[Medical language directed to the rheumatologist: pitfalls and common mistakes]. / Linguagem médica voltada para o reumatologista: armadilhas e erros comuns.

The purpose of this article is to stimulate the use of the vernacular by health professionals, commenting a few words usually employed in communication between rheumatologists.

Diagnostic value of tendon thickness and structure in the sonographic diagnosis of supraspinatus tendinopathy: room for a two-step approach.

OBJECTIVE: The aim of our study was to systematically compare different methodologies to establish an evidence-based approach based on tendon thickness and structure for sonographic diagnosis of supraspinatus tendinopathy when compared to MRI. METHODS: US was obtained from 164 symptomatic patients with supraspinatus tendinopathy detected at MRI and 42 asymptomatic controls with normal MRI. Diagnostic yield was calculated for either maximal supraspinatus tendon thickness (MSTT) and tendon structure as isolated criteria and using different combinations of parallel and sequential testing at US. Chi-squared tests were performed to assess sensitivity, specificity, and accuracy of different diagnostic approaches. RESULTS: Mean MSTT was 6.68 mm in symptomatic patients and 5.61 mm in asymptomatic controls (P<.05). When used as an isolated criterion, MSTT>6.0mm provided best results for accuracy (93.7%) when compared to other measurements of tendon thickness. Also as an isolated criterion, abnormal tendon structure (ATS) yielded 93.2% accuracy for diagnosis. The best overall yield was obtained by both parallel and sequential testing using either MSTT>6.0mm or ATS as diagnostic criteria at no particular order, which provided 99.0% accuracy, 100% sensitivity, and 95.2% specificity. Among these parallel and sequential tests that provided best overall yield, additional analysis revealed that sequential testing first evaluating tendon structure required assessment of 258 criteria (vs. 261 for sequential testing first evaluating tendon thickness and 412 for parallel testing) and demanded a mean of 16.1s to assess diagnostic criteria and reach the diagnosis (vs. 43.3s for sequential testing first evaluating tendon thickness and 47.4s for parallel testing). CONCLUSIONS: We found that using either MSTT>6.0mm or ATS as diagnostic criteria for both parallel and sequential testing provides the best overall yield for sonographic diagnosis of supraspinatus tendinopathy when compared to MRI. Among these strategies, a two-step sequential approach first assessing tendon structure was advantageous because it required a lower number of criteria to be assessed and demanded less time to assess diagnostic criteria and reach the diagnosis.

The carpal boss: a review of different sonographic findings / Revisão sobre as diferentes apresentações da bossa carpal na ultrassonografia

Carpal boss is an uncommon condition whose incidence is underestimated and that is frequently confused with other causes of development of tumor-like lesions on the dorsum of the wrist. From the clinical point of view, the main obstacle to its recognition is the nonspecificity of symptoms, frequently attributed to dorsal ganglion cysts, since both conditions share a similar location on the dorsum of the wrist. The assessment by ultrasonography allows for a correct diagnosis and appropriate management, with better chances of resolution of the clinical complaint and lower probability of iatrogenic worsening of the lesion. The present review is aimed at describing the different sonographic findings of carpal boss.

A bossa carpal é uma enfermidade incomum, porém de incidência subestimada, frequentemente confundida com outras causas de tumoração no carpo dorsal. Do ponto de vista clínico, o principal obstáculo ao seu reconhecimento reside na inespecificidade dos sintomas, frequentemente atribuídos a cistos dorsais, já que ambos compartilham localização muito semelhante no carpo. A avaliação por ultrassonografia permite diagnóstico correto e manejo específico, que resulta em melhores chances de resolução da queixa clínica e menor probabilidade de piora iatrogênica da lesão. O objetivo deste artigo é revisar as diferentes apresentações ultrassonográficas da bossa carpal.

Role of sonography and magnetic resonance imaging in detecting deltoideal acromial enthesopathy: an early finding in the diagnosis of spondyloarthritis and an under-recognized cause of posterior shoulder pain.

The acromial origin of the deltoid is a target structure of ankylosing spondylitis and related spondyloarthritis, which are often overlooked and underdiagnosed as causes of posterior shoulder pain. The objective of this article is to review the roles of sonography and magnetic resonance imaging in detecting deltoideal acromial enthesopathy and their importance for optimizing management in individuals with posterior shoulder pain. Adequate awareness of such enthesopathy as a potential manifestation of inflammatory rheumatic disorders is critical for early diagnosis of spondyloarthritis.

