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Manske RC, Wolfe C, Page P, Voight M. Diagnostic Musculoskeletal Ultrasound in the Evaluation of the Median Nerve. Int J Sports Phys Ther 2025; 20:756-761. [PMID: 40322522 PMCID: PMC12048358 DOI: 10.26603/001c.136985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2025] Open
Abstract
The median nerve is a crucial structure in the forearm and wrist, responsible for motor and sensory functions. Accurate diagnosis of nerve injury is essential for appropriate treatment planning and optimizing patient outcomes. Although magnetic resonance imaging (MRI) and nerve conduction studies (NCS) are the gold standard for nerve assessment, diagnostic musculoskeletal (MSK) ultrasound offers a portable, real-time, and cost-effective alternative that is gaining traction in rehabilitation and sports medicine settings. MSK ultrasound has emerged as a valuable, non-invasive imaging modality for evaluating median nerve pathology, including carpal tunnel syndrome (CTS), nerve entrapment, and traumatic nerve injuries. This article reviews the utility of MSK ultrasound in evaluating the median nerve injury, including its anatomy, common injury patterns, sonographic techniques, and clinical implications for professional rehabilitation. By integrating MSK ultrasound into clinical practice, providers can improve the accuracy of diagnosis, monitor healing progression, and guide rehabilitation strategies for optimal patient outcomes.
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Manske RC, Wolfe C, Page P, Voight M. Diagnostic Musculoskeletal Ultrasound in the Evaluation of the Deltoid Ligament of the Ankle. Int J Sports Phys Ther 2025; 20:641-647. [PMID: 40182903 PMCID: PMC11964700 DOI: 10.26603/001c.132251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025] Open
Abstract
The deltoid ligament of the ankle is a critical stabilizer of the medial aspect of the joint, often implicated in injuries ranging from sprains to complex fracture-dislocation scenarios. Injuries to the deltoid ligament are less common than lateral ankle sprains but can lead to chronic instability and dysfunction if not properly diagnosed and managed. Accurate diagnosis of deltoid ligament injuries is essential for appropriate treatment planning and optimizing patient outcomes. While magnetic resonance imaging (MRI) is considered the gold standard for ligament assessment, diagnostic musculoskeletal (MSK) ultrasound offers a portable, real-time, and cost-effective alternative that is gaining traction in rehabilitation and sports medicine settings. This article reviews the utility of MSK ultrasound in evaluating the deltoid ligament, including its anatomy, common injury patterns, sonographic techniques, and clinical implications for rehabilitation professionals. By integrating MSK ultrasound into clinical practice, providers can improve the accuracy of diagnosis, monitor healing progression, and guide rehabilitation strategies for optimal patient outcomes.
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3
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Koris J, Calder JDF, Dalmau‐Pastor M, Fernandez MA, Ramasamy A. Deltoid ligament injuries: A review of the anatomy, diagnosis and treatments. Knee Surg Sports Traumatol Arthrosc 2024; 32:3052-3064. [PMID: 38796726 PMCID: PMC11605033 DOI: 10.1002/ksa.12274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/28/2024] [Accepted: 05/07/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE Ankle sprains remain the most common soft tissue injury presenting to Emergency Departments. Recently, there has been increased awareness and reporting of deltoid ligament injuries in association with injuries to the lateral ligament complex as well as with fibula fractures. This article reviews the currently available literature on the anatomy of the deltoid ligament, clinical and radiological diagnosis of injuries to the deltoid ligament and treatment recommendations. METHODS A literature review was conducted for keywords associated with deltoid ligament injuries. MEDLINE, PubMed and Embase databases were utilised for this search. Articles were included if involving an adult population, were English-language, were related to deltoid ligament injuries (with or without associated injuries) and reported on patho-anatomy, clinical or radiological diagnosis or treatment methods. RESULTS A total of 93 articles were assessed for relevance from the database search, and 47 were included after the removal of irrelevant articles and duplicates. Several studies reported on the clinical findings of deltoid ligament injury, as well as the radiographic analysis. Arthroscopy was considered the gold standard of diagnosis, with authors reporting on the potential benefit of performing arthroscopic repair or reconstruction at the same time. There were no studies that provided a system for the classification of deltoid ligament injury or larger studies of treatment pathways. Long-term studies of the incidence of instability in deltoid ligament injuries were not available. CONCLUSION There is limited evidence available regarding deltoid ligament injuries, particularly in terms of treatment options, either in isolation or with concomitant injuries. Long-term follow-up studies are needed to obtain more accurate data on the number of complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jacob Koris
