We report a case of a rare isolated avulsion of the long head of the triceps tendon detected at m... more We report a case of a rare isolated avulsion of the long head of the triceps tendon detected at magnetic resonance (MR) examination occurring in a 35-year-old male surfer. Isolated long-head triceps tendon avulsions have rarely been reported and, to our knowledge, the MR findings have not previously been described in the world literature.
Background: First metatarsocuneiform (MC) instability is recognized as a pathologic contributor t... more Background: First metatarsocuneiform (MC) instability is recognized as a pathologic contributor to hallux valgus. There are no studies identifying the first MC joint as an independent pain generator in the foot that may require surgical arthrodesis for its management. Materials and Methods: The authors reviewed the records of all patients with this newly described pathology in the first MC joint. There were 61 patients with 85 feet who underwent a fluoroscopically guided local anesthetic injection into the first metatarsocuneiform joint to assess pain relief. Patient's complaints, physical exam findings, treatment decisions, patient characteristics, and radiographic findings were evaluated. Results: Seventy-nine percent of patients (67/85) injected had relief of their symptoms. Eight or these 67 patients were eventually treated with first MC arthrodesis with complete relief of symptoms. The average time from onset of symptoms to presentation was 21 (range, 1 to 72) months. Eight...
... The radiographic appearance of microcystadenomas and macrocystic adenomas or adenocarcinomas ... more ... The radiographic appearance of microcystadenomas and macrocystic adenomas or adenocarcinomas has been described in several small series [4, 6,7,8, 11,12,13]. The largest single-institution study to date, reported by Johnson et al. ... The retrospective study by Johnson ...
A case of Little Leaguer&... more A case of Little Leaguer's shoulder (LLS) in a 12-year-old male is presented. Classically, LLS is an overuse injury affecting adolescent pitchers. The diagnosis is the result of a thorough history, physical examination, and radiographic evaluation. Clinicians unfamiliar with LLS may fail to detect this injury and order a magnetic resonance imaging (MRI) study without radiographs. The objective of this case report is to help radiologists become more familiar with the MRI and radiographic findings of LLS.
Category: Sports Introduction/Purpose: Lateral ankle pain persists in 10%-20% of patients followi... more Category: Sports Introduction/Purpose: Lateral ankle pain persists in 10%-20% of patients following severe ankle sprains treated non-operatively. The authors hypothesize that the peroneal tendons may become interposed between the ruptured ends of the calcaneofibular ligament (CFL). Though previously visualized and noted in the literature, no studies have evaluated this lesion biomechanically and anatomically. The purpose of this study is to demonstrate that following a severe lateral ankle sprain that the interposition of the peroneal tendons between the ruptured ends of the CFL can occur. Methods: Eight fresh-frozen cadaveric lower extremity specimens (defrosted) were secured by the foot to a wooden board in the method of Lauge-Hansen. A manual inversion force was then applied to the ankle, both with the ankle in plantar flexion and also in a neutral position to approximate a severe ankle sprain. Magnetic resonance imaging (MRI) was then performed on each ankle. Each specimen was t...
Background: The modalities currently available to clinicians to confirm the clinical suspicion of... more Background: The modalities currently available to clinicians to confirm the clinical suspicion of posterior tibial tendinitis include MRI, CT, sonography, tenography, and local anesthetic tendon sheath injections. There are no reports in the literature comparing local anesthetic tendon sheath injection to MRI as tools for diagnosing posterior tibial tenosynovitis. Methods: The authors reviewed the records of all patients with stage 1 posterior tibial tendon dysfunction between the dates of September 1, 2001, to November 21, 2004. Fifteen patients (17 ankles) had a local anesthetic injection into the posterior tibial tendon sheath and MRI for clinically suspected tenosynovitis of the posterior tibial tendon. Results: Seventeen (100%) of 17 ankles had complete relief of symptoms after the local anesthetic tendon sheath injections. Fifteen (88%) of 17 ankles had abnormally increased fluid signal within the posterior tibial tendon sheath seen on MRI. Two of two ankles (100%), after havi...
