VIDEO: Ultrasound Evaluation of External Shoulder Impingement.

OBJECTIVE: The purpose of this video article is to show sonographic anatomy at the shoulder joint relevant to impingement and to describe the diagnostic techniques that can be used to diagnose this condition. The article contains several video clips depicting both the normal and pathologic appearances of the bursa during dynamic assessment. The technique for guided injection at this location with sonographic guidance will be covered as well as pitfalls for reporting impingement. CONCLUSION: Dynamic ultrasound assessment of the shoulder is a useful adjunct to clinical assessment in the evaluation and diagnosis of impingement.

Magnetic Resonance Imaging of Arthritis of the Knee.

The knee joint is involved in a wide variety of arthritides, and imaging has always played a major role in both aiding diagnosis and assessing the severity of such diseases. Plain film radiography has traditionally been used as the primary imaging modality for radiographic diagnosis of arthritis. However, magnetic resonance imaging (MRI) shows a greater sensitivity to both the bone and soft tissue features of this group of conditions. This article reviews the imaging features of osteoarthritis (OA) of the knee shown on MRI and the criteria used to diagnose this condition. It also discusses imaging features that suggest the underlying arthropathy is not OA.

Imaging in Foot and Ankle Arthritis.

The foot and ankle are commonly involved in a range of arthritides that affect the joints, bones, and soft tissues. Accurate plain film interpretation can often aid the diagnosis and monitor disease progression and treatment response. Ultrasound and MRI afford superior depiction of the soft tissues, and advances over recent years have centered on early detection of synovitis, enabling earlier diagnosis and treatment. Advantages and disadvantages of the imaging techniques of radiography, multidetector computed tomography, ultrasound, and MRI are discussed, as is optimization of these modalities for the assessment of the anatomically complex joints of the foot and ankle. Diagnostic features enabling differentiation between rheumatoid arthritis, seronegative spondyloarthropathies, osteoarthritis, gout, crystal deposition disease, pigmented villonodular synovitis, Charcot arthropathy, septic arthritis, synovial osteochondromatosis, hemophilia, and reflex sympathetic dystrophy are also reviewed.

Radiological intervention of the hand and wrist.

The role of radiological guided intervention is integral in the management of patients with musculoskeletal pathologies. The key to image-guided procedures is to achieve an accurately placed intervention with minimal invasion. This review article specifically concentrates on radiological procedures of the hand and wrist using ultrasound and fluoroscopic guidance. A systematic literature review of the most recent publications relevant to image-guided intervention of the hand and wrist was conducted. During this search, it became clear that there is little consensus regarding all aspects of image-guided intervention, from the technique adopted to the dosage of injectate and the specific drugs used. The aim of this article is to formulate an evidence-based reference point which can be utilized by radiologists and to describe the most commonly employed techniques.

The prevalence of tenosynovitis of the interosseous tendons of the hand in patients with rheumatoid arthritis.

AIM: The aim of this study was to establish the prevalence of tenosynovitis affecting the interosseous tendons of the hand in a rheumatoid arthritis (RA) population and to assess for association with metacarpophalangeal (MCP) joint synovitis, flexor tendon tenosynovitis or ulnar drift. METHODS: Forty-four patients with RA underwent hand MRI along with 20 normal controls. Coronal 3D T1 VIBE sequences pre- and post-contrast were performed and reconstructed. The presence of interosseous tendon tenosynovitis was recorded alongside MCP joint synovitis, flexor tendon tenosynovitis and ulnar drift. RESULTS: Twenty-one (47.7%) patients with RA showed interosseous tendon tenosynovitis. Fifty-two (14.8%) interosseous tendons showed tenosynovitis amongst the RA patients. Interosseous tendon tenosynovitis was more commonly seen in association with adjacent MCP joint synovitis (p < 0.001), but nine MCP joints (5.1%) showed adjacent interosseous tenosynovitis in the absence of joint synovitis. Interosseous tendon tenosynovitis was more frequently seen in fingers which also showed flexor tendon tenosynovitis (p < 0.001) and in patients with ulnar drift of the fingers (p = 0.01). CONCLUSION: Tenosynovitis of the hand interosseous tendons was found in 47.7% of patients with RA. In the majority of cases this was adjacent to MCP joint synovitis; however, interosseous tendon tenosynovitis was also seen in isolation. KEY POINTS: • Tenosynovitis of the interosseous tendons of the hand occurs in rheumatoid arthritis. • Interosseous tendon tenosynovitis has a prevalence of 47.7% in patients with RA. • Interosseous tendon tenosynovitis is related to MCP joint synovitis in the adjacent joints.

