Chiara Martini

Double-needle ultrasound-guided percutaneous treatment of rotator cuff calcific tendinitis: tips & tricks

Rotator cuff calcific tendinitis is a very common disease and may result in a very painful shoulder. Aetiology of this disease is still poorly understood. When symptoms are mild, this disease may be treated conservatively. Several treatment options have been proposed. Among them, ultrasound-guided procedures have been recently described. All procedures use one or two needles to inject a fluid, to dissolve calcium and to aspirate it. In the present article, we review some tips and tricks that may be useful to improve performance of an ultrasound-guided double-needle procedure.

Ultrasound Assessment of the Rotator Cuff Cable: Comparison Between Young and Elderly Asymptomatic Volunteers and Interobserver Reproducibility

Our aim was to characterize rotator cable ultrasound appearance in shoulders of different-aged asymptomatic volunteers, also estimating interobserver reproducibility. We studied 83 shoulders in 42 young volunteers (mean age 26 ± 7.0 years, range 21-35 years) and 66 shoulders in 36 elderly volunteers (65-81 years, 73 ± 4.9 years), noting rotator cable visibility and its minimum thickness and width. Interobserver reproducibility was tested in elderly volunteers by two blinded observers. χ(2), U Mann-Whitney, t-test, Bland-Altman, and κ statistics were used. Rotator cable was less frequently detected in younger than elderly volunteers (25/83 vs. 36/66 shoulders; p = 0.002). Young subjects had thicker (1.5 ± 0.2 mm, range 1.3-1.8 mm vs. 1.1 ± 0.1 mm, 0.9-1.3 mm; p < 0.001) and wider rotator cable (5.8 ± 0.7 mm, 4.5-7.1 mm vs. 4.0 ± 1.2 mm, 2.5-7.1 mm; p < 0.001) than elderly volunteers. Thickness and width reproducibility index were 89% and 94%, respectively; κ = 0.87. Ultrasound demonstrated different rotator cable consistency in younger and elderly asymptomatic patients, with high interobserver reproducibility.

High-resolution ultrasound of the extrinsic carpal ligaments

Thanks to its intrinsic high spatial resolution, ultrasound is an ideal imaging modality for examining very thin, superficial structures, and this makes it very helpful in the evaluation of extrinsic carpal ligaments. These structures, which arise from the radius and ulna and insert on the carpal bones, are extremely important for wrist stability. Previous studies have assessed the use of ultrasound to study the extrinsic carpal ligaments in cadavers, healthy asymptomatic subjects, and patients with rheumatoid arthritis. In the present report, we review the normal anatomy, biomechanics, and ultrasound appearance of these ligaments.

A Visual Computing Approach for Estimating the Motility Index in the Frail Elder

The accurate estimation of frailty is an important objective to assess the overall well-being and to predict the risk of mortality of elderly. Such evaluation is commonly based on subjective quantities both from selfreported outcomes and occasional physicians evaluations, leading to possibly biased results. An objective and continuous frailty screening tool may be more appropriate for routine assessment. In this paper, we present a data driven method to evaluate one of the main aspect contributing to the frailty estimation, i.e. the motility of the subject. To this aim, we define a motility index, estimated following a visual computing approach analysing streams of RGB-D data. We provide an extensive experimental assessment performed on two sets of data acquired in a sensorised facility located within a local hospital. The results are in good agreement with the assessment manually performed by the physicians, nicely showing the potential of our approach.

Designing Assistive Tools for the Market

Abstract In this chapter we consider assistive environments and discuss the possible benefits for an aging population. As a study case we summarize the current state of a research project taking place in collaboration with Galliera Hospital (Genoa, Italy). A protected discharge model is being developed to assist elderly users after they have been dismissed from the hospital and before they are ready to go back home, with the perspective of coaching them towards a healthy lifestyle. We focus in particular on the vision-based modules designed to automatically estimate a frailty index of the patient that would allow physicians to assess the patients health status and state of mind. We contribute to this frailty index by supplying a set of motility features obtained by continuously analyzing the motion patterns of the patient. We show very promising results which have received positive feedback from the geriatricians participating in the project.

Data-Driven Continuous Assessment of Frailty in Older People

The process of aging affects an individuals potential in several dimensions, encompassing the physical, cognitive, psychological, economic, and social domains. The assessment of frailty in elderly patients is key to estimate their overall well-being and to predict mortality risk. In the clinical practice, frailty is usually estimated through medical tests and questionnaires performed sporadically. Continuous automatic assessment may help physicians in evaluating frailty by complementing their assessments with quantitative and non sporadic measurements. In this paper we present the state-of-the-art in frailty evaluation, we summarize recent research achievements that could lead to an improved assessment, and we illustrate a case study we are conducting in our institution. Finally, based on our experience and results, we comment on the open challenges of automatic assessment of frailty.

The Hand: Focused US Anatomy and Examination Technique

There are nine flexor tendons for each hand, a flexor digitorum superficialis and a flexor digitorum profundus for each finger, from the second to the fifth. The thumb is provided with a single flexor tendon only. The flexor digitorum profundus tendon originates from the anterior and medial aspects of the ulna, while the flexor digitorum superficialis tendon has two heads: humero-ulnar and radial. Both muscles originate from long tendons that proximally enter the carpal tunnel and then insert on the fingers. Deep tendons run straight up to the bases of the distal phalanges, where they insert. Superficial tendons run up to the middle of the proximal phalanges, where they split into two branches that surround the deep tendons and insert on the head of the middle phalanges. The superficial and deep tendons have common tendon sheaths. Flexor tendons are kept in place by several fibrous bands referred to as pulleys.