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Seminars in Musculoskeletal Radiology

Athena Plagou, James Teh, Andrew J Grainger, Claudia Schueller-Weidekamm, Iwona Sudoł-Szopińska, Winston Rennie, Gunnar Åström, Antoine Feydy, Chiara Giraudo, Henri Guerini, Giuseppe Guglielmi, Amanda Isaac, Lennart Jans, Anne Grethe Jurik, Franz Kainberger, Mario Maas, Carlo Martinoli, Vasco V Mascarenhas, Falk Miese, Philip O'Connor, Edwin H Oei, Mikkel Østergaard, Philippe Peetrons, Hannes Platzgummer, Monique Reijnierse, Philip Robinson, Mitja Rupreht, Paolo Simoni, Marius C Wick, Anna Zejden, Andrea S Klauser
This article presents the recommendations of the European Society of Musculoskeletal Radiology Arthritis Subcommittee on the use of ultrasonography (US) in rheumatic disease, focused on the examination of joints in the adult population. The recommended examination technique and protocols used in a radiologic work-up are discussed. The main US features that can lead to a final diagnosis in the most common rheumatic diseases are addressed. The differential diagnosis that should be considered at image interpretation is presented...
November 2016: Seminars in Musculoskeletal Radiology
Ambrose J Huang
Osteoid osteomas are small painful benign bone tumors that can be effectively treated by radiofrequency ablation (RFA) in most situations. This article briefly reviews the typical imaging findings of osteoid osteomas and the RFA technique used to treat them at our institution. It concludes with several examples of osteoid osteomas in difficult-to-reach places and the approaches used to access and treat them.
November 2016: Seminars in Musculoskeletal Radiology
Anderanik Tomasian, Adam N Wallace, Travis J Hillen, Jack W Jennings
Percutaneous image-guided ablation has been shown to be safe and effective for the treatment of benign osseous lesions and has evolved into the treatment of metastatic lesions for both pain palliation and local tumor control. Ablation is increasingly becoming part of the treatment algorithm of painful bone lesions, requiring multidisciplinary input from radiation, surgical, and medical oncologists. Substantial pain reduction is often possible in those who have failed to benefit from conventional therapies such as systemic and radiation therapy...
November 2016: Seminars in Musculoskeletal Radiology
Sahlya Djebbar, Ignacio M Rossi, Ronald S Adler
The real-time nature of ultrasound makes it ideally suited to provide guidance for a variety of musculoskeletal interventional procedures involving peripheral nerves. Continuous observation of the needle ensures proper placement and allows continuous monitoring when performing localized ablative therapy and therefore more accurate positioning of a cryoprobe, use of smaller needles, as well as access to small structures. We describe our experience performing cryoablative procedures. Patients undergoing cryoneurolysis have largely reported varying degrees of long-term pain relief and improvement in function; no serious complications have yet been identified...
November 2016: Seminars in Musculoskeletal Radiology
Alberto Tagliafico, Bianca Bignotti, Carlo Martinoli
This article is a practical review update on ultrasound (US)-guided interventional procedures on peripheral nerves. Technical considerations, biopsy techniques, and some examples of injections are described. US is considered a safe imaging guidance for interventional procedures, due to its high spatial resolution and the possibility to image the needle and inject drugs in real time. US-guided injections could be considered a diagnostic and therapeutic option in the most common neuropathy, before or as an alternative to surgery...
November 2016: Seminars in Musculoskeletal Radiology
Ivan R B Godoy, Dean M Donahue, Martin Torriani
Botulinum toxin (BTX) is used for multiple clinical indications due to its ability to induce temporary chemodenervation and muscle paralysis. This property has supported its application in treating a variety of musculoskeletal conditions, especially those involving muscular hyperactivity and contractures such as cerebral palsy and dystonia. However, off-label use of BTX injection in other musculoskeletal disorders is gaining increased acceptance, such as in neurogenic thoracic outlet syndrome, epicondylitis, and shoulder pain after stroke...