Six types of ankle impingement are described in the literature, and each takes its name from its ... more Six types of ankle impingement are described in the literature, and each takes its name from its location about the ankle joint. The 3 most common impingement syndromes are anterior impingement, anterolateral impingement, and posterior impingement. Three other ankle impingement syndromes—anteromedial impingement, posteromedial impingement, and syndesmotic impingement—are less well characterized in the literature. Posterior impingement syndrome is characterized by posterior ankle pain with forceful plantar flexion. Soft tissues, bony processes, unfused ossicles, or osseous fragments entrapped between the posterior tibial plafond and the superior calcaneus lead to symptoms. Structures implicated in the etiology of posterior impingement of the ankle include the os trigonum, a prominent posterolateral process of the talus, fractures of the ossicle or talar process, enlarged posterior process of the calcaneus, the posterior intermalleolar ligament, soft-tissue impingement, loose bodies, ganglia, calcified inflammatory tissue, a low-lying flexor hallucis longus muscle belly, and anomalous muscles. 1 Pathology of the os trigonum–talar process is the most common cause of posterior impingement syndrome. 2 Os trigonum syndrome is a subset of posterior ankle impingement caused by pathology at the posterolateral process of the talus. Os trigonum syndrome is seen in athletes who engage in forceful plantar flexion or push-off maneuvers, such as jumping, downhill running, or kicking. Clinical presentation may be either acute secondary to trauma or chronic as a result of repetitive stress. Ballet dancers are commonly afflicted, and female ballerinas are particularly susceptible, given the extreme plantar flexion of the en pointe position. 2 The os trigonum, a secondary ossification center at the posterolateral corner of the talus, mineralizes between ages 7 and 13 years. Usually, this ossicle fuses to the talus to form the posterolateral process of the talus. Incomplete ossification may occur in up to 14% of the population, leaving a synchondrosis or syndesmosis between the talus and the ossicle. When an os trigonum is present, it is bilateral in 50% of patients. There are 4 anatomical variants of the posterolateral talus: I (normal posterolateral talar process), II (elongated posterolateral talar process, or Stieda process), III (accessory bone or os trigonum), and IV (os trigonum fused with posterolateral talus by synchondrosis or syndesmosis). Diagnosis of os trigonum syndrome is based primarily on clinical examination and history. Imaging findings support the diagnosis. Patients typically complain of posterior ankle pain between the Achilles and peroneal tendons exacerbated by forced plantar flexion or wearing of high-heeled shoes. There may be a history of antecedent trauma. Some patients may have coincident symptoms of flexor hallucis longus tenosynovitis manifesting as posterior ankle pain radiating into the arch. On physical examination, ankle and subtalar range of motion should be fully assessed. Care must be taken to differentiate between Achilles-tendon–related pain and posterior ankle impingement. In the passive forced plantar flexion test, the patient sits with knee flexed at 90°, and multiple quick hyper– plantar-flexion movements are performed at the ankle. Imaging findings of posterior impingement may vary according to the etiology of the symptoms. The most common plain radiograph finding is presence of os trigonum or the prominent elongated posterolateral process of the talus known as the Stieda process (Figure 1). There may be degenerative change across or frank disruption of the synchondrosis of the os trigonum (Figure 2). A fracture of the os or the Stieda process may be encountered. Bone scans may show abnormal radionuclide
Many soft tissue masses have an indeterminate appearance on MRI, often displaying varying degrees... more Many soft tissue masses have an indeterminate appearance on MRI, often displaying varying degrees and extent of T2 hyperintensity. However, a subset of neoplasms and tumor-like lesions may exhibit prominent areas of T2 hypointensity relative to skeletal muscle. The hypointensity observed on T2-weighted MRI can be caused by a variety of substances, including evolving blood products, calcifications or other inorganic crystals, or fibrous tissue. Carefully evaluating the presence and pattern of T2 hypointensity in soft tissue masses and considering potential causes in their associated clinical contexts can help to narrow the differential diagnosis among neoplastic and non-neoplastic possibilities. These include endometriosis, aneurysmal bone cysts, tenosynovial giant cell tumor, arteriovenous malformation and pseudoaneurysm, calcium pyrophosphate and hydroxyapatite deposition diseases, tumoral calcinosis, gout, amyloidosis, hemangiomas with phleboliths, low-grade fibromyxoid sarcoma, ossifying fibromyxoid tumor, collagenous fibroma, desmoid-type fibromatosis, myxofibrosarcoma, peripheral nerve sheath tumors, dedifferentiated liposarcoma, and treated sarcoma.
