scholarly journals Is anterior and posterior ankle impingement under-diagnosed? A review

2021 ◽  
Vol 2 ◽  
pp. 58-65
Author(s):  
Ankit Khurana ◽  
Inderjeet Singh ◽  
Maninder Shah Singh
Keyword(s):  
Early Diagnosis ◽  
Clinical Signs ◽  
Return To Sport ◽  
Invasive Procedure ◽  
X Rays ◽  
Early Management ◽  
Ankle Impingement ◽  
Soft Tissue Impingement ◽  
Posterior Ankle Impingement ◽  
Magnetic Resonance Imaging Mri

The impingement of the ankle is diagnosed based on history, clinical signs, physical examination, and conventional radiographic observations and is often a diagnosis of exclusion. Normal X-rays may display spurs, but are mainly useful in the evaluation of other osseous and articular diseases, which may masquerade impingement symptoms. Orthopedic literature seems to embrace the idea that magnetic resonance imaging (MRI) plays a significant role in pre-operative imaging of impingement lesions and MRI is a highly useful method for evaluating acute and chronic foot and ankle disorders. Arthroscopy of the ankle is an important minimally invasive procedure for the treatment of this disease. The majority of patients who have refractory symptoms are treated for ankle impingement using debridement through arthroscopy or an open procedure. According to recent reports, arthroscopic patients for osseous impingement had done better than soft-tissue impingement arthroscopic patients. Ankle arthroscopy has outstanding functional outcomes with few complications and reproducible results. Diagnosis and treatment should be initiated immediately in sportsmen so that the competing athlete can return to sport in an expedient way. The surgeon’s increased suspicion of this disorder is necessary to avoid substantial loss of time and early management. This review highlights the author’s arthroscopic method of impingement resection and discusses the latest available literature on etiopathogenesis, diagnosis, and management of both anterior and posterior ankle impingement. A greater understanding of this disorder can assist the clinician in the early diagnosis and intervention of impingement in sportsmen and dancers. Early diagnosis and intervention are the foundation for successful return to the profession and daily activities.

scholarly journals ROLE OF PHYSICAL THERAPY IN THE TREATMENT OF POSTERIOR ANKLE IMPINGEMENT IN PEDIATRIC ATHLETES - A PROSPECTIVE STUDY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0008
Author(s):  
Adam Saloom ◽  
Nick Purcell ◽  
Matthew Ruhe ◽  
Jorge Gomez ◽  
Jonathan Santana ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Prospective Study ◽  
Conservative Management ◽  
Pediatric Patients ◽  
Weight Bearing ◽  
Return To Sport ◽  
Time To Surgery ◽  
Ankle Impingement ◽  
Posterior Ankle Impingement

Background: Posterior ankle impingement (PAI) is a known cause of posterior ankle pain in athletes performing repetitive plantarflexion motion. Even though empirically recommended in adult PAI, there is minimal literature related to the role of conservative physical therapy (PT) in pediatric patients. Purpose: To identify patient characteristics and determine if there is a difference in pediatric patients with PAI who were successful with conservative PT and those who were unsuccessful, requiring surgical intervention. Methods: Prospective study at a tertiary children’s hospital included patients <18 years diagnosed with PAI and underwent PT. Patients who received PT at an external facility were excluded. Collected data included demographics, initial presentation at PT evaluation, treatment throughout PT, patient presentation at PT discharge, time to return to sport (RTS) from initial PT evaluation (if successful), time to surgery from initial PT evaluation (if unsuccessful). Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were collected. Group comparisons were conducted using independent t-tests or chi-square analyses (alpha level set at .05). Results: 31 (12 males, 19 females) patients diagnosed with PAI were enrolled with a mean age 12.61 years (range: 8-17). Gymnastics, football, and basketball were the most commonly implicated sports (42% patients). All patients underwent initial conservative PT for an average of 16.24 weeks (9.23 visits ±7.73). 20/31(64.5%) patients failed conservative management and underwent arthroscopic debridement. PAI pathology was predominantly bony in 61.3% and soft tissue 38.7%. Between the successful PT group and unsuccessful PT group, there was no difference in the proportion of athletes/non-athletes (p=.643). Average RTS time for successful group was 11.47 weeks and average time to surgery for unsuccessful group was 17.82 weeks. There were no significant differences in sex (p=.332), age (p=.674), number of PT visits (p=.945), initial weight-bearing status (p=.367), use of manual therapy (p=.074) including manipulation (p=.172) and mobilization (p=.507), sport (p=.272), initial evaluation ankle ROM (p>.05). Initial AOFAS scores for pain, function, alignment, or total were not significantly different (p=.551, .998, .555, .964 respectively). Conclusion: The first prospective study in pediatric patients with PAI demonstrates that even though success of PT is not dependent on age, sex, sport or PAI pathology, a notable proportion of patients who undergo PT do not need surgery. Conservative management including PT should be the initial line of management for PAI. PT treatment and surgery (if unsuccessful with PT) allowed patients to return to prior level of activity/sports. Tables/Figures: [Table: see text]

