[Shoulder pain: imaging examinations]. / Epaule douloureuse: quels examens d'imagerie demander?

Non-traumatic shoulder pain is a diagnostic challenge for clinicians. Usually, the clinical examination is supplemented by nowadays well-defined imaging studies. Radiography is the first examination to be requested on a systematic basis. It always includes several views to study the whole scapular region (glenohumeral joint, subacromial space, acromioclavicular joint etc.). If the radiographic examination is not precise enough, a noninvasive and non-irradiating examination is performed, either ultrasonography or magnetic resonance imaging. The latter seems to be more comprehensive than ultrasonography. However, the usefulness of the association radiography-ultrasonography should be emphasized: both examinations are perfectly complementary, inexpensive and easy to access. Invasive examinations, such as CT arthrography, are still too often requested following a radiological examination. Since they do not investigate the whole shoulder, they should be limited to the investigation of specific diseases, often as part of presurgical assessments required for or by the orthopedic surgeon.

Acitretin-induced enthesitis in a patient with psoriatic arthritis.

A patient with psoriatic arthritis and cutaneous psoriasis took acitretin for 10 years to treat his skin lesions. Radiographs disclosed exuberant ossifications in several entheses. Their features were not typical for psoriatic arthritis but were consistent with acitretin-induced hyperostosis. Retinoids are known to induce hyperostosis, most notably when they are used in high dosages and over long periods. The concomitant presence of two conditions affecting the entheses may explain the exuberant nature of the ossifications in our patient.

Percutaneous catheterization of the long bones: experimental study.

The objective of this study was to develop a technique which would permit access to the entire contents of long bones using a minimally invasive approach. Vascular catheterization techniques were used to allow access to the entire marrow cavity through a minimal percutaneous approach. A new device was also developed to reach the epiphysis of the long bone. The study was performed on animal and human anatomical specimens. A percutaneous approach was made through the bone shaft from a remote entry site using principles from endoscopy in an ex vivo experiment. This method may become an alternative technique when a direct approach to lesional sites in long bones is dangerous or impossible. For example, it could be used in cases of preventive cement injections in weakened bones.