Caso clínico: Lesão de Stener no Futebol. A Importância da Ecografia na Decisão Clínica

Ligament thumb injuries are uncommon in professional or amateur football. In this paper, we discuss the physical examination and the choice of imaging tests for the diagnosis of Stener’s injury in an amateur goalkeeper. Traditionally, the hand radiography is the first image exam performed, and it may fail because it does not diagnose ligament injury. Ultrasound is more sensitive than conventional radiography for the diagnosis of these lesions and it does not use ionizing radiation and is widely available. Therefore, its use in the medical departments of clubs and hospitals should be encouraged as a first-line exam.

Caso clínico: Lesão de Stener no Futebol. A Importância da Ecografia na Decisão Clínica

Ligament thumb injuries are uncommon in professional or amateur football. In this paper, we discuss the physical examination and the choice of imaging tests for the diagnosis of Stener’s injury in an amateur goalkeeper. Traditionally, the hand radiography is the first image exam performed, and it may fail because it does not diagnose ligament injury. Ultrasound is more sensitive than conventional radiography for the diagnosis of these lesions and it does not use ionizing radiation and is widely available. Therefore, its use in the medical departments of clubs and hospitals should be encouraged as a first-line exam.

Digital Ulcers as Presentation of Carpal Tunnel Syndrome

Ulcerating and mutilating variant of carpal tunnel syndrome occurs in longstanding cases of untreated disease. Pa- tients present with painless ulcers of the second and third fingers, accompanied with other cutaneous and sensory changes. These patients are often misdiagnosed as having a Raynaud disease or systemic sclerosis. Clinical assessment is the gold standard for the diagnosis of carpal tunnel syndrome, but hand radiography and electromyography help supporting the diagnosis. The authors present two cases of this ulcerating variant of carpal tunnel syndrome.

Sequential spine-hand radiography for assessing skeletal maturity with low radiation EOS imaging system for bracing treatment recommendation in adolescent idiopathic scoliosis: a feasibility and validity study

Purpose The EOS-imaging system is increasingly adopted for clinical follow-up in scoliosis with the advantages of simultaneous biplanar imaging of the spine in an erect position. Skeletal maturity assessment using a hand radiograph is an essential adjunct to spinal radiography in scoliosis follow-up. This study aims at testing the feasibility and validity of a newly proposed EOS workflow with sequential spine-hand radiography for skeletal maturity assessment and bracing recommendation. Methods EOS spine-hand radiographs from patients with diagnosis of idiopathic scoliosis, including both sexes and an age range of ten to 14 years, were scored using the Thumb Ossification Composite Index (TOCI), Sanders and Risser methods. Intraclass correlation coefficients (ICCs) were calculated for inter/intraobserver agreement and were tested with Cronbach’s alpha values. Results In all, 60 EOS-spine hand radiographs selected from subjects with diagnosis of adolescent idiopathic scoliosis (AIS), including 32 male patients (mean age 11.53 years; 10 to 14) and 28 female patients (mean age 11.50 years; 10 to 13) who underwent sequential spine-hand low dose EOS imaging were generated for analysis. The overall interobserver (ICC = 0.997) and intraobserver agreement (α > 0.9) demonstrated excellent agreement for TOCI staging; ICC > 0.994 for both TOCI and Sanders staging comparing traditional digital versus EOS hand radiography; ICC ≥ 0.841 for agreement on bracing recommendation among TOCI versus the Risser and Sanders system. Conclusion With the proposed new EOS workflow it was feasible to produce high image quality for skeletal maturity assessment with excellent reliability and validity to inform consistent bracing recommendation in AIS. The workflow is applicable for busy daily clinic settings in tertiary scoliosis centres with reduced time cost, improved efficiency and throughput of the radiology department. Level of evidence III

Imaging of Erosive Osteoarthritis

Chapter 45 discusses imaging of erosive osteoarthritis (EOA), a severe phenotype of osteoarthritis (OA) characterized by erosions and superimposed synovitis, most typically seen in women in the interphalangeal (IP) joints of the hand. Radiography is the primary imaging modality used in the diagnosis of EOA. EOA is distinguished from non-EOA based on the presence of erosions on radiography. US and MRI can be useful in detecting erosions, joint effusion, and active synovitis that may precede radiographic changes. The most common differential diagnosis of EOA is psoriatic arthritis (PsA), which exhibits additional characteristic imaging features such as bony proliferations and periostitis.