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Introduction: wrist ligament injuries and triangular fibrocartilage complex (TFCC) lesions are common but often underdiagnosed conditions causing chronic wrist pain. The diagnostic challenge necessitates a combination of clinical examination, imaging studies, and arthroscopy, considered the gold standard. Ligament injuries, particularly scapholunate ligament (SL), and TFCC lesions account for significant wrist instability and ulnar-sided wrist pain, respectively. Material and methods: this retrospective observational study, conducted at Hospital Ángeles Pedregal, Mexico City, aimed to assess the diagnostic accuracy of wrist magnetic resonance imaging (MRI) compared to arthroscopic findings. The sample included patients with clinical suspicion of wrist ligament or TFCC lesions who underwent both wrist MRI and arthroscopy. Clinical examination maneuvers were also evaluated. The study assessed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each diagnostic modality. Results: arthroscopic evaluation, considered the gold standard, revealed a high prevalence of TFCC and scapholunate ligament lesions (96.6% and 96.6%, respectively). Sensitivity for TFCC lesions on MRI was 71.4%, with 100% specificity. For ligament injuries (SL, lunotriquetral, and radioscapholunate), sensitivities ranged from 21.4% to 60.7%, with 100% specificity. Clinical examination showed higher sensitivity (29.2% to 89.3%) but lower specificity (0% to 100%) compared to MRI. Conclusion: wrist MRI remains the non-invasive imaging choice, although discrepancies exist between MRI and arthroscopic findings, emphasizing the need for careful interpretation. Clinical examination enhances sensitivity but lacks specificity. The study highlights the ongoing challenge in achieving optimal diagnostic accuracy for wrist ligament and TFCC lesions, emphasizing the importance of a multimodal diagnostic approach. [ABSTRACT FROM AUTHOR]

Introduction: lumbar foraminal stenosis refers to the constriction of the lateral canal through which the nerve root exits the spinal canal in the lumbar spine. It occurs in 8-11% of patients aged over 40 years. Failure to detect and alleviate foraminal constriction can contribute to up to 60% of instances of unsuccessful lumbar surgery. This study aimed to develop an index to assess the extent of foraminal narrowing, thereby aiding decisions regarding direct or indirect foraminal decompression. Material and methods: a cross-sectional study was conducted, involving 49 patients, wherein measurements of all five lumbar foramina were taken using X-rays and simple magnetic resonance imaging. These measurements primarily focused on the foraminal width and the lower endplate, which were then correlated to establish a foraminal width/lower endplate index. Results: the foraminal width/lower endplate index < 10% yielded an odds ratio (OR) of 3.07 on lateral radiography, 3.59 on flexion radiography, and 4.01 on extension radiography. In MRI, an OR of 0.195 was found for the left foramina, while an OR of 3.07 was observed for the right foramina. Conclusion: this study paves the way for further exploration of preoperative and postoperative clinical outcomes across various surgical decompression methods guided by the FW/LE index. To enhance decision making, it is recommended to conduct research comparing pre- and postoperative clinical findings in individual patients, considering their FW/LE index measurements. [ABSTRACT FROM AUTHOR]

Introduction: arthroscopy is the gold standard for detecting rotator cuff tears, but its invasive nature limits widespread use. Magnetic resonance imaging (MRI) serves as a precise alternative. The correlation and diagnostic agreement between MRI and arthroscopy are unclear in the Mexican population. Material and methods: adults with rotator cuff syndrome who underwent shoulder arthroscopy and MRI were included. Findings were classified as total tear (100%), partial tear grade I (< 50%), partial tear grade II (≥ 50%), or no tear. Concordance and correlation between MRI and arthroscopy were evaluated. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI for diagnosing rotator cuff tears were calculated. Results: we included 147 patients with rotator cuff syndrome. MRI identified tears in 83%, of which 91.8% were confirmed by arthroscopy. Diagnostic agreement between arthroscopy and MRI was moderate (kappa = 0.452, p = 0.0001). Similarly, arthroscopy and MRI showed moderate agreement in classifying partial tears grade I, partial tears grade II, and complete tears (kappa = 0.412, p = 0.0001). Significant correlations were found in detecting partial tears grade I, partial tears grade II, and complete tears (rho = 0.77, p = 0.0001) between MRI and arthroscopy. Conclusions: magnetic Resonance Imaging (MRI) and arthroscopy demonstrated moderate diagnostic agreement (kappa = 0.452, p = 0.0001) along with a strong positive correlation (rho = 0.77, p = 0.0001) for detecting rotator cuff tears, regardless of severity. [ABSTRACT FROM AUTHOR]

