scholarly journals Dorsal Wrist Pain in the Extended Wrist-Loading Position: An MRI Study

2017 ◽  
Vol 06 (04) ◽  
pp. 276-279 ◽  
Author(s):  
Erin Nance ◽  
David Byun ◽  
Yoshimi Endo ◽  
Scott Wolfe ◽  
Steve Lee
Keyword(s):  
Ganglion Cyst ◽  
Weight Bearing ◽  
Retrospective Chart Review ◽  
Wrist Pain ◽  
Control Group ◽  
Level Of Evidence ◽  
Ganglion Cysts ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Study ◽  
Dorsal Ganglion

Background The etiology of dorsal wrist pain associated with loading of the wrist in extension has not been clearly identified in the literature. Purpose Many exercise disciplines incorporate upper extremity weight-bearing exercises in an extended wrist posture, for example push-ups, plank position, and various yoga and Pilates poses. This study evaluates patients with dorsal wrist pain in the extended wrist-loading position and identifies anatomic abnormalities in the wrist using magnetic resonance imaging (MRI). Methods A retrospective chart review was performed comparing MRI of patients who complained of dorsal wrist pain while performing weight bearing in a wrist extension position with a control group of patients who complained of ulnar-sided wrist pain. The primary MRI outcome was dorsal wrist pathology, including occult dorsal ganglion cyst, scapholunate ligament tear or degeneration, and dorsal capsulitis. Results Dorsal wrist pathology was significantly more prevalent in patients with dorsal wrist pain (84%) than in the patient cohort with ulnar-sided wrist pain (12%). Occult dorsal ganglion cysts were the most common sources of pathology (76%). Conclusion MRI demonstrated an identifiable dorsal abnormality in 84% of patients with dorsal wrist pain associated with weight bearing on the extended wrist. Occult dorsal ganglion cysts are the most common cause of dorsal wrist pain, followed by partial scapholunate tears. When patients complain of dorsal wrist pain during specific extended loading wrist positions such as push-ups, yoga, or Pilates poses, an MRI may be warranted to help identify anatomic abnormalities that may help guide treatment choices. Level of Evidence Diagnostic, Level III.

scholarly journals Radiologist Identification of Occult Dorsal Wrist Ganglion Cysts on MRI

2019 ◽  
Vol 08 (04) ◽  
pp. 276-279
Author(s):  
Gregory Versteeg ◽  
Kanu Goyal
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Radiology Report ◽  
Level Of Evidence ◽  
Ganglion Cysts ◽  
Magnetic Resonance Imaging Mri ◽  
Dorsal Ganglion ◽  
Dorsal Wrist Ganglion

Background Occult dorsal ganglion cysts (ODGC) require imaging or an operation for detection. It is currently unknown how often a radiologist identifies an ODGC on magnetic resonance imaging (MRI) and whether surgeon indication for MRI aids the radiologist in detection. Questions/Purposes The aim of the study was to investigate the following questions: how accurately do radiologists identify ODGC on MRIs? What factors may be associated with missed ODGCs? Patients and Methods We retrospectively studied patients who underwent an operation for an ODGC and had a preoperative wrist MRI. Radiology report and surgeon's notes were evaluated to determine whether identification of the ODGC was noted and whether the surgeon indicated that the MRI was to evaluate for an ODGC. MRIs were reviewed, dimensions of cysts measured and volume of cyst calculated. Results Twenty-four patients and 25 MRIs were analyzed. The radiologist identified the ODGC in 19 cases (76%). Fifteen of the 25 MRIs (60%) ordered had ODGC listed in the requisition comment by the ordering surgeon. Thirteen of these 15 (87%) ODGCs were seen by the radiologist. Ten of the 25 MRIs (40%) ordered did not mention ODGC in the requisition. Six of these 10 (60%) ODGCs were seen by the radiologist. The volume of the ODGCs missed by radiologists was smaller (mean, 0.049 cm3) than those the radiologists identified (mean, 0.31 cm3; p = 0.004). Conclusions Radiologists will not always identify the ODGC on an MRI, but they were more likely to if the surgeon was concerned for one. Hand surgeons should report suspicion of an ODGC on MRI requisition and review all imaging independently. Level of Evidence This is a Level III, prognostic study.

scholarly journals Ultrasound-Guided Aspiration Does Not Reduce the Recurrence Rate of Ganglion Cysts of the Wrist

