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While ultrasound has become a preferred tool for musculoskeletal imaging, differing ultrasound findings that have been reported in patients with adhesive capsulitis can create confusion and misconceptions. This systematic review was aimed at summarizing all the ultrasound features currently described in the literature and providing a critical analysis of the sources to allow the readers to make a well-informed decision on the reliability of these features in the diagnosis of this condition. Databases were searched for original studies up to August 2021. Twenty-three studies were included. The QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool was used to assess the quality of each selected article. Fourteen ultrasound features were identified. A quality analysis of all ultrasound features was performed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. All studies exhibited considerable heterogeneity in investigated ultrasound features and methodologies employed; therefore, meta-analysis was not considered to be appropriate. Hence, narrative synthesis was performed. The overall quality of each ultrasound outcome was found to be of "low" to "very low" level, and the generalisability of the results was also thought to be limited. Cautious interpretation and clinical correlation are recommended while applying these ultrasound features in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Kwah LK, Herbert RD, Harvey LA, Diong J, Clarke JL, Martin JH, Clarke EC, Hoang PD, Bilston LE, Gandevia SC. Passive mechanical properties of gastrocnemius muscles of people with ankle contracture after stroke. Objective: To investigate the mechanisms of contracture after stroke by comparing passive mechanical properties of gastrocnemius muscle-tendon units, muscle fascicles, and tendons in people with ankle contracture after stroke with control participants. Design: Cross-sectional study. Setting: Laboratory in a research institution. Participants: A convenience sample of people with ankle contracture after stroke (n=20) and able-bodied control subjects (n=30). Interventions: Not applicable. Main Outcome Measures: Stiffness and lengths of gastrocnemius muscle-tendon units, lengths of muscle fascicles, and tendons at specific tensions. Results: At a tension of 100N, the gastrocnemius muscle-tendon unit was significantly shorter in participants with stroke (mean, 436mm) than in able-bodied control participants (mean, 444mm; difference, 8mm; 95% confidence interval [CI], 0.2–15mm; P=.04). Muscle fascicles were also shorter in the stroke group (mean, 44mm) than in the control group (mean, 50mm; difference, 6mm; 95% CI, 1–12mm; P=.03). There were no significant differences between groups in the mean stiffness or length of the muscle-tendon units and fascicles at low tension, or in the mean length of the tendons at any tension. Conclusions: People with ankle contracture after stroke have shorter gastrocnemius muscle-tendon units and muscle fascicles than control participants at high tension. This difference is not apparent at low tension. [Copyright &y& Elsevier]

Summary: Problem: Many midwives continue to use continuous foetal monitoring on low risk women in labour, despite evidence based clinical guidelines to the contrary. Continuous foetal monitoring has been linked to increased rates of medical intervention during labour and birth with no improvement in long term neonatal outcomes. Participants: Midwives who used continuous foetal monitoring on low risk women in labour at two regional Queensland hospitals. Methods: This Grounded Theory study explored midwives’ decision-making processes related to the use of continuous electronic foetal monitoring on low risk labouring women. Primary data were gathered in semi-structured interviews with five purposively selected midwives and concurrently analysed using Grounded Theory techniques of theoretical sampling and constant comparison. Findings: The midwives made the decision that led to continuous electronic foetal monitoring on low risk women at two key decision points during labour care; the first during the midwives’ initial assessment of the woman and foetus, and the second when the midwives categorised the women as high or low risk. However, various factors impacted on these decisions including trust and staff workloads within a context of risk management and medical dominance. There was limited opportunity for women to be involved in the decision-making process about foetal monitoring and only partial information was provided prior to cardiotocography. Conclusions: Consistent with current clinical guidelines which recommend open, consultative discussion with the woman about foetal monitoring and a partnership approach towards decision-making following informed choice, a woman-centred foetal monitoring decision-making pathway is proposed. This pathway is applicable in midwifery education, research and clinical practice to promote both evidence based practice and woman-centred decision-making. [Copyright &y& Elsevier]

