Search

This case report describes the evaluation, surgical intervention, and postoperative outcome of a 36-year-old male patient with chronic left hip pain following a rectus femoris injury which persisted despite conservative management and intra-articular steroid injection. Imaging revealed prominent ossification extending from the anterior inferior iliac spine at the proximal rectus femoris insertional, a femoral cam lesion, and tearing of the superior through anterior labrum, compatible with both subspine and femoroacetabular impingement. Subsequent arthroscopic femoroplasty, acetabuloplasty, labral repair, and excision of rectus femoris ossification provided lasting symptomatic relief. Identification of lesions resulting in subspine impingement is essential in the preoperative work up of patients with hip pain to ensure appropriate surgical management and optimize postoperative outcomes., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Background: The impact of early glenohumeral osteoarthritis (GHOA) on clinical outcomes after rotator cuff repair (RCR) remains unclear. The magnetic resonance imaging (MRI)-based Shoulder Osteoarthritis Severity (SOAS) score is a comprehensive approach to quantifying glenohumeral degeneration., Purpose: To investigate the association between SOAS scores and changes in American Shoulder and Elbow Surgeons (ASES) scores in patients who underwent RCR., Study Design: Cohort study; Level of evidence, 3., Methods: Two reviewers independently analyzed the preoperative MRI scans of 116 shoulders and assigned SOAS scores. Spearman correlation was used to calculate the association of mean SOAS scores with patient demographic characteristics and change in ASES scores over the 2-year follow-up period (ΔASES). Multivariate regression analysis was performed between the independent variables of patient age, sex, body mass index, and significant SOAS score components as determined by univariate analysis, with the dependent variable being ΔASES. Significance was defined as P < .05 for univariate analysis and P < .0125 after application of the Bonferroni correction for multivariate analysis., Results: The mean ASES scores were 55.8 ± 18.6 preoperatively and 92.1 ± 12.1 at 2 years postoperatively. The mean preoperative SOAS score was 15.2 ± 7.1. On univariate analysis, the total SOAS score was positively correlated with patient age ( r S = 0.41; P < .001), whereas ΔASES was negatively correlated with patient age ( r S = -0.27; P = .0032). Increasing SOAS subscores for supraspinatus/infraspinatus tear size ( r S = -0.28; P = .024), tendon retraction ( r S = -0.23; P = .015), muscle atrophy ( r S = -0.20; P = .034), paralabral ganglia ( r S = -0.23; P = .015), and cartilage degeneration ( r S = -0.21; P = .024) were negatively correlated with ΔASES. A negative correlation was found between increasing total SOAS score and ΔASES ( r S = -0.22; P = .016). On multivariate analysis, increasing supraspinatus/infraspinatus tear size was significantly and negatively correlated with ΔASES (β = -3.3; P = .010)., Conclusion: Increasing the total SOAS score was predictive of less improvement in ASES scores at 2 years postoperatively. On univariate analysis, SOAS subscores with the strongest negative correlations with ΔASES scores included tear size, muscle atrophy, tendon retraction, paralabral ganglia, and cartilage wear. On multivariate analysis, only tear size was significantly associated with a lower change in the ASES score., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.R.D. has received education payments from Evolution Surgical. C.B.M. has received research support from Aesculap, Samumed, and Zimmer Biomet; consulting fees from Conmed, Stryker, and Tornier; and royalties from Conmed and SLACK. B.T.F. has received research support from Orthofix and hospitality payments from Zimmer Biomet and has stock/stock options in Bioniks and Kaliber. D.A.L. has received education payments from Arthrex/Evolution Surgical, Wright Medical/Tornier, Vericel, and Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

Ultrasound guidance is valuable for performing precise joint interventions. Joint interventions may be requested for therapeutic and diagnostic pain injections, joint aspiration in the setting of suspected infection, or contrast injection for arthrography. In practice, interventions of the shoulder girdle, elbow, and hand/wrist joints may be performed without any imaging guidance. However, imaging guidance results in more accurate interventions and better patient outcomes than those performed by palpation alone. When compared to other modalities used for imaging guidance, ultrasound has many potential advantages. Radiologists should be prepared to perform ultrasound-guided upper extremity joint interventions utilizing recommended techniques to optimize clinical practice and patient outcomes. KEY POINTS: 1. Ultrasound-guided injections of the glenohumeral, acromioclavicular, sternoclavicular, elbow, and hand/wrist joints have higher accuracy than injections performed without imaging guidance. 2. Ultrasound-guided aspirations of upper extremity joints have advantages to fluoroscopic-guided aspirations because of the potential to identify effusions, soft tissue abscess, or bursitis. 3. Ultrasound-guided contrast injection prior to MR arthrography is as accurate as fluoroscopic-guided injection for upper extremity joints., (© 2022. The Author(s).)

