Search

Ultrasonography may be very useful for the positive and differential diagnosis of inflammatory rheumatic disorders (rheumatoid arthritis [RA], polymyalgia rheumatica [PMR] and spondylarthropathies) and if necessary, for the treatment response evaluation (RA). Later in the course of the disease, ultrasonography may help in diagnosing some peripheral complications (tendinous ruptures, synovial cysts, superficial bursitis...) and is useful to guide corticosteroid injections (RA, spondylarthropathies). This article addresses the main ultrasonographic features of inflammatory rheumatic disorders and the role of ultrasonography relative to other imaging modalities (especially magnetic resonance [MR] imaging).

Resume Les tendons peuvent etre atteints dans de nombreuses conditions pathologiques, y compris celles provoquees par les pathologies degeneratives et les maladies inflammatoires. L’echographie est un moyen tres sensible dans la detection des lesions tendineuses en raison de sa haute resolution spatiale et de ses possibilites comparatives et dynamiques. De plus, sa large disponibilite lui confere la premiere place des modalites a utiliser pour ces indications. Cet article passe en revue l’aspect echographique des lesions inflammatoires et degeneratives des tendons.

Resume Les manifestations hemorragiques de l'hemophilie predominent au systeme locomoteur, avec notamment des hemarthroses debutant des l'âge de l'apprentissage de la marche dans les formes severes. Les sieges preferentiels sont le genou, le coude, la cheville et la hanche. La repetition des episodes aboutit a l'arthropathie hemophilique, qui participe grandement a la gravite de la maladie en raison de l'impotence fonctionnelle qu'elle genere. Nous rapportons dans cet article les stades radiographiques, la semiologie par imagerie par resonance magnetique (IRM) et l'evolution de cette pathologie dont la prise en charge therapeutique precoce et adaptee est fondamentale.

Resume Propos. – La camptocormie ou cyphose lombaire progressive est une projection du tronc vers l’avant apparaissant en position debout ou plus volontiers a la marche et reductible en decubitus. Il s’agit d’une atteinte musculaire paravertebrale du sujet âge de plus de 60 ans correspondant a une involution graisseuse des muscles spinaux dont le mecanisme ne fait pas l’unanimite. Methode. – Nous rapportons sept observations de camptocormie revelant une authentique myopathie. Resultat. – Il s’agit de cinq femmes et de deux hommes âges de 55 a 72 ans. Tous les patients ont en commun une attitude camptocormique ainsi qu’une degenerescence adipeuse des muscles paravertebraux particulierement bien visible a l’IRM. Les quatre premiers patients repondent aux criteres de Bohan et Peter de polymyosite et dermatomyosite. Dans les autres cas, la biopsie musculaire paravertebrale ou peripherique permet de diagnostiquer une myopathie congenitale, une myopathie mitochondriale et une myopathie amyloide. Les quatre premiers patients ont beneficie d’un traitement par corticoides associes soit aux immunoglobulines polyvalentes soit a la cyclosporine avec une amelioration de la camptocormie dans trois cas. Le traitement dans les autres cas a comporte une chimiotherapie du fait de la severite du syndrome nephrotique dans le cas de l’amylose AL, un traitement par coenzyme Q chez le patient atteint de cytopathie mitochondriale et une kinesitherapie seule dans le cas de la myopathie congenitale : aucune amelioration de la camptocormie n’a ete observee chez ces trois patients. Conclusion. – La camptocormie apparait comme un symptome musculaire refletant une myopathie axiale et repondant a des causes multiples et variees. Sa decouverte implique un bilan etiologique afin de proposer un traitement adapte associee a la reeducation.

