Ultrasound-guided injection of ganglia with coricosteroids

  Objective. The aim of this study was to demonstrate the use of ultrasound guidance in confirming intralesional injection of corticosteroids and local anesthetic into symptomatic ganglia, and to propose potential advantages of this technique. Design and patients. Ten patients (five men, five women) underwent ultrasound-guided injection of a ganglion. Seven ganglia were near the wrist, one was adjacent to a finger interphalangeal joint and two were adjacent to the talus. All were injected with a 1:1 mixture of long-acting corticosteroid and local anesthetic, the actual volume being dependent on the size of the ganglion. Three patients had a second injection 9–18 months following the initial injection. Results. In four patients the ganglia resolved completely. In five patients there was significant improvement, with a reduction in size of the ganglion and symptomatic relief. Conclusion. Ultrasound-guided injection insures intralesional deposition of corticosteroids and may provide an alternative to surgery in the management of ganglia.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42068/1/256-25-7-635_60250635.pd

Baseline indices of iron load predict severity of arthropathy in C282Y homozygous HFE haemochromatosis

Objective: To determine the relationship between baseline indices of iron load and severity of arthropathy in C282Y homozygous HFE haemochromatosis (HH). Method: Genetically proven HH participants from a previous community-based study who had clinical and radiologically confirmed arthropathy compatible with HH were included. The most recent joint imaging and blood tests available up to November 2021 were used to assess the summative joint damage score (SJDS), which comprises the sum of radiological grades in all clinically affected joints and all joints in the hands. Relevant x-rays were examined by both a rheumatologist and musculoskeletal radiologist. Joint scores were assigned in keeping with published systems of classification. Discrepancies were resolved by consensus. Results: Nineteen participants with HH and arthropathy (median age 55 years) were analysed. Statistically significant correlations were observed between SJDS and serum ferritin at diagnosis of HH and between SJDS and the red cell mean corpuscular volume (MCV) at diagnosis of HH, [r = 0.58, p = 0.01 and r = 0.474, p = 0.04, respectively]. There was no statistically significant correlation between transferrin saturation at diagnosis and SJDS. Neither current ferritin nor current transferrin saturation were found to correlate with SJDS. Conclusion: Indices of iron metabolism at the time of HH diagnosis and, in particular, serum ferritin concentrations and elevation of the MCV were found to be associated with the radiological severity of HH arthropathy. This finding suggests that baseline iron load is a prognostic marker for joint disease severity and that ferritin concentration at diagnosis is likely to be mechanistically important in the development of chondral damage

Extraskeletal mesenchymal chondrosarcoma of the rectus sheath

 Mesenchymal chondrosarcomas (MSCs) are a rare form of chondrosarcoma which usually arise in bone. Extraskeletal chondro-sarcomas constitute a minority (14–25%) of MSCs. We describe the imaging features of an extraskeletal mesenchymal chondrosarcoma that arose from the rectus abdominus muscle.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42070/1/256-26-8-501_70260501.pd

The existence of cords in olecranon bursae.

The purpose of this study was to document the existence of transverse cords in olecranon bursae in patients undergoing excision of the bursa and to describe the unique clinical presentation of patients with these cords. A retrospective study was performed on 24 patients who had surgery to excise an olecranon bursa between 2006 and 2011. The patient's history, preoperative radiographs, ultrasound images, intraoperative photographs, and findings on histologic analysis were reviewed in all cases. Nine olecranon bursae had cords (cord group) and 15 did not have cords (noncord group). All patients in the cord group were male manual laborers, and nearly all had olecranon enthesophytes (n?=?8). Patients in the noncord group had associated medical conditions or an infection. A higher level of satisfaction was reported in the noncord group after surgical excision. This study documents the existence of transverse cords oriented at right angles to the long axis of the olecranon. Olecranon bursae with cords have a unique presentation and are found in male manual workers, are nearly always associated with an olecranon enthesophyte, and do not present with infections

Ultrasonography detects deep tissue injuries in the subcutaneous layers of the buttocks following spinal cord injury

Background: Ultrasonography may have potential as an effective diagnostic tool for deep tissue injury (DTI) in tissues overlying bony prominences that are vulnerable when under sustained loading in sitting. Methods: Three cases of DTI in the fat and muscle layers overlying the ischial tuberosity of the pelvis in 3 persons with spinal cord injury (SCI) with different medical histories and abnormal tissue signs are described. Conclusion: There is a need for prospective studies using a reliable standardized ultrasonography protocol to diagnose DTI and to follow its natural history to determine its association with the development of pressure injuries.</p

Ultrasonography detects deep tissue injuries in the subcutaneous layers of the buttocks following spinal cord injury

\u3cp\u3eBackground: Ultrasonography may have potential as an effective diagnostic tool for deep tissue injury (DTI) in tissues overlying bony prominences that are vulnerable when under sustained loading in sitting. Methods: Three cases of DTI in the fat and muscle layers overlying the ischial tuberosity of the pelvis in 3 persons with spinal cord injury (SCI) with different medical histories and abnormal tissue signs are described. Conclusion: There is a need for prospective studies using a reliable standardized ultrasonography protocol to diagnose DTI and to follow its natural history to determine its association with the development of pressure injuries.\u3c/p\u3

Adaptation of a MR imaging protocol into a real-time clinical biometric ultrasound protocol for persons with spinal cord injury at risk for deep tissue injury:A reliability study

\u3cp\u3eBackground: High strain in soft tissues that overly bony prominences are considered a risk factor for pressure ulcers (PUs) following spinal cord impairment (SCI) and have been computed using Finite Element methods (FEM). The aim of this study was to translate a MRI protocol into ultrasound (US) and determine between-operator reliability of expert sonographers measuring diameter of the inferior curvature of the ischial tuberosity (IT) and the thickness of the overlying soft tissue layers on able-bodied (AB) and SCI using real-time ultrasound. Material and methods: Part 1: Fourteen AB participants with a mean age of 36.7 ± 12.09 years with 7 males and 7 females had their 3 soft tissue layers in loaded and unloaded sitting measured independently by 2 sonographers: tendon/muscle, skin/fat and total soft tissue and the diameter of the IT in its short and long axis. Part 2: Nineteen participants with SCI were screened, three were excluded due to abnormal skin signs, and eight participants (42%) were excluded for abnormal US signs with normal skin. Eight SCI participants with a mean age of 31.6 ± 13.6 years and all male with 4 paraplegics and 4 tetraplegics were measured by the same sonographers for skin, fat, tendon, muscle and total. Skin/fat and tendon/muscle were computed. Results: AB between-operator reliability was good (ICC = 0.81–0.90) for 3 soft tissues layers in unloaded and loaded sitting and poor for both IT short and long axis (ICC = −0.028 and −0.01). SCI between-operator reliability was good in unloaded and loaded for total, muscle, fat, skin/fat, tendon/muscle (ICC = 0.75–0.97) and poor for tendon (ICC = 0.26 unloaded and ICC = −0.71 loaded) and skin (ICC = 0.37 unloaded and ICC = 0.10). Conclusion: A MRI protocol was successfully adapted for a reliable 3 soft tissue layer model and could be used in a 2-D FEM model designed to estimate soft tissue strain as a novel risk factor for the development of a PU.\u3c/p\u3