November 2016: Seminars in Musculoskeletal Radiology
Gajan Rajeswaran, Jeremiah C Healy, Justin C Lee
Trigger digit and carpal tunnel syndrome are both conditions traditionally treated with open surgery but are potentially amenable to curative treatment using percutaneous techniques. The advantages of minimally invasive techniques are lower risk of wound breakdown and infection, quicker healing, reduced postprocedural pain, reduced complications, and a quicker return to normal activity. The advent of high-resolution ultrasound has allowed percutaneous release procedures for these conditions to be developed and performed with a potential for a reduced risk of complications and an increased likelihood of success...
November 2016: Seminars in Musculoskeletal Radiology
Kenneth S Lee
Platelet-rich plasma injection is a minimally invasive treatment method for common overuse tendon injuries. This article discusses the biology of platelet-rich plasma (PRP), the healing cascade that PRP promotes, and how PRP composition may differ depending on centrifuge method. It also highlights the common uses of PRP tendon injection and offers an update on the most current clinical evidence-based literature.
November 2016: Seminars in Musculoskeletal Radiology
Jon A Jacobson, Sung Moon Kim, Monica Kalume Brigido
Of the many treatment options for tendinopathy, percutaneous tenotomy has been used throughout the body with success. With this procedure, a needle is repeatedly passed into the abnormal tendon with the goal of converting a chronic degenerative process to an acute inflammatory condition that will progress to tendon healing. Ultrasound guidance for this procedure is essential to ensure that the abnormal region of the tendon is accurately targeted. The treatment has few contraindications, and negligible complications have been described...
November 2016: Seminars in Musculoskeletal Radiology
Carmelo Messina, Luca Maria Sconfienza
Rotator cuff calcific tendinopathy (RCCT) is a common disease that may cause highly disabling shoulder pain. No treatment is required for asymptomatic calcifications; mild symptoms may be treated conservatively. Among several therapeutic options, ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) is currently accepted as the first-line safe and effective treatment for RCCT, with significant pain improvement and a very low rate of minor complications. Different approaches have been reported to dissolve calcified deposits, all including the use of a fluid (local anesthetic or saline solution) and the use of one or two needles to inject and retrieve the fluid/dissolved calcium...
November 2016: Seminars in Musculoskeletal Radiology
Véronique Freire, Nathalie J Bureau
Corticosteroids are routinely injected into soft tissues, tendon sheaths, bursae, and joints. These anti-inflammatory agents have different potency and solubility, and solubility is inversely correlated with the duration of action. Corticosteroids carry a low risk of complications but commonly cause systemic and local adverse effects. The use of intra-articular corticosteroid injections in the treatment of inflammatory arthritis and osteoarthritis is well established. Evidence also supports the use of injectable corticosteroids in the treatment of inflammatory tenosynovitis and bursitis associated with rheumatic diseases, trigger finger and de Quervain disease, and carpal tunnel syndrome...
November 2016: Seminars in Musculoskeletal Radiology
Kenneth S Lee
No abstract text is available yet for this article.
November 2016: Seminars in Musculoskeletal Radiology
G Solomou, John Damilakis
This article provides an overview of the literature regarding the magnitude of radiation exposure associated with the current radiologic methods used in patients with suspected osteoporosis. The use of X-ray-based techniques for the detection and monitoring of osteoporosis has increased over the last few decades. Dual-energy X-ray absorptiometry is the most common method, used worldwide for the assessment of osteoporosis, and it may be applied at several skeletal sites. Quantitative computed tomography comprises an alternative validated technique, increasingly used for skeleton assessment...
September 2016: Seminars in Musculoskeletal Radiology
Francisco Aparisi
Vertebroplasty and kyphoplasty are minimally invasive treatments and indispensable tools in the treatment of osteoporotic compression fractures. This method of treatment is performed using fluoroscopy or a scanner control an access via the pedicle or the posterolateral angle of the vertebral body. Vertebroplasty requires a smaller caliber needle than kyphoplasty, so it is technically easier. Vertebroplasty uses high-pressure injection, whereas in kyphoplasty the injection is held at low pressure, which together with the effect of compression on the bone that the balloon produces reduces the risk and rate of cement leakage...
