Ultrasound diagnosis of femoral nerve neurostenalgia : a cause of hip pain in a young adult

Femoral neurostenalgia is a compressive neuropathy which is an uncommon cause of hip pain in active young adults. Compression of the nerve can cause debilitating pain and an inability to walk. Correct clinical diagnosis and correct treatment can result in complete relief of symptoms. We present a case of a young female with a spontaneous acute onset of severe hip pain for ten months. After seeing several specialists and having undergone numerous special investigations, femoral nerve compression by the iliopsoas was demonstrated on ultrasound, but only confirmed during surgery for a suspected femoral hernia. After decompression of the nerve the patient was completely pain free.http://www.charpublications.co.za/C_JournalsORTH.aspay201

Popliteal artery entrapment syndrome misdiagnosed as chronic exertional compartment syndrome in a young male athlete : role of dynamic ultrasound

Popliteal artery entrapment syndrome (PAES) is an uncommon cause of exercise-induced pain in the lower extremity of young athletes. However, it might explain the symptoms of those athletes who do not respond to treatment for the more common overuse syndromes. We present a case of a young professional male athlete who was diagnosed with bilateral chronic exertional compartment syndrome (CECS), for which he was operated on twice. His symptoms persisted for 5 years before PAES was diagnosed with dynamic ultrasound, and after bilateral surgical release a few months apart, he was completely symptom-free except for some discomfort in the fasciotomy scars.http://www.journals.co.za/sama/m_sajsm.htm

Role of ultrasound in the evaluation of rotator cuff muscle quality

The evaluation of the quality of rotator cuff muscles has become an important part of the preoperative ultrasound examination. Ultrasound is accurate in the evaluation of rotator cuff integrity, but has been found to be insufficient compared to magnetic resonant imaging (MRI) in the evaluation of rotator cuff muscle quality. Complete tears of the rotator cuff lead to muscle atrophy and fatty infiltration, these changes are known to be important negative prognostic factors with regard to the anatomical and functional results after tendon repair. Several classifications and grading systems have been described for computed tomography (CT) and MRI. A number of studies have been directed at the ultrasound assessment of muscle atrophy and fatty infiltration of the rotator cuff, however, no quantitative method or grading systems have been established. At present MRI is the preferred choice for evaluation of rotator cuff fatty infiltration and muscle atrophy in clinical practice. Ultrasound is widely available, cost effective and safe; the aim of this literature review is to investigate if there is a role for ultrasound in the examination of rotator cuff muscle quality.http://www.ajol.info/journal_index.php?jid=153&ab=ajpher

Metal-on-metal arthroplasty using the Metasul prosthesis with a minimum ten-year follow-up

Despite concern in recent literature about the adverse effects and complications of metal-on-metal total hip replacements, we have obtained excellent results ten to 15 years after metal-on-metal total hip arthroplasty in 11 out of 12 patients (91.66%) that were available for clinical follow-up. We could trace 15 out of a total of 18 patients (88.33%). Three patients died between the nine- and ten-year follow-up. All our available patients were clinically examined using the Harris Hip Score; hip radiographs; ultrasound and blood investigations. Only one patient (8.33%) needed revision surgery. This information can be used to reassure both orthopaedic surgeons and patients who had metal-on-metal total hip arthroplasty performed in the past that not all metal-on-metal total hip replacements need to be revised. We would advise that if patients present with symptoms or signs they should be thoroughly examined clinically and radiologically, and undergo laboratory investigations, before considering revision surgery.As for the future, the Editors of the SAOJ would like to refer orthopaedic surgeons to the memorandum circulated to all orthopaedic surgeons by our President, Prof TLB le Roux.http://www.charpublications.co.za/C_JournalsORTH.aspam2013ay201

A comparative study of the identification of rotator cuff calcifications : x-ray versus ultrasound