The present study aimed to characterize bone microarchitecture assessed by computed tomography (CT) at the calcaneus in male subjects suffering from osteoporosis. Seventy-nine subjects were assessed (45 with osteoporosis and 34 control subjects matched for age). Osteoporosis was defined according to the World Health Organization classification either at the lumbar spine or at the femoral neck. Thirty-three subjects (73%) had a past history of low-energy fracture mainly represented by vertebral fractures (24/33). Nine axial sections (1 mm in width and 2 mm apart) were selected for each subject. Bone microarchitecture analysis was performed using structural (binary and skeletonized images but also skeletonization from gray levels) and fractal analyses. Bone densitometry by dual-energy X-ray absorptiometry (DXA) at the calcaneus was also performed in 73 cases. Bone mineral density (BMD) was decreased in osteoporotic patients compared with controls both at the lumbar spine and hip and also at the calcaneus (p

Resume Les auteurs rapportent un cas de muscle manieux ou court extenseur des doigts bilateral, hypertrophie du cote dominant chez un jeune patient sportif. Le diagnostic a ete etabli en imagerie par resonance magnetique et en echographie. L’abstention therapeutique a ete decidee.

In a 12-year old girl suffering from autosomal recessive axonal Charcot-Marie-Tooth (CMT) neuropathy, pes cavovarus was treated with botulinum toxin injection in the tibialis posterior. The patient underwent a clinical evaluation, video analysis of spatiotemporal gait parameters and dynamic foot plantar pressure assessment before treatment and then two weeks, three months and six months thereafter. The video gait analysis revealed a decrease in varus during the swing phase of gait. The dynamic foot plantar pressure decreased by 50% in the excessive pressure at the side of the foot six months after the injection (maximal pressure=42.6N/cm2 before treatment and 18.9 N/cm2 after 6 month). Botulinum toxin injection appears to be an efficacious means of correcting pes cavovarus in CMT disease. A larger-scale clinical trial is now required to evaluate the putative longer-term preventive effect of this treatment on the pes cavus deformity.

Mots cles : Poliomyelite ; Sequelles ; Devenir fonctionnel ; Reeducation Objectif .– Determiner les caracteristiques epidemiologiques des patients atteints de poliomyelite suivi en milieu de reeducation ambulatoire. Patients et methode.– Etude descriptive retrospective effectuee sur 11 ans de 2002 a 2013, incluant les patients ayant des sequelles de poliomyelite qui ont consulte au service de reeducation fonctionnelle du CHU Fattouma Bourguiba de Monastir. Les variables analysees sont d’ordre epidemiologique, clinique et evolutif. Resultats.– Vingt-deux patients (11 hommes et 11 femmes), avec une moyenne d’âge de 47 ans, 50 % avaient une monoplegie droite, 27,7 % une monoplegie gauche et 22,7 % une diplegie. La moyenne d’âge de l’atteinte polio etait de quatre ans. Le motif de consultation etait dans 86,4 % en rapport avec les sequelles de poliomyelite avec 40,9 % renouvellement de leur appareillage, 22,7 % troubles de la marche, 9,1 % inegalite de longueur d’un membre inferieur, 4,5 % scoliose, 4,5 % durillon plantaire et 9,1 %NCB. 27, 3 % avaient eu recours a un traitement chirurgical de leurs sequelles avec 9,1 % d’arthrodese, 4,5 % de double arthrodese et 4,5 % d’allongement d’un membre inferieur. Tous les cas ont ete pris en MPR avec un programme adapte a leur motif de consultation, recours a un appareillage et aides techniques pour 95,5 % des cas : 40,9 % semelles, 27,7 % GAM, 18,8 % orthese cruropedieuse, 18,8 % canne, 9,1 % attelle des releveurs des orteils, 4,5 % ceinture lombaire. Une amelioration clinique a ete constatee pour 36,4 % des cas. Discussion.– La degradation tardive des patients aux antecedents de poliomyelite est souvent multifactorielle. Elle doit etre prevenue par un suivi medical adapte, une information pertinente et desmesures adequates afin de limiter les sequelles et les complications telles qu’un syndrome post poliomyelite.

