Sonography of the Rotator Cuff: Comparison of Arm Positions / 대한정형외과학회잡지

PURPOSE: To evaluate the objective difference of the shoulder position during ultrasound examination regarding diagnostic value for shoulder lesion, view range and visibility. MATERIALS AND METHODS: A prospective study was performed enrolling 312 patients who underwent diagnostic ultrasonography due to shoulder pain between January 2016 and June 2016. Examination was performed by a single orthopaedic surgeon with 5 years of musculoskeletal ultrasonography experience. Images of the longitudinal and transverse plane of the supraspinatus tendon and the nearby soft tissues (subscapularis and biceps long head tendon, subdeltoid bursa, etc.) were obtained in the three different positions, shoulder extension, modified Crass, and Crass position. The correlation between the demographic data (age, sex and body mass index) and the visual analogue scale (VAS) of the affected shoulder & the capable shoulder position was analyzed. Another orthopaedic independently measured the size of the tear and using classified the image visibility of the supraspinatus, subscapularis, and biceps long head tendon on the short-axis view from the rotator interval into I to III and X. RESULTS: Of the 312 patients, 126 were excluded and total of 186 cases were included in this study. None of the demographic data were related to the possible arm position. However, VAS for pain was the only factor related with the number of possible arm positions during sonography. Kappa agreements for the diagnosis were mostly high of over 0.90. Grades of the short-axis view from the rotator interval in each position were mostly grade II or grade III, which refers to that the anterior portion of supraspinatus tendon, which is the most fragile portion to the tear and it was well-defined regardless of the arm position. The average longitudinal tear sizes were 1.48, 1.52, and 1.61 cm in the shoulder extension, modified Crass (Middleton), and Crass position, respectively. CONCLUSION: Shoulder extension position during ultrasonography examination of shoulder shows similar diagnosis rate of supraspinatus tendon tear or calcific tendinitis compared to modified Crass (Middleton) or Crass position, the two well-known standard positions. It is also a useful position for patients who suffer with severe shoulder pain.

Differentiation of Osteoporotic Fracture from Metastatic Fracture in Spine using MRI / 대한골다공증학회지

OBJECTIVES: To determine that compression fracture of L5 and posterior convexity of the vertebral body on MRI are useful indicators of spinal metastasis. MATERIALS AND METHODS: Forty seven cases of vertebral compression fractures with magnetic resonance imaging (MRI) were reviewed. They were classified into two groups: the metastatic fracture (MF) group (n=23) and the osteoporotic fracture (OF) group (n=24). Each cases were evaluated according to their MRI findings of fracture site location, and the presence of posterior convexity of the vertebral body, intact midseptum and anterior signal change. Conventional T1 and T2 weighted images were obtained. Statistical analysis was done using the paired t-test and fisher's exact test. RESULTS: The MF group had 100% incidence of fracture in L5 (P<0.01). The incidence of positive posterior convexity was also 100%. The incidence of a positive anterior signal change was 67% (n=16) and intact septum was seen in 16 patients (67%). In the OF group, there were no fractures in L5 (16 cases with L1 fractures [67%]) and only 3 cases with posterior convexity (12.5%). Midseptum was intact in 19 cases (79%) and 6 patients with positive anterior signal change (25%). CONCLUSIONS: The location of vertebral fracture, especially in L5 and convex deformity of posterior vertebral body are reliable indicators of spinal metastasis.