Sonography of the iliotibial band: spectrum of findings / Ultrassonografia do trato iliotibial: espectro de achados

Iliotibial band lesions constitute a potential source of discomfort and are frequently confounded with other conditions which cause pain on the lateral aspect of the hip, thigh and knee. Ultrasonography is usually regarded as a first-line imaging modality in the assessment of such conditions because of its excellent diagnostic accuracy, low cost and wide availability. The correct identification of the structure involved in the production of symptoms leads to an appropriate management and to a higher probability of resolution of the clinical complaint. The present article is aimed at reviewing the different sonographic presentations of iliotibial band syndromes.

Lesões no trato iliotibial constituem potencial fonte de desconforto e são frequentemente confundidas com outras enfermidades causadoras de dor na face lateral do quadril, coxa e joelho. A ultrassonografia é reconhecida como um método de imagem de primeira linha na investigação destas alterações, em virtude da excelente capacidade diagnóstica, baixo custo e ampla disponibilidade. A correta identificação da estrutura geradora dos sintomas resulta em tratamento específico e maior probabilidade de resolução da queixa clínica. O objetivo deste artigo é revisar as diferentes apresentações ultrassonográficas de doença do trato iliotibial.

Linguagem médica voltada para o reumatologista: armadilhas e erros comuns

O objetivo deste artigo é estimular o uso da lí ngua vernácula pelos profissionais da Área da saúde, comentando algumas palavras usualmente empregadas na comunicação entre médicos reumatologistas.

The purpose of this article is to stimulate the use of the vernacular by health professionals, commenting a few words usually employed in communication between rheumatologists.

The carpal boss: a review of different sonographic findings.

Carpal boss is an uncommon condition whose incidence is underestimated and that is frequently confused with other causes of development of tumor-like lesions on the dorsum of the wrist. From the clinical point of view, the main obstacle to its recognition is the nonspecificity of symptoms, frequently attributed to dorsal ganglion cysts, since both conditions share a similar location on the dorsum of the wrist. The assessment by ultrasonography allows for a correct diagnosis and appropriate management, with better chances of resolution of the clinical complaint and lower probability of iatrogenic worsening of the lesion. The present review is aimed at describing the different sonographic findings of carpal boss.

A bossa carpal é uma enfermidade incomum, porém de incidência subestimada, frequentemente confundida com outras causas de tumoração no carpo dorsal. Do ponto de vista clínico, o principal obstáculo ao seu reconhecimento reside na inespecificidade dos sintomas, frequentemente atribuídos a cistos dorsais, já que ambos compartilham localização muito semelhante no carpo. A avaliação por ultrassonografia permite diagnóstico correto e manejo específico, que resulta em melhores chances de resolução da queixa clínica e menor probabilidade de piora iatrogênica da lesão. O objetivo deste artigo é revisar as diferentes apresentações ultrassonográficas da bossa carpal.

Static and dynamic sonography for diagnosis of abdominal wall hernias.

Sonography is a fast, painless, inexpensive, and widely available tool usually regarded as a first-line imaging modality for abdominal wall evaluation. This article provides illustrative images and videos on the use of sonography for diagnosis of abdominal wall hernias. A variety of pitfalls that may present clinically as pseudohernias are also described.

Ultrasonography in rheumatoid arthritis: what rheumatologists should know.

Ultrasonography has recently gained prestige as an adjuvant method for the diagnosis and therapeutic follow-up of rheumatoid arthritis, although radiography remains the imaging modality traditionally and widely used for those purposes. The great advantage of the ultrasonographic study, which has motivated enthusiastic research in the area, resides in its capacity to detect synovitis and bone erosion at a pre-radiographic phase, which has been increasingly valued in preventing late and definitive structural damage. Because that is a relatively new subject, several scientific articles have been published in recent years about the potential applications of ultrasonography in individuals with rheumatoid arthritis, some of which directed to researchers and others to clinical rheumatologists. This study aimed at assessing the currently available bibliography on the subject and at describing only the concepts that are of practical applicability in the daily routine of clinical rheumatologists.

Aspectos práticos e contemporâneos da linguagem médica voltada para o imaginologista: armadilhas e erros comuns / Practical and contemporary aspects of medical language in diagnostic imaging: pitfalls and common mistakes

O intuito deste artigo é estimular o uso da língua culta pelos médicos que atuam na área de diagnóstico por imagem.

The purpose of this paper is to encourage the correct use of vocabulary in the field of diagnostic imaging.

Top ten pitfalls to avoid when performing musculoskeletal sonography: what you should know before entering the examination room.

