Search

Objective: To evaluate femoral cartilage thickness in patients with Behçet's disease (BD) by using ultrasonography., Methods: Thirty-one patients with BD (18 M, 13 F; mean age: 32.87 ± 8.5 years) and 31 age-, gender- and body mass index-matched healthy subjects were enrolled. Demographic features and medications of the patients were recorded. The femoral cartilage thicknesses of both knees were measured with a 7-12 MHz linear probe while subjects' knees were held in maximum flexion. Three mid-point measurements were taken from both knees: lateral femoral condyle (LFC), intercondylar area (ICA) and medial femoral condyle (MFC)., Results: Cartilage measurements of BD patients were significantly thinner at the ICA (p = 0.009) and LFC (p = 0.007) on the left knee, and at the MFC on both sides (both p < 0.05). Left knee cartilage thickness value at MFC (p = 0.005) was decreased in BD patients with arthritis compared to the healthy control group., Conclusion: These preliminary findings of decreased femoral cartilage thickness in BD patients with arthritis should be complemented with future studies. However, the possibility of early knee joint degeneration and eventual osteoarthritis in BD should also be kept in mind.

Objective: To evaluate femoral cartilage thickness in patients with ankylosing spondylitis (AS) by using ultrasonography., Methods: Eighty-four patients (55 M, 29 F) with a diagnosis of AS and 84 age-, gender- and body mass index-matched healthy subjects were enrolled. Demographic and clinical characteristics of the patients including disease duration, morning stiffness and medications were recorded. The femoral cartilage thicknesses of both knees were measured with a 7-12 MHz linear probe while subjects' knees were held in maximum flexion. Three mid-point measurements were taken from both knees (lateral femoral condyle (LFC), intercondylar area (ICA) and medial femoral condyle (MFC))., Results: Concerning both ICA (p < 0.001) and left MFC (p = 0.013), cartilage measurements were significantly thicker in AS patients than control subjects. In a subgroup analysis (anti-tumour necrosis factor (TNF) users vs anti-TNF naive), cartilage thickness measurements - bilateral ICA (p = 0.000) and left MFC (p = 0.017) - were found to be greater in AS patients under anti-TNF treatment (n = 65) when compared with those of healthy controls., Conclusion: We imply that AS patients seem to have thicker femoral cartilage, which could be related to anti-TNF treatment.

Background: The relationship between osteoporosis (OP) and osteoarthritis (OA) is yet unclear., Aim: To evaluate the possible effect of OP on the femoral cartilage thickness in female patients with knee OA., Materials and Methods: Eighty patients with a diagnosis of knee OA were enrolled. Forty subjects who also had OP comprised Group I and the remaining 40 OA subjects comprised Group II. Antero-posterior knee radiographs were obtained in standing position and they were evaluated according to Kelgren-Lawrence (K-L) grading scale. Femoral cartilage evaluations were performed using a linear array US probe (7-12 MHz). In addition, ultrasonographic femoral cartilage grading was also performed for each knee., Results: Left knee scores pertaining to both gradings were found to be lower (p = 0.02, p = 0.04, respectively) in Group I when compared with those of Group II. The two grading scores were positively correlated for both knees-statistically significant only for the right side (r = 0.727, p = 0.01). No significant difference was found between the groups in terms of femoral cartilage thicknesses (all p > 0.05)., Discussion: Ultrasonographic and roentgenographic gradings were consistent and patients with OP had lower scores for both gradings. On the other hand, the presence of OP did not seem to have any effect on cartilage thickness measurements., Conclusions: To the best knowledge of the authors, this study is the first to have explored the impact of OP on OA using US in the literature.

Aim: To explore the relationship among clinical, radiological and ultrasonographical findings in knee osteoarthritis (OA)., Method: Sixty-one patients (122 knees) with knee OA were enrolled. Patients' knees were classified into two groups according to symptom severity. Group I consisted of 61 more symptomatic knees and Group II comprised 61 less symptomatic knees. Subjects were clinically assessed for pain and functional status by using a visual analog scale and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), respectively. Knee radiographs were evaluated by using the Kellgren-Lawrence (K-L) grading system. All knees were also evaluated ultrasonographically for meniscal bulging, distal femoral cartilage thickness, cartilage grading and also for the presence of effusion, Baker's cyst and so on., Results: Baker's cyst and joint effusion were observed more in Group I when compared with Group II. Positive correlations were found between meniscal bulging and all WOMAC scores (all P < 0.05). K-L grades of the patients were also positively correlated with WOMAC scores (all P < 0.05). Meniscal bulging measurements and K-L grades were positively correlated (P < 0.001). There was a negative correlation between cartilage grades and cartilage thickness measurements (all P < 0.001)., Conclusions: We found that joint space narrowing seemed to be associated with meniscal bulging. Moreover, increased meniscal bulging and presence of Baker's cyst/joint effusion were associated with worse pain or poorer function., (© 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.)

