Jean Jose

Glenohumeral Findings on Magnetic Resonance Imaging Correlate With Innings Pitched in Asymptomatic Pitchers

Background: In recent years, there has been a documented increase in the number of professional baseball players on the disabled list and the total number of days on the disabled list. Pitchers account for the largest number of disabled list reports. Purpose: To examine the relationship between magnetic resonance imaging (MRI) findings in asymptomatic professional pitchers and subsequent time on the disabled list (DL). Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: A total of 21 asymptomatic professional pitchers from a single Major League Baseball (MLB) organization underwent preseason MRIs of their dominant shoulder from 2001 to 2010. Asymptomatic was defined as no related DL stays in the 2 seasons before the MRI. These studies were reevaluated by a fellowship-trained musculoskeletal radiologist who was blinded to patient name, injury history, and baseball history. A second investigator who was blinded to the MRI results collected demographic data, total career number of innings pitched, and any subsequent DL reports for each subject. Results: The mean age at the time of MRI was 29.04 years (range, 20-39 years). Eleven of 21 pitchers had a rotator cuff tear (RCT): 9 had an articular surface tear (AST), and 2 had a full-thickness rotator cuff tear (FTT). Ten had superior labral anterior posterior (SLAP) tears, and 13 had either anterior or posterior labral tears. There was a statistically significant relationship between the number of innings pitched and presence of an RCT (AST + FTT). The mean number of career innings pitched by those with an RCT was 1014 compared with a mean of 729 innings pitched in pitchers without an RCT (P < .01). In addition, the number of career innings pitched was moderately correlated with presence of RCT (r = 0.46) and presence of superior and anterior/posterior labral tears (r = 0.43). There were no statistically significant findings between any single preseason MRI finding and subsequent time on the DL. Conclusion: The MRI findings in asymptomatic MLB pitchers do not appear to be related to near future placement on the DL. However, there was a significant difference in numbers of innings pitched between pitchers who had an RCT and those who did not and a moderate correlation between innings pitched and the presence of RCT as well as the presence of labral lesions. This finding supports the notion that RCT and labral injury in pitchers may result from repetitive overhead motion with subsequent strain on the rotator cuff tendons and glenoid labrum. Asymptomatic shoulder lesions in professional baseball pitchers appear to be more frequent than previously thought.

Ultrasound-guided aspiration of symptomatic intraneural ganglion cyst within the tibial nerve

Intraneural ganglia are rare non-neoplastic cysts caused by the accumulation of thick mucinous (mucoid) fluid within the epineurium of peripheral nerves, encased in a dense fibrous capsule [1, 2]. These cysts cause compression of adjacent nerve fascicles, resulting in leg paresthesias, pain, weakness, muscle denervation, and atrophy [3]. The peroneal (fibular) nerve at the level of the fibular neck is most commonly affected [4–6]. Involvement of other peripheral nerves surrounding articular surfaces (including the radial, ulnar, median, sciatic, tibial and posterior interosseous nerves) has been previously described [6–21]. Tibial intraneural ganglia in the knee region are particularly rare, with fewer than 15 reported cases in the literature [2, 8–15]. Although their ultrasound (US) and magnetic resonance imaging (MRI) appearance has been previously documented [8–15, 22], to our knowledge no one has reported the ultrasound-guided aspiration of a symptomatic intraneural ganglion cyst within the tibial nerve.

Use of Ultrasonography as a Diagnostic and Therapeutic Tool in Sports Medicine

Ultrasonography has many important advantages over other imaging modalities and many important applications in sports medicine. This article presents an evidence-based discussion of the use of ultrasound technology to diagnose and treat common musculoskeletal disorders, with emphasis on the shoulder, elbow, hip, knee, and foot and ankle. Topics include basic principles, scan artifacts, the appearance of musculoskeletal structure characteristics and pathologies, and various diagnostic and therapeutic applications in sports medicine.

Imaging of Tarsal Navicular Disorders A Pictorial Review

The tarsal navicular is a bone within the midfoot that plays a critical role in maintaining the arch of the foot. This bone is clinically relevant because it may be affected by a wide array of pathologies. Our approach includes a detailed description of the imaging characteristics and disorders affecting the tarsal navicular. Organization includes (a) normal imaging, (b) accessory ossicles, (c) coalition, (d) fractures, (e) Kohler’s disease, (f) osteonecrosis, (g) osteochondral lesions, (h) arthropathies, and (i) tumors. The purpose of this article is to discuss normal variants and pathological processes that can affect the tarsal navicular, with emphasis on the often-overlooked imaging findings.

Sonographically Guided Therapeutic Injection for Primary Medial (Tibial) Collateral Bursitis

The purpose of this article is to describe a sonographically guided technique to perform therapeutic injection into the medial collateral ligament bursa. Scans are performed using a high‐frequency linear transducer with the scan plane corresponding to the anatomic coronal plane. The transducer is positioned along the medial aspect of the knee; a 25‐gauge needle is placed along the inferior border of the bursa; and a standardized therapeutic mixture (anesthetic and long‐active corticosteroid) is injected. Distention of the bursa is the determining factor for a successful injection. Sonography allows confirmation of correct injection placement, resulting in increased accuracy and more successful patient outcomes.

