Estimation of joint torque in dynamic activities using wearable A-mode ultrasound.

The human body constantly experiences mechanical loading. However, quantifying internal loads within the musculoskeletal system remains challenging, especially during unconstrained dynamic activities. Conventional measures are constrained to laboratory settings, and existing wearable approaches lack muscle specificity or validation during dynamic movement. Here, we present a strategy for estimating corresponding joint torque from muscles with different architectures during various dynamic activities using wearable A-mode ultrasound. We first introduce a method to track changes in muscle thickness using single-element ultrasonic transducers. We then estimate elbow and knee torque with errors less than 7.6% and coefficients of determination (R2) greater than 0.92 during controlled isokinetic contractions. Finally, we demonstrate wearable joint torque estimation during dynamic real-world tasks, including weightlifting, cycling, and both treadmill and outdoor locomotion. The capability to assess joint torque during unconstrained real-world activities can provide new insights into muscle function and movement biomechanics, with potential applications in injury prevention and rehabilitation.

Galectin-9 as an indicator of functional limitations and radiographic joint damage in patients with rheumatoid arthritis.

Background: Previous studies have revealed that Galectin-9 (Gal-9) acts as an apoptosis modulator in autoimmunity and rheumatic inflammation. In the present study, we investigated the potential role of Gal-9 as a biomarker in patients with rheumatoid arthritis (RA), especially as an indicator of functional limitations and radiographic joint damage. Methods: A total of 146 patients with RA and 52 age- and sex-matched healthy controls were included in this study. Clinical data including disease activity, physical function, and radiographic joint damage were assessed. Functional limitation was defined as the Stanford Health Assessment Questionnaire (HAQ) disability index >1. Subjects with joint erosion >0 or joint space narrowing >0 were considered to have radiographic joint damage. Serum Gal-9 levels were detected by an enzyme-linked immunosorbent assay. Univariate and multivariate logistic regression analysis were used to evaluate the association between Gal-9 and high disease activity and functional limitations, and a prediction model was established to construct predictive nomograms. Results: Serum levels of Gal-9 were significantly increased in patients with RA compared to those in healthy controls (median 13.1 ng/mL vs. 7.6 ng/mL). Patients with RA who were older (>65 years), had a longer disease duration (>5 years), longer morning stiffness (>60mins), elevated serum erythrocyte sedimentation rate and C-reactive protein, and difficult-to-treat RA had significantly higher Gal-9 levels than those in the corresponding control subgroups (all p <0.05). Patients with RA were divided into two subgroups according to the cut-off value of Gal-9 of 11.6 ng/mL. Patients with RA with Gal-9 >11.6 ng/mL had a significantly higher core clinical disease activity index, HAQ scores, Sharp/van der Heijde modified Sharp scores, as well as a higher percentage of advanced joint damage (all p<0.05) than patients with Gal-9 ≤11.6 ng/mL. Accordingly, patients with RA presenting either functional limitations or radiographic joint damage had significantly higher serum Gal-9 levels than those without (both p <0.05). Furthermore, multivariate logistic regression analysis showed that a serum level of Gal-9 >11.6 ng/mL was an independent risk factor for high disease activity (OR=3.138, 95% CI 1.150-8.567, p=0.026) and presence of functional limitations (OR=2.455, 95% CI 1.017-5.926, p=0.046), respectively. Conclusion: Gal-9 could be considered as a potential indicator in patients with RA, especially with respect to functional limitations and joint damage.

Assessing joint health in haemophilia patients: The combined value of physical examination and ultrasound imaging.