Background: Mild to moderate glenohumeral joint osteoarthritis is a common finding among patients who are evaluated for rotator cuff tears. However, the impact of preoperative shoulder joint degeneration on patient-reported outcomes after rotator cuff repair (RCR) is not well-established., Purpose: To apply the magnetic resonance imaging (MRI)-based Shoulder Osteoarthritis Severity (SOAS) score to the evaluation of patients undergoing RCR and determine the relationship between preoperative shoulder pathology present on MRI and postoperative Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE) scores., Study Design: Case-control study; Level of evidence, 3., Methods: Seventy-one MRI scans corresponding to 71 patients were analyzed by 2 independent reviewers and scored using the SOAS criteria. Intraclass correlation coefficients were calculated for total SOAS score as well as for each subscore. Spearman correlations were calculated between averaged SOAS scores, patient characteristics, and PROMIS-UE scores. Linear regression analysis was performed between the independent variables of patient age, sex, body mass index, and significant SOAS score components determined by univariate analysis with the dependent variable of PROMIS-UE score. Significance was defined as P < .05 for univariate analyses and < .0125 for multivariate analyses using the Bonferroni correction., Results: The mean PROMIS-UE score of this cohort was 51.5 ± 7.4, while the mean total SOAS score was 21.5 ± 8.4. There was a negative correlation between total SOAS score and postoperative PROMIS-UE score ( r = -0.24; P = .040). Both cartilage wear ( r = -0.33; P = .0045) and acromioclavicular joint degeneration ( r = -0.24; P = .048) individually demonstrated negative correlations with PROMIS-UE score. When a multivariate linear regression with Bonferroni correction was applied to the significant variables identified in univariate analysis along with patient characteristics, none were independently correlated with PROMIS-UE score., Conclusion: In this cohort of patients undergoing RCR, increasing preoperative total SOAS score was predictive of lower postoperative PROMIS-UE scores. SOAS subscores with the strongest negative correlations with PROMIS-UE scores included cartilage wear and acromioclavicular joint degeneration. The cartilage subscore was negatively correlated with PROMIS-UE scores independent of patient factors in multivariate analysis., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.T.F. has received education payments from Evolution Surgical. D.L. has received education payments from Evolution Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2023.)

Introduction: As an inflammatory phenomenon, optic neuritis (ON) that causes demyelination in the optic nerve damages the retinal cells, and leads to visual impairment. Herein, we aimed to investigate the potential therapeutic effects of memantine on ON., Methods: In this double-blinded randomized clinical trial, participants with the first episode of acute ON meeting the inclusion criteria were enrolled and were randomly divided into memantine group (MG; N = 20) and placebo group (PG; N = 18). Patients of MG received memantine for 6 weeks. The thickness of the retinal nerve fiber layer (RNFL), visual evoked potential (VEP), and visual acuity (VA) was measured in both groups at baseline and 3-month follow-up., Results: Thirty-eight patients with ON were enrolled. In the follow-up, mean RNFL thickness of both groups significantly decreased in all quadrants (P < 0.001). Also, RNFL thickness of all but temporal quadrants were significantly higher in the MG than placebo. The reduction in RNFL thickness difference was insignificant between two groups in all but the inferior quadrant which was significantly lower in MG (P = 0.024). In follow-up, mean-to-peak of P100 of the affected eye were significantly lowered (P < 0.001). The changes in VEP were insignificant. Originally, the mean VA was 0.15 ± 0.08 and 0.17 ± 0.09 in MG and PG, respectively, but was improved significantly to 0.92 ± 0.06 and 0.91 ± 0.06 in MG and PG, respectively, in follow-up., Conclusion: Memantine can reduce the RNFL thinning in three quadrants by blocking NMD receptors. However, visual acuity did not show a significant difference between the two groups., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Heterotopic ossification (HO) is a process by which bone forms abnormally in soft tissues. Known risk factors for developing HO include male sex, spinal cord injury, trauma, and surgery. We investigated additional risk factors in the development of HO after hip arthroplasty., Methods: We performed a retrospective review of electronic medical records of 4070 individuals who underwent hip arthroplasty from September 2010 to October 2019 at the University of California, San Francisco Hospital. Demographics, anthropometrics, medications, and comorbid conditions were used in logistic regression analysis to identify factors associated with the development of HO., Results: A total of 2541 patients underwent primary hip arthroplasty in the analyzed timeframe (46.04% men, mean age at procedure: 62.13 ± 13.29 years). The incidence of postsurgical HO was 3% (n = 80). A larger proportion of individuals who developed HO had underlying osteoporosis (P < 0.001), vitamin D deficiency (P < 0.001), spine disease (P < 0.001), type 1 or 2 diabetes (P < 0.001), amenorrhea (P = 0.037), postmenopausal status (P < 0.001), parathyroid disorders (P = 0.011), and history of pathologic fracture (P = 0.005). Significant predictors for HO development were Black/African American race [odds ratio (OR) 2.97, P = 0.005], preexisting osteoporosis (OR 2.72, P = 0.001), spine disease (OR 2.04, P = 0.036), and low estrogen states (OR 1.99, P = 0.025). In the overall group, 75.64% received perioperative nonsteroidal anti-inflammatory drugs (NSAIDs), which negatively correlated with HO formation (OR 0.39, P = 0.001)., Conclusions: We identified new factors potentially associated with an increased risk of developing HO after primary hip arthroplasty, including African American race, osteoporosis, and low estrogen states. These patients may benefit from HO prophylaxis, such as perioperative NSAIDs., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society.)