- Trauma & Orthopaedic Specialty Registrar, John Radcliffe HospitalOxfordUK
| | - James D. F. Calder
- Department of BioengineeringImperial College LondonLondonUK
- Fortius ClinicLondonUK
| | - Miki Dalmau‐Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society)MerignacFrance
| | | | - Arul Ramasamy
- Department of BioengineeringImperial College LondonLondonUK
- Academic Department of Military Trauma and OrthopaedicsRoyal Centre for Defence Medicine, EdgbastonBirminghamUK
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4
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Beltran LS, Zuluaga N, Verbitskiy A, Bencardino JT. Imaging of Acute Ankle and Foot Sprains. Radiol Clin North Am 2023; 61:319-344. [PMID: 36739148 DOI: 10.1016/j.rcl.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ankle and foot injuries are very common injuries in the general population, and more so in athletes. MR imaging is the optimal modality to evaluate for ligamentous injuries of the ankle and associated conditions after ankle sprain. In this article, the authors discuss the epidemiology, biomechanics, normal anatomy, and pathology of the ankle as well as injuries of the hindfoot and midfoot that are often associated with ankle injuries.
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Affiliation(s)
- Luis S Beltran
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Nicolas Zuluaga
- Department of Radiology, University of Pennsylvania Health System, 3737 Market Street, Philadelphia, PA 19104, USA
| | - Anna Verbitskiy
- Department of Radiology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Jenny T Bencardino
- Department of Radiology, University of Pennsylvania Health System, 3737 Market Street, Philadelphia, PA 19104, USA
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5
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Pre-procedural Imaging. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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6
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Hall MM, Allen GM, Allison S, Craig J, DeAngelis JP, Delzell PB, Finnoff JT, Frank RM, Gupta A, Hoffman DF, Jacobson JA, Narouze S, Nazarian LN, Onishi K, Ray JW, Sconfienza LM, Smith J, Tagliafico A. Recommended Musculoskeletal and Sports Ultrasound Terminology: A Delphi-Based Consensus Statement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2395-2412. [PMID: 35103998 DOI: 10.1002/jum.15947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The current lack of agreement regarding standardized terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice, and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. METHODS A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus which was defined as group level agreement >80%. RESULTS Content was organized into seven general topics including: 1) General Definitions, 2) Equipment and Transducer Manipulation, 3) Anatomic and Descriptive Terminology, 4) Pathology, 5) Procedural Terminology, 6) Image Labeling, and 7) Documentation. Terms and definitions which reached consensus agreement are presented herein. CONCLUSIONS The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients, and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.
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Affiliation(s)
- Mederic M Hall
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | | | - Sandra Allison
- Department of Radiology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Joseph Craig
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joseph P DeAngelis
- Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Atul Gupta
- Department of Radiology, Rochester General Hospital, Rochester, New York, USA
| | - Douglas F Hoffman
- Departments of Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Jon A Jacobson
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samer Narouze
- Department of Surgery and Anesthesiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Levon N Nazarian
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeremiah W Ray
- Departments of Emergency Medicine and Physical Medicine and Rehabilitation, University of California, Davis, Davis, California, USA
| | - Luca M Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Alberto Tagliafico
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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7
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Hall MM, Allen GM, Allison S, Craig J, DeAngelis JP, Delzell PB, Finnoff JT, Frank RM, Gupta A, Hoffman D, Jacobson JA, Narouze S, Nazarian L, Onishi K, Ray JW, Sconfienza LM, Smith J, Tagliafico A. Recommended musculoskeletal and sports ultrasound terminology: a Delphi-based consensus statement. Br J Sports Med 2022; 56:310-319. [PMID: 35110328 DOI: 10.1136/bjsports-2021-105114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 12/26/2022]
Abstract
The current lack of agreement regarding standardised terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus, which was defined as group level agreement of >80%. Content was organised into seven general topics including: (1) general definitions, (2) equipment and transducer manipulation, (3) anatomical and descriptive terminology, (4) pathology, (5) procedural terminology, (6) image labelling and (7) documentation. Terms and definitions which reached consensus agreement are presented herein. The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.
