Susanne Bensler

Lengthening of the subscapularis tendon as a sign of partial tearing in continuity

BACKGROUND The quantification of a subscapularis tendon lesion may be difficult on magnetic resonance imaging, as well as during arthroscopic inspection. Consequently, the surgical decision of whether to only debride a degenerated tendon or to lateralize the more intact tendon portion may be arbitrary. This study aims to quantify the length of the subscapularis tendon as a sign of partial tendon tearing. METHODS We retrospectively identified 92 magnetic resonance arthrography studies of suspected rotator cuff lesions obtained 3 months before shoulder arthroscopy. The myotendinous junction was identified, and the subscapularis tendon and muscle lengths were measured. Findings on arthroscopy performed later were used as the diagnostic gold standard for tendon integrity and compared with the magnetic resonance data. RESULTS Arthroscopy showed an intact subscapularis tendon in 43 patients, tendinopathy in 21 patients, and a partial rupture in 28 patients. The mean subscapularis tendon lengths were 40 mm in cases of intact subscapularis musculotendinous units, 45 mm in cases of tendinopathy, and 53 mm in cases of partial tears, whereas the mean subscapularis muscle lengths were 105 mm, 94 mm, and 95 mm, respectively, in these groups. CONCLUSION Partial tears of the subscapularis tendon lead to muscle shortening by approximately 10% and elongation of the tendon by approximately 32%, which may be interpreted as muscle retraction and a tendon rupture in continuity. If the subscapularis tendon has an apparent length of greater than 60 mm, the probability of a tear is 98%. Determination of the tendon length may therefore be a useful additional tool to quantify the integrity of the subscapularis tendon and degree of myotendinous retraction.

Reliable semiquantitative whole-joint MRI score for the shoulder joint: The shoulder osteoarthritis severity (SOAS) score: MRI Shoulder OA Score: SOAS

Shoulder osteoarthritis causes severe pain and functional disability. Preventive surgical procedures aiming to halt the progression of degenerative changes are increasingly applied. However, no MRI‐based score exists that may be applied for scoring of osteoarthritic changes and their progression.

Pincer-type MRI morphology seen in over a third of asymptomatic healthy volunteers without femoroacetabular impingement: Hip: Pincer FAI in Asymptomatic Volunteers

In daily routine, pincer femoroacetabular impingement (FAI) findings are often seen without a clinical diagnosis of pincer FAI.

CAIPIRINHA-accelerated 10-min 3D TSE MRI of the ankle for the diagnosis of painful ankle conditions: Performance evaluation in 70 patients

ObjectivesTo test the hypothesis that MRI of the ankle with a 10-min 3D CAIPIRINHA SPACE TSE protocol is at least equivalent for the detection of painful conditions when compared to a 20-min 2D TSE standard of reference protocol.MethodsFollowing institutional review board approval and informed consent, 70 symptomatic subjects underwent 3T MRI of the ankle. Six axial, sagittal and coronal intermediate-weighted (IW) and fat-saturated T2-weighted (T2FS) 2D TSE (total acquisition time, 20 min), and two sagittal isotropic IW and T2FS 3D CAIPIRINHA TSE (10 min) pulse sequence prototypes were obtained. Following randomization and anonymization, two musculoskeletal radiologists evaluated the 2D and 3D datasets independently. Descriptive statistics, inter-reader reliability, inter-method concordance, diagnostic definitiveness tests were applied. P-values < 0.05 were considered significant.ResultsRaters diagnosed 116 cartilage defects with 2D and 109 with 3D MRI, 35 ligament tears with 2D and 65 with 3D MRI, 18 tendon tears with 2D and 20 with 3D MRI, and 137 osseous abnormalities with 2D and 149 with 3D MRI. The inter-reader agreement was high for 2D (Kendall W, 0.925) and 3D MRI (W, 0.936) (p < 0.05), as was the inter-method concordance (W, 0.919). The diagnostic definitiveness of readers was higher for 3D MRI than 2D MRI in 10-27% of the time, while the reverse was true in 7-11% of the time (p < 0.01).ConclusionsThe performance of 10-min 3D CAIPIRINHA SPACE MRI for the detection of painful ankle conditions is similar to that of a 20-min 2D TSE MRI reference standard.Key Points• CAIPIRINHA Acceleration facilitates isotropic 3D MRI of the Ankle in 10 min.• 10-min 3D CAIPIRINHA MRI and 20-min 2D TSE MRI have similar performance.• 3D CAIPIRINHA SPACE MRI afforded higher diagnostic definitiveness of readers.