scholarly journals The Prevalence and Clinical Significance of FHL Tears in Athletes with Posterior Ankle Impingement Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0034
Author(s):  
David A Porter ◽  
Angela Rund ◽  
Robert Kulwin ◽  
Madison Walrod
Keyword(s):  
Surgical Treatment ◽  
Return To Sport ◽  
Recovery Process ◽  
Flexor Hallucis Longus ◽  
Chi Square ◽  
Posterior Ankle Impingement ◽  
Magnetic Resonance Imaging Mri ◽  
One Year ◽  
Ankle Function

Category: Ankle, Hindfoot, Sports Introduction/Purpose: Posterior ankle pain in the athlete is common and thought to be caused by Flexor Hallucis Longus (FHL) tendon tear/tendinopathy or Os trigonum syndrome. The association of flexor hallucis longus (FHL) pathology in conjunction with PAIS has not been described. The purpose of this study is to report the prevalence of FHL tears in athletes who undergo surgical treatment for PAIS. We also report the outcome of 36 athletes treated with FHL repair with PAIS surgery and compare them to 122 athletes undergoing PAIS surgery without FHL tears. The utility of advanced imaging, standardized outcome scores at standard post-operative time intervals, return to sport (RTS) and time to RTS were all evaluated in the 158 athletes. Methods: Our clinical database was searched for appropriate surgical codes, and patients from 1996 through March 2016 were retrospectively collected. Inclusion criteria included surgical treatment of PAIS, age between ten and 50, and participation in recreational or competitive athletics. Exclusion criteria included other injuries that could affect return to sport or recovery process. 158 patients met these criteria, (36 dancers, 122 non-dancers). Pre-operative imaging, operative records, dorsiflexion range of motion at six weeks and one year postoperatively, and time to return to sport are reported. AAOS Foot & Ankle, and Lower Limb Core Module (FALLC) scores were obtained (six weeks, three months, and one year post-operatively). Questionnaire data and functionality scores were compared between the two groups using two-sample Student t-tests. Categorical data outcomes were compared using chi-square tests or Fisher’s exact tests. Results: 74/158 patients had magnetic resonance imaging (MRI) pre-operatively. 5/14 patients with an FHL tear had positive MRI suggesting an FHL tear, 9/14 patients with FHL tear had negative MRI (sensitivity of 0.26). FHL tears occurred in 36/158 (23%) of athletes with PAIS, 16/36 (44.4%) of dancers and 20/122 (16.4%) non-dancers. RTS did not differ between athletes with and without FHL tears, but time until RTS increased-average of 13.5 days (67.5 versus 81) with FHL repairs. Dancers with FHL tears reported increased foot pain and lower foot and ankle function at 3 months relative to those without tears. Scores were similar at one year. Conclusion: FHL tears in athletes undergoing surgical treatment for PAIS is 23% and in dancers can be as high as 44%. Pre- operative MRI has a poor sensitivity for FHL tears in this population. Concomitant FHL tear with repair during PAIS surgery does not decrease the rate of RTS or long term overall outcome. Overall, dancers have a higher rate of FHL tear at time of PAIS than non-dancers. FHL results in only a mild delay in RTS time. This is the first study to note FHL tear rate in association with PAI surgery.