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Affiliation(s)
- Mederic M Hall
- Orthopedics and Rehabilitation, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | - Joseph Craig
- Radiology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | | | - Jonathan T Finnoff
- Department of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel M Frank
- Orthopedic Surgery, University of Colorado, Denver, Colorado, USA
| | - Atul Gupta
- Radiology, Rochester General Hospital, Rochester, New York, USA
| | - Douglas Hoffman
- Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Jon A Jacobson
- Radiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samer Narouze
- Surgery and Anesthesiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Levon Nazarian
- Radiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Kentaro Onishi
- Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeremiah Wayne Ray
- Emergency Medicine, University of California Davis, Davis, California, USA
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Biomedical Sciences for Health, University of Milan, Milano, Italy
| | - Jay Smith
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
- Institute of Advanced Ultrasound Guided Procedures, Sonex Health, Inc, Eagan, Minnesota, USA
| | - Alberto Tagliafico
- Health Sciences, University of Genoa, Genova, Italy
- Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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8
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Rein S, Hagert E, Sterling-Hauf T. Alterated ligamento-muscular reflex pattern after stimulation of the anterior talofibular ligament in functional ankle instability. Knee Surg Sports Traumatol Arthrosc 2021; 29:1544-1553. [PMID: 32851428 DOI: 10.1007/s00167-020-06232-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Ligamento-muscular reflex pattern following stimulation of the anterior talofibular ligament (ATFL) was examined. METHODS The peroneus longus (PL), the tibialis anterior (TA), and tibialis posterior (TP) muscles were investigated in sixteen patients with functional ankle instability (FAI) and 16 age- and gender-matched controls. The ATFL was stimulated with a fine wire electrode while electromyographic (EMG) activities were recorded during isometric foot contraction of 20% maximal force in plantarflexion, dorsiflexion, supination and pronation. The complete measurement was repeated after a peroneal block anesthesia. RESULTS Statistically significant changes in post-stimulus EMG activity were observed in all three muscles and all four tested foot positions. In supination, the PL showed no reactions in both groups before and after anesthesia. The post-stimulus inhibition of the TA seen after 80 and 180 ms disappeared in controls after anesthesia. The TP had similar inhibitory responses in both groups. CONCLUSION Ligamento-muscular reflex pattern is alterated in FAI. While early reactions are essential in protecting the ankle joint in sudden movements, the later responses indicate a supraspinal control of neuromuscular stability of the ankle joint. Proprioceptive rehabilitation of the PL, TA, and TP is crucial in FAI to compensate for post-traumatic ligamentomuscular reflex deficiencies. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Klinikum Sankt Georg, Delitzscher Straße 141, 04129, Leipzig, Germany. .,Martin-Luther-University of Halle-Wittenberg, Halle, Germany.