This paper reports on recent changes and future plans concerning the International Society of Physical and Rehabilitation Medicine. Issues discussed are its structural organization, collaboration and recognition, liaison with the World Health Organization , work in strengthening science, and its future agenda.

Background and Objectives: Measurement of the femoral cartilage thickness by using in-vivo musculoskeletal ultrasonography (MSUS) has been previously shown to be a valid and reliable method in previous studies; however, to our best notice, normative data has not been provided before in the healthy population.The aim of our study was to provide normative data regarding femoral cartilage thicknesses of healthy individuals with collaborative use of MSUS., Methods: This is across-sectional study run at Physical and Rehabilitation Medicine Departments of 18 Secondary and Tertiary Centers in Turkey. 1544 healthy volunteers (aged between 25-40 years) were recruited within the collaboration of TURK-MUSCULUS (Turkish Musculoskeletal Ultrasonography Study Group). Subjects who had a body mass index value of less than 30 and who did not have signs and symptoms of any degenerative/inflammatory arthritis or other rheumatic diseases, history of knee trauma and previous knee surgery were enrolled. Ultrasonographic measurements were performed axially from the suprapatellar window by using linear probes while subjects' knees were in maximum flexion. Three (mid-point) measurements were taken from both knees (lateral condyle, intercondylar area, medial condyle)., Results: A total of 2876 knees (of 817 M, 621 F subjects) were taken into analysis after exclusion of inappropriate images. Mean cartilage thicknesses were significantly lower in females than males (all p< 0.001). Thickness values negatively correlated with age; negatively (females) and positively (males) correlated with smoking. Men who regularly exercised had thicker cartilage than who did not exercise (all p < 0.05). Increased age (in both sexes) and absence of exercise (males) were found to be risk factors for decreased cartilage thicknesses., Conclusion: Further data pertaining to other countries would be interesting to uncover whether ethnic differences also affect cartilage thickness. Collaborative use of MSUS seems to be promising in this regard.

A 60-yr-old woman reported severe pain in the proximal part of her left forearm. The pain was also radiating toward the median nerve-innervated areas of the arm, especially during elbow flexion. Ultrasonographic imaging showed a well defined ganglion cyst around the distal biceps tendon close to the median nerve. Under ultrasound guidance, the cyst was aspirated and corticosteroid injection was performed. The patient's complaint improved 1 wk after the injection, and she started to flex her elbow without any pain. This case highlights the role of ultrasonography as a useful adjunctive tool not only to morphologically confirm a peripheral nerve entrapment but also to uncover the possible underlying etiology and to guide precisely during an intervention.

Background: Lower limb amputation sometimes predisposes to degenerative secondary disorders., Objectives: To evaluate the distal femoral cartilage thicknesses of patients with unilateral transtibial amputations using ultrasound and to investigate the relationship between cartilage thickness and disease-related parameters., Study Design: Cross-sectional study., Methods: Twenty-four unilateral transtibial amputees (mean age: 46.4 ± 8.5 years, range: 28-60 years) were evaluated. Duration of prosthesis use (years) and daily walking time with prosthesis (hours) were recorded. Functional status was assessed by gate velocity (m/s), and 6-min walking distance (m) with prosthesis. Ultrasound was used to measure distal femoral cartilage thicknesses bilaterally at medial/lateral condyles and the intercondylar areas. The percentages of cartilage loss (of the amputee-side in comparison with the nonamputee-side) were calculated., Results: Compared to the nonamputee-sides, distal femoral cartilage was significantly thinner at lateral condyles and the intercondylar areas on the amputee-sides (p < 0.05). Significant positive correlations were detected between the percentage of cartilage loss (at all three sites of measurement) and gate velocity, 6-min walking distance, and daily walking time with prosthesis (all p < 0.05)., Conclusions: Future prospective controlled studies are warranted to determine the principles of optimum prosthetic use regarding its possible effects on the femoral cartilage of amputee patients., Clinical Relevance: The correlations between the cartilage loss in the amputee extremity with faster gait and longer daily prosthetic use suggest that abnormal gait patterns might increase the loading on the amputated extremity.