INTRODUCTION: Early diagnosis of joint damage is pivotal in haemophilia to prevent the occurrence and progression of haemophilic arthropathy thus providing optimal personalised management. The haemophilia joint health score version 2.1 (HJHS) is based on a physical examination of the mainly affected joints. Musculoskeletal ultrasound has demonstrated the capability to detect early changes in terms of synovitis and osteochondral damage. The haemophilia early detection with ultrasound (HEAD-US) score has been proposed as a simple and reliable evaluation tool. AIM: This study aims to investigate the correlation between the HJHS and the HEAD-US scores performed by two independent operators (physical therapist and musculoskeletal ultrasound expert) for the evaluation of the joint health status of patients with haemophilia. METHODS: Consecutive adult patients independent of the severity degree were included. Elbows, knees and ankles were evaluated by a physical therapist by HJHS and by a musculoskeletal ultrasound expert following the HEAD-US protocol. RESULTS: We observed a good positive correlation between HJHS and HEAD-US (Spearman's rho 0.72). The main discrepancy in conceptually similar domains was found between the HJHS swelling and the HEAD-US synovitis (rho 0.17), as ultrasound was able to detect even mild synovitis when HJHS swelling was scored 0 in up to 40% of cases. CONCLUSIONS: The HJHS and HEAD-US correlate well even when performed by two independent operators. Musculoskeletal ultrasound is particularly useful for the early detection of synovitis. The routine assessment of both scores helps clinicians define the stage and extension of joint involvement and set up a personalised treatment.

Reliability assessment of the OMERACT whole-body magnetic resonance imaging scoring system for juvenile idiopathic arthritis.

Inter-reader reliability of a new scoring system for evaluating joint inflammation and enthesitis in whole body MRI (WBMRI) in juvenile idiopathic arthritis was tested. The scoring system grades 732 item-region combinations of bone marrow and soft tissue changes for commonly involved joints and entheseal sites. Five radiologists rated 17 WBMRI scans through an online rating platform. Item-wise reliability was calculated for 117 items with non-zero scores in >10 % of readings. Interquartile ranges of the five-reader Kappa reliability coefficients were 0.58-0.73 (range: 0.36-0.88) for the joints, 0.65-0.81 (range: 0.39-0.95) for the entheses, and 0.62-0.75 (range: 0.60-0.76) for chronic nonbacterial osteomyelitis-like lesions.

Validity of ChatGPT-generated musculoskeletal images.

OBJECTIVE: In the evolving landscape of medical research and radiology, effective communication of intricate ideas is imperative, with visualizations playing a crucial role. This study explores the transformative potential of ChatGPT4, a powerful Large Language Model (LLM), in automating the creation of schematics and figures for radiology research papers, specifically focusing on its implications for musculoskeletal studies. MATERIALS AND METHODS: Deploying ChatGPT4, the study aimed to assess the model's ability to generate anatomical images of six large joints-shoulder, elbow, wrist, hip, knee, and ankle. Four variations of a text prompt were utilized, to generate a coronal illustration with annotations for each joint. Evaluation parameters included anatomical correctness, correctness of annotations, aesthetic nature of illustrations, usability of figures in research papers, and cost-effectiveness. Four panellists performed the assessment using a 5-point Likert Scale. RESULTS: Overall analysis of the 24 illustrations encompassing the six joints of interest (4 of each) revealed significant limitations in ChatGPT4's performance. The anatomical design ranged from poor to good, all of the illustrations received a below-average rating for annotation, with the majority assessed as poor. All of them ranked below average for usability in research papers. There was good agreement between raters across all domains (ICC = 0.61). CONCLUSION: While LLMs like ChatGPT4 present promising prospects for rapid figure generation, their current capabilities fall short of meeting the rigorous standards demanded by musculoskeletal radiology research. Future developments should focus on iterative refinement processes to enhance the realism of LLM-generated musculoskeletal schematics.

Comparison of Angio PLanewave UltraSensitive and Power Doppler Ultrasound in Detecting Synovial Blood Flow in Wrist and Finger Joints of Rheumatoid Arthritis Patients.