2018 ◽  
Vol 08 (02) ◽  
pp. 100-103 ◽  
Author(s):  
Gregory Kurkis ◽  
Albert Anastasio ◽  
Marijke DeVos ◽  
Michael Gottschalk
Keyword(s):  
Recurrence Rate ◽  
Ultrasound Guidance ◽  
Ganglion Cyst ◽  
High Recurrence Rate ◽  
P Value ◽  
Ultrasound Guided ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Ganglion Cysts ◽  
Significant Difference

Background Ganglion cysts are the most frequent soft tissue tumor encountered in the upper extremity and are commonly treated by aspiration or by surgical excision. Ultrasound is a promising addition to traditional aspiration, as it allows for visualization of the needle within the ganglion before aspiration. Questions Are ganglion cysts of the wrist less likely to reoccur if they are aspirated under ultrasound guidance versus “blind” aspiration without the use of ultrasound guidance? Does patient functionality change based on whether or not the cyst recurred? Patients and Methods In total, 52 patients were successfully contacted and recurrence rates were compared between those whose cyst was treated with ultrasound-guided (13 patients) with those whose cyst was treated with blind aspiration (39 patients). Mean follow-up time was 2.9 years. Results Recurrence rates were 69% (9 patients) and 74% (29 patients) for the ultrasound-guided and blind aspiration groups, respectively (p-value: 0.73), showing no significant difference in recurrences of wrist ganglion between the two groups. A metric of functionality (Quick–DASH [Disabilities of the Arm, Shoulder, and Hand]) revealed worse outcomes in patients who experienced return of ganglion cyst after aspiration versus those who did not. Conclusion Additional studies with improved sample sizes are needed to demonstrate the superiority of ultrasound-guided aspiration versus blind aspiration. Due to a high recurrence rate following aspiration (both ultrasound-guided and blinded), a lower threshold for surgical intervention is likely reasonable. Level of Evidence This is a Level IIIb study.

scholarly journals Pisotriquetral Pain Treated with Bilateral Pisiform Excision in a Collegiate Diver

2018 ◽  
Vol 07 (05) ◽  
pp. 415-418
Author(s):  
Nathan Rietberg ◽  
Matthew Brown ◽  
Steven Haase
Keyword(s):  
Corticosteroid Injection ◽  
Weight Bearing ◽  
Wrist Pain ◽  
Return To Play ◽  
Full Weight Bearing ◽  
Full Time ◽  
Surgical Options ◽  
Magnetic Resonance Imaging Mri ◽  
And Function ◽  
High Degree

Background Pisiform excision and pisotriquetral arthrodesis are two surgical options for the treatment of pisotriquetral joint pain when conservative methods fail. However, it is unclear which option is best for patients who experience substantial, repetitive loading on their wrists and wish to preserve wrist flexibility and function. Case Description We present a case of bilateral ulnar-sided wrist pain related to the pisotriquetral joint in a 19-year-old collegiate diver. The pain was exacerbated by activities specific to this sport that requires wrist hyperextension, namely full weight-bearing on the hands (handstands), and has an impact on the hands and wrists upon water entry during dives due to direct palmar pressure. There were no radiographic signs of arthritis; however, there were bone marrow changes on magnetic resonance imaging (MRI). Management with rest, splinting, and corticosteroid injection failed to relieve the pain and precluded his ability to return to full-time diving. Treatment consisted of bilateral pisiform excision. Postoperatively, the patient returned to full-time competitive diving with resolution of his painful symptoms. Literature Review Pisiform excision has been shown to have successful outcomes in terms of return to play for lower impact athletes (such as badminton) but has not been reported in athletes who experience a high degree of force repetitively (such as gymnasts or divers). There is one report of pisotriquetral arthrodesis in a young gymnast with suboptimal results. Clinical Relevance This case report demonstrates that pisiform excision is a successful treatment for elite athletes who experience repetitive, palmar force on hyperextended wrists and subsequently develop ulnar-sided wrist pain.

