Haron Obaid

Bacterial contamination of ultrasound probes at a tertiary referral university medical center.

OBJECTIVE The purpose of this study was to assess the adequacy of our institutions ultrasound probe-disinfecting protocols, determine compliance with the guidelines, and then implement changes if needed. MATERIALS AND METHODS We first assessed the prevalence of bacterial contamination (and thus the potential for bacterial transmission) by swabbing all ultrasound probes (n = 31) in the radiology department and culturing the samples. Next, in conditions simulating the typical work environment, we determined the efficacy of our probe-disinfecting protocols by seeding probes with 10(4)-10(9) CFU/mL of methicillin-resistant Staphylococcus aureus (MRSA), disinfecting the seeded probes with 0.5% accelerated hydrogen peroxide, and then swabbing the disinfected probes to assess for bacterial growth. RESULTS Seven of 31 (22.6%) probes were positive for bacterial growth--none of which were endocavity probes (0/4). Four of 14 visibly soiled probes (28.6%) showed bacterial growth, and four of seven probes positive for bacteria (57.1%) were visibly soiled. No MRSA grew after seeding probes with MRSA and then disinfecting with 0.5% accelerated hydrogen peroxide. Sonography guidelines and general disinfecting guidelines were reviewed. CONCLUSION Our protocols for disinfecting nonendocavity and endocavity probes are compliant with sonography guidelines and general disinfecting guidelines. Although limited by a small sample size, our study showed that our protocol for disinfecting endocavity probes seems adequate. With a 25.9% bacterial contamination rate for nonendocavity probes, the adequacy of our protocol for disinfecting nonendocavity probes is more debatable; however, this bacterial contamination rate is at the lower end of the values reported in the literature. With the use of an effective disinfectant, education of sonographers, and implemented changes, we hope to decrease bacterial contamination rates and thus decrease the potential for bacterial transmission.

Feasibility of ultrasound‐guided percutaneous tenotomy of the long head of the biceps tendon—A pilot cadaveric study

To describe an ultrasound‐guided proximal percutaneous tenotomy technique of long head of the biceps tendon (LHBT).

Bilateral Ulnar Neuropathy at the Elbow Secondary to Neuropathic Arthropathy Associated With Syringomyelia

Neuropathic arthropathy (NA), also known as Charcot joint, refers to a chronic progressive degenerative arthritis that is associated with an underlying central or peripheral neurologic disorder. The elbow is rarely reported to be involved in NA, but when affected, it is commonly a result of a cervical syrinx or tabes dorsalis. Few reports in the literature describe ulnar neuropathy at the elbow (UNE) associated with NA of the elbow, and none describe bilateral UNE in association with a cervicothoracic syrinx. We present a unique case of bilateral UNE resulting from NA of the elbow associated with a cervicothoracic syrinx.

The role of radiology in the quantification of digital ulnar deviation in rheumatoid arthritis patients.

Rheumatoid arthritis (RA) is a common inflammatory polyarthritis, which causes functional digital ulnar deviation (UD). Radiographic and magnetic resonance imaging (MRI) assessment of the hands is essential in RA, but its role in the quantification of UD remains unclear.

Right thigh pain

Bisphosphonates inhibit bone resorption by inducing apoptosis of osteoclasts, preventing deterioration of the bone microarchitecture and increasing overall bone density, and they reduce the risk of fractures [1]. In 2005, a case series of nine patients by Odvina et al. [2] suggested an association between AFFs and bisphosphonates. A later study by Abrahamsen [3] compared patients with and without bisphosphonate treatment, showing both groups having similar numbers of AFFs. Nevertheless, the Food and Drug Administration authority (FDA) issued a statement in 2010 advising that caution be taken when prescribing bisphosphonates (http:// w w w . f d a . g o v / D r u g s / D r u g S a f e t y / PostmarketDrugSafetyInformationforPatientsandProviders/ ucm203891.htm). A causal relat ionship between bisphosphonates and AFFs remains unclear; however, a recent Swedish publication in the New England Journal of Medicine of a retrospective radiographic analysis of patients on bisphosphonates concluded that chronic bisphosphonate administration is likely an important risk factor for AFF, and the current evidence base weakly supports long-term bisphosphonate use [4]. To date, the hypothesized pathogenesis of these fractures following chronic use of bisphosphonates is reduced bone turnover leading to microtrauma and, eventually, insufficiency fractures [5]. These fractures were first described as “atypical” by Lenart et al. in 2008 [5], as they tend to occur at the points of maximum weight-bearing stress of the femur: the subtrochanteric region and diaphysis. This terminology distinguished AFFs from “typical” osteoporotic fractures that commonly affect the femoral neck and intertrochanteric region. AFFs are incomplete initially and usually seen as an area of cortical beaking, possibly with a radiolucent line, at the lateral cortex of the subtrochanteric region on radiographs in patients with thigh or groin pain [5–8]. Findings may evolve into a complete subtrochanteric fracture. If radiographs are negative or equivocal, a bone scan, MRI or CT is a reasonable alternative. Additionally, imaging of the contralateral femur is warranted as these fractures may be bilateral [9]. The American Society of Bone and Mineral Research (ASBMR) set out major and minor criteria for describing AFFs. Major criteria include a proximal fracture line inferior to the lesser trochanter but proximal to the femoral condyles, no trauma or low-energy trauma, a transverse or oblique The case presentation can be found at doi: 10.1007/s00256-014-2087-z