Objective: To qualitatively evaluate the utility of zero echo-time (ZTE) MRI sequences in identifying osseous findings and to compare ZTE with optimized spoiled gradient echo (SPGR) sequences in detecting knee osseous abnormalities., Materials and Methods: ZTE and standard knee MRI sequences were acquired at 3T in 100 consecutive patients. Three radiologists rated confidence in evaluating osseous abnormalities and image quality on a 5-grade Likert scale in ZTE compared to standard sequences. In a subset of knees (n = 57) SPGR sequences were also obtained, and diagnostic confidence in identifying osseous structures was assessed, comparing ZTE and SPGR sequences. Statistical significance of using ZTE over SPGR was characterized with a paired t-test., Results: Image quality of the ZTE sequences was rated high by all reviewers with 278 out of 299 (100 studies, 3 radiologists) scores ≥ 4 on the Likert scale. Diagnostic confidence in using ZTE sequences was rated "very high confidence" in 97%, 85%, 71%, and 73% of the cases for osteophytosis, subchondral cysts, fractures, and soft tissue calcifications/ossifications, respectively. In 74% of cases with osseous findings, reviewer scores indicated confidence levels (score ≥ 3) that ZTE sequences improved diagnostic certainty over standard sequences. The diagnostic confidence in using ZTE over SPGR sequences for osseous structures as well as abnormalities was favorable and statistically significant (p < 0.01)., Conclusion: Incorporating ZTE sequences in the standard knee MRI protocol was technically feasible and improved diagnostic confidence for osseous findings in relation to standard MR sequences. In comparison to SPGR sequences, ZTE improved assessment of osseous abnormalities., (© 2022. ISS.)

Objective: To investigate the incidence of coronavirus disease 2019 (COVID-19) cases, hospitalizations and deaths in Iranians vaccinated with either AZD1222 Vaxzevria, CovIran® vaccine, SARS-CoV-2 Vaccine (Vero Cell), Inactivated (lnCoV) or Sputnik V., Methods: We enrolled individuals 18 years or older receiving their first COVID-19 vaccine dose between April 2021 and January 2022 in seven Iranian cities. Participants completed weekly follow-up surveys for 17 weeks (25 weeks for AZD1222) to report their COVID-19 status and hospitalization. We used Cox regression models to assess risk factors for contracting COVID-19, hospitalization and death., Findings: Of 89 783 participants enrolled, incidence rates per 1 000 000 person-days were: 528.2 (95% confidence interval, CI: 514.0-542.7) for contracting COVID-19; 55.8 (95% CI: 51.4-60.5) for hospitalization; and 4.1 (95% CI: 3.0-5.5) for death. Compared with SARS-CoV-2 Vaccine (Vero Cell), hazard ratios (HR) for contracting COVID-19 were: 0.70 (95% CI: 0.61-0.80) with AZD1222; 0.73 (95% CI: 0.62-0.86) with Sputnik V; and 0.73 (95% CI: 0.63-0.86) with CovIran®. For hospitalization and death, all vaccines provided similar protection 14 days after the second dose. History of COVID-19 protected against contracting COVID-19 again (HR: 0.76; 95% CI: 0.69-0.84). Diabetes and respiratory, cardiac and renal disease were associated with higher risks of contracting COVID-19 after vaccination., Conclusion: The rates of contracting COVID-19 after vaccination were relatively high. SARS-CoV-2 Vaccine (Vero Cell) provided lower protection against COVID-19 than other vaccines. People with comorbidities had higher risks of contracting COVID-19 and hospitalization and should be prioritized for preventive interventions., ((c) 2022 The authors; licensee World Health Organization.)

Musculoskeletal ultrasound has grown substantially in use over the past several years as an indispensable companion to magnetic resonance imaging and other imaging modalities. This article reviews 10 integral applications of musculoskeletal ultrasound as a problem-solving tool with correlative case examples. These applications include the following: (1) accessibility and portability, (2) targeted imaging, (3) dynamic imaging, (4) contralateral comparison, (5) Doppler imaging, (6) increased spatial resolution, (7) solid versus cystic comparison, (8) posttraumatic imaging, (9) postsurgical imaging, and (10) treatment delivery and optimization. The review will help the radiologist recognize the complementary uses of musculoskeletal ultrasound with radiography, computed tomography, and magnetic resonance imaging., (© 2020 American Institute of Ultrasound in Medicine.)