Imaging of gout

2016 ◽  
Author(s):  
Robert T. Keenan ◽  
Sneha Pai ◽  
Naomi Schlesinger
Keyword(s):  
Soft Tissues ◽  
Clinical Signs ◽  
Urate Oxidase ◽  
Imaging Modalities ◽  
Dual Energy Ct ◽  
X Rays ◽  
Advanced Imaging ◽  
Crystal Deposition ◽  
Bone Changes ◽  
Magnetic Resonance Imaging Mri

Gout is a systemic metabolic disease. The enzyme urate oxidase (uricase) that catalyses the oxidation of uric acid to the more soluble compound allantoin is inactive in humans. This may lead to hyperuricaemia. Hyperuricaemia is often present for many years prior to clinical signs of gout. Acute attacks occur as a result of an inflammatory response to monosodium urate (MSU) crystal deposition leading to intense pain and inflammation in the affected joints. Uncontrolled hyperuricaemia and resultant gout can evolve into a destructive arthritis. Imaging may be helpful in the diagnosis of gout as well as in monitoring the response to gout treatment. Plain X-rays are widely used for joint imaging in patients with gout. However, plain X-rays of joints affected by gout are frequently normal, especially early in the disease. In these cases, advanced imaging modalities may be useful. Advanced imaging can help evaluate inflammation, structural joint changes, and magnitude of tophaceous deposits. Advanced imaging modalities include computed tomography (CT), dual-energy CT (DECT), magnetic resonance imaging (MRI), and ultrasound (US). CT may be most suitable to evaluate bone changes in gouty joints and DECT to evaluate tophaceous deposits. MRI may best evaluate soft tissues and Inflammation. US is useful during patients’ visits to the rheumatologist and allows evaluation of cartilage, soft tissues, synovium, and tophaceous deposits. This chapter reviews imaging modalities used in gout patients and discusses their application in the diagnosis and management of gout.

scholarly journals Posterior Ankle Impingement Syndrome in Elite Athletes: Arthroscopic Tratment Return to Sport

2021 ◽  
Vol 37 (1) ◽  
pp. e69-e70
Author(s):  
Francesco Allegra ◽  
Stefano Carli ◽  
Mario Guerrisi ◽  
Carlo Paglialuna ◽  
Edoardo Barberini
Keyword(s):  
Elite Athletes ◽  
Return To Sport ◽  
Impingement Syndrome ◽  
Ankle Impingement ◽  
Posterior Ankle Impingement

scholarly journals Sensitivity of Awaji Criteria and Revised El Escorial Criteria in the Diagnosis of Amyotrophic Lateral Sclerosis (ALS) at First Visit in a Tunisian Cohort

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Bademain Jean Fabrice Ido ◽  
Imen Kacem ◽  
Mahamadi Ouedraogo ◽  
Amina Nasri ◽  
Saloua Mrabet ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Retrospective Study ◽  
Early Diagnosis ◽  
Disease Progression ◽  
Clinical Signs ◽  
Fatal Disease ◽  
Early Management ◽  
El Escorial Criteria ◽  
Study Population ◽  
Lateral Sclerosis

Background. Amyotrophic lateral sclerosis (ALS) is a fatal disease whose diagnosis and early management can improve survival. The most used diagnostic criteria are the revised El Escorial criteria (rEEC) and Awaji criteria (AC). The comparison of their sensitivities showed contradictory results. Our study aimed to compare the sensitivities of these two criteria in the diagnosis of definite ALS, at first visit, in a Tunisian hospital cohort. Materials and Methods. This was a retrospective study including 173 patients diagnosed with ALS at the Department of Neurology of the Razi Hospital between January 2003 and April 2018.After studying the clinical features of the disease in our study population,each patient was categorized according to the rEEC and AC based on data collected in his medical record during his first visit to our department. Then, we compared the sensitivities of these two criteria in the diagnosis of definite ALS. Results. Our Tunisian cohort was characterized by a slower disease progression. The sensitivity of the AC (69.4%) was significantly higher than that of the rEEC (40.5%) ( p  < 0.001). When the clinical signs evolved for less than 6 months, the sensitivities were 61% for AC and 12% for rEEC ( p  < 0.001). After 24 months of disease progression, the sensitivities were 78.2% for AC and 69.1% for rEEC ( p  = 0.063). It was impossible to categorize seventeen patients by the two criteria. Conclusion. Our study demonstrated that patients in AC are more sensitive than rEEC in the early diagnosis of ALS in our Tunisian cohort. However, this superiority is gradually reduced during the evolution of the disease.

