Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 34
Filter
3.
Magn Reson Imaging Clin N Am ; 5(4): 767-85, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9314507

ABSTRACT

The nature of instability, its diagnostic components, and the facts needed to treat it are presented in this article from the viewpoints of orthopedic surgeons of varying philosophies.


Subject(s)
Joint Instability/diagnosis , Magnetic Resonance Imaging , Shoulder Dislocation/diagnosis , Shoulder Joint/pathology , Adult , Humans , Joint Instability/surgery , Male , Shoulder Dislocation/surgery , Shoulder Injuries
4.
Magn Reson Imaging Clin N Am ; 5(4): 841-59, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9314510

ABSTRACT

The field of MR imaging of the postoperative shoulder continues to evolve. As the indications expand for obtaining postoperative shoulder studies, there arises a need for delineation and definition of criteria associated with these imaging studies. Further investigations are necessary to analyze these data in greater detail, and to correlate these data to clinical situations.


Subject(s)
Magnetic Resonance Imaging , Postoperative Complications/diagnosis , Shoulder Joint/pathology , Shoulder/pathology , Humans , Joint Instability/diagnosis , Joint Instability/surgery , Rotator Cuff/pathology , Rotator Cuff/surgery , Shoulder/surgery , Shoulder Dislocation/diagnosis , Shoulder Dislocation/surgery , Shoulder Impingement Syndrome/diagnosis , Shoulder Impingement Syndrome/surgery , Shoulder Joint/surgery
5.
J Urol ; 155(2): 529-33, 1996 Feb.
Article in English | MEDLINE | ID: mdl-8558653

ABSTRACT

PURPOSE: Because prevalence of structural lesions of the pituitary and hypothalamus in impotent men with secondary hypogonadism was undefined, we evaluated 164 men 27 to 79 years old whose chief complaint was erectile dysfunction and who repeatedly had low serum testosterone levels (less than 230 ng./dl.). MATERIALS AND METHODS: With computerized tomography or magnetic resonance imaging of the sella we detected potentially serious lesions (pituitary lesions greater than 5 mm. or any hypothalamic lesion) in 11 men (6.7%, 95% confidence interval 2.9 to 10.5%), including 5 pituitary microadenomas (5 mm. or larger), 4 pituitary macroadenomas and 2 hypothalamic lesions. RESULTS: Mean serum testosterone was lower in patients with (121 +/- 66 ng./dl., standard deviation) than without (177 +/- 39 ng./dl.) hypothalamic or pituitary imaging abnormalities (p < 0.001). For every 10 ng./dl. decrease in testosterone the risk of hypothalamic or pituitary imaging abnormalities increased 1.2-fold (p < 0.005). Macroadenomas and hypothalamic lesions were confined to 6 subjects with testosterone levels of 104 ng./dl. or less. CONCLUSIONS: The risk of hypothalamic or pituitary imaging abnormalities is low among men evaluated for erectile dysfunction and secondary hypogonadism. However, this risk increases markedly when the serum testosterone level is markedly decreased.


Subject(s)
Erectile Dysfunction/etiology , Hypogonadism/complications , Hypothalamic Diseases/etiology , Pituitary Diseases/etiology , Adult , Aged , Erectile Dysfunction/blood , Humans , Hypogonadism/blood , Hypothalamic Diseases/blood , Hypothalamic Diseases/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Pituitary Diseases/blood , Pituitary Diseases/pathology , Prevalence , Prospective Studies , Testosterone/blood
6.
Magn Reson Imaging Clin N Am ; 1(1): 105-23, 1993 Sep.
Article in English | MEDLINE | ID: mdl-7584206

ABSTRACT

Orthopedic surgeons often have different philosophies regarding the diagnosis and treatment of glenohumeral instability. Some surgeons will rely extensively on imaging studies to ascertain pathology relevant to a specific method of treatment; others will only use imaging in cases where the diagnosis is uncertain. This article reviews the concept of glenohumeral instability and its treatment.


