Guillermo Álvarez Rey

Popliteal artery entrapment syndrome in an elite rower: sonographic appearances.

Popliteal artery entrapment syndrome (PAES) occurs when an abnormal anatomic relationship between the popliteal artery and the surrounding musculotendinous structures causes repeated arterial compression with exercise. Popliteal artery entrapment syndrome often affects young sports participants or athletes who have no known cardiovascular risk factors. Symptoms include transient tingling or coldness in the foot, with later intermittent claudication. If diagnosis is delayed, there may be irreversible arterial damage, which can impair viability of the affected limb. We present a case of PAES in a young rower and comment on the diagnostic findings with duplex color Doppler sonography, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and arteriography as well as on the course of the syndrome after treatment with intra-arterial thrombolysis and corrective surgery. We present sonographic descriptions of the 3 different pathologic stages of this entity.

New technologies applied to ultrasound diagnosis of sports injuries

IntroductionThe aim of this study was to compare the ultrasound images of different soft tissue lesions from two different portable sonography devices: a conventional portable sonography device (ultrasound [US]-A, Micromaxx model; Sonosite Inc., Bothell, WA, USA), and a recently marketed compact device (US-B, Logiq e; General Electric Healthcare, Wauwatosa, WI, USA). The US-B device uses the new technologies of tissue harmonic imaging, real-time compound ultrasound, panoramic view, three-dimensional imaging, and virtual convex imaging.MethodsWe compared ultrasound images of six different types of soft tissue lesions (muscle contusion, muscle strain, patellar tendinosis, calcifying patellar tendinosis, rupture of the lateral internal ligament of the knee, and deep infrapatellar synovial bursa), from six different subjects. Analysis of images was performed by the same ultrasound specialist. In accordance with the classical criteria for ultrasound studies, the following quantitative indicators and parameters of ultrasound quality were used to evaluate the images: degree of echogenicity, size of the lesion area, aspect, shape, borders, and overall visualization.ResultsIn muscle lesions due to contusion, not only is the edematous area better visualized with the new system, but definition of hemorrhagic area borders and their content is especially increased. In lesions of the tendons, the new system affords better definition of the borders of the hypoechogenic area of tendinous degeneration and perfect visualization of the extension of the damaged area using a panoramic study. Sonographic study of ligaments with chronic lesions permits visualization of scar areas. Finally, use of the new system with a small synovial bursa shows the content of the bursa and thickness of the walls more clearly.ConclusionOverall, the quantitative indicators and parameters of image quality performed in this study of common sports lesions demonstrate the improvement in visualization of damaged soft tissues with the new technologies now incorporated into portable sonography devices.

Avances técnicos aplicados a la ecografía musculoesquelética de la lesión deportiva

Resumen Metodos Se comparan dos equipos portatiles de ultrasonografia de alta definicion (E-A y E-B). Uno de ellos (E-B) integra en su sistema la imagen armonica, la ecografia compuesta en tiempo real, la vision panoramica, la imagen en 3D y el convex virtual. Se comparan 5 tipos de lesiones: contusion muscular, lesion muscular intrinseca, tendinosis rotuliana, tendinosis calcificante del tendon rotuliano y rotura parcial del ligamento lateral interno de la rodilla. Criterios de valoracion: grado de ecogenicidad, tamano del area de lesion, aspecto, forma, bordes, visualizacion global. Resultados Contusion muscular: con el E-B se visualizan mas las zonas anecoicas e hipoecoicas. Lesion muscular intrinseca: con el E-B se detecta el area hipoecoica de rotura 4 semanas despues de la lesion y se observan vasos sanguineos en este territorio. Tendinosis rotuliana: con el E-B se reduce el efecto anisotropico y mejoran la definicion y los limites de lesion. Tendinosis calcificante del tendon rotuliano: el sistema 3D del E-B permite una mejor valoracion de la disposicion de la calcificacion. Rotura parcial del ligamento lateral interno de la rodilla: con el E-B se localiza tejido fibroso de reparacion en el fasciculo profundo del ligamento. Conclusiones Los nuevos sistemas integrados en los equipos de ultrasonografia portatil mejoran la visualizacion de los tejidos lesionados. En las lesiones musculares se incrementa la definicion de las areas de sangrado y de su contenido. En las lesiones musculares por distraccion, se prolonga en el tiempo de visualizacion de la lesion y la hipervascularizacion. En las lesiones tendinosas se delimitan mejor los bordes de degeneracion tendinosa y su extension lesional. El sistema 3D define con gran exactitud la invasion del deposito calcico del interior de las fibras tendinosas. En la lesion del ligamento se visualizan las zonas cicatriciales.