Thirty per cent of the paragangliomas and pheochromocytomas reported are hereditary. Mutations in SDHB, SDHC, SDHD, and more recently SDHAF2 and TMEM127 genes have been described in these hereditary tumors. We looked for mutations in these 5 genes in a series of 269 patients with paragangliomas and/or pheochromocytomas. The SDHB, SDHC, and SDHD genes were analyzed in a series of 269 unrelated index patients with paragangliomas and/or pheochromocytomas using dHPLC screening of point mutations followed by direct sequencing and Multiplex PCR Liquid Chromatography to detect large rearrangements confirmed by quantitative PCR. In a second phase, we adapted Multiplex PCR Liquid Chromatography to the SDHAF2 and TMEM127 genes. This method and direct sequencing were applied to 230 patients without the SDHB, C, D mutations. Of the 269 patients, 44 carried a mutation (16.3%). Thirty-seven different mutations were identified: 18 in SDHB (including 2 large deletions), 8 in SDHD, 6 in SDHC, 5 in TMEM127, and no mutations in SDHAF2. Thirteen mutations have not been published so far. An exhaustive study of the different genes is needed to make possible a familial genetic diagnosis in paraganglioma and pheochromocytoma hereditary syndromes. Although mutations in SDHC and TMEM127 are less frequent than mutations in SDHB and SDHD, they also have less evident clinical feature indicators. Analyzing SDHAF2 must be restricted to familial extra-adrenal paragangliomas. Multiplex PCR Liquid Chromatography is a sensitive, fast, and inexpensive method for screening large rearrangements, which are infrequent in these syndromes.

While the imaging features of established spondylodiscitis are well known, other presentations may be misleading. The purpose of this article is to review the typical imaging features of spondylodiscitis as well as some more atypical and unusual imaging features (early spondylodiscitis, sceptic spondylitis, septic arthritis of facet joints, primary epidural abscess, unusual germs, neonate).

Ultrasonography may be very useful for the positive and differential diagnosis of inflammatory rheumatic disorders (rheumatoid arthritis [RA], polymyalgia rheumatica [PMR] and spondylarthropathies) and if necessary, for the treatment response evaluation (RA). Later in the course of the disease, ultrasonography may help in diagnosing some peripheral complications (tendinous ruptures, synovial cysts, superficial bursitis...) and is useful to guide corticosteroid injections (RA, spondylarthropathies). This article addresses the main ultrasonographic features of inflammatory rheumatic disorders and the role of ultrasonography relative to other imaging modalities (especially magnetic resonance [MR] imaging).

The purpose of this review is to describe the value of the different radiographic projections of the wrist and hand, provide criteria for quality control and key interpretation points. Plain radiographs of the hand and wrist are still, in this era of cross-sectional imaging, of great importance in the assessment and understanding of bone and joint disorders, particularly in the setting of trauma. Indeed postero-anterior and lateral views have to be completed with additional projections depending on the suspected lesion and clinical presentation.

We report the first European tibial muscular dystrophy (TMD) family outside the Finnish population. Clinical examination showed late onset distal leg myopathy similar to the description of TMD. A molecular genetic study was made owing to the very recent TMD linkage findings on chromosome 2q31. All five clinically affected patients segregated a specific haplotype for the locus, whereas two unaffected patients had different haplotype. The results of this family without Finnish ancestors show that TMD exists outside the Finnish population.

Tendons may be affected by a variety of pathologic conditions, including those caused by overuse and inflammatory diseases. Sonography is a very sensitive means of detecting tendonous pathology because of its spatial resolution and its comparative and dynamic capabilities. Moreover its wide availability makes it the preferred first-line imaging modality in these cases. This paper reviews the inflammatory and degenerative conditions that may involve the tendons and their sonographic appearances.