The iliotibial band originates from the iliac crest and the hip joint capsule, extending along the entire lateral surface until it inserts onto tuberculum anterolateralis tibiae on the anterolateral tibia. It acts as an agonist of the anterior cruciate ligament. In short, the iliotibial band primarily contributes to the lateral stabilization of the knee joint. One of the main causes of iliotibial band tear is sports-related injuries. Isolated iliotibial band tear is rare due to the specific requirement of pure varus stress for its occurrence, involving a combination of knee joint flexion with internal rotation. Diagnosing this condition is challenging due to its rarity and difficult clinical suspicion. We present a case of 51-year-old male patient, amateur football player, with proximal iliotibial band tear. The clinical presentation, radiographic and Magnetic Resonance Imaging (MRI) findings, treatment and return to play are discussed. [ABSTRACT FROM AUTHOR]

Purpose of the study: determine the sensitivity and specificity of magnetic resonance imaging in anterior cruciate ligament injuries and associated injuries through arthroscopic findings. Material and methods: this is a retrospective, longitudinal, cross-sectional study in 96 patients with ACL injuries were included and who underwent arthroscopic surgery; arthroscopic findings were compared with diagnostic magnetic resonance images as well as associated lesions. Results: for ACL lesions the following data were found in relation to the agreement by MRI and arthroscopic findings; 93.68% sensitivity, 100% specificity. Negative predictor value of 14.28% and a positive predictor value of 100%. Conclusion: MRI is an accurate and non-invasive imaging modality for the evaluation of knee injuries, the diagnostic association is considerably high. [ABSTRACT FROM AUTHOR]

Introduction: In rotator cuff rupture, the supraspinatus tendon ranks first in frequency. MRI is the study of choice for preoperative diagnosis and planning. The objective of this study was to assess the concordance between findings observed with MRI and transoperative in patients with supraspinatus tendon rupture. Material and methods: A retrospective analysis was conducted from January 2014 to January 2020. Including patients over the age of 18, with MRI and supraspinatus tendon rupture report. A χ2 analysis was performed for sensitivity, specificity, predictive values and diagnostic certainty using surgical findings as a reference. The kappa index was used to show the concordance between MRI and transoperative findings. Results: A total of 79 patients were included in the study, 45 male and 34 female. The average age was 52.14 years. MRI correctly diagnosed 60.76% of supraspinatus ruptures, showing 74% sensitivity and 96% specificity for complete ruptures. For partial ruptures I show a sensitivity of 96%, a specificity of 33%. The kappa index showed a match of 0.90 for total ruptures and 0.53 for partial. Conclusions: MRI demonstrated good sensitivity and specificity for diagnosing complete ruptures, with good match to surgical findings. MRI proved to be a nonspecific study for the identification of partial ruptures, which causes these lesions to be overdiagnosed. [ABSTRACT FROM AUTHOR]

SCIWORA (Spinal Cord Injury without Radiologic Abnormality) is a rare condition that mainly affects pediatric patients; We present the case of a teenage male patient diagnosed with SCIWORA/Brown Séquard Syndrome. In admission, he has multiple bruises on his neck and right hemibody and immediately he refers paraesthesia in all four limbs and spastic hemiparesis with right predominance, as well as inability to stand up and urinary continence. Treatment based on NASCIS III study is initiated and after the imaging tests, a diagnosis has already been made. We present the most current definitions of SCIWORA and the recommendations to make its diagnosis, as well as its relationship and coexistence with spinal syndromes. [ABSTRACT FROM AUTHOR]

Introduction: Despite the MRI findings present an adequate sensitivity and specificity for the diagnosis of adhesive capsulitis, there is a poor correlation between the imaging results in imaging centers and the diagnosis of a shoulder surgeon and the surgical findings. Objective: To evaluate the correlation of the diagnosis of adhesive capsulitis by MRI between imaging centers and the shoulder and elbow surgery service, with subsequent surgical verification. Material and methods: Retrospective, observational and comparative study in 41 patients with adhesive capsulitis diagnosis, the concordance among the MRI reports of different radiology cabinets and the Joint reconstruction clinic was calculated, in 10 cases the diagnosis was corroborated by surgery. The κ index was determinated between both interpretations and the surgical findings. Results: The concordance among the reports analyzed by the shoulder surgeon of the Joint reconstruction clinic and the cabinets was low, with a κ index of 0.12, in all the surgical cases the presence of adhesive capsulitis was proved with a κ index of 0.10 with respect to the cabinets reports. Conclusion: The imaging findings described in the literature are reliable for the diagnosis of adhesive capsulitis. The low concordance with the imaging cabinets leads us to think that it is an underdiagnosed entity. [ABSTRACT FROM AUTHOR]

