Role of shoulder ultrasonography in the evaluation of the painful shoulder.

The purpose of this study was to determine the accuracy of ultrasonography in the detection of rotator cuff tears. In a prospective study of 41 patients, the ultrasound results could be compared with the combined results of (CT) arthrography, arthroscopy and operation. The sensitivity of sonography in detecting partial and total rotator cuff tears was 86%, the specificity 91%, the positive predictive value 96% and the negative predictive value 73%. In spite of the relatively small size of this series, our results are comparable with those of most other studies. Based on these results, sonography can provide a non-invasive, rapid and inexpensive diagnostic method for screening patients with shoulder complaints. A disadvantage of the method is its long learning curve.

[Comment on the publication "Sonographic follow-up of hip dysplasia with expanding trouser therapy"]. / Stellungnahme zu der Publikation "Sonographische Verlaufskontrollen der Hüftdysplasie unter Spreizhosentherapie".

It should be pointed out that hipsonography by application of a flexible control procedure is not only suitable for introduction of therapy for CHD at an early stage, but also for avoiding superfluous treatment. Secondly, the authors are of the opinion that universal screening for CHD by means of hipsonography is for financial considerations not justifiable.

Clinical diagnosis, arthrography, stress examination and surgical findings after inversion trauma of the ankle.

In a series of 921 patients with acute inversion trauma of the ankle joint, the diagnostic features of lateral ligamentous ruptures were evaluated. Patients with proven lateral ligamentous rupture (150 patients in this series) were submitted to a prospective trial to compare three methods of treatment. In the 50 patients operated upon, the results of clinical diagnosis, stress radiography, and ankle arthrography were compared with surgical findings. Clinical diagnosis proved to be of very little value. The positive signs of ankle arthrography showed a reliability of 96% in predicting ligamentous rupture. Inversion stress radiography under full anesthesia showed a reliability of 92%, but the same investigation under local anesthesia, however, was only 68%.

Arthrography, talar tilt and surgical findings after inversion trauma of the ankle.

Both inversion stress examination under general anesthesia and arthrography are sensitive indicators of lateral ankle ligament pathology (91%, 96% resp.). Arthrography is significantly superior to inversion stress examination done under local anesthesia (96%, 70% resp.). Peroneus tendon sheath filling is always pathological, but although this does not always indicate calcaneo-fibular ligament rupture, such rupture cannot be excluded in its absence. Talar tilt difference cannot be correlated with the extent of ligamentous rupture and therefore inversion stress examination, while providing valuable additional information, must be regarded as a secondary technique to ankle arthrography.

Arthrographic differential diagnosis between ruptures of the anterior talofibular ligament, the joint capsule and the anterior tibiofibular ligament.

From literature study, surgical findings and cadaver experiments, it is unlikely that, in an inversion type ankle sprain, rupture of the anterior tibiofibular ligament frequently accompanies rupture of the capsule and the lateral ligaments. Contrary to the experience of other authors, we found the presence or absence of a) a contrast-free zone, b) the tibiofibular recess, or c) both together, on ankle arthrography in no way indicative of a rupture of the anterior tibiofibular ligament. Contrast leakage out of the joint into the soft tissues without leakage below and lateral to the lateral malleolus indicates rupture of the joint capsule. Leakage below and lateral to the lateral malleolus indicates rupture of the anterior talofibular ligament. The anatomic relationships between the syndesmosis, the joint capsule, the tibiofibular recess and the anterior talofibular recess and the anterior talofibular ligament were studied on cadavers and during surgery. Contrast spread in the soft tissues is probably determined by the arrangement of and damage to the soft tissues and by the size of the haematoma and follows the path of least resistance.

The significance of the peroneus tendon sheath in ankle arthrography.

Bilateral distension arthrography was performed in 40 non traumatized cadavers and the ratio of peroneus tendon sheath filling, and filling of the subtalar joints and medial tendon sheaths were compared with data from groups of normal and pathological arthrograms in patients who had sustained inversion trauma. The investigation confirms that filling of the peroneus tendon sheath is always of pathological significance, and is independent of age. The different mechanisms which may produce filling of the peroneus tendon sheath are discussed. Filling of the medial tendon sheaths and subtalar joints are normal arthrographic findings, not related to trauma or age.

Filling of lymphatic vessels in ankle arthrography.

3 patients are described in whom lymphatic filling occurred in ankle arthrography. There were no clinical and arthrographic features of rheumatoid arthritis. It is therefore concluded that these occurrences are due to a pressure phenomenon.

Adhesive capsulitis of the ankle (frozen ankle).

Adhesive capsulitis or "frozen ankle" is a syndrome resulting from repeated ankle sprains, or perhaps following immobilization after trauma. Ankle arthrography is a useful and safe diagnostic procedure in this syndrome. Typical arthrographic features are described together with case histories of two patients with frozen ankle. We suggest that early mobilization of the patient following trauma is particularly important in preventing the development of a forzen ankle syndrome.