The focus of most ultrasound programs is to produce clinically competent sonographers who attain the requisite psychomotor skills, recognition of sonographic anatomy and pathology, and clinical reasoning for accurate diagnosis. University education directed towards these ends however, can leave the 'learning to learn' skills, and longer-term learning, under-appreciated. Education should provide students with opportunities to 'sustain effective learning now and in the future'. One strategy used extensively in health and medical education to equip students with lifelong learning skills is Portfolio assessment. Portfolios have long been suggested as a logical bridge between university study and continuing professional education. Thirty-three sonography students at a metropolitan Australian university volunteered over three consecutive years, to participate in educational design research targeting a Portfolio tool. The tool was re-designed to foster longer-term learning by adding specific learning skills to existing professional competencies. Five interventions were included: independent learning, judgement, reflection, self-assessment and self-demonstration of competence. Data was gathered from focus groups, individual in-depth interviews and thematic analysis of participant portfolios. An iterative approach to participant feedback was employed, such that improvements were implemented as each data collection was analysed. Data was also gathered from four sonographers in repeat interviews after one year of qualified practice. The major themes identified from the learning skills added to the Portfolio were the benefits of continuous engagement, gains in confidence from demonstrating success, and the value of portfolios as an evidential base of achievement. The evidence base took various forms including interesting case collections or film libraries, used as both aide-memoires for ultrasound appearances of pathology and for teaching peers. Academics came to understand the criticality of portfolio induction, the necessity of scaffolding support for each of the learning skills, and strategies to make the assessment sustainable. Additionally, important workplace 'doings' were identified from the data, which adhered to the notion of a learning 'practice', suggesting valuable learning takes place in everyday working social interactions, which could receive greater recognition in student assessment tasks. This research clearly identified that Portfolio assessment which encouraged skills of longer term learning proved valuable to both students and faculty. The Portfolio increased participants' confidence, clinical judgement and independent learning, extending into qualified practice. Academics gained useful insights into scaffolding, Portfolio learning and practice theory. Importantly, this research showed that the design and development of portfolios benefit from iterative approaches using participant feedback for ongoing improvement. [ABSTRACT FROM AUTHOR]

While intra-operative duplex ultrasound scanning can be readily performed in renal transplantation, the value of this intervention in routine practice is not established. Three hundred thirty-one consecutive single renal transplants in adult recipients underwent intraoperative scanning at implantation. Early graft losses were compared with those recorded in the ANZDATA Registry. Nine overt vascular abnormalities were corrected prior to scanning. Four further suspected venous outflow restrictions were confirmed by ultrasound and revised. Another 11 major vascular revisions were performed following intraoperative ultrasound consisting of 7 otherwise unsuspected inflow abnormalities, all corrected, and 4 anastomoses redone to reposition the graft. Thirty-two (9.7%) grafts were repositioned under ultrasound guidance to improve cortical perfusion but without vascular revision. One graft with hyperacute rejection was explanted 4 days postimplantation and one graft with primary nonfunction remained well perfused. Two patients died within 90 days, both with functioning grafts. Twenty-three grafts were re-explored within 7 days, including 9 solely for graft hypoperfusion. There were no postoperative arterial thromboses and, at re-exploration, no arterial anastomoses required revision. There were no postoperative venous thromboses, although one venous anastomosis was revised. No grafts were lost within 90 days for surgical or technical reasons compared with 76 (1.0%) of 7603 contemporaneous grafts in the ANZDATA Registry (P =.077 Fisher's exact test, P =.069 χ2 test). The routine use of intraoperative ultrasound appears to be of benefit by identifying otherwise unrecognized vascular abnormalities, leading to a reduction in early graft losses because of surgical factors. [ABSTRACT FROM AUTHOR]

Both mechanical and structural properties of tendon change after injury however the causal relationship between these properties is presently unclear. This study aimed to determine the extent of biomechanical change in post-injury tendon pathology and whether the sulphated glycosaminoglycans (glycosaminoglycans) present are a causal factor in these changes. Equine superficial digital flexor tendons (SDF tendons) were surgically-injured in vivo ( n =6 injured, n =6 control). Six weeks later they were harvested and regionally dissected into twelve regions around the lesion (equal medial/lateral, proximal/distal). Glycosaminoglycans were removed by enzymatic (chondroitinase) treatment. Elastic modulus (modulus) and ultimate tensile strength (UTS) were measured under uniaxial tension to failure, and tendon glycosaminoglycan content was measured by spectrophotometry. Compared to healthy tendons, pathology induced by the injury decreased modulus (−38%; 95%CI −49% to −28%; P <0.001) and UTS (−38%; 95%CI −48% to −28%; P <0.001) and increased glycosaminoglycan content (+52%; 95%CI 39% – 64%; P <0.001) throughout the tendon. Chondroitinase-mediated glycosaminoglycan removal (50%; 95%CI 21–79%; P <0.001) in surgically-injured pathological tendons caused a significant increase in modulus (5.6 MPa/µg removed; 95%CI 0.31–11; P =0.038) and UTS (1.0 MPa per µg removed; 95%CI 0.043–2; P =0.041). These results demonstrate that the chondroitin/dermatan sulphate glycosaminoglycans that accumulate in pathological tendon post-injury are partly responsible for the altered biomechanical properties. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Anthracycline agents are undermined by their cardiotoxicity. As life expectancy following treatment is greatly improved, techniques that ensure early detection and timely management of cardiotoxicity are essential. The aim of the present study was to evaluate left ventricular (LV) systolic function with LV ejection fraction (LVEF) and two-dimensional myocardial strain up to 12months after anthracycline chemotherapy, specifically in HER2/neu negative breast cancer patients. Methods: Seventy-eight consecutive anthracycline naïve breast cancer patients were studied before and immediately after anthracycline chemotherapy. Fifty HER2/neu negative patients were studied over 12months with serial echocardiograms at four time points. All patients were treated with standard regimens containing anthracyclines. Results: Global systolic strain was significantly reduced immediately after, and 6months after anthracyclines (−19.0±2.3% to −17.5±2.3% (P <0.001) and −18.2±2.2% (P =0.01) respectively). A non-uniform reduction in strain was observed each time with relative sparing of the LV apex. LVEF remained largely unchanged at both time points. Global strain normalised by 12months in the majority of patients. Persistently reduced strain was observed in 16% (n =8); these patients had a greater reduction in strain at 6months (⩽−17.2%), and had received higher cumulative anthracycline doses. Conclusion: Myocardial strain imaging is more sensitive than LVEF for the early detection and intermediate term monitoring of LV systolic function following anthracycline chemotherapy in HER2/neu negative breast cancer patients, and may aid in the development of improved monitoring protocols. [Copyright &y& Elsevier]