Initiation and propagation of cracks in composite materials can severely affect their global mechanical properties. Due to the lower strength of the interlaminar bonding compared to fibers and the matrix, delamination between plies is known to be one of the most common failure modes in these materials. It is therefore deemed necessary to gain more insight into this type of failure to guide the design of composite structures towards ensuring their robustness and reliability during service. In this work, delamination of interlaminar bonding in composite end-notched flexure (ENF) samples was modeled using a newly developed stochastic 3D extended finite element method (XFEM). The proposed numerical scheme, which also incorporates the cohesive zone model, was used to characterize the mode II delamination results obtained from ENF testing on polyphenylene sulfide (PPS)/glass unidirectional (UD) composites. The nonrepeatable material responses, often seen during fracture testing of UD composites, were well captured with the current numerical model, demonstrating its capacity to predict the stochastic fracture properties of composites under mode II loading conditions.

A 17-year-old adolescent boy was referred by an orthopaedic physician to physical therapy for chronic left shoulder pain and a clinical diagnosis of labral tear. The physician ordered current radiographs, which were noncontributory. Findings during physical therapy examination warranted referral back to the physician, with a request for magnetic resonance imaging. Magnetic resonance imaging revealed a soft tissue abnormality in the infraclavicular and subcoracoid spaces. The patient was referred to orthopaedic oncology, where biopsy confirmed a desmoid tumor. J Orthop Sports Phys Ther 2020;50(8):467. doi:10.2519/jospt.2020.9596 .

Osteopetrosis comprises a rare, heterogeneous group of heritable conditions that are characterized by a defect in bone resorption by osteoclasts. We report the case of a 53-year-old woman with previously undiagnosed osteopetrosis who presented with a pathologic proximal humeral fracture secondary to pleomorphic sarcoma, which is previously undescribed in the English literature. Management of the primary lesion necessitated ablative surgery, but the malignancy nonetheless was associated with rapidly progressive metastatic disease., (Copyright Journal of Radiology Case Reports.)

Purpose: To describe the imaging, anatomic, and clinical features of a series of secondary aneurysmal bone cysts (ABC) and to ascertain their most commonly associated primary bone lesions., Methods: Forty-nine cases of histopathologically proven secondary ABCs were retrospectively reviewed. Demographic data and clinical history were obtained. Radiographic, computed tomographic, magnetic resonance, and nuclear medicine imaging were analyzed. Lesion location, imaging characteristics, and associated primary lesions were documented. Linear regression analysis and Chi-squared testing was performed for statistical analysis., Results: Twenty-four males and 25 females were included, with an age range of 8-79 years (mean 29.7 + - 4.5 years). Eleven types of primary bone lesion were identified, with giant-cell tumor (n = 17, 35%), chondroblastoma (n = 11, 22%), fibrous dysplasia (n = 6, 12%), osteoblastoma (n = 4, 8%) and osteosarcoma (n = 4, 8%) being the most frequent. The lesions involved chiefly the long bone epiphyses (n = 25, 51%). Secondary ABC imaging findings and locations most closely approximated those of their primary counterparts, although fluid-fluid levels were seen at a higher frequency than previously reported in primary chondroblastoma (9/11, 82%), fibrous dysplasia (2/6, 33%), osteoblastoma (4/4, 100%), osteosarcoma (3/4, 75%), and chondromyxoid fibroma (1/2, 50%)., Conclusion: The most common primary lesions associated with secondary ABC were giant cell tumor and chondroblastoma, located in the long bone epiphyses. The majority of the secondary ABCs demonstrate predominant imaging characteristics typical of the primary bone lesions, but with a higher presence of fluid-fluid levels., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare disorder marked by painful, recurrent flare-ups and heterotopic ossification (HO) in soft and connective tissues, which can be idiopathic or provoked by trauma, illness, inflammation, or surgery. There are currently no effective treatments for FOP, or for patients with FOP who must undergo surgery. Palovarotene, an investigational retinoic acid receptor-γ agonist, offers a potential avenue to prevent HO formation., Case Presentation: The patient is a 32 year-old male, who at age 29 enrolled in a study evaluating palovarotene to prevent HO formation in FOP. One year after starting palovarotene, he fell resulting in a left intertrochanteric fracture. He underwent intramedullary nailing of the femur shaft with screw placement at the distal femur. After surgery, he received palovarotene at 20 mg/day for 4 weeks, then 10 mg/day for 8 weeks. Imaging 12 weeks after surgery showed new bridging HO at the site of intramedullary rod insertion and distal screw. Nine months after the left hip fracture, the patient had a second fall resulting in a subdural hematoma, left parietal bone fracture, and right intertrochanteric fracture. He underwent intramedullary nailing of the right hip, in a modified procedure which did not require distal screw placement. Palovarotene 20 mg/day was started at fracture occurrence and continued for 4 weeks, then reduced to 10 mg/day for 8 weeks. HO also formed near the insertion site of the intramedullary rod. No HO developed at the right distal intramedullary rod. After each fracture, the patient had prolonged recurrent flare-ups around the hips., Conclusion: Surgery is only rarely considered in FOP due to the high risks of procedural complications and potential for inducing HO. This case emphasizes the risks of increased flare activity and HO formation from injury and surgery in patients with FOP. The efficacy of HO prevention by palovarotene could not be assessed; however, our observation that palovarotene can be administered in an individual with FOP following surgery with no negative impact on clinical fracture healing, osteointegration, or skin healing will help facilitate future trials testing the role of palovarotene as a therapy for HO.