MRI Assessment of Supra- and Infratrochanteric Femoral Torsion: Association With Femoroacetabular Impingement and Hip Dysplasia

OBJECTIVE The objective of our study was to evaluate a novel measurement technique for assessing the supra- and infratrochanteric components of femoral torsion, establish reference values in healthy volunteers, and compare supra- and infratrochanteric torsion angles in patients with hip dysplasia and patients with femoroacetabular impingement (FAI) with those in healthy volunteers. MATERIALS AND METHODS Femoral torsion was assessed in 380 patients and 61 healthy volunteers on MRI. For assessing supra- and infratrochanteric torsion, three measurement techniques (i.e., Kim, simplified Kim, and centroid methods) were evaluated by two readers on 100 patients. The technique with the highest interreader reliability was selected to perform measurements on all patients and volunteers. Supra- and infratrochanteric torsion angles of patients were stratified by hip disorders, which were diagnosed by specialized hip surgeons, and were compared with reference values of healthy volunteers. Statistical analysis included the independent t test, Mann-Whitney U test, and intraclass correlation coefficient (ICC). RESULTS The centroid method showed the highest interreader reliability for measuring supra-and infratrochanteric torsion with an ICC of 0.979. The supra- and infratrochanteric torsion values of the volunteers were 31.5° ± 7.4° (mean ± SD) and -18.3° ± 9.9°, respectively. In comparison with the volunteers, patients with hip dysplasia had significantly higher supraand infratrochanteric torsion values of 37.5° ± 10.3° (p = 0.001) and -9.6° ± 11.7° (p < 0.001) and patients with pincer-type FAI had significantly higher supratrochanteric torsion values of 37.8° ± 8.0° (p = 0.002). CONCLUSION The supra- and infratrochanteric components of femoral torsion differ substantially between hip disorders: Patients with hip dysplasia have predominantly increased infratrochanteric torsion, whereas patients with pincer-type FAI have increased supratrochanteric torsion. Quantification of separate supra- and infratrochanteric torsion angles allows a more detailed analysis of hip disorders and may influence treatment planning.

Particulate versus non-particulate corticosteroids for transforaminal nerve root blocks: Comparison of outcomes in 494 patients with lumbar radiculopathy

AbstractPurposeWe set out to compare outcomes in CT-guided lumbar transforaminal nerve root block patients receiving either particulate or non-particulate corticosteroids.Materials and methodsThis was a retrospective comparative effectiveness outcomes study on two cohorts of lumbar radiculopathy patients. 321 received particulate and 173 non-particulate corticosteroids at CT-guided transforaminal lumbar nerve root injections. The particulate steroid was used from October 2009 until May 2014 and the non-particulate steroid was used from May 2014. Pain levels were collected at baseline using an 11-point numerical rating scale (NRS) and at 1 day, 1 week and 1 month. Overall ‘improvement’ was assessed using the Patients’ Global Impression of Change (PGIC) at these same time points (primary outcome). The proportions of patients ‘improved’ were compared between the two groups using the Chi-square test. The NRS change scores were compared using the unpaired t-test.ResultsA significantly higher proportion of patients treated with particulate steroids were improved at 1 week (43.2 % vs. 27.7 %, p = 0.001) and at 1 month (44.3 % vs. 33.1 %, p = 0.019). Patients receiving particulate steroids also had significantly higher NRS change scores at 1 week (p = 0.02) and 1 month (p = 0.007).ConclusionParticulate corticosteroids have significantly better outcomes than non-particulate corticosteroids.Key Points• Better pain relief is achieved with particulate steroids. • Significantly more patients report overall ‘improvement’ with particulate steroids. • Significantly more patients report ‘worsening’ at 1 week with non-particulate steroids.