The purpose of this study was first to determine the normal blood supply of the heel entheses with cadaver injection, and second, to identify by means of ultrasound (US) this blood supply in healthy volunteers before and after the intravenous injection of a US contrast agent (SonoVue). Twenty cadaver lower limbs were cut into sagittal, coronal, or axial sections after the injection of a red-colored gelatin solution. Ten anatomical samples were selected for histology. Then 10 healthy volunteers were enrolled in a contrast-enhanced ultrasonography study (CUS). Calcaneal tendon and plantar aponeurosis entheses were studied first without any contrast-agent (B-mode, power Doppler). A single dose (2.4 ml) of the contrast agent was then administered for studying each enthesis of the right foot. The operators had to look for blood flow within the entheses and in the adjacent soft tissues. Anastomotic transverse branches were seen macroscopically at the back of the calcaneal tendon, giving some capillaries penetrating the enthesis. None of these vessels could be seen with CUS. In contrast, a high-density vascular network could be detected in Kager's triangle with CUS. No blood vessel could be seen within the plantar aponeurosis enthesis, either macroscopically or microscopically. No evidence of entheseal vascularization was found with any contrast-enhanced imaging technique. Inferior branches of the lateral plantar artery were seen on coronal and sagittal sections of the hindfoot, and could be detected with CUS. These arterioles were running toward the anterior aspect of the calcaneal tuberosity, near the plantar aponeurosis insertion. In conclusion, no vascularization was detected with CUS at the cortical bone insertion of normal heel entheses. However, some vascularization could be seen in the immediate vicinity of heel entheses. The latter feature has to be kept in mind, as it may represent a pitfall for the diagnosis of early inflammatory changes in patients, especially those with seronegative spondylarthropathies.

The present study aimed to characterize the relationships between several variables reflecting bone microarchitecture assessed by both computed tomographic (CT) image analysis and histomorphometry (conventional CT system) at the calcaneus. A total of 24 cadaveric specimens were studied. The mean age at death was 78 ± 10 years (range, 53–93 years). A total of 15 sagittal sections (1 mm in width and spaced 2 mm apart) were selected for CT analysis; 6 undecalcified sections (7 μm) were analyzed for histomorphometry. The histomorphometric analysis was performed on a Leica Quantimet Q570 image analyzer. Features measured by both methods were: bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N), interconnectivity index (ICI), number of nodes (N Nd), number of terminus (N Tm), node-to-node strut count (NNS), node-to-terminus strut count (NTS), terminus-to-terminus strut count (TTS), marrow space star volume (SV), Euler number (EN), and fractal dimension (FD). The coefficient of correlations’ values (simple linear regression) between histomorphometry and CT image analysis varied according to the parameters selected. R values were high for BV/TV, Tb.N, and Tb.Sp (range, 0.69–0.90; P < 0.01). R values were less significant for some variables also obtained from the binary image: SV (0.5, P < 0.05) and EN (0.43, P < 0.05). Finally R values were also significant for (two) variables obtained from skeletonized images, i.e., N Nd (0.4, P < 0.05) and N Tm (0.61, P < 0.01). Other correlations were not statistically significant. Moreover, for some variables the relationships between the two methods (CT analysis and histomorphometry) seemed best-described by using nonlinear models. For example, a logarithmic model was more appropriate for SV (r = 0.71, P < 0.01), N Nd (r = 0.52, P < 0.01). Finally the relationship between apparent (App) N Tm and N Tm was most satisfying when using an exponential model (r = 0.64, P < 0.01). In conclusion, trabecular bone structure measures determined on CT images show highly significant correlations with those determined using histomorphometry. The level of correlation varies according to the type of method used for characterizing bone structure, however, and the strongest correlations were found for the most basic features (Parfitt’s parameters). Finally, for some variables, nonlinear models seem more appropriate.

