Rob Campbell

Clinical indications for musculoskeletal ultrasound: A Delphi-based consensus paper of the European society of musculoskeletal radiology

AbstractObjectiveTo develop clinical guidelines for musculoskeletal ultrasound (MSKUS) referral in Europe.MethodsSixteen musculoskeletal radiologists from seven European countries participated in a consensus-based interactive process (Delphi method) using consecutive questionnaires and consensus procedure meetings at several European radiology meetings. The evaluation of musculoskeletal diseases was established by literature reviews, followed by consensus on clinical utility in three consensus meetings. This involved a thorough, transparent, iterative approach which including interview, questionnaire, Delphi and standard setting methodologies. European MSK radiologists with a special interest in MSKUS formed two different expert groups who worked on reaching a consensus in the first two meetings. The third meeting resolved questions that did not achieve a consensus level of 67% using the first two questionnaires.ResultsOn expert consensus, the use of MSKUS is indicated to detect joint synovitis, fluid and septic effusion for potential aspiration, and poorly indicated to detect loose bodies. Recommendations for most appropriate use of musculoskeletal ultrasound are reported in six areas relevant to musculoskeletal ultrasound: hand/wrist, elbow, shoulder, hip, knee and ankle/foot.ConclusionA comprehensive evidence-based, expert consensus-defined educational framework on clinical ultrsound is presented. This should facilitate referrals for this important imaging technique throughout Europe.Key Points• Musculoskeletal ultrasound is indicated for detecting joint synovitis, effusions and fluid collections. • Musculoskeletal ultrasound is poor at detecting loose bodies. • Musculoskeletal ultrasound is relevant for most joints.

Sports-related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury and management

The extensor carpi ulnaris (ECU) muscle plays a key role not only in the active movements of wrist extension and ulnar deviation but also in providing stability to the ulnar side of the wrist. Its position relative to the other structures in the wrist changes with forearm pronation and supination. As such, it must be mobile yet stable. The ECU tendon relies on specific stabilising structures to hold it in the correct positions to perform its different functions. These structures can be injured in a variety of different athletic activities such as tennis, golf and rugby league, yet their injury and disruption is predictable when the mechanics of the ECU and the techniques of the sport are understood. The ECU tendon is also vulnerable to tendon pathologies other than instability. It lies subcutaneously and is easily palpated and visualised with diagnostic ultrasound, allowing early diagnosis and management of its specific conditions. Treatment includes rest, splintage and surgery with each modality having specific indications and recognised outcomes. This review described the functional anatomy in relevant sporting situations and explained how problems occur as well as when and how to intervene.

A radiological technique for the assessment of wear in prosthetic knee replacements.

Abstract Objective. Wear of the polyethylene insert is a well-recognised cause of implant failure in total knee replacements. The purpose of this study was to evaluate a simple, digital fluoroscopic technique for the assessment of wear in knee prostheses. Design.Fluoroscopic images of knee prostheses were produced both of a phantom and in a patient group. Joint space thickness was measured by reference to a known diameter. Measurements were made to assess repeatability of positioning, inter- and intra-observer variance and the effect of angulation. Results. Standard phantom images showed small variation between measurements, high inter-reader correlation (Pearson’s correlation coefficient, r=0.98, P<0.001; coefficient of variation=0.53%) and low intra-reader variation (coefficient of variation=0.57%). Inter- and intra-imager variation were low (coefficient of variation=1.05% and 0.88%, respectively). In the patient group, the range of joint space measurements was 1.9–8.9 mm. The coefficient of variation in insert measurements on repeated images was 2.0%. Repeatability of measurements was 0.2 mm with 99% confidence interval. Conclusions. This technique allows repeatable, precise measurement of insert thickness. The technique may be adapted to any implant where a reliable calibrating distance is present.

Ultrasound of the athletic groin.

Athletic groin pain may be the result of a wide variety of different pathologic processes. Clinical diagnosis may be difficult, and imaging can play a vital role in diagnosis. Magnetic resonance imaging is frequently used as the primary imaging modality. However, ultrasound is the best image modality for dynamic assessment of soft tissue abnormality and for guided intervention. Ultrasound (US) is often used as a problem-solving tool. This article briefly reviews the specific roles for US in management of groin pain in the athlete.

A cholesterol-containing foreign body granuloma presenting as an inter-metatarsal bursa

A 68-year-old man presented with progressive forefoot swelling which coincided with the onset of type 2 diabetes mellitus. Imaging revealed a cystic inter-metatarsal mass containing two foreign bodies, which had been present for many years. Following aspiration of the mass, cholesterol crystals were observed on polarised microscopy. It is postulated that the development of diabetes triggered the shedding of cholesterol crystals around a long-standing quiescent foreign body granuloma.

Microinstability and internal impingement of the shoulder.

Internal impingement refers to entrapment of the rotator cuff and capsulolabral structures between the glenoid and humeral head in certain positions of the shoulder. This may be a normal physiologic phenomenon. However, it may occur as a pathologic process, especially in sports with repetitive overhead activity. The two types of internal impingement are posterosuperior and anterosuperior, with established radiologic manifestations. These conditions were initially thought to be due to repetitive mechanical entrapment. Subsequent observational studies have led to the concepts of microinstability and glenohumeral internal rotatory deficit. Controversy remains regarding the exact pathophysiology, reflected in the variable outcomes in the treatment of these syndromes. The reporting radiologist must be aware of the constellation of image findings to alert the referring physician to the possibility of microinstability and internal impingement.

