Papel de las técnicas de imagen en el diagnóstico de la hipertrofia selectiva del músculo tensor de la fascia lata / Role of imaging techniques in the diagnosis of selective hypertrophy of the tensor fascia lata

El músculo tensor de la fascia lata es una estructura muscular que forma parte de la porción lateral de la pelvis y del muslo proximal. La patología de este músculo no es bien conocida y descrita en la literatura. Por el contrario, la hipertrofia y la seudohipertrofia del músculo tensor de la fascia lata son hallazgos por imagen relativamente frecuentes que a menudo no se diagnostican y entran en un diagnóstico diferencial con patologías más complejas y peligrosas. En este artículo, nuestro objetivo es describir las características anatómicas y funcionales del músculo tensor de la fascia lata, profundizando en la descripción del músculo en radiología, su patología y un resumen de la literatura sobre el tema.(AU)

The tensor fascia lata is a muscular structure that forms part of the lateral portion of the pelvis and proximal thigh. Because conditions affecting this muscle have not been widely reported and are relatively unknown, hypertrophy and pseudo-hypertrophy of the tensor fascia lata, although relatively common imaging findings, often go undiagnosed; instead, radiologists perform the differential diagnosis with more complex and more dangerous conditions. This article aims to review the anatomic and functional characteristics of the tensor fascia lata, going into detail about the radiological description of this muscle and pathological conditions that can affect it, as well as reviewing the relevant literature.(AU)

Calcifying Aponeurotic Fibroma: A Multimodal Imaging Description of an Unusual Case Involving Soft Tissues Adjacent to the Clavicle.

Calcifying aponeurotic fibromas (CAFs) are rare benign tumors that typically develop in the soft tissue of the extremities. We report a case of 64-year-old woman with a CAF in the soft tissue surrounding her left clavicle. A plain radiograph showed an asymmetrical increase in opacity of the left internal clavicular region. Computed tomography and magnetic resonance imaging confirmed the presence of a heterogeneous lesion of the periclavicular soft tissue, with peripheral calcifications, and remodeling of the adjacent clavicular bone. Following ultrasound-guided biopsy and surgical resection of the mass, the final histological diagnosis was made. To the best of our knowledge, this is the first case of a CAF described in the soft tissue adjacent to the clavicle. It is essential to use all the diagnostic methods available (X-ray, ultrasound, CT, MRI, and percutaneous biopsy) to obtain the final diagnosis of this rare disease.

Role of imaging techniques in the diagnosis of selective hypertrophy of the tensor fascia lata. / Papel de las técnicas de imagen en el diagnóstico de la hipertrofia selectiva del músculo tensor de la fascia lata.

The tensor fascia lata is a muscular structure that forms part of the lateral portion of the pelvis and proximal thigh. Because conditions affecting this muscle have not been widely reported and are relatively unknown, hypertrophy and pseudo-hypertrophy of the tensor fascia lata, although relatively common imaging findings, often go undiagnosed; instead, radiologists perform the differential diagnosis with more complex and more dangerous conditions. This article aims to review the anatomic and functional characteristics of the tensor fascia lata, going into detail about the radiological description of this muscle and pathological conditions that can affect it, as well as reviewing the relevant literature.

Clinical And Plantar Fascial Morphologic Changes After Proximal Medial Gastrocnemius Release Treatment of Recalcitrant Plantar Fasciitis.

BACKGROUND: Magnetic resonance imaging (MRI) has been used as a diagnostic and prognostic instrument to evaluate the results of conservative treatment for plantar fasciitis. However, there are scarce data available relative to changes in the plantar fascia after operative treatment. The primary objective of this study is to evaluate the imaging changes in patients with recalcitrant plantar fasciitis treated operatively by means of proximal medial gastrocnemius release. METHODS: Thirteen patients with recalcitrant plantar fasciitis were studied with MRI preoperatively and 1 year after operative treatment. Quantitative (plantar fascia thickness) and qualitative variables (hyperintensity in the plantar fascia, insertional calcaneus bone edema, a plantar fascia tear, and the presence of perifascial collections) were assessed by 2 musculoskeletal radiologists. Clinical results were also measured with American Orthopaedic Ankle & Society (AOFAS), visual analog scale (VAS) pain, and 36-Item Short Form Health Survey (SF-36) scales. RESULTS: The mean plantar fascia thickness was 6.59 mm preoperatively and 6.37 mm postoperatively (P = .972). No statistically significant differences were found in any of the qualitative variables on comparing the pre- and postoperative periods. Patients reported clinical improvements in pain VAS, AOFAS measurement, and the physical subdomains of the SF-36 scale. CONCLUSION: Quantitative and qualitative variables assessed for the plantar fascia on MRI did not show any significant change after medial gastrocnemius release despite clear clinical improvement. LEVEL OF EVIDENCE: Level II, perspective cohort study.