The purpose of this study was to compare structural measurements obtained from MR images of the calcaneus with those obtained from conventional histomorphometry. Sagittal magnetic resonance (MR) images of the calcaneus of 24 fresh human cadaveric feet were obtained at a spatial resolution achievable in vivo. A three-dimensional gradient echo-sequence was used with a slice thickness of 700 microm and in plane resolution of 172 x 172 microm. Structural analysis (four histomorphometric parameters; seven connectivity parameters) was performed in the superior region of the calcaneus. Bone biopsy specimens were obtained in the same area and were sectioned for histomorphometric study. Most of the MR histomorphometric parameters were overestimated (by a factor ranging from 0.8 to 3), as compared with histomorphometry. However, significant ( P0.05) correlations were found between MR imaging and histomorphometric measurements for bone volume/tissue volume, trabecular separation, trabecular number, star volume of the marrow space, node count and terminus count. MR histomorphometric parameters correlated much better with histomorphometry than connectivity parameters. This study suggests that structural parameters characterizing cancellous bone in the calcaneus can be derived from MR images in the limited spatial resolution regime applicable in vivo.

Pseudo-winging of the scapula and scapular snapping are two clinical signs of upper girdle insufficiency. The association of these two signs is highly suggestive, if not pathognomonic, of exostosis of the ventral aspect of the scapula. Resection of the exostosis is recommended to prevent pain and sarcomatous degeneration.

Technological advances in the field of ultrasound imaging may have, especially in metacarpophalangeal joints, an impact on decision making in patients with early rheumatoid arthritis. First, the normal anatomy of the metacarpophalangeal joints is briefly reviewed. Then, the authors describe the main ultrasound imaging findings of early RA. The role of ultrasound imaging in the assessment of therapeutic response as well as the benefit of microbubble ultrasound contrast agents are considered.

Relationships among quantitative ultrasound of bone (QUS), bone mineral density (BMD) and bone microarchitecture have been poorly investigated in human calcaneus.Twenty-four specimens, from 12 men and 12 women (mean age 78 +/- 10 years; range 53-93), removed from cadavers were studied. The feet were axially sectioned above the ankle. Two variables were measured for QUS (Achilles, Lunar): broadband ultrasound attenuation (BUA) and speed of sound (SOS). A third variable, the stiffness index (SI), which is a combination of both BUA and SOS, was also calculated. BMD (a lateral view) was measured on a QDR 2000 densitometer (Hologic). Bone microarchitecture was assessed by computed tomography (CT) using a conventional CT-system. Fifteen sagittal sections (1 mm in width and 2 mm apart) were selected for CT. Methods used for characterizing bone microarchitecture consisted in structural (trabecular network characterization) and a fractal analyses. The relationships between QUS and bone microarchitecture were assessed by simple linear regression analysis with and without adjustment for BMD (partial correlation) and by backward stepwise regression analysis. Strong relationships were found between BMD and QUS. Adjusted r(2) values were 0.545 for SOS and 0.717 for SI. Two microarchitectural variables were also significantly correlated with both SOS and SI: apparent trabecular separation (App Tr Sp) and trabecular bone pattern factor (App TBPF). After adjustment for BMD few correlations between QUS and microarchitectural variables were always significant. Adjusted squared semipartial coefficients of correlation (rsp2) values between SOS and bone microarchitecture were 6%, 6.8%, 13.2% and 4.6% for App BV/TV, App Tr Sp, App TBPF and fractal dimension (FD), respectively. For SI, corresponding figures were 3.7%, 4.1%, 5.2% and 3.2%. Backward stepwise regression analysis using BMD and microarchitecture showed a slight increase of r(2) values that varied from 8.4% for SI to 17.8% for SOS, compared with BMD alone. The current study suggests that although BMD is a major determinant of acoustic properties of human calcaneus, significant density independent relationships with bone microarchitecture should also be taken into account.

