High-resolution ultrasound of rotator cuff and biceps reflection pulley in non-elite junior tennis players: anatomical study

BACKGROUND: Tennis is believed to be potentially harmful for the shoulder, therefore the purpose of this study is to evaluate the anatomy of the rotator cuff and the coraco-humeral ligament (CHL) in a-symptomatic non-elite junior tennis players with high-resolution ultrasound (US). METHODS: From August 2009 to September 2010 n = 90 a-symptomatic non-elite junior tennis players (mean age ± standard deviation: 15 ± 3) and a control group of age- and sex- matched subjects were included. Shoulder assessment with a customized standardized protocol was performed. Body mass index, dominant arm, years of practice, weekly hours of training, racket weight, grip (Eastern, Western and semi-Western), kind of strings were recorded. RESULTS: Abnormalities were found at ultrasound in 14/90 (15%) players. Two players had supraspinatus tendinosis, two had subacromial impingement and ten had subacromial bursitis. CHL thickness resulted comparable in the dominant and non-dominant arms (11.3 ± 4.4 mm vs. 13 ± 4.2, p > 0.05). Multivariate analysis demonstrated that no association was present among CHL thickness and the variables evaluated. In the control group, abnormalities were found at ultrasound in 6/60 (10%) subjects (sub-acromial bursitis). No statistically significant differences between players and control group were found (p = 0.71). CONCLUSION: In a-symptomatic non-elite junior tennis players only minor shoulder abnormalities were found

Ultrasound of distal brachialis tendon attachment: normal and abnormal findings

Objective: To demonstrate normal and abnormal findings of distal brachialis tendon attachment in cadavers, normal volunteers and patients by means of ultrasound. Methods: 3 cadaveric specimens, 30 normal volunteers and 125 patients were evaluated by means of ultrasound. Correlative MRI was obtained in volunteers. Results: In all cases, ultrasound demonstrated the distal brachialis tendon shaped by two distinct tendons belonging to the deep head and superficial head of the brachialis muscle. Correlative MRI demonstrated that the brachialis is composed of two distinct tendons in 83% of volunteers (25/30). In the patient group, four avulsions with bony detachment involving the deep head, one delayed onset muscular soreness and three tendinous detachments with no bony avulsion involving one or two tendons were identified. The four patients with bony avulsion were immediately referred to the orthopaedic surgeon for a presurgical evaluation. Patients without bony avulsion were not referred to the surgeon. Conclusion: Detailed anatomy of the distal tendon is discernible in 100% of cases with ultrasound. There are two distinct tendons, and ultrasound can differentiate isolated lesions. In patients with distal brachialis tendon lesions, ultrasound may modify the clinical management of the patient. Advances in knowledge: Detailed anatomy of the distal brachialis tendon is discernible with ultrasound and there are two distinct tendons

Letter to Editor: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement

A response to Chalidis et al: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement. World J Surg Oncol 2007, 5:92

The primary role of radiological imaging in the diagnosis of rare musculoskeletal diseases. Emphasis on ultrasound

Objective: In July 2017 a multidisciplinary clinical Center specialized in rare diseases was activated. A rare disease can involve the musculoskeletal system. A multimodality musculoskeletal imaging approach allows for a rapid diagnosis. The purpose of this study was to assess when musculoskeletal radiology, ultrasound in particular, plays a primary role in the diagnostic path of a rare disease. Methods and materials: The Center included a list of 621 main rare diseases. Pathologies in which radiology has a primary diagnostic role were extracted from the list. From September 2017 to January 2018 all conditions involving the musculoskeletal system, including the peripheral nervous system, were systematically evaluated by one radiologist. The second radiologist, an official consultant of the Center, verified the list for consistency. Descriptive analysis was performed. Results: A total of 101/621 (16%) rare diseases can be diagnosed for the first time in the diagnostic path of the patient with medical imaging. A total of 36/101 (36%) rare diseases involve the musculoskeletal system. A total of 14/36 (39%) are pediatric diseases, 10/36 (28%) are adult age diseases, while 12/36 (33%) diseases affect all ages. A total of 23/36 (64%) of the selected rare diseases could be diagnosed with MRI, 19/36 (53%) with CT, 23/36 (64%) with X-ray, 9/36 (25%) with an US, and 1/36 (3%) with PET. Conclusions: Musculoskeletal imaging could be important for a non-invasive diagnosis in up to 36/101 (36%) rare diseases, as well as for outcome prediction, especially in pediatrics. Musculoskeletal imaging plays a crucial role in the diagnosis of rare diseases and could strongly influence the clinical pathway. Ultrasound is crucial in up to 25% of patients with rare diseases affecting the musculoskeletal system

Variations in the Course and Diameter of the Suprascapular Nerve: Anatomical Study