Management and Outcomes of Clinical Scaphoid Fractures in Children

Hand ◽  
2020 ◽  
pp. 155894472093029
Author(s):  
Aneesh Karir ◽  
Minh N. Q. Huynh ◽  
Sasha Carsen ◽  
Kevin Smit ◽  
Kevin Cheung
Keyword(s):  
Scaphoid Fracture ◽  
Clinical Signs ◽  
Fracture Rate ◽  
X Rays ◽  
Advanced Imaging ◽  
Scaphoid Fractures ◽  
Fractures In Children ◽  
Magnetic Resonance Imaging Mri ◽  
Mean Time ◽  
Pediatric Center

Background: Acute wrist trauma with clinical suspicion of a scaphoid fracture, but normal radiographs, is known as a clinical scaphoid fracture. Standard treatment involves immobilization and repeat radiographs in 10 to 14 days. When repeat radiographs are normal but a scaphoid fracture is still clinically suspected, the optimal management in children is unknown. This study retrospectively assessed the management and outcomes of pediatric patients diagnosed with clinical scaphoid fractures. Methods: A retrospective study was performed of all patients over a 2-year period treated for a clinical scaphoid fracture at a tertiary pediatric center. Patients were included if they had clinical signs of a scaphoid fracture and 2 negative x-rays 7 to 14 days apart postinjury. Results: Ninety-one patients with a mean age of 13.2 years (range: 7.8-17.7) were included. Sixteen patients (17.6%) underwent computed tomography (CT) or magnetic resonance imaging (MRI) at a mean time of 10.2 weeks postinjury. Five patients (5.5%) were diagnosed with a scaphoid fracture by x-ray or CT at an average of 4.5 weeks postinjury (range: 3-6). Six patients were diagnosed with other wrist fractures at a mean time postinjury of 3.1 (range: 3-6.5) weeks. Out of 195 total radiographs, the surgeon and radiologist disagreed on 59 (30.2%) images. No patients underwent surgery. Conclusions: Management of clinical scaphoid fractures at our institution was relatively uniform: nearly all patients were immobilized and less than 20% received advanced imaging. Our findings suggest a low but non-zero occult scaphoid fracture rate, discordance in radiologic interpretation, and lack of advanced imaging, providing an avenue for future prospective studies.

Os Trigonum Syndrome or Posterior Ankle Impingement (PAI)

2014 ◽  
Vol 07 (01) ◽  
pp. 94-95
Author(s):  
Pornthep Mamanee ◽  
Nathapon Chantaraseno ◽  
Somsak Geraplangsub
Keyword(s):  
Os Trigonum ◽  
Ankle Impingement ◽  
Posterior Ankle Impingement

Desmoid tumour of the distal forearm involving the distal radioulnar joint

2020 ◽  
Vol 13 (11) ◽  
pp. e237097
Author(s):  
Apoorv Sehgal ◽  
Pratyush Shahi ◽  
Avijeet Prasad ◽  
Manoj Bhagirathi Mallikarjunaswamy
Keyword(s):  
Distal Radioulnar Joint ◽  
Treatment Modalities ◽  
Desmoid Tumour ◽  
X Rays ◽  
Distal Forearm ◽  
Left Wrist ◽  
Radioulnar Joint ◽  
Magnetic Resonance Imaging Mri ◽  
Epidemiology Investigation