This study was undertaken to determine the reproducibility of measurements of fatty degeneration of the rotator cuff using computed tomography (CT).Fifty-six patients who had undergone surgery for rotator cuff tear were included in this retrospective study. The extent of fatty infiltration was evaluated on CT scans with soft tissue windows in all 56 shoulders using a five-stage scoring system described by Goutallier. Five independent observers made the assessments. The same operation was repeated one month later to test intraobserver agreement. Four parameters were recorded: fatty infiltration of three muscles (supraspinatus, infraspinatus, subscapularis), and overall fatty infiltration grading. Interobserver variability was determined for each parameter using the intercorrelation coefficient (a test of reproducibility of quantitative measurements).The most reproducible measurement was the overall fatty infiltration grade. For this parameter, interobserver agreement was good with an intercorrelation coefficient of 0.75. The interval of confidence was +/- 0.5. Intraobserver agreement depended on the observer's level of experience. It was good for overall fatty infiltration grade assess by three senior observers (r=0.78) and moderate for two junior observers.The overall fatty infiltration grade is a reproducible parameter that should be used to evaluate the degree of fatty infiltration as the safety margin of this value (graded 0 to 4) is about 0.5. Fatty infiltration of a torn cuff would not be the only criterion to improve indications for treatment of rotator cuff tears.

Camptocormia or progressive lumbar kyphosis is an anterior bend of the trunk. It appears in orthostatism or while walking and is reducible in the decubitus position. It concerns patients older than 60 years of age. It is due to a fatty degeneration of the paravertebral muscles, although the physiopathology remains unclear.We report seven cases of camptocormia revealing authentic myopathies.Our observations concern five women and two men of 55 to 72 years of age. All patients present lumbar kyphosis and had a fatty involution of the paraspinal muscles on the muscular MRI. Four patients fulfilled the Bohan and Peter criteria of polymyositis and dermatomyositis. In the other cases paravertebral muscular biopsies led to the diagnosis of a congenital myopathy, a mitochondrial myopathy and an amyloid myopathy. Four patients received a corticosteroid-immunoglobulins or cyclosporin regimen. An improvement in the camptocormia was observed in three cases. In the other cases the treatment consisted of chemotherapy on account of severe nephrotic syndrome, a coenzyme-Q treatment for the patient with mitochondrial myopathy and only physiotherapy in the case of congenital myopathy, but without positive effect on camptocormia.Camptocormia appears as a muscular symptom that may reveal an axial myopathy due to multiple and varied pathologies. Thus, the discovery of camptocormia requires an aetiological investigation in order to propose an adequate treatment, which should be associated with physiotherapy.

The purpose of this paper is to present the contribution of imaging in the assessment of synovial diseases, especially in the differentiation between infectious synovitis and rheumatoid arthritis, and in the diagnosis of tumoral and pseudotumoral synovial lesions (idiopathic (osteo)chondromatosis, pigmented villonodular synovitis, synovial hemangioma, lipoma arborescens...).

Cortical septic osteitis is defined as a predominant or exclusive infection of the cortex which may lead to diagnosis pitfalls. With the two cases presented here, principal radiological features allowing a correct diagnosis are recalled.

Bone texture analysis might provide information about bone structure in a noninvasive manner. In a prospective case–control cross-sectional study we investigated the value of computed tomography (CT) image analysis of the distal radius in the assessment of osteoporosis. Twenty patients suffering from postmenopausal osteoporosis were studied and compared with 21 age-matched controls. Eight slices were selected in each patient: four consecutive coronal slices and four consecutive cross-sectional slices. Bone texture analysis was performed using statistical, fractal and structural methods leading to the measurement of 32 features. Structural variables derived from histomorphometric parameters were measured after segmentation from a binary or a skeletonized image. Bone mineral density was measured by dual-energy X-ray absorptiometry both at the lumbar spine and the femoral neck. Eight of the 9 statistical features were significantly different in osteoporotic women as compared with controls (coronal slices, p < 0.05). Seven structural variables were statistically different between the two groups on coronal slices (p < 0.05): valley surface area, bone volume/tissue volume, trabecular partition, Euler’s number, trabecular bone pattern factor, node-to-node strut count and terminus-to-terminus strut count. The most significant results on coronal slices (p < 0.01) concerned 4 structural features: trabecular partition, Euler’s number, trabecular bone pattern factor and terminus-to-terminus strut count. Three features were statistically different (p < 0.01) between the two groups on cross-sectional slices (skeletonization from gray levels). A few features yielded by texture analysis were correlated with both lumbar spine and femoral neck bone mineral density, but the level of these correlations was weak (r < 0.5). In conclusion, CT image analysis of the distal radius is a useful tool for characterizing bone texture alterations in osteoporotic women. These findings are in keeping with microarchitectural osteoporosis-related changes diagnosed on bone biopsies.