Lateral heel pain

Baxter’s nerve originates from the lateral plantar nerve near the trifurcation of the posterior tibial nerve at the level of the medial malleolus [1–5]. It may also infrequently arise directly from the tibial nerve or at the common origin of the medial calcaneal nerve [5]. It then travels between the abductor hallucis and quadratus plantae muscles before turning laterally to pass anterior to the medial calcaneal tuberosity. From here, it courses between the quadratus plantae and flexor digitorum brevis muscle before innervating the abductor digiti minimi muscle [3, 4]. Two key sites have been identified for Baxter’s nerve entrapments. The nerve is often compressed between the quadratus plantae and abductor hallucis muscle as it turns laterally. It is also commonly compressed as it passes anteriorly to the medial calcaneal tuberosity [1–3]. Compression occurs from either a hypertrophied abductor hallucis muscle, as often seen in long-distance runners, by thickened plantar fascia, inferior calcaneal enthesophytes, or as a result of altered foot biomechanics and internal derangements leading to nerve stretching from the hypermobile foot [2, 3, 6, 7]. Diagnosis is achieved through the use of MRI, which is the preferred imaging modality [8, 9]. T1-weighted spinecho or fast spin-echo sequences can characterize the nerve’s anatomy along with its surrounding structures, while T2-weighted spin-echo or fast spin-echo sequences allow for better identification of edema within the nerve and its surrounding structures [8, 9]. As Baxter’s nerve provides some motor innervations to the flexor digitorum brevis, quadratus plantae and abductor digiti minimi muscles, MRI changes of a denervated muscle can occur as early as 4 days after a traumatic nerve injury [9]. Neurogenic edema may be seen in the subacute phase while muscular atrophy with fatty infiltration may be seen in the chronic phase [9]. One of the hallmark features of Baxter’s neuropathy is fatty infiltration and atrophy of the abductor digiti minimi muscle as seen in Fig. 1 of the case presentation [2–4, 6, 7]. One may also find abductor hallucis muscle hypertrophy, a calcaneal enthesophyte (Fig. 2 of the case presentation), surrounding soft tissue edema (Fig. 1 and Fig. 3 of the case presentation), and potential cofounding signs of plantar fasciitis on MRI [7]. One study suggests that Baxter’s neuropathy may account for an upward of 20 % of heel pain [3]. As Baxter’s nerve provides sensory innervation to the long plantar ligament and calcaneal periosteum, patients with Baxter’s neuropathies typically present with medial heel pain that is often difficult to distinguish from plantar fasciitis [2, 3, 6, 7]. Other symptoms may include paresthesia along the lateral third of the sole of the foot and the characteristic abductor digiti minimi muscle weakness [2, 3]. The differential diagnosis includes plantar fasciitis, Achilles tendinosis, painful heel pad syndrome, bone tumors, heel spur fracture, calcaneal stress fracture, and bursitis among others [3, 5]. Overall, conservative treatment is often sufficient for Baxter’s neuropathy and is nearly identical to the treatment The case presentation can be found at doi: 10.1007/s00256-013-1598-3

Femoroacetabular impingement: a consideration in younger adults with hip pain

A 32-year-old woman with a family history of rheumatoid arthritis was referred to a rheumatology clinic with symptoms of right knee and hip discomfort. These joint symptoms had been progressive over the last 10 or more years. Her symptoms were predominantly mechanical rather than inflammatory in

Posterior ankle labral changes at MRI: A preliminary study

The transverse ligament in the ankle joint has been described as a labrum‐like structure in a previous cadaveric study. The purpose of this study is to assess the spectrum of abnormal changes related to this structure on imaging/MRI, and correlate these findings with other ankle joint findings and patient symptoms.