Background: Musculoskeletal ultrasound is becoming an increasingly popular clinical tool in the hands of physiatrists. Herewith, although the role of direct supervision (by an expert) is universally recognized as the core element for appropriate ultrasound training, to our best notice, its impact on ultrasonographic measurements has not been studied quantitatively in the hitherto literature., Aim: To quantify the effect of supervision in the early period of musculoskeletal ultrasound training by using three different tissues (muscle-cartilage-tendon) as models., Design: A blinded randomized cross-over study., Setting: Physical Medicine and Rehabilitation Department of a University Hospital., Population: A total of 9 sonographers (8 novice and 1 expert) were involved whereby the novice sonographers were randomly divided into two groups; Group A (N.=4) and Group B (N.=4)., Methods: All sonographers performed three thickness measurements; medial head of the gastrocnemius muscle, patellar tendon and femoral cartilage on the left lower limb of the same subject. The expert supervised Group A in the first half of the study (9 days), and Group B in the second half (9 days). Throughout the study period, all the participants were blinded to the data. Relative effectiveness, expert effect, order effect, treatment-period effect were studied for cross-over variance analysis., Results: For all the three sites, measurements under the supervision of the expert were significantly different than those without him -p values pertaining to relative effectiveness, expert effect were 0.014, 0.013 for femoral cartilage; <0.001, <0.001 for gastrocnemius and <0.001, <0.001 for patellar tendon, respectively). For gastrocnemius muscle measurements, studying with the expert in the second half of the study (vs in the first half) was better concerning the precision of the measurements (order effect P<0.001)., Conclusion: Supervision during measurements of novice sonographers is crucial and their data should otherwise be interpreted attentively.

Study Design: Cross-sectional controlled study., Objectives: To evaluate the elbow joint with ultrasound in paraplegic patients, determine the related factors and compare it with healthy controls., Setting: A training and research rehabilitation hospital in Istanbul., Methods: A total of 30 paraplegic patients and 20 healthy controls were included in the study. Patients demographic data, pain in the elbow joint, level and duration of injury, ambulation status, type of wheelchair used, daily duration of wheelchair and other ambulation equipment usage, transfers being dependent or independent, daily number of push-ups were recorded. Elbow joints were evaluated with ultrasound for presence of fluid and thickness of the triceps tendon., Results: Mean triceps tendon thickness values of the right side were larger in spinal cord injury (SCI) patients when compared with those of healthy controls'. Joint effusion on the right elbow joint was also found to be more common in SCI patients than in normal subjects. Triceps tendon thickness measurements were not found to be correlated with demographic and clinical factors. Seven paraplegic patients (23%) reported that they have pain in the elbow., Conclusion: In this preliminary study, our results showed that right elbow effusion was more frequent and right triceps tendon was thicker in SCI patients when compared with healthy subjects.

Case reports (CR) have led to the description and discovery of new diseases, syndromes, therapeutic complications or side-effects, and previously unknown potential benefits of pharmacologic agents. CRs may also be used as an effective training strategy for novice authors to develop the skills needed for medical writing. Yet, too often, CRs do not follow standards for excellence in scientific writing. Therefore, in this article, the American Journal of Physical Medicine and Rehabilitation (AJPMR) and the European Journal of Physical and Rehabilitation Medicine (EJPRM) collaborate with the purpose of providing guidance to authors in selecting CRs that might be appropriate for publication. In addition, we discuss different aspects of the preparation of a well-written CR in accordance with the mission and editorial views of both journals.

Systemic lupus erythematosus (SLE) is a multisystem chronic inflammatory disease with a broad spectrum of clinical and serological manifestations. Although articular involvement is known in SLE, articular cartilage has not been studied before. Therefore, in this study, we have evaluated the femoral cartilage by using ultrasonography. Twenty-nine SLE patients (5 M, 24 F) with a mean age of 37.93 ± 10.66 years and mean disease duration of 3.69 ± 3.24 years and 29 age-, gender- and body mass index-matched healthy subjects were enrolled. Demographic and clinical characteristics of the patients were recorded. The thickness of the femoral articular cartilage was measured by using a 7- to 12-MHz linear probe. Three mid-point measurements were taken from each knee; from right lateral condyle, right intercondylar area (RIA), right medial condyle (RMC), left medial condyle, left intercondylar area (LIA) and left lateral condyle (LLC). Although SLE patients had thicker femoral cartilage values than those of the control group at all measurement sites, the differences were not statistically significant (all p > 0.05). Twenty-two patients (75.9 %) were using corticosteroids, and when those patients were compared with their healthy controls, the difference reached statistical significance at RIA (p = 0.022), LIA (p = 0.059) and LLC (p = 0.029). We found that SLE patients seem to have thicker femoral cartilage values and that this increase could be related with corticosteroid treatment. In addition to studies that have shown the favorable effects of corticosteroids on chondrogenesis, further studies are needed to clarify the scenario in SLE patients.