Background: Adult patients with nontraumatic plantar heel pain often present to orthopaedic surge... more Background: Adult patients with nontraumatic plantar heel pain often present to orthopaedic surgeons for evaluation. A thorough history and physical examination are often sufficient for diagnosis, yet radiographs usually are ordered during the initial evaluation. The purpose of this study was to evaluate the value and cost-effectiveness of these radiographs. Methods: A retrospective chart and radiographic review of 157 consecutive adults (215 heels) presenting with nontraumatic heel pain was done to evaluate the utility of routine radiographs in the initial evaluation. Results: The most common diagnosis was plantar fasciitis (80.9%, 174 of 215). Radiographs were normal in (17.2%, 37 of 215), and incidental radiographic findings were observed in 81.4% (175 of 215). The most common incidental findings were plantar calcaneal spurs (59.5%, 128 of 215) and Achilles spurs (46.5%, 100 of 215). Only (2%, 4 of 215) of all patients had abnormal findings that prompted further evaluation. Concl...
Figure 1. Anteroposterior (A) and lateral (B) radiographs show L4 vertebral body with uniformly i... more Figure 1. Anteroposterior (A) and lateral (B) radiographs show L4 vertebral body with uniformly increased opacity—the ivory vertebra sign. There is sclerosis of posterior elements. Vertebra remains normal in size and contour, and adjacent intervertebral discs ...
To examine the association between tibial pilon and calcaneal fracture classification and tendon ... more To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft für Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injur...
TEACHING POINTS 1. Common and present in children and adults 2. Several important structures supp... more TEACHING POINTS 1. Common and present in children and adults 2. Several important structures support the plantar arch 3. Failure of the arch may result in other deformities such as hindfoot valgus and subfibular impingement 4. Available treatment strategies range from conservative to surgical 5. Radiologist plays a key role in diagnosis TABLE OF CONTENTS/OUTLINE Anatomy and mechanism of support Involved supporting structures: static and dynamic stabilizers - Epidemiology Adults (primary focus) - Children Clinical manifestations - Types Rigid versus flexible Associated systemic processes Degenerative Tarsal coalition - The role of imaging Radiographs, CT, US and MRI Pes planus associations Hindfoot valgus - Subfibular impingement - Management Conservative Surgical approaches Indications and contraindications for surgery
American journal of orthopedics (Belle Mead, N.J.)
Despite their low clinical yield, knee radiographs are among the most commonly acquired radiograp... more Despite their low clinical yield, knee radiographs are among the most commonly acquired radiographic trauma studies in the emergency department. Although obvious fractures may be present, several subtler radiographic findings suggest internal derangement and significant injury. In this review, we provide an overview of traumatic knee radiography, including anatomy, acquisition techniques, and pitfalls with associated magnetic resonance imaging correlation when available.
Sports-related injuries of the wrist and hand are commonly encountered in clinical practice. Athl... more Sports-related injuries of the wrist and hand are commonly encountered in clinical practice. Athletic injuries create special challenges for the orthopedic surgeon and radiologist, as these patients expect to recover quickly and return to the same athletic endeavors that caused their original injuries. A thorough understanding of the mechanism of injury and imaging findings are necessary for accurate diagnosis and effective therapy. This knowledge allows the clinician to effectively educate the athlete concerning the risks, complications, and prognosis of the injury and its treatment. This article will review mechanisms of injury, imaging findings, and some therapeutic options of common sports-related injuries to the wrist and hand.