| | - Elisabet Hagert
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Arcademy, H.M Queen Sophia Hospital, Stockholm, Sweden
| | - Thorben Sterling-Hauf
- Department of Otolaryngology, University Hospital, Franz-Joseph-Strauß-Allee 11, 93053, Regensburg, Germany
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9
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Halabchi F, Hassabi M. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop 2020; 11:534-558. [PMID: 33362991 PMCID: PMC7745493 DOI: 10.5312/wjo.v11.i12.534] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/04/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023] Open
Abstract
Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40% of all sports-related injuries. It is especially common in basketball, American football, and soccer. The majority of sprains affect the lateral ligaments, particularly the anterior talofibular ligament. Despite its high prevalence, a high proportion of patients experience persistent residual symptoms and injury recurrence. A detailed history and proper physical examination are diagnostic cornerstones. Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules. Several interventions have been recommended in the management of acute ankle sprains including rest, ice, compression, and elevation, analgesic and anti-inflammatory medications, bracing and immobilization, early weight-bearing and walking aids, foot orthoses, manual therapy, exercise therapy, electrophysical modalities and surgery (only in selected refractory cases). Among these interventions, exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process. An exercise program should be comprehensive and progressive including the range of motion, stretching, strengthening, neuromuscular, proprioceptive, and sport-specific exercises. Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables, manual tests for stability, and functional performance testing. There are some common myths and mistakes in the management of ankle sprains, which all clinicians should be aware of and avoid. These include excessive imaging, unwarranted non-weight-bearing, unjustified immobilization, delay in functional movements, and inadequate rehabilitation. The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.
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Affiliation(s)
- Farzin Halabchi
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran 14167-53955, Iran
| | - Mohammad Hassabi
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran 19979-64151, Iran
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10
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Bruns A, Möller I, Martinoli C. Back to the roots of rheumatology - Imaging of regional pain syndromes. Best Pract Res Clin Rheumatol 2020; 34:101630. [PMID: 33272828 DOI: 10.1016/j.berh.2020.101630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Musculoskeletal regional pain syndromes (RPS) often lead to patient referrals in general and rheumatological practice. Detailed history taking and clinical examination can, in most cases, reveal the cause for pain and direct the subsequent management of the conditions. Yet, when in doubt, imaging methods, such as ultrasound (US) may support the clinical assessment. This paper reviews the underlying pathologies of some of the most frequently encountered RPS and the role of musculoskeletal US imaging for their diagnosis and treatment. If available, data on diagnostic accuracy and comparisons with gold standards are reported. The article stresses the importance of anatomical and sonoanatomical knowledge for the proper interpretation of the US images, points out the advantages and disadvantages of this imaging tool, and suggests the future research agenda.
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Affiliation(s)
- Alessandra Bruns
- Division of Rheumatology, Sherbrooke University, Sherbrooke, Canada.
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
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11
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Rein S, Houschyar KS, Sterling-Hauf T. Ultrasound Analysis of Lateral Ankle Ligaments in Functional Ankle Instability. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3228-3238. [PMID: 32933796 DOI: 10.1016/j.ultrasmedbio.2020.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
The anterior talofibular ligament and the calcaneofibular ligament were sonographically investigated in 16 patients with functional ankle instability (FAI) and 16 controls under neutral and standardized stress conditions of 15 kp with a TELOS device. Clinical investigation revealed a significantly higher rate of a positive anterior drawer and talar tilt (p <0.001, respectively), significantly increased supination (p = 0.047) of the right ankle joint and increased plantarflexion (p = 0.009) of the left ankle joint in the FAI group compared with controls. Significantly higher rates of inhomogeneity and hypo-echogenicity were sonographically observed in both ligaments in the FAI group (p < 0.05, respectively). The anterior talofibular ligament was significantly longer under stress conditions, and the calcaneofibular ligament was significantly longer under both neutral and stress conditions in the FAI group (p < 0.05, respectively). Peritendinous edema of the peroneal tendons was found in 22% of the FAI group and 6% of controls.
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Affiliation(s)
- Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Klinikum Sankt Georg, Leipzig, Germany; Martin-Luther-University of Halle-Wittenberg, Halle-Wittenberg, Germany.