Objective: To assess femoral cartilage thickness in patients with spinal cord injury (SCI)., Subjects: Forty-six patients with SCI (35 men, 11 women; mean age: 33.6 years (standard deviation 8.1) and 46 age-, sex- and body mass index (BMI)-matched healthy subjects were enrolled., Methods: Patients were evaluated with the American Spinal Injury Association (ASIA) Impairment Scale, Modified Ashworth Scale, Walking Index for Spinal Cord Injury, and Functional Independence Measurement. Mid-point ultrasonographic femoral cartilage thickness measurements were taken from the right lateral condyle, right intercondylar area, right medial condyle, left medial condyle, left intercondylar area and left lateral condyle., Results: Ultrasonographic measurements revealed significantly thicker values in the intercondylar areas (bilaterally) and the medial condyle (left knee) of patients with SCI compared with those of controls. When the subgroups were compared with their paired healthy controls, measurements pertaining to the motor complete group were found to be significantly thicker in the intercondylar areas (bilaterally) and the medial condyle (left knee). Cartilage thickness values correlated negatively with the duration of immobilization (for bilateral intercondylar areas), and with BMI and ASIA level (for bilateral lateral condyles)., Conclusion: Femoral cartilage thicknesses were found to change after SCI, and to have a negative correlation with disease duration and severity. Future studies including histological evaluations may elucidate whether such changes are favourable for the knee joints of patients with spinal cord injury.

More and more physiatrists are interested in learning how to use musculoskeletal ultrasonography in their clinical practice. The possibility of high resolution, dynamic, comparative and repeatable imaging makes it an important diagnostic tool for soft tissue pathology. There is also growing interest to use sonography for guiding interventions such as aspirations and infiltrations. In daily practice these are often done blindly or palpation-guided. To improve the accuracy of interventions, fluoroscopy or computed tomography were traditionally used for guidance. Since sonography is non-ionizing, readily available and relatively low cost, it has become the first choice to guide many musculoskeletal interventions. Ultrasound allows real-time imaging of target and needle as well as surrounding vulnerable structures such as vessels and nerves. Many different techniques are proposed in the literature. Interventions under ultrasound guidance have been proven to be more accurate than unguided ones. Further studies are required to prove better clinical results and fewer complications. Infection is the most dreaded complication. This review wants to highlight technical aspects of ultrasound guidance of interventions and give a survey of different interventions that have been introduced, with emphasis on applications in Physical Medicine and Rehabilitation. Results and complications are discussed. Finally training requirements and modalities are presented.

Although the combination of a detailed physical examination and a subsequent electrodiagnostic study is used for the diagnosis of peripheral nerve disorders, prompt imaging may also be necessary in daily practice. In this regard, as having higher spatial resolution, and being a faster, more cost-effective and dynamic study; ultrasound (US) has become a very convenient first-line imaging modality for the diagnosis, follow-up and treatment (i.e. guiding interventions or planning for surgery) of peripheral nerve pathologies. Yet, using the probe of US to "sono-auscultate" the peripheral nerves is indisputably paramount for unmasking the whole scenario of injury. Likewise, in this review, we will try to exemplify the role of US for the diagnosis and follow-up of peripheral nerve disorders in clinical practice.

Each day, the role of musculoskeletal ultrasound (US) in the management of sports injuries is being consolidated. Yet, there is no doubt that the probe of US is (should be) the stethoscope of musculoskeletal physicians dealing with sports medicine. Not only for the diagnosis, but also for the close follow-up of the athletes and during likely onward interventions for their treatment, would US be of paramount importance. Accordingly, in this review paper on common sports injuries, we tried to shed light into the actual role of US in the clinical practice of sports medicine.