To confirm juxtascleral delivery of anecortave acetate in rabbit eyes by ocular imaging technique... more To confirm juxtascleral delivery of anecortave acetate in rabbit eyes by ocular imaging techniques and to determine drug localization and distribution as a function of time after injection. Four female New Zealand white rabbits (weight, 2.5-3.0 kg) received a single juxtascleral posterior sub-Tenon capsule injection of 0.5 mL or 1 mL of 30 mg/mL anecortave acetate. Rabbit eyes were imaged with ultrasonography and magnetic resonance imaging (MRI) before injection, immediately after injection, and at 2 hours, 1 week, and 4 weeks after injection. Rabbit eyes were also imaged with b-mode ultrasonography during the juxtascleral injections. Ultrasonography and MRI demonstrated that juxtascleral posterior sub-Tenon capsule injection of anecortave acetate effectively delivered the drug in direct apposition to the posterior pole of the rabbit eye. The drug remained in the juxtascleral site for at least 5 weeks. The drug was visualized clearly by MRI immediately after injection, decreasing in...
This article presents three patients with acute calcific periarthritis (ACP) of the hand and wris... more This article presents three patients with acute calcific periarthritis (ACP) of the hand and wrist. ACP is an unusual, painful, monoarticular, periarticular inflammatory process associated with juxtaarticular deposits of amorphous calcium hydroxyapatite. ACP is a distinct clinical subset of hydroxyapatite deposition disease. ACP has a high rate of misdiagnosis because of its rare occurrence and its clinical resemblance to other entities. Clinical presentation may simulate infection, and the associated periarticular calcifications may be mistaken for gout, pseudogout, or other entities. One third of patients with ACP provide a history of antecedent trauma. Treatment is conservative. Patients typically will have a reduction in symptoms within 4-7 days after the acute onset of pain. Radiographically, the periarticular mineralization usually resolves or markedly decreases within 2-3 weeks, although on occasion, some calcifications may remain visible for months. Failure to recognize and ...
We report a case of a rare isolated avulsion of the long head of the triceps tendon detected at m... more We report a case of a rare isolated avulsion of the long head of the triceps tendon detected at magnetic resonance (MR) examination occurring in a 35-year-old male surfer. Isolated long-head triceps tendon avulsions have rarely been reported and, to our knowledge, the MR findings have not previously been described in the world literature.
Background: First metatarsocuneiform (MC) instability is recognized as a pathologic contributor t... more Background: First metatarsocuneiform (MC) instability is recognized as a pathologic contributor to hallux valgus. There are no studies identifying the first MC joint as an independent pain generator in the foot that may require surgical arthrodesis for its management. Materials and Methods: The authors reviewed the records of all patients with this newly described pathology in the first MC joint. There were 61 patients with 85 feet who underwent a fluoroscopically guided local anesthetic injection into the first metatarsocuneiform joint to assess pain relief. Patient's complaints, physical exam findings, treatment decisions, patient characteristics, and radiographic findings were evaluated. Results: Seventy-nine percent of patients (67/85) injected had relief of their symptoms. Eight or these 67 patients were eventually treated with first MC arthrodesis with complete relief of symptoms. The average time from onset of symptoms to presentation was 21 (range, 1 to 72) months. Eight...
... The radiographic appearance of microcystadenomas and macrocystic adenomas or adenocarcinomas ... more ... The radiographic appearance of microcystadenomas and macrocystic adenomas or adenocarcinomas has been described in several small series [4, 6,7,8, 11,12,13]. The largest single-institution study to date, reported by Johnson et al. ... The retrospective study by Johnson ...
A case of Little Leaguer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;... more A case of Little Leaguer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s shoulder (LLS) in a 12-year-old male is presented. Classically, LLS is an overuse injury affecting adolescent pitchers. The diagnosis is the result of a thorough history, physical examination, and radiographic evaluation. Clinicians unfamiliar with LLS may fail to detect this injury and order a magnetic resonance imaging (MRI) study without radiographs. The objective of this case report is to help radiologists become more familiar with the MRI and radiographic findings of LLS.
