Effectiveness of fluoroscopy-guided intra-articular steroid injection for hip osteoarthritis.

AIM: To demonstrate the benefits of fluoroscopy-guided intra-articular steroid injection in the hip with varying degrees of disease severity, and to investigate the financial aspects of the procedure and impact on waiting time. MATERIALS AND METHODS: A prospective study was undertaken of patients who underwent fluoroscopic intra-articular steroid injection over the 9-month study period. Comparative analysis of the Oxford hip pain score pre- and 6-8 weeks post-intra-articular injection was performed. Hip radiographs of all patients were categorised as normal, mild, moderate, or severe disease (four categories) based on the modified Kellgren-Lawrence severity scale, and improvement on the Oxford hip pain score on each of these four severity categories were assessed. RESULTS: Within the study cohort of 100 patients, the mean increase in post-procedure hip score of 7.32 points confirms statistically significant benefits of the therapy (p<0.001, 95% confidence interval: 5.55-9.09). There was no significant difference in pre-injection hip score or change in score between the four severity categories (p=0.51). Significant improvement in hip score (p<0.05) was demonstrated in each of the four severity categories 6-8 weeks post-injection. No associated complications were observed. CONCLUSION: The present study confirms that fluoroscopy-guided intra-articular steroid injection is a highly effective therapeutic measure for hip osteoarthritis across all grades of disease severity with significant cost savings and the potential to reduce waiting times.

Ultrasound changes in the extensor pollicis longus and flexor pollicis longus tendons following open reduction and internal fixation of displaced intra-articular fractures of the distal radius.

A previous ultrasound study showed inflammation around the extensor pollicis longus tendon and surrounding structures at 6 weeks after manipulation, with or without pin fixation, and immobilization for distal radius fracture. Ultrasound examination after plating of distal radius fracture followed by early active mobilization of the wrist showed a short-lived inflammatory response, evident at 2 weeks but not at 6 weeks, around the extensor pollicis longus tendon (26 wrists examined) and flexor pollicis longus tendon (18 wrists examined). Early active mobilization of the wrist appears to limit the duration of inflammation around these tendons.

Aggressive fibromatosis: is PET-CT useful in lesion characterization?

Deep extra-abdominal fibromatoses (desmoids) are rare benign fibrous mesenchymal tumours occurring in adults, which may mimic primary malignancy on imaging. We present a case of a 64-year-old man with a hard painless lump in his left calf. The solid and partially hypervascular appearance on ultrasound, the infiltrative appearance, lesion heterogeneity and heterogeneous enhancement pattern on Magnetic Resonance Imaging (MRI) were suspicious for a soft tissue sarcoma. Moreover, PET-CT demonstrated FDG-avidity. Despite these aggressive imaging features, histopathology revealed a benign but locally aggressive desmoid tumour. The radiologist should be aware that PET-CT is not always helpful as an additional tool for differentiation between malignant and benign soft tissue lesions. Intralesional bandlike areas of low signal intensity on all pulse MR sequences and intimate relationship with the muscle fascia are more useful clues to the diagnosis of this soft tissue lesion.

Vertebrobasilar dolichoectasia: a rare cause of obstructive hydrocephalus: case report.

Here, we describe neuroimaging findings of an unusual case of severe vertebrobasilar dolichoectasia producing obstructive hydrocephalus. CT and MRI performed in a 71-year-old woman presenting with clinical features of raised intracranial pressure revealed severely ectatic and tortuous vertebral and basilar arteries. The ectatic basilar artery was causing compression and flattening of the midbrain. This had resulted in aqueductal compression and consequent obstructive hydrocephalus. The patient underwent emergency ventricular drainage, with resulting decompression of the ventricles and resolution of symptoms. Vertebrobasilar dolichoectasia refers to a markedly dilated and tortuous vertebrobasilar arterial system, occasionally presenting with thomboembolic episodes or symptoms related to local compressive effects, such as cranial nerve palsies. Direct midbrain compression with obstructive hydrocephalus is a rare complication that mandates emergency ventricular decompression.

The value of MRI undertaken immediately after reduction of the hip as a predictor of long-term acetabular dysplasia.

Our aim was to determine whether abnormalities noted on MRI immediately after reduction for developmental dysplasia of the hip could predict the persistance of dysplasia and aid surgical planning. Scans of 13 hips in which acetabular dysplasia had resolved by the age of four years were compared with those of five which had required pelvic osteotomy for persisting dysplasia. The scans were analysed by two consultant musculoskeletal radiologists who were blinded to the outcome in each child. The postreduction scans highlighted a number of anatomical abnormalities secondary to developmental dysplasia of the hip, but statistical analysis showed that none were predictive of persisting acetabular dysplasia in the older child, suggesting that the factors which determine the long-term outcome were not visible on these images.