Background: Research and publications are increasing in Physical and Rehabilitation Medicine (PRM). Hence, there appears to be a multifaceted and challenging turnover in our scientific niche involving authors, editors, publishers and readers in a complex interplay., Aim: To explore the manuscript submission process from the side of the authors, and to better understand their perceptions and preferences., Design: A survey study., Setting: E-mail and personal contact., Population: European researchers working in the field of PRM., Methods: A questionnaire was specifically prepared for this study. The first part included questions regarding personal and scientific background; in the second part the attendants rated 20 items (with respect to several journal characteristics) on a 4-point semantic differential scale; and the third part contained two open ended questions regarding additional factors that the authors considered during submission., Results: Area of interest (mission and contents) of the journal within the "Rehabilitation" category, absolute impact factor of the journal, match between perceived "quality" of their study and journal impact factor were considered to be the three most important factors by the authors., Conclusion: In a scientific environment where the numbers of research and publication outlets alike are growing, it is important to understand how authors choose where to publish their papers., Clinical Rehabilitation Impact: We believe that editors, and publishers as well, would take into account our findings to best meet the needs of all actors in the competitive marketplace of scholarly publishing in PRM.

Reported here is a 35-year-old man with findings of thoracic outlet syndrome and bilateral segmental vitiligo on C8-T1 dermatomes. The possible causal relationship between the two disorders under the common denominator of cervical sympathetic involvement is discussed for the first time in the literature.

Objectives: To evaluate the sciatic nerves of patients with unilateral sciatica by using an ultrasound, and to determine whether ultrasonographic findings were related to clinical and electrophysiologic parameters., Design: Cross-sectional study., Setting: Physical medicine and rehabilitation departments of a university hospital and a rehabilitation hospital., Participants: Consecutive patients (N=30; 10 men, 20 women) with complaints of low back pain and unilateral sciatica of more than 1 month of duration were enrolled., Interventions: Not applicable., Main Outcome Measures: All patients underwent a substantial clinical assessment, and they were also evaluated by electromyogram and magnetic resonance imaging. Pain was evaluated by a visual analog scale and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Scale. A linear array probe (7.5-12MHz) was used to scan sciatic nerves bilaterally in the prone position. Sciatic nerve diameters-thickness (short axis) and width (long axis)-and cross-sectional areas were measured bilaterally at the same levels, proximal to the bifurcation and midthigh. The values pertaining to the unaffected limbs were taken as controls., Results: When compared with the unaffected sides, mean values for sciatic nerve measurements-long axis at bifurcation level (P=.017) and cross-sectional area at midthigh level (P=.005)-were significantly larger on the affected sides. Swelling ratios negatively correlated with symptom duration (r=-.394, P=.038) and LANSS scores (r=-.451, P=.016) at only midthigh level., Conclusions: Sciatic nerves seem to be enlarged on the side of sciatica in patients with low back pain. Our preliminary results may provide insight into better understanding the lower limb radiating pain in this group of patients., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Reported here is a 19-year-old female patient with familial Mediterranean fever who was seen for altered mental status and seizures. She was eventually diagnosed to have posterior reversible leukoencephalopathy syndrome. Although a variety of conditions have been reported in association with this syndrome, to our best notice, this is the second case in whom familial Mediterranean fever and posterior reversible leukoencephalopathy coexists.

The aim of this study was to compare--clinically and ultrasonographically--the therapeutic effects of physical therapy modalities (hot pack, ultrasound therapy, and friction massage), local corticosteroid injection, and extracorporeal shock wave treatment (ESWT) in lateral epicondylitis (LE). Fifty-nine elbows of 59 patients with LE were randomized into three treatment groups receiving either physical therapy, a single corticosteroid injection, or ESWT. Visual analogue scale (VAS) was used to assess pain intensity, Jamar hydraulic dynamometer for grip strength, finger dynamometer for pinch strength (before treatment, on the first, third, and sixth months of treatment). All subjects were also evaluated with ultrasonography before and 6 months after treatment. In all groups, VAS scores of the patients were found to decrease significantly on the first, third, and sixth months of treatment. With respect to grip strength evaluations, the increase after treatment was significant only on the first month in group II; on the first and third months in group I; and on the first, third, and sixth months of treatment in group III. Pinch strength and ultrasonographical findings did not change during follow-up in any group. We imply that physical therapy modalities, corticosteroid injection, and ESWT have favorable effects on pain and grip strength in the early period of LE treatment. The increase in grip strength lasts longer with ESWT. On the other hand, ultrasonographic findings do not change in the first six months of these treatment methods.