Objective: Musculoskeletal ultrasound imaging is increasingly being used for static and dynamic imaging of tendons, muscles, ligaments, and bones. New, hand-held, pocket-sized ultrasounds are more portable and affordable. The purpose of this study was to evaluate the feasibility of pocket-sized ultrasound to diagnose shoulder pathology., Design: Prospective cohort study., Setting: Tertiary Care Hospital., Methods: Ten consecutive patients (mean age 54; range 42-68 years) referred for a shoulder ultrasound for evaluation of shoulder pain were recruited. A diagnostic ultrasound was performed first with a pocket-sized ultrasound machine (VScan; General Electric, Northville, MI) and cine images saved for later review. Next, standard diagnostic ultrasound by a radiology technician specialized in musculoskeletal ultrasound was performed using (LOGIQ; General Electric, Northville, MI) ultrasound. The radiology report from the standard diagnostic ultrasound was used as the gold standard for diagnoses. Two independent evaluators, a musculoskeletal-trained radiologist and a sports-medicine-trained physician with over 8 years of experience with musculoskeletal ultrasound, reviewed the images from the pocket-sized ultrasound., Results: Nine of the studies were diagnosed with a pathologic entity during the standard diagnostic ultrasound and 1 was found to be normal. Diagnoses ranged from biceps tendinopathy, calcific tendonitis, and partial-articular-sided rotator cuff tear. Evaluator 1 correctly identified 7/10 diagnoses and evaluator 2 correctly identified 8/10 diagnoses. The evaluators also rated their confidence in diagnosis as 4.2/5 and the image quality as 3.7/4 from the pocket-sized ultrasound., Discussion: The findings from this study demonstrate that pocket-sized, hand-held ultrasound machines may be used to identify shoulder pathology.

Objective: Evaluate the MR distribution of inflammatory sacroiliac joint changes in axial spondyloarthritis phenotypes, including Ankylosing Spondylitis (AS) and non-radiographic Axial Spondyloarthritis (nrAxSpA)., Methods: A retrospective review of 94 patients seen for treatment of axial spondyloarthritis (SpA) who underwent sacroiliac joint MRI between January 2011 and December 2015 was performed. MR images from 68 patients (20 with AS and 48 with nrAxSpA) were reviewed independently by two radiologists. Images were scored on presence of active inflammatory and chronic structural lesions. These lesions were further categorized as unilateral, bilateral and asymmetric, or bilateral and symmetric., Results: No statistically significant difference was found in the distribution (laterality or symmetry) of bone marrow edema or sclerosis between the AS and nr-axSpA groups. Osseous erosions were more commonly bilateral symmetric in AS than nr-axSpA (11/20 vs. 8/48, p = 0.01). No statistically significant difference was noted between bone marrow edema scores in the AS and nr-axSpA subgroups (2.6 vs 3.3, p = 0.514). Patients with AS had a significantly higher fat metaplasia score compared to patients with nr-axSpA (7.3 vs 1.1, p = 0.001). Patients with nr-axSpA had a higher mean score for erosions (11.6 vs 4.2, p = 0.001). Only patients classified as AS were found to have bony ankylosis. Inter-observer reliability was strong to excellent., Conclusion: Ankylosing spondylitis findings at the sacroiliac joints are classically described as bilateral and symmetric on radiographs. Our study demonstrates that distribution on MRI at an individual time point is variable. The variable distribution should be considered when radiologists evaluate MRI exams of AS patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Serious side effects of vaccinations are not common, though rare complications can occur. We present a case of one such uncommon side effect, influenza vaccine-related subacromial/subdeltoid bursitis. A 72-year-old female presented with severe shoulder pain following influenza vaccination. The pain persisted for up to two months despite conservative measures, and MRI demonstrated moderate subacromial/subdeltoid bursitis. Vaccine-related shoulder dysfunction includes a range of pathology, from osteonecrosis to bursitis, which will be reviewed in this report. Recognition of infrequent vaccine-related musculoskeletal pathology is important to prevent delay of diagnosis.