RATIONALE AND OBJECTIVES: The purpose of this study is to conduct a comparison between the newly introduced Angio PLanewave UltraSensitive (AngioPLUS) method and the power Doppler ultrasound (PDUS) technique, evaluating the efficacy of these two methods in detecting synovial blood flow in wrist and finger joints of rheumatoid arthritis (RA) patients. Furthermore, the study aimed to investigate the potential associations between the observed blood flow patterns and various symptoms and indicators associated with RA. MATERIALS AND METHODS: A cohort of 101 patients diagnosed with RA was included and subsequently categorized into two groups: 20 male participants (19.80%) and 81 female participants (80.20%). Their grayscale ultrasound, PDUS, and AngioPLUS were utilized to acquire data, and subsequent scoring was conducted. Serological tests of the patients were also performed, and DAS28 scores were calculated. The McNemar and Wilcoxon tests were used to compare the blood flow display rate and grading of PDUS as well as AngioPLUS, respectively. RESULTS: AngioPLUS blood was significantly improved compared to PDUS. In all joints, the proportion of slight and significant improvement in wrist joints was the highest (14.11% and 1.98%, respectively). AngioPLUS was moderately correlated with C-reactive Protein (CRP), Disease Activity Score that includes 28-joint counts, and swollen joint counts and weakly correlated with platelet, hemoglobin, tender joint counts, and CRP before and after treatment. CONCLUSION: Compared to PDUS, AngioPLUS has a better auxiliary diagnostic role in evaluating disease activity and can provide a reference to improve the management of RA further.

Ultrasound-guided injection and aspiration of small joints: techniques, pearls, and pitfalls.

Ultrasound (US)-guided musculoskeletal intervention of small joints or joints other than the shoulder, elbow, hip, knee, and ankle can be technically challenging. Small joints produce a narrower landing zone for the needle and a smaller target that may be made even more inaccessible by bulky osteophytes. Sonographic (US) guidance offers important advantages including near-field visualization of the joint and soft tissues, ease of access, portability, ability to compare with the contralateral side, and lack of ionization radiation. This review article focuses on the performance of US-guided injections and aspirations involving small joints (joint capacity < 2 mL and/or typically evaluated or injected with a compact linear transducer). For each joint (temporomandibular, acromioclavicular, sternoclavicular, distal radioulnar, symphysis pubis, and joints of the digits of the hands and feet), a brief overview of the relevant anatomy, indications, procedural description, pearls and pitfalls will be highlighted. This article demonstrates the various approaches to diagnostic or therapeutic injection and aspiration of small joints with the aid of US images, cines and graphic illustrations, emphasizing joint positioning, anatomic landmarks, and needle trajectory for a safe and efficacious procedure. A brief review of available literature for each joint will also be provided.

Arthrocentesis approaches to the phalangeal joints of the one humped camel (Camelus dromedarius).

Irrespective of the exceptional adaptation of dromedaries to harsh environmental conditions, they remain highly susceptible to joint lameness resulting from a range of diverse factors and conditions. The joints most often affected by traumatic osteoarthritis in dromedaries are the metacarpophalangeal and metatarsophalangeal joints. A comprehensive understanding of joint anatomy and topography of the dromedary is required to perform arthrocentesis correctly on affected joints. Forty-two distal limbs were taken from 28 camels and studied by gross dissection, casting, ultrasonography, and computed tomography (CT). Representative three-dimensional models of the joint cavities, recesses, and pouches were obtained using different casting agents. This study provides a detailed description of dorsally, axially, and abaxially positioned joint recesses, as well as palmar/plantar positioned joint pouches. The safety and feasibility of the different arthrocentesis approaches were evaluated. The traditional dorsal arthrocentesis approach of the metacarpophalangeal, metatarsophalangeal, proximal interphalangeal, and distal interphalangeal joints, has limitations due to the risk of damaging the tendon structures and articular cartilage, which can lead to joint degeneration. A lateral arthrocentesis approach via the proximal palmar/plantar pouches of the metacarpophalangeal/metatarsophalangeal and proximal interphalangeal joints is recommended. This approach eliminates the potential needle injury to the articulating joint cartilage and other surrounding joint structures, such as tendons, blood vessels, and nerves.

Use of Ultrasonography in Diagnosis of Medial Compartment Disease of the Elbow in Dogs.

OBJECTIVE: The objective of this prospective study was to evaluate the use of ultrasonography in the diagnosis of medial coronoid process disease in unclear cases. STUDY DESIGN: Fifteen elbows (on thirteen dogs) for which radiography and computed tomography did not lead to a clear diagnosis of medial coronoid process disease were included. On each elbow, ultrasonography was performed with a high frequency linear transducer (12-18Hz). Then, arthroscopic examination of the joint was performed by a surgeon who was unaware of ultrasonographic findings to confirm medial coronoid process disease. RESULTS: At least one ultrasonographic lesion was detected in 13 out of 15 elbows. The main reported ultrasonographic lesions were joint effusion (10/15 elbows) and an abnormal shape of the medial coronoid process (irregular, ill-defined or fragmented) (9/15). CONCLUSION: Ultrasonography can be a helpful additional diagnostic tool to confirm medial coronoid process disease of the elbow joint before performing arthroscopy in unclear cases. Further studies will be needed to evaluate the use of higher frequency transducers and determine if it could improve the diagnostic value of ultrasonography.