Objective: To compare the femoral cartilage thickness values of polycystic ovary syndrome (PCOS) patients with those of age-matched, healthy women and to find out whether cartilage thickness changes with the clinical parameters., Design: A cross-sectional controlled study., Setting: A secondary care center and a tertiary care center., Patient(s): Thirty-three women with PCOS (mean age: 23.7 ± 3.5 years; 66 knees) and 30 healthy control women matched for age and body mass index (mean age: 24.8 ± 4.2 years; 60 knees)., Intervention(s): Measurement of knee cartage thickness of infertile PCOS patients., Main Outcome Measure(s): The thickness of femoral articular cartilage measured with an ultrasound with a linear probe (7-12 MHz) as well as three midpoint measurements taken from each knee: the lateral condyle, intercondylar area, and medial condyle., Result(s): The demographic and clinical features of the PCOS patients, the laboratory evaluations, and the endometrial thickness values were recorded, and the three midpoint measurements were taken from each knee. The PCOS patients had thicker cartilage values than the control group at all measurement sites. There was no correlation between the clinical parameters and the cartilage thickness values of PCOS patients., Conclusion(s): Our findings support the possible favorable effects of estrogen and androgens in PCOS patients. However, our data cannot determine whether PCOS patients have less risk of developing osteoarthritis later in life because they also have higher BMI values. The possible long-term changes in cartilage thickness in PCOS patients require further study., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Interest in the use of musculoskeletal ultrasonography in the field of Physical Medicine and Rehabilitation has increased significantly over recent years. In order to determine to what extent this growing interest among Physical and Rehabilitation Medicine physicians is resulting in publications, we reviewed the trend in publications by physiatrists on musculoskeletal ultrasonography., Methods: We searched retrospectively for all papers indexed in Science Citation Index-Expanded and Index Medicus in which "rehabilitation medicine" was addressed as at least one of the authors' affiliations (up to 2011). All papers were examined individually for the authors' affiliations, document types, publication years, countries, and journal categories., Results: A total of 171 papers was included in the study. After 2004, there appears to be a significant amount of increase in the number of publications. USA, Turkey, Taiwan and South Korea were the leading countries in which physiatrists carry out research and publish papers on musculoskeletal ultrasonography. The top 5 journal categories in which these papers were published were: Rehabilitation (44.3%), Orthopaedics (14.1%), Radiology (10.7%), Neurology (8.1%) and Rheumatology (6.7%)., Conclusion: The number of scientific publications by physiatrists about musculoskeletal ultrasonography is increasing in parallel with the interest regarding its routine use in Physical Medicine and Rehabilitation clinics.

Complete absence or variations of extensor pollicis brevis and abductor pollicis longus; absence of the extrinsic extensors, abductor pollicis longus, thenar muscles along with congenital hypoplasia of the thumb; absence of flexor pollicis brevis and abductor pollicis brevis; and bilateral absence of extensor pollicis have been reported previously. Those cases mainly comprised absence/variations of the first extensor compartment either with or without thumb anomalies. This article presents a case of a patient in which the constituents of the first and third compartments (extensor pollicis brevis, abductor pollicis longus and extensor pollicis longus) were absent unilaterally. Herewith, we also highlight the role of static/dynamic sonography for prompt imaging in this regard.A 24-year-old man presented with difficulty using the left thumb. He reported no trauma and had not used the affected thumb since childhood. On physical examination, the left thumb was observed to be in flexion and opposition. He was unable to perform active extension and abduction but passive motion was free. Neurological examination of the left upper extremity was unremarkable. No organ anomaly was present on systemic examination. Radiographs of the left hand revealed no joint problems or hypoplasia. Ultrasonographic evaluation was consistent with absence of the first and third extensor compartment tendons. Tendon transfer was recommended but the patient refused surgery., (Copyright 2010, SLACK Incorporated.)

A 20-year-old man with the complaints of malaise, fever, and tooth gum bleeding presented at a hospital. He was found to have generalized lymphadenopathy, thrombocytopenia, and leukocytosis. Ensuing bone marrow biopsy led to a diagnosis of acute lymphoblastic leukemia (ALL). He also had a sense of "facial stretching" and difficulty during eating. After clinical examination, he was diagnosed with right-sided peripheral type facial nerve paralysis (Bell's palsy). The magnetic resonance imaging studies demonstrated bilateral facial nerve involvement, predominantly on the right side. The patient received steroid treatment and local facial radiotherapy for Bell's palsy. A concurrent facial exercise program was ordered. Seemingly a less significant diagnosis in a leukemia patient, we considered our case notable since an ALL patient presenting with Bell's palsy, especially at the very beginning of the disease, is not that common. The cases of relapsing ALL reported in the literature initially presenting with the same scenario further strengthen the significance.