Background: Musculoskeletal ultrasonography is a tool that is being used increasingly. However, the interpretation of ultrasound images of fractures is not incorporated into orthopaedic training programs. This paper presents the results of an initiative to train orthopaedic surgery residents to accurately interpret images of distal radial fractures in adults and to assess their confidence levels and attitudes regarding their future use of ultrasonography., Methods: Six junior residents were given a pretest with 100 distal radial images that had been made with a pocket-sized ultrasound device; they were asked to determine fracture versus nonfracture cases (50 cases) as well as reduced fracture versus nonreduced fracture cases (50 cases). Following the pretest, residents completed a 30-minute tutorial (didactic and practical) on distal radial ultrasonography. The residents then completed a period of self-practice during 2 separate trauma rotations (a total of 14 to 16 weeks in a single academic year). Following completion of their second trauma rotation, the residents completed a posttest. Comfort level using a pocket-sized ultrasound device also was assessed during pretesting and posttesting., Results: The median number of days from the pretest to the posttest was 212 days (range, 175 to 225 days). Residents demonstrated an overall improvement in positive predictive value (PPV) of identifying a fracture from the pretest (86.0%; range, 77.5% to 93.1%) to the posttest (93.5%; range, 91.4% to 94.2%). The overall negative predictive value (NPV) for identifying a fracture also improved from the pretest (69.4%; range, 60.0% to 76.9%) to the posttest (81.0%; range, 76.4% to 86.7%; p = 0.04). The overall PPV for detecting a reduced fracture improved from 67.1% with the pretest (range, 54.2% to 82.4%) to 88.9% with the posttest (range, 83.3% to 94.1%; p = 0.04). The comfort level with using the ultrasound device also increased between pretesting and posttesting, and the residents felt that ultrasonography would be useful in the care of distal radial fractures., Conclusions: After a focused training session and a period of self-practice, orthopaedic residents improved their interpretation of ultrasound images and their comfort level using pocket-sized ultrasound devices with adult patients with distal radial fractures. Residents felt that a pocket-sized ultrasound device was useful for fracture diagnosis and evaluation of reduction.

Case: Intra-articular osteoid osteoma (IAOO) is a relatively rare entity and can pose a therapeutic challenge due to proximity to the cartilage surface. We present 2 cases of subchondral osteoid osteomata within the distal femur treated with excision and osteochondral grafting of the resultant defect., Conclusions: Subchondral IAOO can pose a therapeutic challenge. Our patients had an effective pain relief and return to activities with this treatment strategy.

We present the clinical, imaging, and laboratory findings of a 41-year-old male with culture proven Sporothrix schenckii osteoarticular infection of the right knee. Fungal arthropathies are a rare and indolent form of septic arthritis, which often leads to a delayed diagnosis. Early diagnosis and treatment of fungal arthropathies is critical to preventing permanent functional disability., (Copyright Journal of Radiology Case Reports.)

Background: Superior labral anterior-posterior (SLAP) tears can be associated with pain and shoulder dysfunction. Relatively little is known about the age-related prevalence of SLAP tears., Purpose: To investigate the age-related prevalence of imaging-diagnosed SLAP tears in a heterogeneous grouping of shoulder conditions in a large cohort at a single institution with multiple blinded reviewers., Study Design: Cross-sectional study; Level of evidence, 3., Methods: A total of 281 shoulder magnetic resonance imaging (MRI) scans obtained over 8 months were reviewed by a musculoskeletal radiologist and an orthopaedic surgeon. The mean ± SD age of the group was 49.6 ± 15.5 years, and 107 of the patients were female (38.1%). Patients were divided into 4 age groups: 35 years or younger, 36 to 50 years, 51 to 65 years, and older than 65 years. Statistical analyses were completed by use of the Fisher exact test to compare proportions of SLAP tears between age groups, odds ratios to determine the likelihood of having a SLAP tear in each age group, and a logistic regression to control for associated abnormalities., Results: There was a significant diffference in the proportion of SLAP tears found on the MRIs for each age group ( P < .001). Patients were significantly more likely to have SLAP tears if aged 51 to 65 years (66.7%; odds ratio [OR], 2.00; 95% CI, 1.27-3.15) and if older than 65 years (81.2%; OR, 4.31; 95% CI, 2.36-7.88). No increased prevalence was observed in patients aged 35 years or younger (47.5%; OR, 0.91; 95% CI, 0.55-1.50) or 36 to 50 years (51.8%; OR, 1.08; 95% CI, 0.70-1.67). Logistic regression demonstrated that age was the only significant predictor for having a SLAP tear ( P < .001). Kappa values were 0.46 to 0.65 between reviewers, indicating moderate to substantial agreement., Conclusion: An increasing prevalence of MRI-based SLAP tears was observed with increasing patient age. Patients older than 50 years were significantly more likely to have superior labral abnormalities regardless of other shoulder injury or disease., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: D.A.L. has received educational and research support from Arthrex and Smith & Nephew. B.T.F. has received hospitality payments from Zimmer/Biomet. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Objective: Fibrodysplasia ossificans progressiva is a rare genetic disorder characterized by congenital skeletal deformities and soft tissue masses that progress to heterotopic ossification. Deformities of the great toes are distinctive, and heterotopic ossification in the soft tissues follows an expected anatomic and temporal pattern. In addition to heterotopic ossification, osteochondromata, middle ear ossification, demyelination, lymphedema, and venous thrombosis are characteristic. Awareness of this constellation of findings is important to early diagnosis and surveillance., Conclusions: Recognition of the imaging manifestations of fibrodysplasia ossificans progressiva is imperative to early diagnosis in order to appropriately direct patient care and preclude unnecessary biopsies or surgical procedures.