Category: Sports Introduction/Purpose: Lateral ankle pain persists in 10%-20% of patients followi... more Category: Sports Introduction/Purpose: Lateral ankle pain persists in 10%-20% of patients following severe ankle sprains treated non-operatively. The authors hypothesize that the peroneal tendons may become interposed between the ruptured ends of the calcaneofibular ligament (CFL). Though previously visualized and noted in the literature, no studies have evaluated this lesion biomechanically and anatomically. The purpose of this study is to demonstrate that following a severe lateral ankle sprain that the interposition of the peroneal tendons between the ruptured ends of the CFL can occur. Methods: Eight fresh-frozen cadaveric lower extremity specimens (defrosted) were secured by the foot to a wooden board in the method of Lauge-Hansen. A manual inversion force was then applied to the ankle, both with the ankle in plantar flexion and also in a neutral position to approximate a severe ankle sprain. Magnetic resonance imaging (MRI) was then performed on each ankle. Each specimen was t...
Background: The modalities currently available to clinicians to confirm the clinical suspicion of... more Background: The modalities currently available to clinicians to confirm the clinical suspicion of posterior tibial tendinitis include MRI, CT, sonography, tenography, and local anesthetic tendon sheath injections. There are no reports in the literature comparing local anesthetic tendon sheath injection to MRI as tools for diagnosing posterior tibial tenosynovitis. Methods: The authors reviewed the records of all patients with stage 1 posterior tibial tendon dysfunction between the dates of September 1, 2001, to November 21, 2004. Fifteen patients (17 ankles) had a local anesthetic injection into the posterior tibial tendon sheath and MRI for clinically suspected tenosynovitis of the posterior tibial tendon. Results: Seventeen (100%) of 17 ankles had complete relief of symptoms after the local anesthetic tendon sheath injections. Fifteen (88%) of 17 ankles had abnormally increased fluid signal within the posterior tibial tendon sheath seen on MRI. Two of two ankles (100%), after havi...
Six types of ankle impingement are described in the literature, and each takes its name from its ... more Six types of ankle impingement are described in the literature, and each takes its name from its location about the ankle joint. The 3 most common impingement syndromes are anterior impingement, anterolateral impingement, and posterior impingement. Three other ankle impingement syndromes—anteromedial impingement, posteromedial impingement, and syndesmotic impingement—are less well characterized in the literature. Posterior impingement syndrome is characterized by posterior ankle pain with forceful plantar flexion. Soft tissues, bony processes, unfused ossicles, or osseous fragments entrapped between the posterior tibial plafond and the superior calcaneus lead to symptoms. Structures implicated in the etiology of posterior impingement of the ankle include the os trigonum, a prominent posterolateral process of the talus, fractures of the ossicle or talar process, enlarged posterior process of the calcaneus, the posterior intermalleolar ligament, soft-tissue impingement, loose bodies, ganglia, calcified inflammatory tissue, a low-lying flexor hallucis longus muscle belly, and anomalous muscles. 1 Pathology of the os trigonum–talar process is the most common cause of posterior impingement syndrome. 2 Os trigonum syndrome is a subset of posterior ankle impingement caused by pathology at the posterolateral process of the talus. Os trigonum syndrome is seen in athletes who engage in forceful plantar flexion or push-off maneuvers, such as jumping, downhill running, or kicking. Clinical presentation may be either acute secondary to trauma or chronic as a result of repetitive stress. Ballet dancers are commonly afflicted, and female ballerinas are particularly susceptible, given the extreme plantar flexion of the en pointe position. 