 19 knees (injection group, 10; therapy group, 9) in 17 patients. An overall improvement was detected in both groups between baseline and final assessments. The injection group fared better than the therapy group in static VAS scores (3.33 ± 1.70 versus 0.56 ± 1.33), while there was no such difference for dynamic VAS. Incidence of suprapatellar tenderness decreased in both groups, statistically significantly in the injection group (from 100% to 0%). Pain reduction was greater in the injection group at the first month (88.9% – 90% good response versus 50% – 66.7% good response, static-dynamic VAS scoring, respectively), whereas there was no such superiority at the sixth month. No severe adverse events were identified. Conclusion: Ultrasonography-guided local injection followed by physical therapy is safe in the management of QFP edema; however, it is not superior to stand-alone physical therapy program in the long term.PubMedWoSScopu

Recessive PIEZO2 stop mutation causes distal arthrogryposis with distal muscle weakness, scoliosis and proprioception defects

The genetic work-up of arthrogryposis is challenging due to the diverse clinical and molecular etiologies. We report a-18(3/12)-year-old boy, from a 2nd degree consanguineous family, who presented at 3(6/12) years with hypotonia, distal laxity, contractures, feeding difficulties at birth. He required surgery for progressive scoliosis at 16 years of age, and walked independently since then with an unstable gait and coordination defects. His latest examination at 18 years of age revealed a proprioceptive defect and loss-of-joint position sense in the upper limbs. Somatosensory evoked potentials supported bilateral involvement of dorsal column-medial lemniscal sensory pathways and nerve conduction studies revealed a mild axonal neuropathy. Muscle biopsy showed myopathic changes with neonatal myosin expression. Mendeliome sequencing led to the discovery of a recessive stop mutation in piezo-type mechanosensitive ion channel component 2 (PIEZO2, NM_022068, c.1384C>T, p.R462*). PIEZO2 is a nonselective cation channel, expressed in sensory endings of proprioceptors innervating muscle spindles and Golgi tendon organs. Dominant PIEZO2 mutations were described in patients with distal arthrogryposis type 5 and Marden-Walker syndrome. Sensory ataxia and proprioception defect with dorsal column involvement together with arthrogryposis, myopathy, scoliosis and progressive respiratory failure may represent a distinct clinical phenotype, and indicate recessive mutations in PIEZO2