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12
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Strakowski JA, Chiou-Tan FY. Musculoskeletal ultrasound for traumatic and torsional alterations. Muscle Nerve 2020; 62:654-663. [PMID: 32696511 DOI: 10.1002/mus.27025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/10/2020] [Accepted: 07/19/2020] [Indexed: 12/20/2022]
Abstract
The sonographic appearance of soft tissue can be altered by trauma and positional change with torsional stress. This creates challenges for ultrasonographic interpretation, because most descriptive literature and standard instructional references are displayed in anatomically neutral or other conventional positions. Knowledge of anatomic alteration and changes in sonographic appearance with torsional stress is essential for accurately assessing soft tissue abnormalities in conditions of spasticity, traumatic and post-surgical changes, and other conditions that distort musculoskeletal relationships. A systematic scanning approach to these alterations is needed for accurate diagnostic interpretation, optimizing electrode placement for electrodiagnostic techniques, effective needle placement for therapeutic ultrasound-guided procedures, and even planning for restorative surgery. This review describes expected positional changes of normal structures with torsional alteration, as well as sonographic recognition of scars, burns, hematomas, fat layer fracture, Morel-Lavallee lesions, abscesses, foreign bodies, myotendinous lesions, muscle injury and denervation, and traumatic peripheral nerve injury.
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Affiliation(s)
- Jeffry A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Faye Y Chiou-Tan
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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13
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Becciolini M, Bonacchi G, Stella SM, Galletti S, Ricci V. High ankle sprain: sonographic demonstration of a posterior inferior tibiofibular ligament avulsion. J Ultrasound 2020; 23:431-433. [PMID: 32248412 DOI: 10.1007/s40477-020-00455-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/23/2020] [Indexed: 12/26/2022] Open
Abstract
Syndesmotic injuries, also referred as high ankle sprains, may cause significant ankle instability and chronic pain. Ultrasound (US) is a well-proven imaging modality to evaluate the ligaments of the ankle, due to its high spatial resolution and the possibility to perform dynamic examinations. However, considering the syndesmosis complex, the sonographic appearance of the posterior inferior tibiofibular ligament (PITFL) is not well described in the pertinent literature and, to the best of our knowledge, we found no report of PITFL avulsion demonstrated at US, as in the case presented.
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Affiliation(s)
- Marco Becciolini
- Misericordia Di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy. .,Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Pisa, Italy.
| | - Giovanni Bonacchi
- Misericordia Di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy.,Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Pisa, Italy
| | - Salvatore Massimo Stella
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Pisa, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Bologna, Italy
| | - Vincenzo Ricci
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Bologna, Italy.,Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
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14
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Dorsiflexion is more feasible than plantar flexion in ultrasound evaluation of the calcaneofibular ligament: a combination study of ultrasound and cadaver. Knee Surg Sports Traumatol Arthrosc 2020; 28:262-269. [PMID: 31327035 DOI: 10.1007/s00167-019-05630-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/15/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Ultrasound (US) is a valuable tool for the evaluation of chronic lateral instability of the ankle; however, the feasibility of US for calcaneofibular ligament (CFL) assessment remains unknown. This study aimed to depict and compare CFL on US in various ankle positions to determine the optimal method for evaluating CFL with US and to interpret US findings using cadaveric specimens. METHODS The US study included 43 ankles of 25 healthy individuals. The CFL was scanned with US in 20° plantar flexion, neutral position, 20° dorsiflexion and maximum dorsiflexion. The distances between fibula and CFL were compared. The cadaveric study included macroscopic qualitative observation of the dynamic change of CFL in 7 ankles and quantitative observation of the directions of CFL and footprints in 17 ankles. RESULTS In the US study, the mean distance (mm) between fibula and CFL was 7.3 ± 1.3 in 20° plantar flexion, 6.7 ± 1.6 in neutral position, 4.3 ± 2.5 in 20° dorsiflexion and 3.1 ± 2.1 in maximum dorsiflexion. The more dorsiflexed the ankle was, the shorter the distance between fibula and CFL was (Jonckheere's trend test p < 0.001). In the cadaveric study, the CFL fibres were aligned parallel between the mid-substance and the fibular attachment in maximum dorsiflexion, whilst CFL was reflected and rotated in plantar flexion. CONCLUSIONS The whole length of the CFL, including its fibular attachment, is more likely to be visualized with US in dorsiflexion than in plantar flexion due to the direction of the CFL at the fibular attachment, which is parallel with the mid-substance in maximum dorsiflexion. LEVEL OF EVIDENCE IV.
