The sonographic squeeze test: Assessing the reliability of the dorsal scapholunate ligament

Background: There is no universally accepted imaging method to diagnose scapholunate ligament (SLL) tears. Our aim was to use sonography to evaluate the reliability of SLL length at baseline compared with a standardized dynamometer maneuver in healthy normals. Materials and methods: Sonographic exams from 31 consented asymptomatic patients between 18 years and 45 years of age were collected on a total of 60 wrists. The length of the SLL was measured superficially and at a depth of 3.0mm during static and dynamic squeeze maneuver. Inter- and intraexaminer reliability was performed using the intraclass correlation coefficient (ICC). Results: The superficial ligament length measured 0.60cm±0.11cm with a deep measurement of 0.20cm±0.06cm. Dynamic evaluation revealed superficial and deep measurements at 0.62±0.12cm and 0.20±0.06cm, respectively. There was no significant difference between the SLL length at rest and during the squeeze test. The interexaminer and intraexaminer reliability was rated at fair to very good. Conclusion: The evaluation of the dorsal SLL by sonographic squeeze test is reliable. Future studies will apply this method to suspected SLL tears. © 2013

The sonographic squeeze test: Assessing the reliability of the dorsal scapholunate ligament

Background: There is no universally accepted imaging method to diagnose scapholunate ligament (SLL) tears. Our aim was to use sonography to evaluate the reliability of SLL length at baseline compared with a standardized dynamometer maneuver in healthy normals. Materials and methods: Sonographic exams from 31 consented asymptomatic patients between 18 years and 45 years of age were collected on a total of 60 wrists. The length of the SLL was measured superficially and at a depth of 3.0mm during static and dynamic squeeze maneuver. Inter- and intraexaminer reliability was performed using the intraclass correlation coefficient (ICC). Results: The superficial ligament length measured 0.60cm±0.11cm with a deep measurement of 0.20cm±0.06cm. Dynamic evaluation revealed superficial and deep measurements at 0.62±0.12cm and 0.20±0.06cm, respectively. There was no significant difference between the SLL length at rest and during the squeeze test. The interexaminer and intraexaminer reliability was rated at fair to very good. Conclusion: The evaluation of the dorsal SLL by sonographic squeeze test is reliable. Future studies will apply this method to suspected SLL tears. © 2013

Cervical spine osteochondroma: Rare presentation of a common lesion

Objective: This case report describes the rare presentation of an osteochondroma arising from the anterior body of C4. This is the first known reported case of an osteochondroma arising from the anterior vertebral body of C4. Clinical Features: A 24-year-old male sought consultation with his primary care physician for neck pain. The patient was then referred for cervical radiography and for chiropractic evaluation and treatment. An osseous lesion was noted arising from the C4 vertebra. Osteochondroma was suspected; however, chondrosarcoma could not be ruled out. After orthopedic consultation, osteochondroma was the confirmed diagnosis with the lesion likely incidental to the chief complaint. Intervention and Outcome: The patient underwent 12 chiropractic treatments for 8 weeks including thoracic and cervical high-velocity, low-amplitude spinal manipulation, interferential current, therapeutic ultrasound, stretching, and therapeutic exercise of the paraspinal musculature. Reevaluation revealed the patient experienced no pain with occupational duties, activities of daily living, and improved sleep quality. He was discharged with a home stretching and strengthening regimen targeting the thoracic and cervical paraspinal musculature. Follow-up at 6 months revealed no return of symptoms. Conclusion: We described the first case of an osteochondroma arising from the anterior aspect of the C4 vertebral body. The clinical evaluation, differential diagnosis, imaging workup, and treatment are addressed. This case also demonstrates that an asymptomatic osteochondroma of the cervical spine may be a relative, not an absolute, contraindication for high-velocity, low-amplitude spinal manipulation. © 2010 National University of Health Sciences

Ultrasonography and radiography to identify early post traumatic myosistis ossificans in an 18-year-old male: A case report