Subject(s)
Joint Instability/diagnosis , Magnetic Resonance Imaging , Shoulder Joint/pathology , Humans , Joint Instability/surgery , Magnetic Resonance Imaging/methods , Shoulder Joint/surgery
8.
Radiology ; 177(3): 817-23, 1990 Dec.
Article in English | MEDLINE | ID: mdl-2243995

ABSTRACT

The signal intensity patterns of rotator cuff lesions at magnetic resonance (MR) imaging were evaluated in 80 patients who had surgical correlation and in 13 asymptomatic individuals (14 shoulders). Six cadaver shoulders were examined with MR, and histologic correlation was obtained in four. All studies were performed at 1.5 T with a flexible circular surface coil. The accuracy of MR imaging in detection of full-thickness cuff tears (31 patients) was 0.95 and of partial thickness tears (16 patients), 0.84. The most common and accurate pattern for full-thickness cuff tears (22 of 31 tears) was a region of intense signal seen on T2-weighted images. Less often the torn region consisted of an extremely degenerated and attenuated tendon with moderate signal intensity or was obscured by low-signal-intensity scar. The intense signal pattern on T2-weighted images was also accurate, although a less common finding (seven of 16 cases), in the diagnosis of partial tears. Tendinitis was recognized as focal or diffuse regions of increased signal intensity or a nonhomogeneous pattern of increased signal often associated with tendinous enlargement. In some patients, manifestations of subacromial-subdeltoid bursitis was present. Tendon degeneration was also manifested as regions of increased signal intensity. Some similarity and overlap of signal patterns of partial interstitial tears, tendinitis, and tendon degeneration are observed.


Subject(s)
Magnetic Resonance Imaging , Shoulder Injuries , Adult , Aged , Bursitis/diagnosis , Cadaver , Female , Humans , Male , Middle Aged , Prospective Studies , Tendinopathy/diagnosis
10.
Clin Sports Med ; 8(2): 203-60, 1989 Apr.
Article in English | MEDLINE | ID: mdl-2665951

ABSTRACT

Patellofemoral disorders are among the most common knee problems in the world. Although they are often considered as a group, pathologically the individual disorders are as variable as fingerprints. Treatment of resistant cases requires a detailed understanding of the disorder mechanism to be corrected. Many radiographic techniques, incorporating plain radiography, arthrography, CT, and MRI have been formulated to determine formats of chondromalacia, instability, and malalignment. Many of the techniques reviewed herein reveal distinct abnormalities but do not necessarily provide insight into the best treatment protocols.


Subject(s)
Femur/diagnostic imaging , Joint Diseases/diagnostic imaging , Knee Injuries/diagnostic imaging , Knee Joint/diagnostic imaging , Patella/diagnostic imaging , Arthrography/methods , Arthroscopy/methods , Biomechanical Phenomena , Humans , Joint Diseases/diagnosis , Joint Diseases/therapy , Knee Injuries/therapy
11.
Am J Sports Med ; 16(4): 352-61, 1988.
Article in English | MEDLINE | ID: mdl-3189659

ABSTRACT

Sixty professional and recreational athletes underwent CT arthrography of the shoulder for evaluation of suspected shoulder joint derangement. These athletes, 46 males and 14 females ranging in age from 15 to 60 years (mean, 32 years), all had persistent pain that interfered with their sports activity and was resistant to conservative treatment. Seventeen patients had shoulder instability based on clinical manifestations and CT arthrographic findings. An additional five patients, also based on clinical manifestations and CT arthrographic findings, were considered to have an unobtrusive degree of anterior joint laxity. Patients with anterior instability (20 cases) all had an anteroinferior tear or detachment of the glenoid labrum, as well as some violation of the insertion of the joint capsule onto the scapula. Those with posterior instability (two cases) had a combination of labral and capsular tears. Two other major patterns of labral tears, both unaffiliated with shoulder instability, were identified. These included total or partial detachment of superior segments of the labrum, and anterior labral tears at the midglenoid level. Moreover, various degrees of labral attenuation (or, less often, enlargement), osteophyte formation, and alterations in articular cartilage were observed. Surgical correlation was obtained in 25 patients, with 95% accuracy of CT arthrographic findings. CT arthrography is a minimally invasive and highly accurate technique for investigation of glenohumeral derangement. Specifically, the extent of pathologic changes associated with instability can be determined and differentiated from other intraarticular causes of incapacity, such as labral tears caused by throwing, or degenerative changes.


Subject(s)
Arthrography , Athletic Injuries/diagnostic imaging , Joint Instability/diagnostic imaging , Shoulder Joint/diagnostic imaging , Sports , Tomography, X-Ray Computed , Adolescent , Adult , Athletic Injuries/physiopathology , Athletic Injuries/surgery , Female , Humans , Joint Instability/physiopathology , Joint Instability/surgery , Male , Middle Aged , Pain , Shoulder Joint/physiopathology , Shoulder Joint/surgery
12.
Orthop Rev ; 17(2): 208-9, 213-5, 220-1, 1988 Feb.
Article in English | MEDLINE | ID: mdl-3174203

ABSTRACT

The martial arts are very popular today as both spectator and participant sports, and a large percentage of the participants are children. More injuries are sustained in tournament competition and many are preventable by using protective gear and by limiting contact. Medical screening and proper execution of technique are also important prophylactic modalities.


