Mark W. Anderson

Fluoroscopically Guided Low-Volume Peritendinous Corticosteroid Injection for Achilles Tendinopathy: A Safety Study

BACKGROUND The safety and efficacy of corticosteroid injection for the treatment of Achilles tendinopathy is not known, with some reports indicating the hazard of tendon rupture and others extolling the efficacy of such injections. This study was undertaken to assess the safety of fluoroscopically guided corticosteroid injections into the peritendinous space for the treatment of Achilles tendinopathy. METHODS A series of patients was treated with fluoroscopically guided corticosteroid injections into the space surrounding the Achilles tendon. Major and minor complications were recorded, as were the number of repeat injections, the duration of symptomatic relief attained with the injection, and a subjective rating of symptoms related to the Achilles tendon. RESULTS Of eighty-three patients who had been treated, seventy-eight were available for follow-up and forty-three met our requirement for a minimum two-year follow-up (average duration of follow-up, 37.4 months). No major complications and one minor complication occurred in the forty-three patients. Seventeen (40%) of the patients reported improvement after the procedure, twenty-three (53%) thought that their condition was unchanged, and three (7%) felt that their condition was worse than it had been prior to the injection. CONCLUSIONS This retrospective cohort study establishes the safety of low-volume injections of corticosteroids for the treatment of Achilles tendinopathy when the needle is carefully inserted into the peritendinous space under direct fluoroscopic visualization.

MR imaging of the meniscus.

It should be the goal of any radiologist who interprets MRI examinations of the knee to be able not only to recognize normal meniscal anatomy and accurately diagnose meniscal pathology, but also to develop a better grasp of the surgical implications of the imaging findings. By thinking more like an arthroscopist, one can provide a more clinically relevant report, and by doing so, add value to the work-up of a patient who presents with a potential meniscal tear.

Chondral Injury After Arthroscopic Meniscal Repair Using Bioabsorbable Mitek RapidLoc Meniscal Fixation

Arthroscopic meniscal repair is a commonly performed procedure in clinical practice. With improvements in bioabsorbable implants, all-inside techniques have increased in popularity. The Mitek RapidLoc meniscal fixation implant may be used to fix reparable meniscal tears arthroscopically without requiring an additional incision. We report 2 potential complications associated with this implant: chondral injury causing femoral grooving and recurrent meniscal tear 4 months after initial surgery.

Overhead Throwing Injuries of the Shoulder and Elbow

Injuries to the shoulder and elbow are common in athletes involved in sporting activities that require overhead motion of the arm. An understanding of the forces involved in the throwing motion, the anatomic structures most at risk, and the magnetic resonance imaging appearances of the most common associated injuries can help to improve diagnostic accuracy when interpreting imaging studies in these patients.

Spinal Sonography and Magnetic Resonance Imaging in Patients with Repaired Myelomeningocele: Comparison of Modalities

The goals of this study were to evaluate the feasibility of using ultrasonography of the spine in the follow‐up evaluation of patients with repaired myelomeningocele at birth and to compare sonography with the accepted modality of magnetic resonance imaging. Over a period of 4 years we performed 165 sonographic studies in 101 patients; 107 sonographic studies had MR imaging results for comparison. We collected our data prospectively. The quality of the sonograms was good in 110 of 129 studies, acceptable in 17 of 129, and poor in two of 129. The sonographic examinations failed in 33 of 165 studies (20%). Concordant information was obtained between ultrasonography and magnetic resonance imaging in the following percentage of studies: level of the distal end of the cord in 82%, position of the cord in the canal in 59%, presence of hydromyelia in 63%, cord duplication in 96%, adhesions in 16%, intradural mass in 37%, cord measurements in 85%, and dural sac measurements in 83%. At the lumbosacral level, we saw no cord pulsation in 57% of the studies in patients with cord adhesions and in 20% of those without adhesions. At the lower thoracic level, we saw no pulsation in 35% of the studies in patients with cord adhesions and in 7% of those without adhesions. Postoperative studies of cord release surgery in eight patients showed varied findings. We conclude that in those patients who have a spinal defect or interlaminar space allowing proper visualization of the lumbosacral spinal canal, ultrasound can provide fairly similar information to that obtained with magnetic resonance imaging of that area with no need for sedation and at a reduced cost. Ultrasonography seems more sensitive than magnetic resonance imaging in the detection of cord adhesions, which is particularly relevant in the diagnosis of tethering.