Reliability of the Pediatric Specific Musculoskeletal Ultrasound Scoring Systems for the Elbow, Wrist, and Finger Joints.

OBJECTIVE: Musculoskeletal ultrasound (MSUS) is increasingly being used in the evaluation of pediatric musculoskeletal diseases. In order to provide objective assessments of arthritis, reliable MSUS scoring systems are needed. Recently, joint-specific scoring systems for arthritis of the pediatric elbow, wrist, and finger joints were proposed by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) MSUS workgroup. This study aimed to assess the reliability of these scoring systems when used by sonographers with different levels of expertise. METHODS: Members of the CARRA MSUS workgroup attended training sessions for scoring the elbow, wrist, and finger. Subsequently, scoring exercises of B mode and power Doppler (PD) mode still images for each joint were performed. Interreader reliability was determined using 2-way single-score intraclass correlation coefficients (ICCs) for synovitis and Cohen [Formula: see text] for tenosynovitis. RESULTS: Seventeen pediatric rheumatologists with different levels of MSUS expertise (1-15 yrs) completed a 2-hour training session and calibration exercise for each joint. Excellent reliability (ICC > 0.75) was found after the first scoring exercise for all the finger and elbow views evaluated on B mode and PD mode, and for all of the wrist views on B mode. After a second training session and a scoring exercise, the wrist PD mode views reached excellent reliability as well. CONCLUSION: The preliminary CARRA MSUS scoring systems for assessing arthritis of the pediatric elbow, wrist, and finger joints demonstrate excellent reliability among pediatric MSUS sonographers with different levels of expertise. With further validation, this reliable joint-specific scoring system could serve as a clinical tool and scientific outcome measure.

Ultrasound-guided interventions of the upper extremity joints.

Ultrasound guidance is valuable for performing precise joint interventions. Joint interventions may be requested for therapeutic and diagnostic pain injections, joint aspiration in the setting of suspected infection, or contrast injection for arthrography. In practice, interventions of the shoulder girdle, elbow, and hand/wrist joints may be performed without any imaging guidance. However, imaging guidance results in more accurate interventions and better patient outcomes than those performed by palpation alone. When compared to other modalities used for imaging guidance, ultrasound has many potential advantages. Radiologists should be prepared to perform ultrasound-guided upper extremity joint interventions utilizing recommended techniques to optimize clinical practice and patient outcomes. KEY POINTS: 1. Ultrasound-guided injections of the glenohumeral, acromioclavicular, sternoclavicular, elbow, and hand/wrist joints have higher accuracy than injections performed without imaging guidance. 2. Ultrasound-guided aspirations of upper extremity joints have advantages to fluoroscopic-guided aspirations because of the potential to identify effusions, soft tissue abscess, or bursitis. 3. Ultrasound-guided contrast injection prior to MR arthrography is as accurate as fluoroscopic-guided injection for upper extremity joints.

Teleguidance for Patient Self-Imaging of Hemophilic Joints Using Mobile Ultrasound Devices: A Pilot Study.