To assess the efficacy and safety of percutaneous vertebroplasty in osteoporotic vertebral compression fractures responsible for severe and persistent pain.Sixteen patients were included in this open prospective study. Inclusion criteria were: one or 2 vertebral fractures responsible for severe pain, i.e., higher than 50 mm on a visual analog scale (VAS: 0-100 mm), scores 3, 4 or 5 according to the McGill-Melzack scoring system, and evolving for more than 3 months. Assessment criteria were the changes over time (Days 3, 30, 90, 180) in VAS and McGill-Melzack scoring system. The changes over time in a generic health status instrument score [the Nottingham Health Profile (NHP)] were also assessed. Statistical comparisons were performed using the Wilcoxon T test.There were 9 women and 7 men: postmenopausal osteoporosis (n = 7), corticosteroid induced osteoporosis (n = 2), and male osteoporosis (n = 7). Vertebroplasty was performed in 20 vertebrae. A statistically significant decrease of both VAS (-53%, p0.0005) and McGill-Melzack scoring system (p0.005) was observed at Day 3. The results were also significant at Days 30, 90, and 180 for both scales (p0.005 and p0.01, respectively). A significant decrease over time for 5/6 dimensions of the NHP score was also noted: pain (p0.01), physical mobility (p0.05), emotional reactions (p0.05), social isolation (p0.05), and energy (p0.05). We observed no adverse event, and no vertebral fracture has occurred after 6 months of followup.Percutaneous vertebroplasty is a useful and safe procedure for treating persistent painful osteoporotic fractures. Controlled studies with longterm followup are required.

Except for instability, a variety of causes has been described in the painful shoulder. A thorough clinical examination may help establish the cause of shoulder pain. Even if modern imaging modalities (ultrasonography, computed tomography, MR imaging) allowed a precise diagnostic and therapeutic approach, plain radiographs are still necessary. Performed by an experienced radiologist, ultrasonography may be useful for the assessment of rotator cuff tears which are a common problem. CT arthrography and MR imaging are only recommended in preoperative assessment. In calcific tendinitis plain radiographs provide evidence of calcifications. It is not difficult to establish clinically the diagnosis of adhesive capsulitis and arthrography is the only technique to reveal the articular capacity limitation reliably. In degenerative osteoarthritis of the glenohumeral joint, CT arthrography is necessary to assess the rotator cuff changes and lenoid osseus findings before undergoing shoulder arthroplasty.

To gain information on bone architecture by performing bone texture analysis in a sample of women covering a broad age range.We studied 29 healthy women aged 23 to 80 years (55 +/- 18 years), 19 of whom were postmenopausal. None was taking drugs known to influence bone mass or bone metabolism. Computed tomography of the nondominant distal radius was performed with 1 mm slice thickness and 1 mm gap. Four consecutive coronal and four consecutive axial sections were selected for each patient and entered into a PC-type computer. Bone texture was evaluated using grey level run length analysis (five parameters), differential local variation analysis (four parameters), fractal analysis (two parameters), trabecular network extraction and three-dimensional relief characterization. The mean of each study parameter for the four coronal sections and for the four axial sections was calculated. Absorptiometry was done in 16 patients.Linear correlations with age were strongest (P0.001) for parameters measured on coronal sections by trabecular network extraction, i.e., trabecular bone volume (r = -0.68), trabecular plate separation (r = -0.65), total skeletal length (r = -0.71), number of nodes (r = 0.73), number of node-node segments (r = -0.74) and trabecular bone pattern factor (r = 0.71). Also, these parameters were significantly different between premenopausal women (33 +/- 9 years) and postmenopausal women (67.3 +/- 9 years). Correlations between bone mineral density and texture parameters were few in number and modest in strength, suggesting that the parameters measured may reflect bone structure rather than bone mass.Bone texture in women undergoes changes with advancing age that may reflect alterations in bone microarchitecture.