Magnetic resonance imaging of the wrist

MR imaging of the wrist has the unique capability of simultaneously demonstrating bone and soft tissue structures. Its exquisite sensitivity for detecting bone marrow edema makes it and ideal screening tool for diagnosing radiographically occult osseous injuries and areas of AVN. This, together with its ability to provide a comprehensive, non-invasive assessment of the ligaments, tendons, nerves, and components of the TFC make MRI a very powerful tool for evaluating patients with wrist pain of uncertain etiology. Its exact role in the work-up of these patients has not been entirely established, but with further advances in technology and the radiologists understanding of wrist anatomy and pathology, MRI is assuming a more central role in this clinical setting.

Treatment of Posttraumatic Adhesive Capsulitis of the Ankle: A Case Series

Background: Adhesive capsulitis of the ankle is a challenging diagnostic and therapeutic problem. Limited information concerning diagnosis and treatment is available in the musculoskeletal literature. Methods: This study retrospectively reviewed a series of patients treated with corticosteroid injections or arthroscopic debridement of posttraumatic adhesive capsulitis of the ankle. The Foot Function Index was used to assess the final treatment outcomes. Results: Forty-one patients with chronic posttraumatic ankle pain were identified. Five were confirmed to have posttraumatic adhesive capsulitis by arthrogram. Four of the five patients failed to respond to steroid injections and three had arthroscopic surgery. Foot Function Index scores indicated that two of these patients treated with arthroscopic debridement had improved function. Conclusions: Results of small series and information from the literature suggest that intra-articular injection of corticosteroid followed by arthroscopic synovectomy and scar resection can be effective as treatment for posttraumatic adhesive capsulitis of the ankle.

Intra-articular migration of a sutureless arthroscopic rotator cuff fixation device

Rotator cuff tears are a common orthopaedic condition. Recent new advances in arthroscopic equipment and devices has allowed many rotator cuff tears to be repaired arthroscopically. Some of these newer devices allow sutureless repair of rotator cuff tears. We report a case of failure in intra-articular migration of such a fixation device. Displacement of the device was noted 4 months after surgery on magnetic resonance arthography. The device was removed arthroscopically with no long-term sequelae. Nevertheless, it is important to recognize that these devices have the potential for intra-articular migration. Due diligence is required in placing these devices. As with all arthroscopic procedures, there appears to be a learning curve associated with the use of sutureless rotator cuff repair fixation devices.

Intraneural perineurioma of the sciatic nerve: An under-recognized nerve neoplasm with characteristic MRI findings

Intraneural perineurioma is a benign peripheral nerve neoplasm that typically affects teenagers and young adults and tends to result in a motor-predominant neuropathy. The lesion is rare, but has likely been underdiagnosed due to a lack of familiarity among both clinicians and radiologists. There have been few reports in the radiology literature despite the lesion having a fairly characteristic imaging appearance. We report a case of a 26-year-old woman with an intraneural perineurioma of the left sciatic nerve confirmed with excisional biopsy and pathologic analysis.

Massive Rotator Cuff Tear in an Adolescent Athlete: A Case Report

Full-thickness rotator cuff tears in the young athlete are a rare injury. These injuries typically result from an acute traumatic event in a contact athlete, as opposed to overuse injuries more commonly seen in throwing athletes. Acute tears may be initially overlooked, with the symptoms attributed to other, more common causes, such as cuff contusion or brachial plexus neuropraxia (“stinger” or “burner”). If undiagnosed, the tear may progress to an irreparable state at the time of eventual diagnosis. Therefore, rotator cuff tear must be included in the differential for acute shoulder injuries in the young athlete. This article presents a case of an adolescent athlete with a traumatic, massive rotator cuff tear that was diagnosed and managed promptly with excellent outcome.