Superior labrum anterior to posterior lesions and the superior labrum.

The fibrocartilaginous glenoid labrum contributes to shoulder stability and provides attachment for the long head of biceps tendon and the glenohumeral ligaments. The superior site of attachment of the long head of biceps (biceps anchor) represents a site of injury to the superior labrum where tearing may extend into the biceps tendon as well as anterior and/or posterior to the biceps anchor. Such tears are known as superior labrum anterior and posterior (SLAP) tears and are a cause of both shoulder instability and pain. SLAP tears are frequently seen in those undertaking repetitive frequent overarm activity such as throwing athletes and swimmers. This article reviews the mechanisms and types of SLAP tears and their imaging appearances. It also discusses associated injuries and pitfalls in diagnosing these injuries.

Rheumatoid arthritis.

Since the advent of disease-modifying antirheumatic drugs for the treatment of rheumatoid arthritis, there has been an increasing emphasis on the early diagnosis and monitoring of this condition. This has led to the greater involvement of advanced imaging techniques such as ultrasound and MRI. Ultrasound appearances of common findings in rheumatoid arthritis are discussed in this review. Comparison of ultrasound in terms of sensitivity and specificity with other imaging modalities and with clinical examination is also made. Quantification is also discussed as a tool to allow assessment of response to drug therapy, an area that is likely to progress further as techniques become increasingly reproducible. Finally, as ultrasound techniques continue to develop, its involvement in the management of patients with rheumatoid arthritis is increasing. New techniques such as fusion imaging and sonoelastography, while at present still largely research-based entities, may offer increasingly improved diagnostic benefits in the field of inflammatory arthropathy.

The technique and application of ultrasound in the diagnosis and management of inflammatory arthritis.

Ultrasound is increasingly used by radiologists and rheumatologists for the diagnosis and assessment of inflammatory arthritis in day-to-day clinical practice. It is ideally suited to demonstrating early changes of these conditions before they are evident using conventional radiography or indeed clinical examination. Ultrasound readily demonstrates synovitis, effusion, soft tissue changes, and some bone features (including erosion and enthesophyte formation) of inflammatory arthritis. It also provides a way to quantify disease activity. This article reviews the ultrasound imaging features of the inflammatory arthritides and techniques involved. It also highlights the advantages and disadvantages of ultrasound as opposed to magnetic resonance imaging.

Rheumatoid arthritis: ultrasound versus MRI.

OBJECTIVE: Rheumatoid arthritis is a predominantly joint-based disease affecting approximately 1% of the world's population. This article will address the increasing use of both ultrasound and MRI in the diagnosis and monitoring of rheumatoid arthritis and will highlight both the strengths and weaknesses of these two imaging modalities, with particular reference to bone erosions and synovitis. CONCLUSION: Because they can detect early disease, both ultrasound and MRI will become increasingly important in the diagnosis and management of rheumatoid arthritis. Future studies with increased patient numbers will be necessary if one of these two modalities is to emerge as a clear winner as the imaging modality of choice.

Ultrasound-guided intervention around the hip joint.

OBJECTIVE: The purpose of this article is to review some of the most common reasons for ultrasound intervention around the hip joint, and describe the techniques involved. CONCLUSION: Ultrasound alleviates the need for exposure to radiation and is already the modality of choice for aspiration of the hip joint, an intervention that may be helpful in guiding antimicrobial therapy and help avoid the need for surgical intervention. Ultrasound can also be used to access the hip for diagnostic or therapeutic injection.