Palmoplantar pustulosis and severe acne are sometimes associated with aseptic skeletal lesions, but such skeletal conditions can be observed without skin lesions. The acronym SAPHO (Synovitis, Acne, Palmoplantar pustulosis, Hyperostosis, Osteitis) has been suggested for this cluster of manifestations. The most frequent site of the disease is the upper anterior chest wall, characterized by predominantly osteosclerotic lesions, hyperostosis, and arthritis of the adjacent joints. Osteosclerosis of the vertebral bodies, hyperostosis, and erosions of the vertebral plates can be encountered. Unilateral sacroiliitis of frequently observed. Long bone involvement consists of osteosclerosis or osteolysis with periosteal new bone formation. Peripheral arthritis is rarely associated with joint destruction. The pathogenesis of this syndrome remains unknown, but a link with seronegative spondylarthropathies is probable. Awareness of the SAPHO syndrome should facilitate proper diagnosis and treatment.

A case of destructive vertebral and discal lesions in a patient with chronic, noninfected rupture of an abdominal aortic aneurysm is reported. The main rheumatic manifestations of abdominal aortic aneurysms are reviewed. Perianeurysmal inflammation may contribute to the development of destructive vertebral and discal lesions.

L’incidence des infections osteoarticulaires de l’enfant est mal connue. Objectif Determiner l’incidence des infections osteoarticulaires (IOA) de l’enfant dans la region Nord-Pas-de-Calais. Methodes Etude regionale descriptive, prospective, multicentrique sur 1 an (juillet 2008-juin 2009) des IOA des enfants Resultats 58 IOA ont ete identifiees (30 arthrites septiques, 24 osteomyelites et 4 spondylodiscites). L’exhaustivite du recueil prospectif etait de 90 %. L’incidence corrigee des IOA etait de 7,1/100 000 enfants Conclusion L’incidence corrigee des infections osteoarticulaires dans la region Nord-Pas-de-Calais etait de 7,1/100 000 enfants

Objectifs Faire le point sur la technologie actuelle des capteurs plans ainsi que sur les fonctions avancees potentiellement interessantes dans le cadre d’une activite d’urgences. Presenter la place possible d’un capteur plan au sein d’un service de radiologie d’urgences. Presenter la problematique du choix d’un capteur plan en fonction de l’activite devolue a la salle. Presenter les differents choix possibles de configurations d’une salle capteur plan. Messages a retenir L’implantation de salles capteurs plans au sein de plateaux techniques d’imagerie d’urgences apparait comme une evolution ineluctable de l’imagerie conventionnelle. Le choix d’une salle capteur plan pour une activite d’urgence est un choix complexe qui doit prendre en compte : l’activite ciblee pour la salle de radiologie, l’integration de cette salle au sein du plateau technique (autres salles de radiologies, proximite d’un scanner…). Le choix d’une salle capteur plan dans des indications ciblees peut permettre une augmentation de la productivite. Resume La numerisation est aujourd’hui incontournable avec le developpement des PACS. Deux options se presentent pour la radiographie numerique : les ecrans radio-luminescents a memoire et les capteurs plans. Le choix d’une salle capteur plan depend de la reponse a certaines questions. Il convient notamment de definir le type d’activite devolue a la salle en fonction de son integration au sein du plateau technique ainsi que la necessite eventuelle de certaines applications avancees. De ces reponses decouleront le choix technologique du capteur plan, la configuration et l’implantation materielle de la salle de radiologie.