Subject(s)
Arm Injuries/physiopathology , Athletic Injuries/physiopathology , Leg Injuries/physiopathology , Sports , Athletic Injuries/classification , Athletic Injuries/prevention & control , Craniocerebral Trauma/physiopathology , Humans , Protective Devices , Spinal Injuries/physiopathology , Stress, Mechanical
13.
J Trauma ; 27(11): 1294-300, 1987 Nov.
Article in English | MEDLINE | ID: mdl-3682041

ABSTRACT

A 22-year-old male sustained a gunshot injury to the left hip region. The bullet lodged in the articular surface of the femoral head posterosuperomedially. The location of the bullet within the hip joint stimulated the performance of an arthroscopy of the hip through a posterior approach. The authors are unaware of any other report in the literature describing such an approach. To minimize the dangers, a limited posterior incision was made and deepened through the short rotators. The arthroscope was introduced through the incision to perforate the posteroinferior portion of the hip joint capsule. The bullet was easily visualized with a 70 degree arthroscope. Positioning at the joint and traction are vital components to visualization. The use of three-dimensional CT scanning is an aid to the graphic understanding of the bullet's pathway and relations to the surfaces of the hip joint.


Subject(s)
Arthroscopy/methods , Femur Head , Foreign Bodies/surgery , Hip Joint , Wounds, Gunshot/surgery , Adult , Humans , Male , Reoperation , Tomography, X-Ray Computed , Wounds, Gunshot/diagnostic imaging
14.
J Bone Miner Res ; 2(5): 367-74, 1987 Oct.
Article in English | MEDLINE | ID: mdl-3455621

ABSTRACT

Circulating levels of parathyroid hormone (PTH) rise with age in normal men and women. To resolve the basis for this observation we measured iPTH in 137 normal men and women, age 23 to 85 years, using two antisera which responded to different portions of the PTH molecule. A midmolecule assay (Mid-PTH) employed antiserum NG-5, which recognizes mid- and carboxy-terminal portions of hPTH, whereas antiserum CK-67, which recognizes determinants in the 1-34 hPTH sequence, was used to measure intact PTH (NH2-PTH). Two-hour fasting urine was collected for measurement of creatinine clearance and excretion indices of phosphorus and cyclic AMP. Serum was analyzed for 25-hydroxyvitamin D (25-OHD) in addition to iPTH. Mid-PTH rose significantly with age in the 72 women (r = 0.38, p less than 0.001) and in the 65 men (r = 0.40, p less than 0.001). NH2-PTH rose with age in women (r = 0.23, p less than 0.05), but a change in men was not significant (r = 0.19, n.s.). Cyclic AMP excretion rose significantly with age in both women (r = 0.42) and men (r = 0.41), whereas phosphorus excretion rose significantly in women only (r = 0.32, p less than 0.01). 25-OHD levels were 27.5 +/- 1.3 ng/ml for women and 26.1 +/- 1.2 ng/ml for men. No change in 25-OHD was observed with age in women, and a significant decrease in men was due entirely to extremely high values in three young subjects.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Aging/blood , Parathyroid Hormone/blood , Adult , Aged , Aged, 80 and over , Calcium/blood , Creatine/urine , Female , Humans , Hydroxycholecalciferols/blood , Immune Sera , Male , Middle Aged , Parathyroid Hormone/immunology , Parathyroid Hormone/metabolism , Peptide Fragments/immunology , Serum Albumin/blood
15.
Clin Orthop Relat Res ; (223): 237-46, 1987 Oct.
Article in English | MEDLINE | ID: mdl-3652582

ABSTRACT

An 18-year-old man suffered four years of undiagnosed knee pain until a CAT scan revealed an epiphyseal osteoid osteoma of the tibia located subchondrally, just medial to the proximal tibiofibular joint. A nidus in this location is not easily accessible, and its proximity to the joint surface raised concerns about damage to the tibial plateau. To facilitate excision of the tumor, cadaveric dissections were performed to develop a limited posterior approach to the proximal, lateral portion of the tibia. The CAT scan was used to calculate the precise dimensions of the tumor and its relation to the posterior tibial cortex and the proximal tibiofibular joint. With the use of the exposure developed in the laboratory and the calculations derived from the CAT scan, the tumor could be excised by removing a single block of bone 15 mm3. Intraoperative radiographs confirmed the presence of the nidus within the excised block of bone. This case report reaffirms the frequent difficulties and tardiness in diagnosing osteoid osteomas and the need to include these tumors in the differential diagnosis of knee pain and epiphyseal lesions. Before CAT scans were used, the working diagnoses were torn meniscus, juvenile rheumatoid arthritis, and bone hemangiomatosis.