Velopharyngeal Structural and Muscle Variations in Children With 22q11.2 Deletion Syndrome: An Unsedated MRI Study

2019 ◽  
Vol 56 (9) ◽  
pp. 1139-1148 ◽  
Author(s):  
Lakshmi Kollara ◽  
Adriane L. Baylis ◽  
Richard E. Kirschner ◽  
D. Gregory Bates ◽  
Mark Smith ◽  
...  
Keyword(s):  
22Q11.2 Deletion Syndrome ◽  
Analysis Of Covariance ◽  
Deletion Syndrome ◽  
Control Group ◽  
Limited Information ◽  
22Q11.2 Deletion ◽  
Mri Protocol ◽  
Magnetic Resonance Imaging Mri ◽  
And Gender ◽  
Mri Study

Objective: The 22q11.2 deletion syndrome (22q11.2DS) is the most common genetic cause of velopharyngeal dysfunction; however, limited information exists regarding variations in velopharyngeal anatomy in this clinically challenging population. The purpose of this study was to examine velopharyngeal characteristics among young children with 22q11.2DS in comparison to a normative cohort using an innovative, nonsedated magnetic resonance imaging (MRI) scanning protocol. Methods: Fifteen children with 22q11.2DS and 15 age- and gender-matched controls with normal velopharyngeal anatomy (ages 4-12) successfully completed the MRI protocol. Eighteen velopharyngeal and 2 related craniofacial measures were examined. Analysis of covariance was used to compare differences between the experimental and the control groups. Results: The 22q11.2DS group demonstrated a significantly thinner velum ( P < .0005) and a larger pharyngeal depth ( P = .007) compared to the matched control group. Findings in the current study also demonstrated that the levator veli palatini muscle is significantly shorter ( P = .037) and thinner ( P = .025) in the 22q11.2DS cohort, with a significantly shorter origin-to-origin distance ( P < .0005) and a greater angle of origin ( P = .001) compared to healthy peers. Conclusion: Children with 22q11.2DS demonstrated multiple variations that may contribute to velopharyngeal dysfunction by altering the anatomic characteristics of the velopharyngeal port, the levator muscle, and associated structures. This investigation represents the first and largest attempt to characterize velopharyngeal anatomy in children with 22q11.2DS using a nonsedated MRI protocol.

ALTERATION OF ELASTIC PROPERTIES IN CONGENITAL/INHERITED AORTIC DISEASES: MRI STUDY IN MARFAN SYNDROME AND BICUSPID AORTIC VALVE

2006 ◽  
Vol 06 (01) ◽  
pp. 47-53
Author(s):  
LUIGI LOVATO ◽  
PAOLO SBARZAGLIA ◽  
SILVIA MAGI ◽  
VINCENZO RUSSO ◽  
ROMANO ZANNOLI ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Marfan Syndrome ◽  
Elastic Properties ◽  
Bicuspid Aortic Valve ◽  
Aortic Distensibility ◽  
Control Group ◽  
Aortic Dilation ◽  
Aortic Diseases ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Study

Marfan Syndrome and Bicuspid Aortic Valve (BAV) are characterized by the congenital/inherited alteration of the fibrillin proteins of aortic wall extracellular matrix, with higher incidence of aortic dissection/rupture even without aortic dilation. Therefore, early identification and treatment of aortic involvement could improve prognosis. The purpose of this study was to evaluate aortic elastic properties of BAV and Marfan Syndrome patients to identify an index of early aortic involvement. Methods: A Magnetic Resonance Imaging (MRI) study was performed on 38 BAV patients, 20 Marfan patients and 14 healthy volunteers as a control group. A high-resolution gradient-echo sequence was applied in the axial plane at the level of pulmonary artery bifurcation to evaluate aortic distensibility. Results: Aortic distensibility was significantly different among the three groups (ANOVA, p = 0.0001) and was sensibly reduced in BAV (0.0056 ± 0.0048 versus 0.025 ± 0.006 control group) and Marfan (0.0085 ± 0.006 versus 0.025 ± 0.006 control group). Intraobserver and interobserver reproducibility for diastolic measurements were 1.2% and 0.4% respectively and for systolic measurements, they were 1.1% and 0.3% respectively. Conclusion: In BAV or Marfan Syndrome patients, MRI evaluation of abnormal distensibility may provide a reliable index of early aortic involvement, even before aortic dilation occurs.