OBJECTIVE: The purpose of this case report is to describe a patient with post traumatic myositis ossificans (PTMO) of the anterior thigh following blunt trauma and discuss the incidence, clinical presentation, management, and imaging findings. CLINICAL FEATURES: An 18-year-old male presented to a chiropractic clinic with a chief complaint of left knee pain and reduced range of motion after an impact injury to his left anterior thigh during hurdling 6 weeks earlier. Immediately after the injury, he presented to the emergency department where radiography of the left knee was negative and he was diagnosed with a muscle sprain. Follow-up radiography and ultrasonography of the left knee in a chiropractic radiology department revealed ossification consistent with PTMO within his vastus intermedius. INTERVENTION AND OUTCOME: The patient underwent a course of rehabilitation for 2 months including ice, class IV cold laser and vibration applied to his anterior thigh, and myofascial release of his quadriceps musculature with targeted and progressive rehabilitative exercises. His left knee pain resolved within 2 weeks of care. He resumed sports participation (American football) pain-free, while wearing protective padding over the affected thigh, 1 month after presentation, which was approximately 2 1/2 months following his injury. CONCLUSION: This case demonstrates that ultrasonography may have the capability to detect early phases of PTMO approximately 2 weeks prior to radiographic evidence and to monitor progression throughout its course

Sonography of occult rib and costal cartilage fractures: A case series

Objective: The purpose of this case series is to describe the use of diagnostic ultrasound (US) in the detection of occult rib and costal cartilage fractures presenting as chest wall pain to a chiropractic clinic. Clinical features: Three patients presented with chest wall pain and tenderness. Two of the patients presented with acute chest wall injury and 1 carried a previous diagnosis of rib fracture after trivial trauma 2 months earlier. Intervention and outcomes: Diagnostic US was selected as a non-ionizing imaging tool for these patients after negative digital radiography studies. All fractures were considered isolated as there was no associated injury, such as pneumothorax. Both of the acute cases were followed up to complete healing (evidence of osseous union) using US. All patients eventually achieved pain-free status. Conclusion: In these cases, US was more sensitive than radiography for diagnosing these cases of acute rib and costal cartilage fractures. Early recognition of rib injury could avoid potential complications from local manipulative therapy. © 2014 National University of Health Sciences

Ultrasound evaluation of the normal ulnar nerve in Guyon's tunnel: Cross-sectional area and anthropometric measurements

Background: Ulnar nerve (UN) entrapment is an infrequent disorder, but is often seen in long-distance cyclists. Electrodiagnosis and imaging modalities, including ultrasound, are used for diagnosis. The goal of this study was to obtain sonographic normative data of the UN in Guyon's tunnel, to establish the diagnosis of Guyon's tunnel syndrome in future studies. Anthropometric measures were also obtained. Methods: A total of 46 healthy volunteers (30 men) were recruited (mean age, 24.7 ± 3.1 years), and a total of 83 wrists were examined. The examinations included anthropometric measurements (wrist width, wrist depth, wrist circumference, palm length, and hand width) and ultrasound measurement of the cross-sectional area (CSA) of the UN in Guyon's tunnel. B-mode sonography and power Doppler were employed. Results: The UN CSA in Guyon's tunnel for male volunteers was 6.0 ± 2.0 mm2, and 5.0 ± 1.0 mm2 for female volunteers. There was a significant difference between female and male volunteers in the measurements of wrist width, wrist depth, wrist circumference, palm length, hand width, and UN CSA (p < 0.001). The UN CSA was correlated with wrist width, wrist depth, wrist circumference, palm length and hand width (p < 0.01). Differences were noted within and between gender groups of UN CSA within Guyon's tunnel. Conclusion: Nerve CSA may differ by gender and this may be related to body size. Therefore, the contralateral side is more useful as a reference standard than the gender mean. © 2015 Chinese Taipei Society of Ultrasound in Medicine