The utility of ultrasound in the assessment of traumatic peripheral nerve lesions: report of 4 cases

Ultrasound technology continues to improve with better image resolution and availability. Its use in evaluating peripheral nerve lesions is increasing. The current review focuses on the utility of ultrasound in traumatic injuries. In this report, the authors present 4 illustrative cases in which high-resolution ultrasound dramatically enhanced the anatomical understanding and surgical planning of traumatic peripheral nerve lesions. Cases include a lacerating injury of the sciatic nerve at the popliteal fossa, a femoral nerve injury from a pseudoaneurysm, an ulnar nerve neuroma after attempted repair with a conduit, and, finally, a spinal accessory nerve injury after biopsy of a supraclavicular fossa lesion. Preoperative ultrasound images and intraoperative pictures are presented with a focus on how ultrasound aided with surgical decision making. These cases are set into context with a review of the literature on peripheral nerve ultrasound and a comparison between ultrasound and MRI modalities.

Symptomatic Ganglion Cyst of the Popliteus Tendon Treated With Ultrasound-Guided Aspiration and Steroid Injection A Case Report

Ultrasound-guided aspiration of symptomatic ganglion cysts about peripheral joints is a valuable and routinely performed therapeutic modality. Intratendinous and peritendinous ganglia involving the popliteus tendon are rare, with only 3 cases previously reported. These ganglion cysts are usually small and can easily be mistaken for normal anatomy on magnetic resonance imaging (ie, small periarticular vessel or fluid within the popliteus tendon sheath), leading to delayed patient diagnosis and appropriate treatment.

Benign and malignant tumors of the foot and ankle

Pain and focal masses in the foot and ankle are frequently encountered and often initiate a workup including imaging. It is important to differentiate benign lesions from aggressive benign or malignant lesions. In this review, multiple examples of osseous and soft tissue tumors of the foot and ankle will be presented. Additionally, the compartmental anatomy of the foot and ankle will be discussed in terms of its relevance for percutaneous biopsy planning and eventual surgery. Finally, a general overview of the surgical management of benign, benign aggressive and malignant tumors of the foot and ankle will be discussed.

Ultrasound-guided needle localization of the saphenous nerve for removal of Neuroma in the infrapatellar branches: Technical report

BACKGROUND Neuromata formation in the infrapatellar branch of the saphenous nerve (IPBSN) has been well described as a potential complication of arthroscopic knee surgery and knee trauma. Resection has been proven to provide improvement of pain and increased range of motion. Currently, physical examination and surgical exploration based on anatomic landmarks are the standard for intraoperative localization of IPBSN neuromas. OBJECTIVE To demonstrate the anatomy of the IPSBN and the use of preoperative ultrasound and needle placement for localization of the nerve before sectioning. METHODS Using both anatomic dissections and the combination of preoperative ultrasound and curved-needle placement, we demonstrate the technical nuances to localize the IPBSN before operative section. RESULTS Cadaveric dissection is used to illustrate the main trunk of the IPSBN and its branches. In 2 cases, ultrasound guidance was effectively used to localize the saphenous nerve and its branches and facilitate the operative treatment of patients with symptomatic IPBSN neuromas. CONCLUSION Ultrasound is a widely accepted and commonly utilized imaging modality; however, in this report, ultrasound-guided needle localization was used to aid in the resection of neuromas of small, painful sensory nerves.

MRI Evaluation of the Anterolateral Ligament of the Knee In The Setting of ACL Rupture.

Objectives: The anterolateral ligament (ALL) of the knee was recently described in the literature. It was hypothesized to help control internal tibial rotation and affect the pivot shift phenomenon. The purpose of this study was to identify the normal appearance of the ALL on magnetic resonance imaging (MRI) and to examine its role in stability of the knee. Methods: A retrospective chart review was performed and 50 patients from a single surgeon’s practice with full thickness anterior cruciate ligament tears over a 2 year period were selected at random. Operative reports detailing the pivot shift examination under anesthesia were documented. Preoperative MRIs were reviewed by a fellowship trained musculoskeletal radiologist. Axial, sagittal, and coronal cuts were used to identify the presence and degree of injury to the ALL (Grade 0-3). The popliteus tendon, lateral collateral ligament, biceps femoris tendon, and iliotibial band were analyzed and graded 0-3. The presence or absence of a Segond fracture was noted. Results: The ALL was identified in 100% of the anterior cruciate ligament deficient knees evaluated. In 27 knees, there was no MRI evidence of ALL injury (Grade 0). A grade 1 injury was noted in 18 knees. A grade 2 injury was noted in 2 knees. A grade 3 injury was observed in only 1 knee. This was the same knee in which the single Segond fracture among the group was noted. Eighty four percent (42/50) of knees showed a positive pivot shift on examination under anesthesia. A positive pivot shift was noted in 37 patients who had no (Grade 0) or mild (Grade 1) ALL injury. Thirteen MRIs showed evidence of injury to the posterolateral corner structures, with 92% (12/13) consisting of mild (Grade 1) injuries. Conclusion: The anterolateral ligament of the knee is readily identifiable on MRI. Its structural integrity was maintained in the overwhelming majority of knees with a complete tear of the ACL, both with and without the presence of rotatory instability on examination. We found no correlation between degree of injury to the ALL and degree of instability. The only complete rupture of the ligament was in the setting of complete rupture of the IT band, which supports its identity as an extension of the IT band. Therefore, we propose that the ALL in itself plays a minimal if any role in stability of the knee. Further biomechanical studies are needed to confirm this.