Pigmented Villonodular Synovitis of the Elbow: A Case Report and Sonographic Findings

Pigmented villonodular synovitis (PVNS) is a disease rarely found in the elbow, and there is limited literature describing its ultrasonographic morphology. We report a case of elbow PVNS, showing the sonographic features of a hyperechoic, heterogenous, irregularly-shaped mass. Compared to knee joint PVNS, elbow joint PVNS has less joint effusion. This is also the first article to demonstrate the increased blood perfusion of PVNS with power-mode Doppler imaging

Serial Ultrasonography for Early Detection and Follow-up of Heterotopic Ossification in Stroke

Heterotopic ossification (HO) is a common complication in patients with neurologic deficits. Once developed, limited range of motion may occur and interfere with rehabilitation programs. Early diagnosis is crucial but difficult because radiographs may be negative, and similar clinical symptoms could appear in deep venous thrombosis, cellulitis, and osteomyelitis. A three-phase bone scan can detect the disease early, but it has high radiation and low specificity. Magnetic resonance imaging (MRI) may also assist in diagnosis, but is costly and has some contraindications. Ultrasonography has been used in HO detection and is safe, economical, easily accessible, and involves no radiation exposure. However, a few studies have described its use in HO, especially in serial follow-ups. We report a case with HO clinical symptoms, but the MRI results created a necrotizing fasciitis suspicion. Serial ultrasonography images implied the formation of HO rather than necrotizing fasciitis. Ultrasonography images serve as a good initial screening tool for HO and are useful for following up such dynamic disease processes

Assessment of Stretching of the Iliotibial Tract With Ober and Modified Ober Tests: An Ultrasonographic Study

Objective: To assess stretching of the iliotibial tract with Ober and modified Ober tests, by assessing morphologic changes of the tract using ultrasonography during stretching. Design: Cross-sectional study. Setting: Orthopedic laboratory. Participants: Thirty-six healthy subjects (age, 24.3加/減4.Oy) were recruited. They had no history of previous low back, gluteus, hip, or knee pain and satisfied the inclusion criteria for this study. Intervention: Each subject was randomly assigned to first undergo either the Ober test or the modified Ober test, and 30 minutes after the first to undergo the other test. Measurements were obtained with the subjects lying on the right side. The left knee was flexed 90¢X for the Ober test and positioned at 00 for the modified test. Main Outcome Measures: The iliotibial tract widths in subjects were measured in 3 gradually increased hip adduction positions (neutral, adducted, adducted with weight) when performing Ober and modified Ober tests. Ten of these 36 subjects were randomly chosen to undergo a repeat of the same protocol to test the reliability of ultrasonographic measurements in the iliotibial tract. Results: Ultrasonography was reliable in measuring the width of iliotibial tract (intraclass correlation coefficient range, .81¡X82). The width of the iliotibial tract was significantly reduced from the neutral to adducted position of the hip with both Ober (P= .001) and modified Ober (P< .001) tests. However, with further stretching using a greater hip adduction angle, the width of the iliotibial tract was only reduced with the modified Ober test. Conclusions: Both the Ober and modified Ober tests are effective in the initial stage of stretching of the iliotibial tract. However, the modified Ober test might be more effective in stretching the iliotibial tract if a further stretching effect is desired

Introduction to Diagnostic Musculoskeletal Ultrasound - Part 2: Examination of the Lower Limb

This is the second of two articles focusing on ultrasound examination of musculoskeletal components of the upper and lower limbs. Treatment of musculoskeletal injuries is based on establishing an accurate diagnosis. No one would dispute that a good history and physical examination by a competent clinician can help achieve that in the majority of cases. However, musculoskeletal imaging is also an essential adjunct in the work- up of many musculoskeletal disorders. This article describes the ultrasound examination of the lower limb in terms of anatomic structure. Normal and pathologic ultrasound features of these structures, including muscles, tendons, ligaments, bursae, and other soft tissues of the lower limb, will be described by reviewing several representative pathologies commonly seen in musculoskeletal medicine