Pictorial review of wrist injuries in the elite golfer

Golf is growing in popularity, with some 20 million players predicted to be playing in China alone by 2020.1 Its inclusion as an Olympic sport will only serve to increase the sports international profile and popularity. At the pinnacle of the sport is a small group of elite professional golfers who, when compared with amateurs, have more reproducible swing mechanics, and generate greater forces and increased repetitive loads, which are thought to result in differing injury rates and patterns from those of the amateur.2 A study carried out by Hawkes et al 3 on professional golfers reported that the majority of injuries were in the leading wrist, with ulnar-sided injury most common. This article will review the biomechanics, clinical presentation and imaging findings in the commonest wrist injuries encountered by the examining sports physician in the elite golfer. We classify these wrist injuries by the anatomical localisation of symptoms; ulnar-sided, radial-sided and dorsal injuries will be described. The reader is also encouraged to review the YouTube video on wrist examination.4 The wrists link the body to the golf club and form the final component of a kinetic chain—composed of the hips, spine and shoulders—which powers and controls the golf swing. The lead side of the body is generally viewed as being more active during the golf swing, providing power to the golf swing; as a result, it is generally more prone to injury. A detailed analysis of wrist biomechanics during the golf swing is beyond the scope of this paper, and this work has already been described several times previously.5–7 An overview of wrist movement through the swing does, however, provide a useful framework on which to consider pathology. The lead (or non-dominant wrist) begins the golf swing in a position of ulnar deviation when addressing …

ISS outreach report

The 2014 Sub-Saharan African ISS outreach program visited the Department of Radiology of Muhimbili University, Dar es Salaam in Tanzania. The United Republic of Tanzania is the largest country in East Africa and is the 13th largest country in all of Africa. The republic was formed in 1964 with the amalgamation of Tanganyika and the islands of Zanzibar, Peruba, and Mafia in the Indian Ocean. There are over 100 languages spoken by the indigenous population including Kiswahili, Arabic, Kiunguja, and English (Figs. 1, 2, and 3). Tanzania is in the African Great Lakes region. It is bordered to the east by the Indian Ocean, to the west by the Republic of Congo, Zambia, Burundi, Rwanda, and Lake Tanganyika. The northern borders include Uganda, Kenya, and Lake Victoria. To the south, the neighbors include, Zambia, Malawi, and Mozambique. There is a population of 44.9 million, of which approximately 70 % is rural in location. The official capital is the city of Dodoma. However, the port city of Dar es Salaam is the country’s political capital, and principal commercial city, with a population of 4.6 million. Tanzania is a relatively poor country on a par with other sub-Saharan countries. The economy is heavily dependent on agriculture, but with strong mining (gold and tanzanite gems) and construction sectors. In recent years, economic growth has been driven by tourism, telecommunications, and banking. The official poverty rate fell from 38.6 % on 1991 to 33.4 % in 2007. Life expectancy is approximately 61 years. The under-five mortality rate is 54/1,000 births. The leading causes of death in children are pneumonia, malaria, diarrhea, and prematurity. The prevalence of HIV/AIDS is 3.1 %. The literacy rate is estimated at 73 %. Although education is compulsory for 7 years until the age of 15 years, it is estimated that only about 57 % of children between the ages of 5 and 14 regularly attend school. Education up to the secondary school level is free, but those families who can afford it often educate their children in private schools, which are numerous. There are two state medical schools, one in Dar es Salaam and the other in Kilimanjaro. Medicine is a 6-year post-secondary school course and graduates are awarded Bachelor of Medicine and Bachelor of Surgery diplomas. After a 1-year internship, the young doctors have the option of practicing as general practitioners (non-specialists) or going into specialist training. Radiology is a 4-year graduate university course after which the trainees take the MSc degree exam. The graduating radiologists are awarded a Master of Science degree in Radiology. The university campus incorporates the Muhimbili University of Health and Allied Sciences (MUHAS), the Muhimbili

Highlights of the annual scientific meeting of the 19th congress of the European Society of Musculoskeletal Radiology (ESSR) 2012.

The 19th Annual Congress of the ESSR was hosted in the beautiful city of Innsbruck, Austria, in the heart of the Tyrolean Mountains, from 28-30th June 2012. There were more than 500 registrants present from Europe, the Middle East, USA and Australia. The Congress President was Prof. Andrea Klauser of Innsbruck. Professor Judith Adams of Manchester, UK was awarded an ESSR honorary membership. The meeting followed the same format as previous years, with a musculoskeletal ultrasound course followed by a 2-day refresher course. The theme of the meeting was hand and wrist imaging, with other focus sessions on the subjects of trauma, arthritis, metabolic disease, sports injuries and nerve imaging. Seventy-two papers were accepted for oral presentation in the scientific sessions, with an additional 106 abstracts accepted for the electronic poster exhibition. The abstracts for the scientific papers were published in the July 2012 edition of Skeletal Radiology [1]. This article summarizes the highlights of the scientific program.

Highlights of the scientific meeting of the 18th Annual Congress of the European Society of Skeletal Radiology (ESSR) 2011

The 18th Annual Congress of the ESSR was hosted in Greece, on the beautiful island of Crete, 9–11 June 2011, with nearly 500 registrants present. The congress president was Prof Apostolos Karantanas. The meeting followed the same format as previous years with a musculoskeletal ultrasound course on the first day. The remaining 2 days of the meeting comprised the refresher course which concentrated on the topic of bone marrow disorders, with further focus sessions including arthritis, intervention, sports imaging, tumours and advances in MSK imaging. Fifty papers were accepted for presentation in the scientific sessions, with a further 77 papers accepted for the electronic poster exhibition. The abstracts for the scientific papers were published in the June 2011 edition of Skeletal Radiology [1]. This article summarises the highlights of the scientific program.