Comparing ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Knee Arthroplasty

2016 ◽  
Vol 30 (05) ◽  
pp. 460-466 ◽  
Author(s):  
Jessica Churchill ◽  
Kathleen Puca ◽  
Elizabeth Meyer ◽  
Matthew Carleton ◽  
Michael Anderson
Keyword(s):  
Total Knee Arthroplasty ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Acquisition Cost ◽  
Retrospective Chart Review ◽  
Aminocaproic Acid ◽  
Control Group ◽  
Level Of Evidence ◽  
Postoperative Blood Transfusion ◽  
Total Knee

AbstractMultiple studies have shown tranexamic acid (TXA) to reduce blood loss and transfusion rates in patients undergoing total knee arthroplasty (TKA). Accordingly, TXA has become a routine blood conservation agent for TKA. In contrast, ε-aminocaproic acid (EACA), a similar acting antifibrinolytic to TXA, has been less frequently used. This study evaluated whether EACA is as efficacious as TXA in reducing postoperative blood transfusion rates and compared the cost per surgery between agents. A multicenter retrospective chart review of elective unilateral TKA from April 2012 through December 2014 was performed. Five hospitals within a health care system participated. Data collected included age, gender, severity of illness score, use of antifibrinolytic and dose, red blood cell (RBC) transfusions and the number of units, and preadmission and discharge hemoglobin (Hb). Dosing of the antifibrinolytic differed based on the agent used, 5 or 10 g (based on weight) for EACA versus 1 g for TXA. The institutional acquisition cost of each antifibrinolytic was obtained and averaged over the study period. Of 2,922 primary unilateral TKA cases, 820 patients received EACA, 610 patients received TXA, and 1,492 patients received no antifibrinolytic (control group). Compared with the control group both EACA and TXA groups had significantly fewer patients transfused (EACA 2.8% [p < 0.0001], TXA 3.2% [p < 0.0001] vs. control 10.8%) and lower mean RBC units transfused per patient (EACA 0.05 units/patient [pt] [p < 0.0001], TXA 0.05 units/pt [p < 0.0001] vs. control 0.19 units/pt]. There was no difference in mean RBC units transfused per patient, percentage of patients transfused, and discharge Hb levels between the EACA and TXA groups (p = 0.822, 0.236, and 0.322, respectively). Medication acquisition cost for EACA averaged $2.23 per surgery compared with TXA at $39.58 per surgery. Administration of EACA or TXA significantly decreased postoperative transfusion rates compared with no antifibrinolytic therapy. Utilization of EACA for unilateral TKA proved to be comparable to TXA in all studied aspects at a lower cost. The level of evidence for the study is Level 3.

Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States

2019 ◽  
Vol 40 (10) ◽  
pp. 1140-1148 ◽  
Author(s):  
Spenser J. Cassinelli ◽  
Stephanie Chen ◽  
Timothy P. Charlton ◽  
David B. Thordarson
Keyword(s):  
Patient Satisfaction ◽  
Case Series ◽  
Retrospective Chart Review ◽  
The United States ◽  
Reoperation Rate ◽  
Hallux Rigidus ◽  
Level Of Evidence ◽  
Physical Dysfunction ◽  
Magnetic Resonance Imaging Mri

Background: The aim of this study was to determine the early outcomes and complications following the implantation of a hydrogel synthetic cartilage implant (SCI, Cartiva) for the treatment of hallux rigidus by a single surgeon. Methods: A retrospective chart review was performed of consecutive patients who underwent treatment for hallux rigidus with an SCI between August 2016 and April 2018 by a single surgeon. Demographic information, radiographic assessment, and concomitant operative procedures performed were evaluated for all patients. Postoperatively, PROMIS physical function (PF) and pain interference (PI) scores, patient satisfaction, reoperation, conversion to arthrodesis, and need for further clinical treatment were collected. Sixty-four SCIs were implanted in 60 patients. Follow-up averaged 18.5 months (range 12-30 months). Results: 14% (9/64) of patients were very satisfied, 28% (18/64) satisfied, 20% (13/64) neutral, 11% (7/64) unsatisfied, and 27% (17/64) very unsatisfied with their outcome. In addition, 45% of patients underwent additional procedures at the time of SCI, and 23% had a history of surgery on the hallux before implantation. PROMIS PF scores averaged 42 and PROMIS PI scores averaged 60. Overall, 63% completed PROMIS PI, 66% completed PROMIS PF, and 100% completed a satisfaction survey. In addition, 30% (19/64) underwent magnetic resonance imaging (MRI) postoperatively due to pain. There was a 20% reoperation rate, which included an 8% rate of conversion to arthrodesis. Conclusion: Synthetic cartilage implantation yielded neutral patient satisfaction, mild pain, and physical dysfunction at early follow-up. We believe patient selection and counseling regarding early postoperative limitations are important before proceeding with SCI. Level of Evidence: Level IV, case series.