Tendon injury is a known complication of distal radius fracture plate and screw fixation. Targeted musculoskeletal sonography is uniquely capable of assessing both tendon integrity and hardware abnormalities not recognized on radiographs. Each of the 3 patients described presented with pain after an open reduction-internal fixation following a distal forearm fracture. In each patient, radiographic findings, specifically the hardware position, were interpreted as normal. Important radiographically occult observations were subsequently made with sonography, including 3 proud screws and tendon injuries, all of which required surgical treatment. This case series demonstrates the clinical utility of musculoskeletal sonography in symptomatic patients after distal radius open reduction-internal fixation with negative radiographic findings. In our practice, sonography has been the most useful modality for precluding missing or delaying the diagnosis and treatment of these hardware complications. We advocate its use as an adjunct in any department performing musculoskeletal imaging., (© 2017 by the American Institute of Ultrasound in Medicine.)

Purpose: To evaluate the success rate of CT-guided bone biopsies in metastatic castration-resistant prostate cancer (mCRPC) and to investigate associated technical, imaging, and clinical parameters affecting diagnostic yields., Materials and Methods: Eighty CT-guided bone biopsy specimens were obtained from 72 men (median age, 68 y; range, 49-89 y) enrolled in a multicenter trial to identify mechanisms of resistance in mCRPC. Successful biopsy was determined by histologic confirmation of tumor cells and successful isolation of RNA for molecular analysis., Results: The overall success rate of CT-guided bone biopsies was 69% (55/80) based on histology and 64% (35/55) based on isolation of molecular material for RNA sequencing. Biopsies performed in lesions with areas of radiolucency had significantly higher diagnostic yields compared with lesions of predominantly dense sclerosis (95% vs 33%; P = .002) and lesions of predominantly subtle sclerosis (95% vs 65%; P = .04). Success rates increased in lesions with density ≤ 475 HU (79% for ≤ 475 HU vs 33% for > 475 HU; P = .001) and in lesions with ill-defined margins (76% for ill-defined margins vs 36% for well-circumscribed margins; P = .005). Alkaline phosphatase was the only clinical parameter to correlate significantly with diagnostic yield (83% for > 110 U/L vs 50% for ≤ 110 U/L; P = .001)., Conclusions: Image-guided bone tumor biopsies can be successfully used to acquire cellular and molecular material for analyses in patients with osteoblastic prostate cancer metastases. Diagnostic yields are significantly increased in lesions with areas of radiolucency, density ≤ 475 HU, ill-defined margins, and interval growth and in patients with alkaline phosphatase > 110 U/L., (Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: Handheld ultrasound technology is increasingly used in health care. Its use for fracture care has not been adequately evaluated. The purpose of this study was to evaluate handheld, pocket-sized ultrasound in the diagnosis and assessment of reductions in distal radius fractures., Methods: A total of 23 patients with distal radius fractures (average age, 53 years; 13 women) and 20 control patients (average age, 53 years; 10 women) were prospectively enrolled. All patients with distal radius fractures underwent standard, 3-view radiographic and ultrasonographic examinations of the wrist before and after closed reduction. Control patients had a one-time standard radiographic and ultrasonographic examination of the wrist. Radiographs were used as the reference standard. All images were assessed for the presence or absence of a fracture by a board-certified, hand fellowship-trained orthopedic surgeon and musculoskeletal fellowship-trained radiologist who were blinded to the study protocol. If a fracture was detected, the adequacy of reduction was assessed., Results: The sensitivity of distal radius fracture diagnosis on ultrasound was 100% and specificity ranged from 90% to 95%. The sensitivity of identifying a satisfactory reduction ranged from 76% to 93% and specificity was 93% to 94%. Interrater reliability between the musculoskeletal radiologist and hand surgeon was κ = 0.86 for diagnosing the fracture and κ = 0.82 for identifying a satisfactory reduction. Intrarater reliability ranged from κ = 0.82 to 0.86., Conclusions: A pocket-sized, handheld diagnostic ultrasound device demonstrates the ability to diagnose distal radius fractures and assess fracture reductions., Type of Study/level of Evidence: Diagnostic II., (Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Objective: Evaluate technical feasibility and potential applications of glenohumeral (GH) joint axial traction magnetic resonance imaging (MRI) in healthy volunteers., Materials and Methods: Eleven shoulders were imaged in neutral and with 4kg axial traction at 3T. Quantitative measurements were assessed., Results: Axial traction was well tolerated. There was statistically significant widening of the superior GH joint space (p=0.002) and acromial angle (p=0.017) with traction. Inter-rater agreement was high., Conclusion: GH joint axial traction MRI is technically feasible and well tolerated in volunteers. Traction of the capsule, widening of the superior GH joint space and acromial angle were observed., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Arterial calcification due to CD73 deficiency (ACDC) is a recently identified rare and debilitating adult-onset disorder caused by autosomal recessive NT5E gene mutations. ACDC is characterized by progressive and painful arterial calcifications primarily affecting the lower extremities, as well as calcifications affecting small joint capsules of the hands and feet. In this case report, the authors provide clinical follow-up for one of the first individuals identified by the National Institutes of Health (NIH) as having ACDC, focusing mainly on the imaging manifestations of periarticular joint mineralization, which are bilateral but slightly asymmetric, bulky up to the levels of the metacarpophalangeal and metatarsophalangeal joints, but smaller and more capsular in distribution at the proximal and distal interphalangeal joints, without erosive change or intra-articular mineralization. Differential considerations for similar appearing joint mineralization are provided.