BACKGROUND: Teleguidance on portable devices opens the possibility of joint self-imaging in persons with hemophilia (PWH). AIMS: Determine the feasibility of patient self-imaging with/without teleguidance. METHODS: Adult PWH received ultrasound teaching including 11 views for hemarthrosis detection in ankles, elbows, and knees. The patients acquired five randomly selected views with the Butterfly/IQ probe without assistance at 2, 6-8 weeks, and 3-4 months later, followed by teleguidance. Image acquisition was timed, patients identified anatomic landmarks, and image quality was graded. Questionnaires assessed the imaging experience. Hemophilia Joint Health Score (HJHS) indicated arthropathy status. RESULTS: Of 132 PWH, 10 (median age 52 years) opted for study inclusion. Most had severe Hemophilia A, were white/non-Hispanic, with at least a high school degree and, overall, similar to the other 122 PWH. At 2 and 6 weeks after training, ~80% images were acquired correctly compared with 53% at 12 weeks. Accuracy of landmark recognition was ~55%. With teleguidance, all images were acquired correctly, with near-perfect image quality (P ≤ .01 compared with the 3-4 month time point). Median HJHS of scanned joints was 11.5 at each time point, demonstrating a similar spectrum of arthropathic changes. Median time of image acquisition was fast, and similar with or without teleguidance (median 01:04 [mm:ss] vs median 01:02), but differed slightly between arthropathic and non-arthropathic joints. Study participants and the imaging facilitator rated that it was easy to navigate mobile technology and acquire images with teleguidance. CONCLUSION: Mobile ultrasound with teleguidance for joint self-imaging is feasible and warrants further exploration.

Deep learning-based automatic-bone-destruction-evaluation system using contextual information from other joints.

BACKGROUND: X-ray images are commonly used to assess the bone destruction of rheumatoid arthritis. The purpose of this study is to propose an automatic-bone-destruction-evaluation system fully utilizing deep neural networks (DNN). This system detects all target joints of the modified Sharp/van der Heijde score (SHS) from a hand X-ray image. It then classifies every target joint as intact (SHS = 0) or non-intact (SHS ≥ 1). METHODS: We used 226 hand X-ray images of 40 rheumatoid arthritis patients. As for detection, we used a DNN model called DeepLabCut. As for classification, we built four classification models that classify the detected joint as intact or non-intact. The first model classifies each joint independently, whereas the second model does it while comparing the same contralateral joint. The third model compares the same joint group (e.g., the proximal interphalangeal joints) of one hand and the fourth model compares the same joint group of both hands. We evaluated DeepLabCut's detection performance and classification models' performances. The classification models' performances were compared to three orthopedic surgeons. RESULTS: Detection rates for all the target joints were 98.0% and 97.3% for erosion and joint space narrowing (JSN). Among the four classification models, the model that compares the same contralateral joint showed the best F-measure (0.70, 0.81) and area under the curve of the precision-recall curve (PR-AUC) (0.73, 0.85) regarding erosion and JSN. As for erosion, the F-measure and PR-AUC of this model were better than the best of the orthopedic surgeons. CONCLUSIONS: The proposed system was useful. All the target joints were detected with high accuracy. The classification model that compared the same contralateral joint showed better performance than the orthopedic surgeons regarding erosion.

A Feasible Multimodal Photoacoustic Imaging Approach for Evaluating the Clinical Symptoms of Inflammatory Arthritis.

Numerous traditional medical imaging methods, including computed tomography with X-rays, positron emission tomography (PET), and magnetic resonance imaging (MRI), are utilized frequently in medical settings to screen for illnesses, diagnose patients, and track the effectiveness of treatments. When examining bone protrusions, CT is preferred over MRI for scanning connective tissue. Although the picture quality of PET is inferior to that of CT and MR, it is outstanding for detecting the molecular markers and metabolic functions of illnesses. To give high-resolution structural pictures and improved ailment sensitivity and specificity within another image, multimodal data and substantial therapeutic influence on advanced diagnostics and therapeutics have been used. The goal was to evaluate the clinical significance of multimodal photoacoustic/ultrasound (PA/US) articular imaging scoring, a cutting-edge image technique that may show the microvessels and oxygen levels of rheumatoid arthritis-related inflamed joints (RA). The PA/US imaging technology analyzed seven tiny joints. The PA and power Doppler (PD) impulses were semiquantified using a 0-3 grading scale, and the averages of the PA and PD scores for the seven joints are computed. Three PA+SO2 types were found determined by the relative oxygen levels (SO2) measurements of the affected joints. Researchers evaluated the relationships between the disease activity ratings and the PA/US imaging ratings. The PA scores and medical ratings that reflect the extent of the pain have strong relationships with each other, as do the PA+SO2 combinations. PA may be clinically useful in assessing RA. Thus, the research evaluated the clinical symptoms of inflammatory arthritis using a multimodal photoacoustic image process.