Musculoskeletal Radiology in the Middle East: Training Programs, Current Practice, and Future Directions.

This article outlines the development of radiology training in the Middle East. It discusses the history of radiology in the region and current available pathways to subspecialize in musculoskeletal (MSK) radiology. Owing to the rapidly changing demographics and health indicators in the region, a major shift has occurred in the government's focus in directing more resources to advance the health care system. This in addition to intraregional initiatives, such as the establishment of many radiologic societies, has provided strong incentives toward developing radiology training programs in the region. There are profound differences in the region regarding the development of radiology, with only few countries offering structured radiology training programs and MSK radiology fellowships. To keep up with the explosion of information in imaging technology and hold clinical ground, current and future MSK radiologists must overcome certain challenges and change their approach to stay clinically relevant.

Injectable Viscoelastic Supplements: A Review for Radiologists.

OBJECTIVE: Hyaluronic acid (HA) is increasingly used by musculoskeletal radiologists in the treatment of osteoarthritis (OA). Although the evidence base for its efficacy is controversial, it remains in common use. With initial evidence suggesting its efficacy in the knee, it is now offered for treating OA of the hip, ankle, and elsewhere. CONCLUSION: HA is available in a wide variety of preparations, which may vary in concentration and chemical composition. Clinicians offering intraarticular HA injection should be familiar with the common preparations available and the principal differences between them, its mechanism of action, and the profile of adverse effects associated with its use.

Sports-Related Groin Pain Secondary to Symphysis Pubis Disorders: Correlation Between MRI Findings and Outcome After Fluoroscopy-Guided Injection of Steroid and Local Anesthetic.

OBJECTIVE: The objective of our study was to correlate patterns of injury on preprocedural MRI with outcome after targeted fluoroscopy-guided steroid and local anesthetic injection of the symphysis pubis and its muscular attachments in a group of athletes with chronic groin pain. MATERIALS AND METHODS: Forty-five patients with chronic sports-related groin pain underwent MRI of the pelvis and a targeted fluoroscopy-guided symphyseal corticosteroid and local anesthetic injection. Preprocedural MRI was reviewed. The presence or absence of a "superior cleft" sign (i.e., rectus abdominis-adductor longus attachment microtearing), "secondary cleft" sign (i.e., short adductor [gracilis, adductor brevis, and pectineus muscles] attachment microtearing), osteitis pubis, and extrasymphyseal pelvic abnormalities was recorded. Patients were followed up a mean time of 23 months after the procedure, and outcome was recorded. Correlation was made between preprocedural MRI findings and outcome. RESULTS: Forty-two percent of the patients had an isolated superior cleft sign, 7% had an isolated secondary cleft sign, and 11% had isolated osteitis pubis. Thirty-one percent of patients had a more complex injury, and 9% had a normal symphysis pubis. Overall, 89% of the patients experienced an improvement in symptoms. The response was sustained after a minimum of 6 months in 58% of the patients. The presence of the superior cleft sign was more frequently associated with a complete recovery. CONCLUSION: Fluoroscopy-guided corticosteroid symphyseal injection is a safe and effective treatment of sports-related groin pain. It is more frequently associated with a complete recovery in patients who display an isolated superior cleft sign on MRI. MRI not only is useful in characterizing groin injuries but also may be helpful in predicting response to therapeutic injection.

Obturator internus muscle strains.

We report 2 cases of obturator internus muscle strains. The injuries occurred in young male athletes involved in kicking sports. Case 1 details an acute obturator internus muscle strain with associated adductor longus strain. Case 2 details an overuse injury of the bilateral obturator internus muscles. In each case, magnetic resonance imaging played a crucial role in accurate diagnosis.

Acetabular paralabral cyst causing compression of the sciatic nerve.

Acetabular paralabral cysts are common. They vary in their clinical presentation and may be asymptomatic or cause pain and restriction at the hip joint. In rare instances they may cause symptoms by compressing local neurovascular structures. We report a case of symptomatic compression of the sciatic nerve by a posteriorly displaced acetabular paralabral cyst.