Background: Suprascapular neuropathy is an important factor contributing to shoulder pain. Given the prevalence of nerve injury and nerve block in the suprascapular notch region, as well as the frequency of arthroscopic procedures on the suprascapular notch, which are recommended in shoulder pain management, its morphology is relevant from a clinical perspective. (2) Methods: Suprascapular nerve course was studied in twelve shoulders by dissection. Its diameter was measured at omohyoid level, proximal to the suprascapular notch and distal to the spinoglenoid notch. A multi-vari chart was used in order to descriptively visualize the results. The variations found were analyzed with a mixed linear model. (3) Results: In two of the six subjects, the suprascapular nerve was divided into two motor branches proximal to the superior transverse scapular ligament. An increase in diameter around the suprascapular notch was detected, with an estimated difference between diameter means of 2.008 mm at the suprascapular notch level and 2.047 mm at the spinoglenoid notch level. (4) Conclusions: A difference in the estimated diameter detected and the fact that the motor branches, which innervate supraspinatus and infraspinatus muscle, were divided proximal to the suprascapular notch may be relevant in the diagnosis and treatment of suprascapular neuropathy and arthroscopic procedures

Variations in the course and diameter of the suprascapular nerve: Anatomical study

Suprascapular neuropathy is an important factor contributing to shoulder pain. Given the prevalence of nerve injury and nerve block in the suprascapular notch region, as well as the frequency of arthroscopic procedures on the suprascapular notch, which are recommended in shoulder pain management, its morphology is relevant from a clinical perspective. (2) Methods_ Suprascapular nerve course was studied in twelve shoulders by dissection. Its diameter was measuredat omohyoid level, proximal to the suprascapular notch and distal to the espinoglenoid notch. A multivarichart was used in order to descriptively visualize the results. The variations found were analyzed with a mixed linear model. (3) Results_ In two of the six subjects, the suprascapular nerve was divided into two motor branches proximal to the superior transverse scapular ligament. An increasein diameter around the suprascapular notch was detected, with an estimated difference between diameter means of 2.008 mm at the suprascapular notch level and 2.047 mm at the spinoglenoid notch level. (4) Conclusions_ A difference in the estimated diameter detected and the fact that the motor branches, which innervate supraspinatus and infraspinatus muscle, were divided proximal to the suprascapular notch may be relevant in the diagnosis and treatment of suprascapular neuropathyand arthroscopic procedure

Ultrasound assessment of degenerative muscle sarcopenia: the University of Barcelona ultrasound scoring system for sarcopenia

AimThis study aimed to (1) determine the intraobserver and interobserver reliability of ultrasonographic measurement of muscle thickness (MT) and cross-sectional area (CSA) of the rectus femoris and biceps brachii, correlating these values with manual measurements on dissected cadavers and (2) develop the first semiquantitative musculoskeletal ultrasound (MSUS) scoring system of muscle morphology in sarcopenia and assess its intraobserver and interobserver reliability. In addition, the MSUS morphology score was compared with the corresponding histological images to verify concurrent validity.MethodsTen cryopreserved limbs of 10 cadavers aged 68-91 years were evaluated. The MSUS scoring system was based on the severity of muscle degeneration on a 3-point qualitative scale: grade 1 (normal), grade 2 (moderate changes) and grade 3 (severe changes). Reliability was assessed with intraclass correlation coefficient (ICC) for the MT and CSA and with Cohen's kappa coefficients (& kappa;) for the MSUS scoring system. Concurrent validity was analysed with ICC.ResultsThe results showed excellent intraobserver and interobserver reliability for both the MSUS evaluation of MT and CSA (ICC & GE;0.93). The MSUS scoring system showed excellent intraobserver reliability (& kappa;=1.0) and very good interobserver reliability (& kappa;=0.85). There was also a high intra- and inter-observer reliability for the histological scorings (& kappa; & GE;0.85 and mean & kappa;=0.70, respectively), as well as high reliability between the histology and MSUS scoring systems (ICC=0.92). All results were statistically significant (p & LE;0.001).ConclusionMSUS measures of MT and CSA and the novel MSUS scoring system for degenerative muscle changes in sarcopenia was found to be reliable and strongly associated with histological findings

Characterization of digital annular pulleys and their entheses: an ultrasonographic study with anatomical and histological correlations

Objectives: Digital annular pulleys (DAP) are important anatomical structures for finger function. The anatomy, histology, and imaging assessment of DAP, particularly at the level of their entheses is still not clearly defined. The advent of high-frequency ultrasound (US) transducers opened new perspectives in evaluating sub-millimeter scale structures, such as pulleys, paving the way for their global assessment. The study aimed at characterizing DAP from an anatomical, histological, and US perspective, focusing on the detection and complete description of pulley entheses. Methods: US assessment and gross anatomy dissection were conducted on 20 cadaveric hands to study DAP thickness and structure including enthesis identification. The results of the US and anatomical measurements were correlated. DAP entheses identified by US were characterized via histological analysis. DAP in 20 healthy controls (HC) were detected and measured by US. The A1, A2, and A4 DAP entheses were assessed using a new dynamic maneuver to better evaluate those structures. Results: 1200 DAP (400 cadaveric, 800 HC) were analyzed. The cadaveric study demonstrated strong correlation between anatomical and US measurement of DAP (r = 0.96). At histological level, DAP entheses at the volar plate, sesamoid bones, or phalangeal ridges contained fibrous and fibrocartilaginous tissue. The US assessment of A1, A2, and A4 DAP in HC allowed the identification of 718/720 (99.73%) entheses. Conclusion: US is an effective tool to detect and study DAP. DAP entheses reveal both fibrous and fibrocartilaginous characteristics. A newly described maneuver to optimize DAP enthesis visualization enhances their detection by US