A deposit of calcium in the rotator cuff tendons, also known as calcifying tendinopathy, is a common condition. Calcifications are often associated with significant pain and restriction of shoulder movement. The hypothesis of this retrospective, descriptive study is that ultrasound is more sensitive to detect calcifications in the rotator cuff than x-rays. The study was done on the records of 60 patients aged between 30 and 72 years of age. The records were selected using a convenient sample from the archives of the Radiology Department of a private hospital. Calcifications were detected with x-rays in the rotator cuff of 10patientsin 7 of these patients the calcification was located in the supraspinatus tendon. With ultrasound calcifications were detected in 9 patients; in 6 of these patients the calcification was located in the supraspinatus tendon and in 3 patients in the infraspinatus tendon. This study indicated that calcifications in the rotator cuff were more often seen on x-ray examination than on ultrasound, though the difference was marginal.http://www.ajol.info/journal_index.php?jid=153&ab=ajpher

Comparative ultrasound study of acute lateral ankle ligament injuries rehabilitated with conventional and jump stretch flex band programmes

The purpose of this study was to establish the difference in rehabilitation outcomes between the Jump Stretch Flex Band (JSFB) programme and conventional ankle rehabilitation programmes of acute lateral ankle ligament injuries. This study compares the process of healing under the guidance of ultrasound in both groups. The return to competitive level of sport dates were also documented and compared. A single blind randomised control study comparing the JSFB rehabilitation programme with conventional ankle rehabilitation programmes was used. Ultrasound examinations were done on all first time lateral ankle ligament injuries 72 hours post injury and repeated every two weeks during rehabilitation. Patients were divided into two groups: JSFB group and Control group. The JSFB group had a six (6) day head start to rehabilitation as ankles were rehabilitated following the Compression, Elevation, Mobilisation and Traction (CEMT) methods with the flexbands. Grade 1 injuries from the JSFB group were compared with grade 1 injuries from the Control group and grade 2 injuries with grade 2 injuries from both groups. The time from injury to return to sport (competitive level) was documented and ligaments were compared by means of swelling, thickness and appearance. With the JSFB programme the general fluid collection in the anterior recess for grade 1 injuries improved significantly (p = 0.0426). Fluid from the posterior recess tended to decrease more for both grade 1 and 2 injuries within the JSFB group. The thickness of the ligaments significantly increased in size (p = 0.0025 for grade 1; p = 0.0038 for grade 2), the ligament appearances tended to return to normal sooner and the return to sport time was significantly shorter (p = 0.0026 for grade 1; p = 0.0081 for grade 2). The study illustrated that with acute grade 1 and 2 lateral ankle ligament injuries the return to competitive level of sport was shorter with the JSFB programme with an earlier start to rehabilitation. Furthermore the fluid from the anterior as well as posterior recess of the ankle tended to decrease with the JSFB programme and ligaments significantly increased in size. It was perceived that ligaments returned to normal sooner with the JSFB programme than with conventional ankle rehabilitation programmes. However this was the subjective interpretation of the investigator.http://www.ajol.info/journal_index.php?jid=153&ab=ajpher

Ultrasound study of the asymptomatic shoulder in patients with a confirmed symptomatic rotator cuff tear in the opposite shoulder

OBJECTIVE: To document the incidence of asymptomatic rotator cuff tears in patients with a confirmed symptomatic tear in the opposite shoulder, and to identify ultrasound findings that may distinguish symptomatic from asymptomatic tears. DESIGN: When patients are referred for an ultrasound examination for the confirmation of symptomatic rotator cuff tear the opposite shoulder is often used for comparison. However, patients often have a similar tear on the asymptomatic side. Fifty patients with a confirmed symptomatic rotator cuff tear and an asymptomatic shoulder on the opposite side were chosen for inclusion. The patients were examined using a Siemens Sonoline Elegra 7.5 MHz linear multi-frequency probe. The appearance of the rotator cuff, long head of the biceps and the subacromial-subdeltoid bursa (SASD bursa) were documented. The antero-posterior (AP) dimension of the supraspinatus muscle and fat between the trapezius and supraspinatus muscles were measured, which indicated if a tear was acute or chronic. The width and length of the rotator cuff tear were measured. SETTING: Division of Sports Medicine, University of Pretoria. RESULTS: Fifty-four per cent of the asymptomatic shoulders had tears. We found that the symptomatic tears were larger, appeared more chronic and had an associated biceps tendinopathy and glenohumeral joint effusion