September 2016: Seminars in Musculoskeletal Radiology
Rati N Patel, Anwar Ashraf, Murali Sundaram
Bisphosphonates have been widely used in the treatment of osteoporosis with well-documented long-term efficacy and safety, particularly in postmenopausal patients. But over the past decade, low-energy atypical subtrochanteric and proximal diaphyseal femoral fractures have emerged as an unexpected complication of prolonged bisphosphonate use. To the radiologist unfamiliar with this entity, the findings may be subtle and often missed, potentially evolving from an early incomplete fracture to a displaced complete fracture with a delay in diagnosis...
September 2016: Seminars in Musculoskeletal Radiology
Catherine M Phan, Giuseppe Guglielmi
Chronic inflammation and malabsorption in gastrointestinal disease can cause bone metabolism alterations and bone mineral loss in children and adults. Gastrointestinal disease is often forgotten as a cause of osteoporosis, osteopenia, or osteomalacia. The etiology of pathologic bone alterations in gastrointestinal disease is multifactorial. Bone alterations were thought to result simply from intestinal malabsorption, but a more complex interaction between cytokines and local/systemic factors influencing bone formation and resorption is envisaged...
September 2016: Seminars in Musculoskeletal Radiology
Michelangelo Nasuto, Vittorio Pansini, Bernard Cortet, Giuseppe Guglielmi, Anne Cotten
Chronic kidney disease (CKD) is a complex systemic disease that induces mineral metabolic dysfunction leading to bone fragility and tissue calcifications. Bone abnormalities in CKD can include increased bone turnover and resorption due to secondary hyperparathyroidism, decreased bone turnover and bone formation, defective bone mineralization, or a mixed pattern of these abnormalities. Other features of musculoskeletal involvement include synovial, tendon, and ligament thickening due to β2-microglobulin amyloidosis, soft tissue masses, or axial and peripheral arthropathies...
September 2016: Seminars in Musculoskeletal Radiology
Benedikt J Schwaiger, Alexandra S Gersing, Thomas Baum, Christian R Krestan, Jan S Kirschke
The differential diagnosis between benign and malignant vertebral fractures is a common challenge in clinical practice, especially because osteoporotic fractures become more frequent within the aging population and many malignant diseases spread to the bone first, impacting bone integrity. This article reviews the morphological features and computed tomography (CT) and magnetic resonance imaging (MRI) imaging findings that help differentiate between benign and malignant fractures. Newer techniques such as MR-based diffusion-weighted imaging, dynamic contrast-enhanced MR, and chemical-shift imaging as well as hybrid techniques such as positron emission tomography-CT are also discussed briefly...
September 2016: Seminars in Musculoskeletal Radiology
Maria Pilar Aparisi Gómez
This article focuses on nonspinal fragility or insufficiency fractures. Fragility fractures occur when normal levels of energy are applied to weakened bone, and they normally represent spontaneous fractures or traumatic fractures from minimal energy trauma that would not normally result in fracture in healthy people. This is the case in osteoporosis, where there is reduction of bone mass as well as loss of normal trabecular architecture leading to changes in structural characteristics that compromise biomechanics...
September 2016: Seminars in Musculoskeletal Radiology
Alberto Bazzocchi, Giuseppe Guglielmi
When bone becomes frail due to metabolic disorders, one or more vertebral fractures (VFs) may occur. A vertebral body fracture after minor trauma is a hallmark of osteoporosis. VFs represent a target in clinical practice and are often an endpoint in clinical trials. The health care and economic burden of VFs is huge, and they also significantly increase mortality and morbidity, as well as impairing function and quality of life. VFs are frequently clinically silent, thus imaging plays a role not only after symptoms appear but also in screening...
September 2016: Seminars in Musculoskeletal Radiology
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