Subject(s)
Bone Neoplasms/surgery , Knee/surgery , Osteoma, Osteoid/surgery , Tibia/surgery , Adolescent , Humans , Male , Methods
16.
J Trauma ; 27(9): 1083-6, 1987 Sep.
Article in English | MEDLINE | ID: mdl-3656473

ABSTRACT

Posterior dislocation of the shoulder, a rare injury, results from direct trauma, indirect trauma, or via a seizure or electrical shock. We present a case with a posterior fracture dislocation of the shoulder secondary to a seizure in which interposition of the biceps tendon precluded closed reduction. The fractured lesser tuberosity fragment included the bicipital groove, allowing the biceps tendon to sublux posteriorly preventing closed reduction, thus requiring a subsequent open reduction.


Subject(s)
Seizures/complications , Shoulder Dislocation/etiology , Shoulder Fractures/etiology , Tendon Injuries/etiology , Humans , Male , Middle Aged
17.
Clin Sports Med ; 6(3): 471-90, 1987 Jul.
Article in English | MEDLINE | ID: mdl-3334027

ABSTRACT

The senior author has performed more than 600 "therapeutic" arthroscopies under local anesthesia since 1978. The authors believe that the cases presented illustrate the increased diagnostic accuracy offered by performing arthroscopy of the knee under local anesthetic in certain types of cases. We are by no means advocating that all arthroscopies of the knee be performed under local anesthesia. Certainly, the majority of knee arthroscopies need not be performed under local anesthesia, because the diagnosis is usually evident. Perhaps when the diagnosis is not clear, a combination of local with regional or with general would be best, with performance of the diagnostic portion of the arthroscopy under local anesthesia. When an instantaneous improvement is possible, such as change in joint motion, or when some change in joint dynamics may be visualized, local should then be continued through the therapeutic conclusion of the procedure. Arthroscopy under local anesthesia has also been performed by the authors on the shoulder, elbow, and ankle, where the diagnostic benefits have been realized. Certain reconstructive operations, such as patellar realignments, are worthy of performance under local anesthesia in selected cases. In conclusion, the authors believe that arthroscopy of the knee and other joints under local anesthesia may add measurably to the diagnostic capability of the arthroscopist, and not infrequently to a therapeutic advantage.


Subject(s)
Anesthesia, Local , Arthroscopy/methods , Knee Joint/surgery , Sports , Adult , Athletic Injuries/diagnosis , Female , Humans , Knee Injuries/surgery , Male
18.
Radiology ; 162(2): 559-64, 1987 Feb.
Article in English | MEDLINE | ID: mdl-3797672

ABSTRACT

Forty-three professional and amateur athletes with persistent shoulder pain that interfered with their sports activities were evaluated by computed tomographic (CT) arthrography. In 19 patients, glenohumeral instability (14 anterior, two posterior, three multidirectional) was diagnosed with CT arthrography based on the simultaneous presence of labral and capsular lesions. The findings were crucial in establishing the diagnosis of instability in six patients in whom the condition was not suggested or could not be confirmed clinically. Another significant injury consisted of labral lesions not associated with glenohumeral instability. These tears often involved the anterior and parasuperior segments of this structure. Other, less frequently detected lesions included segmental labral enlargement and several labra with abnormal orientation (everted labrum). Early onset of degenerative disease was present in many athletes, especially those with a long history of sports activity. CT arthrographic findings were correlated with arthroscopic or surgical results in 19 patients.


Subject(s)
Athletic Injuries/diagnostic imaging , Shoulder Injuries , Tomography, X-Ray Computed , Adolescent , Adult , Female , Humans , Joint Instability/diagnostic imaging , Male , Middle Aged , Shoulder Dislocation/diagnostic imaging , Shoulder Joint/diagnostic imaging
SELECTION OF CITATIONS
SEARCH DETAIL
...