scholarly journals Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Jake Sloane ◽  
Vivek Gulati ◽  
Sreeram Penna ◽  
Philip Pastides ◽  
Davinder Paul Singh Baghla
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ganglion Cyst ◽  
Cruciate Ligament ◽  
Infrapatellar Fat Pad ◽  
Knee Motion ◽  
Ganglion Cysts ◽  
History Of ◽  
Manipulation Under Anaesthesia ◽  
Magnetic Resonance Imaging Mri ◽  
Anterior Cruciate

A 41-year-old female presented with a 3-month history of gradually worsening anterior knee pain, swelling and inability to flex the knee. Magnetic resonance imaging (MRI) revealed a large intra-articular cystic swelling anterior to the anterior cruciate ligament (ACL), extending into the Hoffa's infrapatellar fat pad. Following manipulation under anaesthesia and arthroscopic debridement of the cyst, the patient's symptoms were relieved with restoration of normal knee motion. ACL ganglion cysts are uncommon intra-articular pathological entities, which are usually asymptomatic and diagnosed incidentally by MRI. This is the first reported case of an ACL cyst being so large as to cause a mechanical block to knee flexion.

Dorsal Wrist Ganglion Associated with Extensor Digitorum Brevis Manus: Case Report and Review of the Literature

2017 ◽  
Vol 22 (03) ◽  
pp. 355-358
Author(s):  
Adam M. Feintisch ◽  
Ramazi Datiashvili
Keyword(s):  
Case Report ◽  
Ganglion Cyst ◽  
Extensor Digitorum ◽  
Proper Treatment ◽  
Review Of The Literature ◽  
Ganglion Cysts ◽  
Dorsal Ganglion ◽  
Dorsal Wrist Ganglion ◽  
Accessory Muscles ◽  
Extensor Digitorum Brevis

Aberrant accessory muscles are rare entities in the hand. The extensor digitorum brevis manus (EDBM) muscle is amongst them and may be seen in association with dorsal ganglion cysts. Distinguishing an EDBM muscle is relevant in the diagnostic consideration of a dorsal ganglion in order to facilitate and guide its proper treatment. To date, there have been only few reports of an EDBM in association with a dorsal ganglion cyst. We report our experience with an incidental intraoperative finding of an intramuscular EDBM dorsal ganglion cyst and follow with a literature review and guide to management.

scholarly journals DOES DECUBITUS AFFECT NEURAL ELEMENTS POSITIONING? A MRI STUDY COMPARING DORSAL AND LATERAL POSITION

2020 ◽  
Vol 19 (4) ◽  
pp. 255-257
Author(s):  
LUCAS NUNES SALES DE MELO ◽  
RAFAEL BARRETO SILVA ◽  
JOSÉ CARLOS BARBE GONÇALVES ◽  
GABRIELA AIELLO FERNANDES PANTAROTO
Keyword(s):  
Dura Mater ◽  
Lateral Position ◽  
Medial Wall ◽  
Level Of Evidence ◽  
Shortest Distance ◽  
Lateral Decubitus ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Mri Study

ABSTRACT Objective To evaluate the displacement of nerve structures according to the decubitus position of the patient in a magnetic resonance imaging (MRI) study. Methods MRI was performed at a radiology clinic in 20 patients in dorsal and right lateral decubitus. The measurement considered was the shortest distance between the dura mater and the medial wall of the pedicle. Results The largest measurement was 11.6 mm in left lateral decubitus, 12.2 mm in right lateral decubitus, 10.5 mm in right dorsal decubitus, and 9.2 mm in left dorsal decubitus. In some patients the space between the medial wall of the pedicle and the dura mater was larger when in lateral decubitus, while in others when in dorsal decubitus. The mean displacement of the measurements on the left was 1.14 mm and on the right 1.355 mm. Conclusions The structures moved on average little more than 1 mm in the positions studied. The positioning of the patient for surgery does not change the space to be approached, being the surgeon’s choice according to his learning curve. Level of evidence II; Prospective study of lower quality.

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