A 32-year-old woman presented with progressive pain and swelling of the left wrist for 6 months. Physical examination revealed a firm, tender, oval swelling over the left wrist. X-rays showed a pressure effect on the distal radius and ulna. Magnetic Resonance Imaging (MRI) revealed a well-defined, asymmetrical, dumbbell-shaped soft-tissue lesion involving the interosseous region of the distal forearm and extending until the distal radioulnar joint (DRUJ). Core needle biopsy confirmed the diagnosis of desmoid tumour. Marginal excision of the tumour was done. At the 2-year follow-up, the patient was doing well and had painless and improved left wrist motion. Desmoid tumour involving the DRUJ has not been previously reported. We, through this case, report new observation and discuss the epidemiology, investigation of choice, treatment modalities, and the need for a regular follow-up for appendicular desmoid tumours.

scholarly journals The value of contrast-enhanced FLAIR magnetic resonance imaging in detecting meningeal abnormalities in suspected cases of meningitis compared to conventional contrast-enhanced T1WI sequences

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Wael Hamza Kamr ◽  
Mohamed Gaber Eissawy ◽  
Amr Saadawy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Early Diagnosis ◽  
Diagnosis And Treatment ◽  
Effective Management ◽  
Resonance Imaging ◽  
Flair Sequence ◽  
Csf Analysis ◽  
Contrast Enhanced ◽  
Magnetic Resonance Imaging Mri

Abstract Background Early diagnosis of meningitis with magnetic resonance imaging (MRI) would be useful for appropriate and effective management, decrease morbidity and mortality, and provide better diagnosis and treatment. The objective of the current study is to compare the accuracy of contrast-enhanced FLAIR (CE-FLAIR) and contrast-enhanced T1WI (CE-T1WI) in the detection of meningeal abnormalities in suspected cases of meningitis. Results Out of 45 patients, 37 patients were confirmed to have meningitis on CSF analysis. Out of the 37 patients, 34 patients were positive on CE-FLAIR sequence and 27 were positive on CE-T1WI. The sensitivity of CE-FLAIR sequence was 91.9% and specificity 100%, while the sensitivity of CE-T1WI sequence was 73% and specificity 100%. Conclusion CE-FLAIR is more sensitive than CE-T1WI in diagnosis of meningitis. It is recommended to be used in any cases with clinically suspected meningitis.

scholarly journals Acoustofluidic separation enables early diagnosis of traumatic brain injury based on circulating exosomes

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Zeyu Wang ◽  
Haichen Wang ◽  
Ryan Becker ◽  
Joseph Rufo ◽  
Shujie Yang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Flow Cytometry ◽  
Brain Injury ◽  
Early Diagnosis ◽  
Tissue Injury ◽  
Management Strategies ◽  
Acoustic Properties ◽  
Early Management ◽  
Biomarker Analysis ◽  
Downstream Analysis

AbstractTraumatic brain injury (TBI) is a global cause of morbidity and mortality. Initial management and risk stratification of patients with TBI is made difficult by the relative insensitivity of screening radiographic studies as well as by the absence of a widely available, noninvasive diagnostic biomarker. In particular, a blood-based biomarker assay could provide a quick and minimally invasive process to stratify risk and guide early management strategies in patients with mild TBI (mTBI). Analysis of circulating exosomes allows the potential for rapid and specific identification of tissue injury. By applying acoustofluidic exosome separation—which uses a combination of microfluidics and acoustics to separate bioparticles based on differences in size and acoustic properties—we successfully isolated exosomes from plasma samples obtained from mice after TBI. Acoustofluidic isolation eliminated interference from other blood components, making it possible to detect exosomal biomarkers for TBI via flow cytometry. Flow cytometry analysis indicated that exosomal biomarkers for TBI increase in the first 24 h following head trauma, indicating the potential of using circulating exosomes for the rapid diagnosis of TBI. Elevated levels of TBI biomarkers were only detected in the samples separated via acoustofluidics; no changes were observed in the analysis of the raw plasma sample. This finding demonstrated the necessity of sample purification prior to exosomal biomarker analysis. Since acoustofluidic exosome separation can easily be integrated with downstream analysis methods, it shows great potential for improving early diagnosis and treatment decisions associated with TBI.

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