Multiple hereditary exostoses is an autosomal dominant condition characterized by numerous benign osteochondromas. Complications are rare and can include deformity, growth abnormality, fracture, adventitial bursa formation, local mass effect on a nerve, malignant degeneration, and vascular complications including stenosis, occlusion, arteriovenous fistula, and pseudoaneurysm. We present a case of multiple hereditary exostoses leading to a deep femoral artery pseudoaneurysm in the proximal medial thigh with subsequent rupture and hematoma, masquerading as tumor.

We present the case of an intra-articular osteoid osteoma at the femoral trochlea. Intra-articular osteoid osteoma can present a diagnostic challenge both clinically and with imaging because it presents differently from the classic cortical osteoid osteoma. Given the lesion's proximity to overlying cartilage, the patient underwent resection of the lesion with osteochondral autograft transplantation at the surgical defect. A comprehensive literature review and discussion of intra-articular osteoma will be provided.

Objective: Assess the impact of knee joint loading on meniscal extrusion in normal individuals and those with varying degrees of osteoarthritis (OA)., Methods: 143 healthy volunteers and patients with OA underwent 3 T MRI of the knee under unloaded and loaded conditions. OA was graded with the Kellgren-Lawrence (KL) system. Menisci were evaluated for presence of tear. Descriptive statistics were expressed as mean ± standard deviation. Loaded and unloaded groups were compared using Student's t-test. Statistic significance was defined for all calculations as p < 0.05., Results: The cohort included 87 women and 56 men with an average age of 53 years +/- 9.7 years. Kellgren-Lawrence grade distribution was as follows: 56 with grade 0, 46 with grade 1, 25 with grade 2, 13 with grade 3, and 3 with grade 4. 23% had medial meniscus tears and 16% had lateral meniscus tears. Differences in medial meniscal extrusion between loading and unloading were significant in the entire cohort (p < 0.0001). Statistically significant difference in medial meniscus extrusion with loading and unloading were found for KL score group of 0, 1 and 3 (p < 0.001, p < 0.001 and p = 0.005). Interestingly, no significant differences in extrusion with loading and unloading were found for the lateral meniscus (p = 0.07)., Conclusion: Our study demonstrated that medial meniscal extrusion significantly increased during loading, specifically in those low KL scores (0 and 1) and in KL score of 3. Loaded MRI may more accurately determine the extent of medial meniscal extrusion in particular in those with no to minimal OA.

The exact location of origin for giant cell tumors of bone (GCTB) remains controversial, as lesions are not routinely imaged early but rather late when the tumor is large and clinically symptomatic. At the time of diagnosis, GCTB are classically described as lucent, eccentric lesions with nonsclerotic margins, located within the epiphysis to a greater extent than the metaphysis. Here we present a case of a biopsy proven GCTB initially incidentally seen on MRI as a small strictly metaphyseal lesion, which over the course of several years expanded across a closed physis to involve the epiphysis and abut the articular surface/subchondral bone plate.

Ahead of Print article withdrawn by publisher.

Objective: The purpose of this article is to review frequently encountered pitfalls as they pertain to normal and variant anatomy of the shoulder, including the rotator cuff and rotator cable, blood vessels, glenoid labrum, and the glenohumeral ligaments., Conclusion: MRI is the preferred method for evaluating internal derangement of the shoulder. Radiologists interpreting MR images should have a detailed understanding of pertinent anatomy and knowledge of common and uncommon pitfalls to avoid during image interpretation.

Objective: The purpose of this article is to review frequently encountered pitfalls as they pertain to the biceps tendon, bursae and cysts around the shoulder, incidental findings, postsurgical findings, and frequently encountered imaging artifacts., Conclusion: Imaging pitfalls in and around the shoulder are not limited to normal anatomy and anatomic variants. Radiologists must be cognizant of the vast variability of structures in the shoulder and of the incidental and postsurgical findings and artifacts affecting them.

Objective: The objectives of this article are to discuss the 10 distinct patterns of superior labral anteroposterior (SLAP) tears to facilitate adequate diagnosis and treatment. Correlations with clinical presentation, mechanism of injury, and treatment will enhance understanding., Conclusion: Imaging plays an important role in the diagnosis of SLAP tears. Knowledge of glenolabral anatomy, related structures and variants, proper imaging techniques, and a systematic approach to MRI interpretation is important in the diagnosis and treatment planning of the 10 types of SLAP lesions. Arthroscopy offers a means for definitive diagnosis.