Proximal Medial Gastrocnemius Release Versus Open Plantar Fasciotomy for the Surgical Treatment in Recalcitrant Plantar Fasciitis.

BACKGROUND: Plantar fasciitis is a common cause of foot pain. If conservative treatment fails, there is no consensus as to the best surgical management for recalcitrant plantar fasciitis (RPF). The aim of this study was to compare the results obtained from proximal medial gastrocnemius release (PMGR) with those obtained from open plantar fasciotomy (OPF) in terms of pain, satisfaction, health-related quality of life, and American Orthopaedic Foot & Ankle Society (AOFAS) score. METHODS: This is a prospective randomized trial conducted between 2012 and 2016. Patients with RPF for at least 9 months were included. Diagnosis was clinically made. The exclusion criteria were neuropathic heel pain; a history of previous foot fracture, surgery, or deformity; rheumatoid arthritis; or the need for long-term analgesic administration. After ruling out other conditions with magnetic resonance or ultrasound imaging, patients were randomized to be operated on with OPF or PMGR independently of the Silfverskjold test. Follow-up was carried out for up to 1 year. The AOFAS, visual analog scale (VAS) for pain, SF-36, and Likert scale for satisfaction were used to evaluate the results obtained. The analysis was done with 21 patients in the OPF group and 15 in the PMGR group. The demographic data (age, sex, body mass index, duration of symptoms, and positivity to the Silfverskjold test) of the groups were comparable. RESULTS: No differences were found in terms of the AOFAS (P = .24), VAS (P = .14), or any item of the SF-36. Satisfaction was very good in 85.8% of the PMGR group and 89.5% of the OPF group (P = .27). Faster recovery was observed in the PMGR group. CONCLUSION: OPF and PMGR provided good results for patients with RPF. Neither was superior to the other relative to pain, AOFAS score, satisfaction, or the SF-36. We recommend PMGR as the first option in RPF surgical management in order to avoid potential biomechanical complications related to OPF. LEVEL OF EVIDENCE: Level I, therapeutic randomized controlled trial.

Relationship of Plantar Fascia Thickness and Preoperative Pain, Function, and Quality of Life in Recalcitrant Plantar Fasciitis.

BACKGROUND: The measurement of plantar fascia thickness has been advocated as a diagnostic and prognostic instrument in patients with plantar fasciitis, but there are no data relative to it in recalcitrant plantar fasciitis. The aim of the study is to evaluate the correlation between plantar fascia thickness and pain, functional score, and health perception in patients with this condition. METHODS: Thirty-eight feet were studied with ultrasound and magnetic resonance imaging to measure plantar fascia thickness. The visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society Hindfoot Score (AOFAS), and SF-36 were then recorded for each patient. The relationship between the fascia and these scores was analyzed to evaluate the correlation of thickness with pain, functional level, and health perception of patients. RESULTS: In patients with recalcitrant plantar fasciitis, plantar fascia thickness did not correlate with pain (VAS), AOFAS, or any item of the SF-36. CONCLUSION: The thickness of the plantar fascia in patients with recalcitrant plantar fasciitis did not correlate with its clinical impact, and thus, we believe it should not be used in treatment planning. LEVEL OF EVIDENCE: Level IV, case series.

Corticosteroid Injection for the Treatment of Morton's Neuroma: A Prospective, Double-Blinded, Randomized, Placebo-Controlled Trial.

BACKGROUND: The effectiveness of corticosteroid injection for the treatment of Morton's neuroma is unclear. In addition, most of the studies related to it are case-control or retrospective case series. The purpose of this study was to compare the effectiveness between corticosteroid injection associated with local anesthetic and local anesthetic alone (placebo control group) for the treatment of Morton's neuroma. METHODS: Forty-one patients with a diagnosis of Morton's neuroma were randomized to receive 3 injections of either a corticosteroid plus a local anesthetic or a local anesthetic alone. The patients and the researcher who collected data were blinded to the treatment groups. The visual analog scale for pain and the American Orthopaedic Foot & Ankle Score (metatarsophalangeal/interphalangeal score) were obtained at baseline, after each injection, and at 3 and 6 months after the last injection. RESULTS: There were no significant between-group differences in terms of pain and function improvement at 3 and 6 months after treatment completion in comparison with baseline values. At the end of the study, 17 (48.5%) patients requested surgical excision of the neuroma: 7 (44%) in the experimental group and 10 (53%) in the control group ( P = 1.0). CONCLUSION: The injection of a corticosteroid plus a local anesthetic was not superior to a local anesthetic alone in terms of pain and function improvement in patients with Morton's neuroma. LEVEL OF EVIDENCE: Level I, randomized controlled trial.