Introduction: Carpal tunnel syndrome is the most common compression neuropathy of the upper limb, and the release of the median nerve is the surgical treatment that is carried out. There are several surgical techniques used to treat this condition; However, this virtual cavity, which we call the carpal tunnel, undergoes several morphological and dimensional changes, prior to surgery and after surgery using the various techniques that the surgeon has a predilection for. Material and methods: Observational, prospective and longitudinal study conducted in the period from March to November 2009. We studied patients of both sex, with a diagnosis of carpal tunnel syndrome, who underwent MRI pre and post-surgery studies, to which measurements and analysis of it were made. Results: We evaluated 25 patients with an average of 40 years, 14 female patients and 11 male, finding a palmar displacement of the nerve after surgery with a diameter of 6.2 mm, maintaining changes from the oval to a circular shape. Discussion: There are morphological and dimensional changes, evaluated by magnetic resonance after the release, for which the favorable clinical response after surgery is related; however, we found a larger diameter of the nerve due to the fact that they underwent neurolysis. [ABSTRACT FROM AUTHOR]

The frequent causes of relapsing carpal tunnel syndrome were analyzed. Nine patients were followed-up from January 1st to December 31st, 2011. They underwent a physical exam and imaging tests. Pain was measured in all of them with the VAS, and the Brigham and Women's Hospital questionnaire was used to assess disability. Patients included seven females and two males; mean age was 52 years. Major causes for relapse included postoperative fi brosis with incomplete release in seven patients and incomplete release in two patients in whom minimally invasive approaches were used. Three of the nine patients had retractile scars. The main cause of relapse was postoperative fi brosis associated with the minimally invasive approach. [ABSTRACT FROM AUTHOR]

Background: Several papers have studied the degenerative changes of endplates, but there are no publications referring to the Mexican population. Objective: The purpose of the study is to report the incidence of Modic degenerative changes in the patients seen at the Spine Service, Monterrey Regional ISSSTE Hospital. Specific objectives are: to describe the type of Modic change and the most frequent location, to describe the degeneration patterns and to report the incidence of the various diagnoses made during 2009. Methods: Incidence study using the MRI records at the Radiology Department, Monterrey Regional ISSSTE Hospital, interpreted blindly and independently by two observers. Results: A total of 240 lumbar spine MRIs were reviewed, for a total of 1,200 intervertebral spaces. They were divided by age groups. Group I included 16 patients, Group II 32, Group III 80, and Group IV 112. No patients in Group I had Modic changes. Four patients (12.5%) in Group II had type II Modic changes with < 25% of endplate involvement. Eight patients in Group III had Modic changes with > 25% involvement of L4-L5 (10%); 32% of Group IV patients had changes, with L5-S1 as the most affected level. Most Modic changes (85%) were located in L4-L5 and L5-S1, with the latter as the most frequently affected level. Type I represented 5%, Type II 30%, and Type III 65%. The percentage of patients with Modic changes increased with age, which confirms that degenerative changes are age related. Morphologic disc changes are expressed as the percentage of affected patients in each group. Besides the severity of degeneration, the number of affected levels also increases with age. Thirty percent of patients ages 30-39 years have one or two degenerated levels, while 50% of those over age 50 have 3 or more degenerated levels. The most frequently degenerated level was L5-S1, followed by L4-L5 and L3-L4. The most frequent degeneration pattern was lower segment degeneration (L4-L5, L5-S1). A small proportion of patients over age 50 (4%) did not have disc degeneration, suggesting that age is not the only factor that determines their occurrence. Conclusions: The prevalence of Modic changes was 22% (52 patients). Eight patients had Type II Modic changes at two levels. The most affected levels were L4-L5 and L5-S1, in 85% of cases. Patients over 50 years of age were the most affected age group; frequency increased with age. The most frequent disc degeneration pattern was degeneration of the lower lumbar levels. Risk factors need to be further studied and the correlation with the degree of pain needs to be determined to obtain more information. [ABSTRACT FROM AUTHOR]

Knowledge of the anatomy of the elbow joint has become intricate due to the advent of magnetic resonance imaging (MRI) techniques, as they are superior to represent the different soft tissues. This advantage allows evaluating in detail the increasingly frequent pathologic processes that occur in high performance athletes. The ideal MRI technique includes having the patient in a comfortable position, using an appropriate surface antenna and the right sequences in the appropriate planes depending on the entity. Being familiar with the normal elbow anatomy is crucial to properly identify the pathology and avoid potential diagnostic errors. [ABSTRACT FROM AUTHOR]