2 The os trigonum, a secondary ossification center at the posterolateral corner of the talus, mineralizes between ages 7 and 13 years. Usually, this ossicle fuses to the talus to form the posterolateral process of the talus. Incomplete ossification may occur in up to 14% of the population, leaving a synchondrosis or syndesmosis between the talus and the ossicle. When an os trigonum is present, it is bilateral in 50% of patients. There are 4 anatomical variants of the posterolateral talus: I (normal posterolateral talar process), II (elongated posterolateral talar process, or Stieda process), III (accessory bone or os trigonum), and IV (os trigonum fused with posterolateral talus by synchondrosis or syndesmosis). Diagnosis of os trigonum syndrome is based primarily on clinical examination and history. Imaging findings support the diagnosis. Patients typically complain of posterior ankle pain between the Achilles and peroneal tendons exacerbated by forced plantar flexion or wearing of high-heeled shoes. There may be a history of antecedent trauma. Some patients may have coincident symptoms of flexor hallucis longus tenosynovitis manifesting as posterior ankle pain radiating into the arch. On physical examination, ankle and subtalar range of motion should be fully assessed. Care must be taken to differentiate between Achilles-tendon–related pain and posterior ankle impingement. In the passive forced plantar flexion test, the patient sits with knee flexed at 90°, and multiple quick hyper– plantar-flexion movements are performed at the ankle. Imaging findings of posterior impingement may vary according to the etiology of the symptoms. The most common plain radiograph finding is presence of os trigonum or the prominent elongated posterolateral process of the talus known as the Stieda process (Figure 1). There may be degenerative change across or frank disruption of the synchondrosis of the os trigonum (Figure 2). A fracture of the os or the Stieda process may be encountered. Bone scans may show abnormal radionuclide
Many soft tissue masses have an indeterminate appearance on MRI, often displaying varying degrees... more Many soft tissue masses have an indeterminate appearance on MRI, often displaying varying degrees and extent of T2 hyperintensity. However, a subset of neoplasms and tumor-like lesions may exhibit prominent areas of T2 hypointensity relative to skeletal muscle. The hypointensity observed on T2-weighted MRI can be caused by a variety of substances, including evolving blood products, calcifications or other inorganic crystals, or fibrous tissue. Carefully evaluating the presence and pattern of T2 hypointensity in soft tissue masses and considering potential causes in their associated clinical contexts can help to narrow the differential diagnosis among neoplastic and non-neoplastic possibilities. These include endometriosis, aneurysmal bone cysts, tenosynovial giant cell tumor, arteriovenous malformation and pseudoaneurysm, calcium pyrophosphate and hydroxyapatite deposition diseases, tumoral calcinosis, gout, amyloidosis, hemangiomas with phleboliths, low-grade fibromyxoid sarcoma, ossifying fibromyxoid tumor, collagenous fibroma, desmoid-type fibromatosis, myxofibrosarcoma, peripheral nerve sheath tumors, dedifferentiated liposarcoma, and treated sarcoma.
Background: Adult patients with nontraumatic plantar heel pain often present to orthopaedic surge... more Background: Adult patients with nontraumatic plantar heel pain often present to orthopaedic surgeons for evaluation. A thorough history and physical examination are often sufficient for diagnosis, yet radiographs usually are ordered during the initial evaluation. The purpose of this study was to evaluate the value and cost-effectiveness of these radiographs. Methods: A retrospective chart and radiographic review of 157 consecutive adults (215 heels) presenting with nontraumatic heel pain was done to evaluate the utility of routine radiographs in the initial evaluation. Results: The most common diagnosis was plantar fasciitis (80.9%, 174 of 215). Radiographs were normal in (17.2%, 37 of 215), and incidental radiographic findings were observed in 81.4% (175 of 215). The most common incidental findings were plantar calcaneal spurs (59.5%, 128 of 215) and Achilles spurs (46.5%, 100 of 215). Only (2%, 4 of 215) of all patients had abnormal findings that prompted further evaluation. Concl...
Figure 1. Anteroposterior (A) and lateral (B) radiographs show L4 vertebral body with uniformly i... more Figure 1. Anteroposterior (A) and lateral (B) radiographs show L4 vertebral body with uniformly increased opacity—the ivory vertebra sign. There is sclerosis of posterior elements. Vertebra remains normal in size and contour, and adjacent intervertebral discs ...
To examine the association between tibial pilon and calcaneal fracture classification and tendon ... more To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft für Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injur...