Sonography has been used successfully to evaluate a number of musculoskeletal disorders. The method is operator dependent and familiarity with sonographic pitfalls greatly improves diagnostic accuracy and helps to optimize management. In this article, we discuss ten common pitfalls which can become a source of confusion and misdiagnosis in musculoskeletal sonography.

Ultrassonografia em portadores de artrite reumatoide: o que o reumatologista clínico deve saber / Ultrasonography in rheumatoid arthritis: what rheumatologists should know

Recentemente, a ultrassonografia vem ganhando prestígio como método adjuvante no diagnóstico e no acompanhamento terapêutico da artrite reumatoide, embora a radiografia ainda seja a modalidade de imagem tradicionalmente utilizada em larga escala com esses propósitos. O grande trunfo do estudo ultrassonográfico, que vem motivando pesquisas entusiastas na área, reside em sua capacidade de detectar sinovite e erosão óssea em fase pré-radiográfica, o que tem sido cada vez mais valorizado na prevenção do dano estrutural tardio e definitivo. Por ser um assunto relativamente novo, vários artigos científicos vêm sendo publicados em anos recentes sobre as potenciais aplicações da ultrassonografia em portadores de artrite reumatoide, alguns voltados a pesquisadores, outros voltados ao reumatologista clínico. O objetivo deste artigo é depurar a bibliografia atualmente disponível e descrever apenas os conceitos de aplicabilidade prática na rotina diária do reumatologista clínico.

Ultrasonography has recently gained prestige as an adjuvant method for the diagnosis and therapeutic follow-up of rheumatoid arthritis, although radiography remains the imaging modality traditionally and widely used for those purposes. The great advantage of the ultrasonographic study, which has motivated enthusiastic research in the area, resides in its capacity to detect synovitis and bone erosion at a pre-radiographic phase, which has been increasingly valued in preventing late and definitive structural damage. Because that is a relatively new subject, several scientific articles have been published in recent years about the potential applications of ultrasonography in individuals with rheumatoid arthritis, some of which directed to researchers and others to clinical rheumatologists. This study aimed at assessing the currently available bibliography on the subject and at describing only the concepts that are of practical applicability in the daily routine of clinical rheumatologists.

Tenossinovite e sinovite do primeiro compartimento extensor do punho: o que o ultrassonografista precisa saber / Tenosynovitis and synovitis of the first extensor compartment of the wrist: what sonographers should know

A tenossinovite do primeiro compartimento extensor é uma enfermidade frequente, cercada por mitos. O objetivo deste artigo é revisar cientificamente alguns dos aspectos mais pertinentes ao ultrassonografista sobre sua terminologia, fisiopatogenia, diagnóstico e acompanhamento.

Tenosynovitis of the first dorsal compartment of the wrist is a condition surrounded by myths. The aim of this paper is scientifically review relevant aspects about terminology, pathophysiology, diagnosis, and follow-up of this condition.

Comparison between exclusively long-axis and multiple-axis sonographic protocols for screening of rotator cuff lesions in symptomatic shoulders.

OBJECTIVE: The purpose of this study was to determine whether exclusively long-axis sonography differs from a multiple-axis scanning protocol as a screening tool for rotator cuff lesions in symptomatic shoulders when compared with magnetic resonance imaging (MRI). METHODS: A total of 509 consecutive patients (mean age, 52.8 years) referred for MRI were also routinely evaluated by sonography. We initially performed exclusively long-axis sonography and graded the rotator cuff as normal or abnormal. Patients subsequently underwent a full sonographic protocol using multiple-axis views. Magnetic resonance imaging findings were compared with sonographic findings for both techniques. RESULTS: The overall accuracy of sonography was greater than 90%. We found divergent results from different sonographic techniques in 34 patients. Of these, 8 were multiple-axis false-negative; 14 were exclusively long-axis false-negative; 6 were exclusively long-axis false-positive; and 6 were multiple-axis false-positive. All cases with divergent false-negative findings on multiple-axis sonography showed tendinosis on MRI. Causes for false-negative findings on exclusively long-axis sonography included tendinosis and partial-thickness tears of the supraspinatus. No statistically significant difference was seen between both sonographic techniques compared with MRI in terms of accuracy, sensitivity, specificity, positive predictive value, and negative predictive value (P > .05). CONCLUSIONS: Sonography is reliable for detecting rotator cuff abnormalities. Exclusively long-axis sonography seems appropriate as a screening tool for rotator cuff lesions in symptomatic shoulders.