Spanish Consensus Statement: Clinical Management and Treatment of Tendinopathies in Sport:

On October 15, 2016, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of the Spanish Society for Sports Traumatology (SETRADE), the Spanish Society of Sports Medicine (SEMED), the Spanish Association of Medical Services for Football Clubs (AEMEF), the Spanish Association of Medical Services for Basketball Clubs (AEMB), F.C. Barcelona, and Clínica CEMTRO. The purpose was to consider the most appropriate clinical management and treatment of tendinopathies in sports, based on proven scientific data described in the medical literature as well as on each expert’s experience. Prior to the meeting, each expert received a questionnaire regarding clinical management and treatment of tendinopathies in sports. The present consensus document summarizes the answers to the questionnaire and the resulting discussion and consensus regarding current concepts on tendinopathies in sports.

Spanish Consensus Statement The Treatment of Muscle Tears in Sport

On the 21st of March, 2015, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of The Spanish Society for Sports Traumatology (SETRADE), The Spanish Federation of Sports Medicine (FEMEDE), The Spanish Association of Medical Services for Football Clubs (AEMEF), and The Spanish Association of Medical Services for Basketball Clubs (AEMB) with the aim of establishing a round table that would allow specialists to consider the most appropriate current general actions to be taken when treating muscle tears in sport, based on proven scientific data described in the medical literature. Each expert received a questionnaire prior to the aforementioned meeting comprising a set of questions concerning therapeutic indications generally applied in the different stages present during muscle repair. The present Consensus Document is the result of the answers to the questionnaire and resulting discussion and consensus over which are the best current indications in the treatment of muscle tears in sport. Avoiding immobilization, not taking nonsteroidal anti-inflammatory drugs (NSAIDs) randomly, fostering early mobilization, increasing vascularization of injured, site and regulating inflammatory mechanisms—without inhibiting these from the early stages of the recovery period—all stood out as main points of the Consensus Document. Additionally, there is controversy concerning cell stimulation techniques and the use of growth factors or cell inhibitors. The decision concerning discharge was unanimous, as was the criteria considered when it came to performing sport techniques without pain.

Codo de tenis (tendinosis epicondílea externa): tratamiento esclerosante ecoguiado con polidocanol. A propósito de dos casos

Dos pacientes (2 varones de 42 y 55 anos) con tendinosis epicondilea externa dolorosa fueron tratados mediante un novedoso tratamiento que se basa en la esclerosis con Polidocanol, un agente esclerosante, ecoguiada con Power Color (PC) mediante Doppler color de polidocanol, un agente esclerosante. Tras el tratamiento se produjo una marcada reduccion del dolor recogida mediante una escala analogica visual (VAS) y desaparicion y disminucion de la vascularizacion en cada caso, respectivamente. El caso 1 era deportista y en la ultima revision se encontraba en fase de readaptacion deportiva, mientras que el caso 2 retomo su actividad laboral abandonada previamente. La esclerosis ecoguiada de los neovasos parece ser un tratamiento efectivo para la tendinopatia epicondilea externa dolorosa cronica, sugiriendo que los neovasos desempenan un papel importante en el origen del dolor cronico del tendon.