Objective: To assess the relation between location and intensity of pain in the articular interline as reported by the patient and proven objectively with the physical exam, and the type and location of the meniscal lesion found in the knee imaging study and arthroscopy. Method: Prospective, observational, longitudinal study including 34 consecutive patients with a clinical and arthroscopic diagnosis of symptomatic meniscal tears. Pain location was reported, an MRI was taken and finally all patients were assessed with knee arthroscopy. Results: We found an excellent correlation between the clinical manifestation of pain and the arthroscopic findings (p < 0.001), as well as between the clinical findings and the MRI (p < 0.001). Conclusion: Correlating the clinical expression of meniscal pathology with the anatomical lesion could be useful at the time of deciding to perform surgery, as the clinical identification of certain types of meniscal tears could potentially determine what the best time to perform surgery is. Our study shows that there is no significant relation neither between the magnitude of pain and the laterality of the lesion, nor between the magnitude of pain and the type of lesion diagnosed arthroscopically. This shows that patients cannot be selected considering the anatomy of the lesion based only on the physical exam. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare the diagnostic performance of magnetic resonance imaging with arthroscopy for intra-articular knee conditions. Material and Method: Between January 2000 and February 2007, 93 patients with medial meniscal tear, lateral meniscal tear, anterior cruciate ligament rupture, and articular cartilage pathology were prospectively assessed. After the physical exam, magnetic resonance imaging studies and arthroscopic surgery of the knee were performed. The sensitivity, specificity, positive and negative predictive values and the diagnostic odds ratio were estimated to compare the magnetic resonance imaging diagnoses with the arthroscopic findings. Results: Fifty-two patients were males and 41 females; mean patient age was 42.6 years (16-68 years). The diagnostic odds ratio was significant for medial meniscal tear, anterior cruciate ligament rupture and the coexistence of both meniscal and ligament lesions. Conclusion: The strength of the diagnostic association confirms the usefulness of magnetic resonance imaging for medial meniscal tears, anterior cruciate ligament rupture and the coexistence of both lesions. We do not recommend ordering a routine preoperative magnetic resonance imaging study as a condition for performing knee arthroscopy. [ABSTRACT FROM AUTHOR]

Objective: To analyze the subjective and objective outcome of arthroscopic meniscal repair in patients with chronic meniscal lesions. Methods: A group of patients that underwent arthroscopic meniscal repair of chronic tears with a minimum follow-up of six months was retrospectively evaluated. Physical examination oriented at finding persistent meniscal lesions was performed. IKDC, Lysholm and Tegner scores were applied, and a control magnetic resonance imaging (MRI) was performed. Results: Twenty seven menisci in 25 patients were repaired. There were 21 male and 4 female patients with a mean age of 29.6 ± 8.2 years (20-45). Mean time from lesion to surgery was 25.24 ± 26 months (6-120). 27. There was significant improvement in all parameters evaluated in 21 patients. Four patients were found to have signs and symptoms of persistent meniscal tears. Abnormal increased signal intensity in the repaired menisci was observed by MRI in all patients, not correlating with clinical findings. Conclusions: Short term success rate of 85% was obtained with arthroscopic repair of chronic meniscal lesions in this study, which supports the fact that a long period of time before surgery does not necessarily lead to failure. It is valid to perform a meniscal repair in patients with chronic tears as long as the proper surgical technique and an adequate rehabilitation protocol are used. [ABSTRACT FROM AUTHOR]

Introduction. The idiopathic scoliosis is one of the most common deformities in the adolescent. The incidence has been reported from 0.4% to 13%. A severe, painful, fast evolution of a left thoracic curve and should alert about other intra or extraraquideal abnormalities. Material and methods. We studied 20 patients with left thoracic scoliosis with or without symptoms, all 20 patients underwent MRI of the entire spine to find intraspinal abnormality associated. Results. There were twenty patients, 10 male and 10 female, the average age was 13.4 years in male and 12.3 years in female; eight patients were symptomatic and three with neurologic findings on physical examination; the average Cobb angle of the left thoracic curve was 60°C. Thirteen patients (65%), demonstrated a syringomyelia and Chiari malformation on the magnetic resonance imaging (MRI). [ABSTRACT FROM AUTHOR]

This article describes the Magnetic Resonance Imaging criteria of unstable meniscal tears and also represents the most common pitfalls in meniscal tears, some of the most frequent are normal anatomic variants. A retrospective review of 497 standard consecutive MR images realized within a year, 348 men and 149 women. Arthroscopy was performed in 4.9 % of the patients. The criteria for unstable meniscal tears have been recently described, those are: a) displacement of a meniscal fragment, b) extensive meniscal tear (10 mm or more), c) meniscal tear with more than one orientation or pattern (irregular in contour, meniscal separation or a meniscal tear) and d) tear showing high signal on T2. Magnetic Resonance images showed the menisco-femoral ligaments in 33.2 % of the patients, frequency similar to the reported by other authors; the frequency of the oblique menisco-meniscal ligament was 0.8% (4 patients), less than the reported in the literature. Magnetic Resonance Imaging can show many of the essential characteristics of a meniscal tear, including type, location and extension. It is important to demonstrate MRI normal characteristics of the menisci as much as recognizing the most common normal variants. [ABSTRACT FROM AUTHOR]