TEACHING POINTS 1. Common and present in children and adults 2. Several important structures supp... more TEACHING POINTS 1. Common and present in children and adults 2. Several important structures support the plantar arch 3. Failure of the arch may result in other deformities such as hindfoot valgus and subfibular impingement 4. Available treatment strategies range from conservative to surgical 5. Radiologist plays a key role in diagnosis TABLE OF CONTENTS/OUTLINE Anatomy and mechanism of support Involved supporting structures: static and dynamic stabilizers - Epidemiology Adults (primary focus) - Children Clinical manifestations - Types Rigid versus flexible Associated systemic processes Degenerative Tarsal coalition - The role of imaging Radiographs, CT, US and MRI Pes planus associations Hindfoot valgus - Subfibular impingement - Management Conservative Surgical approaches Indications and contraindications for surgery
American journal of orthopedics (Belle Mead, N.J.)
Despite their low clinical yield, knee radiographs are among the most commonly acquired radiograp... more Despite their low clinical yield, knee radiographs are among the most commonly acquired radiographic trauma studies in the emergency department. Although obvious fractures may be present, several subtler radiographic findings suggest internal derangement and significant injury. In this review, we provide an overview of traumatic knee radiography, including anatomy, acquisition techniques, and pitfalls with associated magnetic resonance imaging correlation when available.
Sports-related injuries of the wrist and hand are commonly encountered in clinical practice. Athl... more Sports-related injuries of the wrist and hand are commonly encountered in clinical practice. Athletic injuries create special challenges for the orthopedic surgeon and radiologist, as these patients expect to recover quickly and return to the same athletic endeavors that caused their original injuries. A thorough understanding of the mechanism of injury and imaging findings are necessary for accurate diagnosis and effective therapy. This knowledge allows the clinician to effectively educate the athlete concerning the risks, complications, and prognosis of the injury and its treatment. This article will review mechanisms of injury, imaging findings, and some therapeutic options of common sports-related injuries to the wrist and hand.
To confirm juxtascleral delivery of anecortave acetate in rabbit eyes by ocular imaging technique... more To confirm juxtascleral delivery of anecortave acetate in rabbit eyes by ocular imaging techniques and to determine drug localization and distribution as a function of time after injection. Four female New Zealand white rabbits (weight, 2.5-3.0 kg) received a single juxtascleral posterior sub-Tenon capsule injection of 0.5 mL or 1 mL of 30 mg/mL anecortave acetate. Rabbit eyes were imaged with ultrasonography and magnetic resonance imaging (MRI) before injection, immediately after injection, and at 2 hours, 1 week, and 4 weeks after injection. Rabbit eyes were also imaged with b-mode ultrasonography during the juxtascleral injections. Ultrasonography and MRI demonstrated that juxtascleral posterior sub-Tenon capsule injection of anecortave acetate effectively delivered the drug in direct apposition to the posterior pole of the rabbit eye. The drug remained in the juxtascleral site for at least 5 weeks. The drug was visualized clearly by MRI immediately after injection, decreasing in...
This article presents three patients with acute calcific periarthritis (ACP) of the hand and wris... more This article presents three patients with acute calcific periarthritis (ACP) of the hand and wrist. ACP is an unusual, painful, monoarticular, periarticular inflammatory process associated with juxtaarticular deposits of amorphous calcium hydroxyapatite. ACP is a distinct clinical subset of hydroxyapatite deposition disease. ACP has a high rate of misdiagnosis because of its rare occurrence and its clinical resemblance to other entities. Clinical presentation may simulate infection, and the associated periarticular calcifications may be mistaken for gout, pseudogout, or other entities. One third of patients with ACP provide a history of antecedent trauma. Treatment is conservative. Patients typically will have a reduction in symptoms within 4-7 days after the acute onset of pain. Radiographically, the periarticular mineralization usually resolves or markedly decreases within 2-3 weeks, although on occasion, some calcifications may remain visible for months. Failure to recognize and ...
Uploads
Papers by Paul Clifford