Abstract: Background: People with spinal cord injury sometimes develop abnormally compliant hamstring muscle-tendon units. This study investigated whether the increased muscle-tendon compliance is due to a change in the passive properties of the muscle fascicles or tendons, or to muscle tears. Methods: Semimembranosus muscle fascicle lengths were measured from ultrasound images obtained from 15 spinal cord injured subjects and 20 control subjects while the hip was passively flexed with the knee extended. Semimembranosus muscles of spinal cord injured subjects were inspected for tears using ultrasound imaging. Findings: The mean (SD) hip angle at 30Nm was 97 (SD 24) degrees in spinal cord injured subjects and 70 (SD 11) degrees in control subjects, indicating that spinal cord injured subjects had very compliant hamstring muscle-tendon units. The ratio of change in fascicle length to change in muscle-tendon length was not statistically different between spinal cord injured subjects and control subjects: muscle fascicles lengthened by 0.30 (SD 0.24) mm/mm in spinal cord injured subjects and 0.42 (SD 0.29) mm/mm in control subjects. These data were used to show that there was evidence of increased tendon compliance of spinal cord injured subjects compared to control subjects, but no evidence of increased muscle fascicle compliance. No tears were observed in semimembranosus muscles of spinal cord injured subjects. Interpretation: The increased hamstring muscle-tendon compliance apparent in some spinal cord injured subjects is due, at least in part, to increased tendon compliance. There was no evidence that the increased muscle-tendon compliance was due to muscle tears. [Copyright &y& Elsevier]

Ankle contracture is common in people with multiple sclerosis (MS) but the mechanisms of contracture are not clear. This study aimed to identify the mechanisms of contracture in MS by comparing passive muscle length and stiffness at known tension, separated into contributions by muscle fascicles and tendons, between people with MS who had contracture and healthy people. Passive length-tension curves of the gastrocnemius muscle-tendon unit were derived from passive ankle torque and angle using a published biomechanical method. Ultrasound images of medial gastrocnemius muscle fascicles were used to partition length-tension curves into fascicle and tendon components. Lengths and stiffness of the muscle-tendon unit, muscle fascicles and tendons were compared between groups with linear regression. Data were obtained from 15 participants with MS who had contracture [age 53 (12) years, mean (SD)] and 25 healthy participants [48 (20) years]. Participants with MS had clinically significant ankle contracture, and had shorter fascicles at slack length (between-groups mean difference −0.8 cm, 95% CI −1.2 to −0.4 cm, p < 0.001) and at 100 N (−0.7 cm, 95% CI −1.3 to −0.1 cm, p = 0.02) compared to healthy participants. There were no differences between groups in all other outcomes. Tension-referenced comparisons of passive muscle length and stiffness show that people with MS who had contracture had shorter fascicles at low and high tension compared to healthy people, but there were no changes to the muscle-tendon unit or tendon. Further studies are needed to identify the causes and mechanisms of contracture in neurological conditions. • People with multiple sclerosis had clinically significant ankle contracture. • Passive gastrocnemius length and stiffness were compared between multiple sclerosis and healthy people. • Gastrocnemius muscle fascicles were shorter in people with multiple sclerosis compared to controls. [ABSTRACT FROM AUTHOR]