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Arthroscopy for acetabular labral tears has minimal impact on pain and function in older patients, especially in the setting of concomitant osteoarthritis. Still, many physicians seek this diagnosis with MR arthrography. Our purpose is to assess the frequency of acetabular labral tears in older patients with hip pain and correlate likelihood of labral pathology with severity of osteoarthritis as visualized on conventional radiograph. From 2004 to 2013, 208 hip MRI arthrograms and corresponding radiographs on patients aged 50 years and older were identified. Age, gender, grade and location of labral tear, alpha angle, Tonnis grade, and joint space width were documented. Labral tears and alpha angle were identified and measured on MR arthrogram. Tonnis grade and joint space width were measured on radiographs. On MR arthrography, true labral tearing was identified in 73 % of patients. There was some degree of labral pathology in 93.3 % of patients, and this increased to 100 % in patients with moderate to severe osteoarthritis, as defined by Tonnis grade 2–3 or joint space width ≤ 2 mm. There were no statistically significant correlations between labral tear grade and Tonnis grade or joint space width. Given the high frequency of labral pathology and the questionable efficacy of arthroscopic surgical intervention in older patients, MR arthrography should be primarily for those with minimal arthritis on radiograph and potential to benefit from surgery. If further imaging beyond radiographs is necessary in these patients, standard MRI may be a more appropriate imaging tool.

Ultrasound is a frontline tool for evaluating, diagnosing, and monitoring rheumatoid arthritis. This article looks at the typical manifestations of rheumatoid arthritis on ultrasound, and why ultrasound is a useful tool in evaluating patients with rheumatoid arthritis. The sonographic manifestations of rheumatoid arthritis are seen much earlier than those on radiographs. Recent scoring systems by the American College of Rheumatology and the European League Against Rheumatism have provided a standardized system of grading and diagnosing rheumatoid arthritis based on ultrasound findings. These scoring systems are useful in aiding treatment decisions to improve diagnosis in cases of clinical uncertainty. Rheumatoid arthritis is a debilitating disease, which should be diagnosed and treated early to prevent permanent disabling arthritis. Ultrasound is a useful and relatively inexpensive tool that aids in the diagnosis and evaluation of the disease. Ultrasound is very sensitive for detecting the early manifestations of synovitis and erosion, which will be occult on radiographs. It is important to recognize the imaging manifestations of the disease to diagnosis, grade, and guide treatment.

This article will demonstrate a variety of diagnostic entities and categories of muscle disease that can be assessed using ultrasound. Illustrative examples based on four general categories of muscle pathology (trauma, edema, fluid collections, and mass) will be presented with pertinent findings highlighted and discussed. Multiple distinct advantages of ultrasound compared to other imaging modalities will be emphasized through these examples. Normal appearance and architecture of muscle on ultrasound will be reviewed with discussion of the specific ultrasound techniques that yield images of greatest diagnostic utility.