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Internal Derangements of the Temporomandibular Joint, Pathological Variations
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
Carrol P Saridin, Pieter G Raijmakers
Schellhas et al.1 performed a study of 743 consecutive arthrograms, and 1,052 TMJs were studied by means of an MRI scan. Forty-three joints were studied with both modalities and the results were correlated to surgical findings. They recommended MRI to be the procedure of choice for diagnosis of uncomplicated internal derangements, whereas arthrography should be performed whenever capsular adhesions or perforations are suspected and whenever MRI is inconclusive. Pullinger2 stated that radiographic condylar concentricity cannot serve as a characteristic of a normal joint because of its high variability. Ireland3 in 1953 and more recently Farrar4 described that internal derangement of the TMJ commonly causes symptoms of clicking and locking. The latter described reciprocal clicking where the click during mandibular retrusion does not occur unless it is preceded by the click during opening. Westesson et al.5 studied morphology, internal derangement, and joint function in 58 randomly selected autopsy specimens of the TMJ. Morphologic alterations were rarely present in joints with superior disc position. Disc deformation was observed in 31% of joints with partially anterior disc position, and in 77% of the joints with completely anteriorly positioned discs. In the last group, irregularities of the articular surface were present in 65%.
Surgery of the Hip
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Daud TS Chou, Jonathan Miles, John Skinner
Hip arthrography is uncomfortable. It is recommended that it is performed under at least sedation but a short general anaesthetic is preferred. The supine position is used. The hip is placed in the position of maximum joint volume to aid injection: 10° abduction10° flexion10° internal rotation
Clinical Perspective on Dual Energy Computed Tomography
Published in Katsuyuki Taguchi, Ira Blevis, Krzysztof Iniewski, Spectral, Photon Counting Computed Tomography, 2020
Charis McNabney, Shamir Rai, Darra T. Murphy
Pilot studies have indicated potential for DECT arthrography (to evaluate joints); however, larger patient trials and refinement of post-processing techniques are required to prove clinical efficacy. Similarly, DECT's use in the detection and follow-up of metastases requires further validation, particularly with respect to presentation of different tumor types and normal variants. DEXA scanning is considered the reference standard for assessment of osteoporosis; however, there are many reported limitations to this technique. A three-dimensional approach can help overcome some of these limitations. DECT with bone mineral density application represents a promising three-dimensional approach in the assessment of osteoporosis, with reduced radiation dose when compared to conventional CT (Mallinson et al. 2016).
The clinical significance of magnetic resonance imaging of the hand: an analysis of 318 hand and wrist images referred by hand surgeons
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Maire Sofia Ratasvuori, Nina Charlotta Lindfors, Markus J. Sormaala
After obtaining institutional review board approval, we conducted a retrospective review of the electronic medical records in a tertiary hospital. All consecutive patients (n = 316) >15 years who underwent at least one arm, wrist or hand MRI investigation referred by a hand surgeon (n = 147) or a hand surgery resident (n = 171) between January and June 2016 were included in the study. If a patient had undergone multiple MRI examinations during the study period, only the first MRI was included in the study. Both MRIs were included if both arms were examined. The patient was imaged either with a GE Optima 430 1.5 T or Sigma HDxt 1.5 T MR scanner. Routine clinical MRI protocols, including coronal T1, PD with fat saturation, gradient-echo T2, sagittal T1, and axial PD and PD with fat saturation were used. The protocols varied based on the clinical question posed by the hand surgeon in the referral to the imaging department. The study included 38 (11.95%) images with intravenous contrast and 43 (13.5%) with arthrography. The locations for imaging were wrist (n = 193, 60.7%), metacarpals (n = 40, 12.6%), fingers (n = 81, 25.5%), thumb (n = 38, 10.7%), and antebrachium (n = 4, 1.3%). The primary MRI reports were analyzed by musculoskeletal radiologists in our university hospital. All MRI images were then re-evaluated by a musculoskeletal radiologist with 7 years of experience in musculoskeletal radiology.
Higher risk of cam regrowth in adolescents undergoing arthroscopic femoroacetabular impingement correction: a retrospective comparison of 33 adolescent and 74 adults
Published in Acta Orthopaedica, 2019
Tomoya Arashi, Yoichi Murata, Hajime Utsunomiya, Shiho Kanezaki, Hitoshi Suzuki, Akinori Sakai, Soshi Uchida
The indication for arthroscopic FAI correction surgery was based on the physical examination and radiographs of symptomatic patients. The clinical inclusion criteria were refractory groin pain after a minimum of 3 months of nonoperative treatment, including activity modification, physical therapy, and nonsteroidal anti-inflammatory agents; restricted hip range of motion (ROM) (flexion < 105° and/or restricted internal rotation in flexion < 20°); and a positive impingement test. All patients underwent diagnostic intra-articular local anesthesia, which resulted in immediate relief from symptoms in all patients. This effect was temporary (Kalberer 2008, Yamasaki et al. 2015); therefore, we also performed the anterior impingement test and flexion–adduction–internal-rotation test before surgery (Shanmugaraj et al. 2018, Troelsen et al. 2009). Radiographic evidence of a cam deformity included alpha angle > 55° or head–neck offset ratio < 0.14 in at least radiographic view or the presence of a cam lesion on CT or MRI (Clohisy et al. 2008). The alpha angle was measured on plain radiographs. We used the highest alpha angle of the 2 views including modified Dunn view and cross-table lateral view for each hip (Notzli et al. 2002). The radiographic FAI subtype was additionally classified as an isolated cam, an isolated pincer, or a combined FAI. Intra-articular pathological abnormalities, including acetabular labral and chondral lesions, were evaluated by gadolinium-enhanced 1.5 Tesla MR arthrography or 3 Tesla MRI.
Isolated complete ulnar collateral ligament tear of the elbow in a gymnast: does it need surgery?
Published in The Physician and Sportsmedicine, 2019
Justin M. Dubin, Jorge L. Rojas, Amrut U. Borade, Filippo Familiari, Edward G. McFarland
Magnetic resonance imaging can be helpful for evaluating ligamentous injuries around the elbow [37–39]. Timmerman et al., studied the accuracy of MRI diagnosing UCL tears in 25 baseball players, and found MRI was highly specific (specificity, 100%) and highly sensible (100%) for complete tears, however, for partial tears sensitivity drops to 14% [29]. CT arthrography or MR arthrography have been recommended as alternatives to conventional MR imaging to distinguish between partial and complete UCL tears. With a partial tear, fluid dissects beyond the normal limits of the joint capsule and passes into but not through the UCL. On CT arthrography, this has been called the ‘T-sign’ [29]. In the same group of 25 baseball players, Timmerman et al. [29] reported that CT arthrography had a higher sensitivity (71%) than conventional MRI (14%) for diagnosing partial UCL tears. In another study of 40 throwing athletes with suspected UCL injury and surgical correlation, MRI arthrography had a sensitivity of 95% for full-thickness tears and a sensitivity of 86% for partial-thickness tears [40]. Dynamic ultrasound with valgus stress may offer an effective option for diagnosing UCL tears of the elbow [41,42]. Some of its advantages include its lower cost, higher availability and the ability to dynamically compare the medial joint opening with valgus stress in both elbows [42]. However, ultrasonography is an operator-dependent test and may be challenging in the acute setting due to the patient pain with valgus stress.