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15
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Allen GM, Wilson DJ, Bullock SA, Watson M. Extremity CT and ultrasound in the assessment of ankle injuries: occult fractures and ligament injuries. Br J Radiol 2019; 93:20180989. [PMID: 31742428 DOI: 10.1259/bjr.20180989] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To assess the rates of fractures and ligament injuries in patients with an acute ankle injury and a normal radiographic examination, and to consider the most appropriate examination protocol. METHODS Patients with an acute ankle injury who presented to the John Radcliffe Hospital Emergency Department with a normal radiographic examination were eligible for the study. They were invited to receive a cone beam CT and ultrasound examination at a local radiology department within 5 days of their ankle injury. RESULTS Of the 100 patients recruited to the study, 19 patients were found to have major fractures and 42 patients had small avulsion fractures. Additionally, 42 patients had ankle effusions and there were a large number of soft tissue injuries. There were 83 acute injuries of the anterior talofibular ligament, 19 of the anterior tibiofibular ligaments, 26 of the calcaneofibular ligament, 39 of the deltoid ligament complex, 21 of the talonavicular ligament, 14 of the spring ligament and 3 of the calcaneocuboid ligament. CONCLUSION Conventional radiographic examination misses significant fractures of the foot and ankle and the presence of an ankle effusion does not relate to the severity of injury. Ultrasound is a useful imaging technique that can supplement clinical practice, but it is unlikely to replace current protocols alone. Cone beam CT is an appropriate alternative to plain radiography, being more sensitive in detecting fractures and delivering a similar dose of radiation. However, neither CT or ultrasound examination can detect all avulsion fractures. Simple anterior process fractures of the calcaneus are associated with talonavicular ligament injuries and the medial ligaments are injured in almost 50% of cases when there is a lateral ligament injury. ADVANCES IN KNOWLEDGE Fractures in the foot and ankle are detected more precisely with cone beam CT compared to radiographs. Cone beam CT delivers similar doses of to conventional radiographs which is around 10% of that resulting from conventional CT. Ultrasound examination is an effective assessment tool to detect ligamentous injuries. The absence of an ankle effusion does not exclude a major fracture.
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Affiliation(s)
- Georgina M Allen
- St Luke's Radiology Oxford Ltd, Oxford, UK.,University of Oxford, Oxford, UK
| | - David J Wilson
- St Luke's Radiology Oxford Ltd, Oxford, UK.,Imperial College London, London, UK
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Hattori S, Alvarez CAD, Canton S, Hogan MV, Onishi K. Ultrasound-Guided Ankle Lateral Ligament Stabilization. Curr Rev Musculoskelet Med 2019; 12:497-508. [PMID: 31749104 PMCID: PMC6942111 DOI: 10.1007/s12178-019-09592-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Ultrasound (US) is an increasingly popular imaging modality currently used both in clinics and operating rooms. The purpose of this review is to appraise literature describing traditional lateral ankle stabilization techniques and discuss potential advantages of US-guided ankle lateral ligament stabilization. In addition, albeit limited, we will describe our experiences in perfecting this technique. RECENT FINDINGS To date, the modified open Broström-Gould technique remains as the gold standard surgical treatment for chronic ankle instability (CAI). In the past decade, modifications of this technique have been done, from a combination of arthroscopic and open procedure to an all-inside arthroscopic technique with a goal of minimizing wound complications, better outcomes, and earlier return to activity. Recently, the use of US as an adjunct to surgical procedures has gained popularity and several novel techniques have been described. The use of US in lateral ankle stabilization could allow accurate placement of the suture anchor at the anatomical attachment of the anterior talofibular ligament (ATFL) without iatrogenic damage to the neurovascular structures such as anterolateral malleolar artery, superficial peroneal nerve, and sural nerve. In summary, the use of US in ankle lateral ligament stabilization is a promising new micro-invasive technique. The theoretical advantages of US-guided ankle lateral ligament stabilization include direct visualization of desired anatomical landmarks and structures which could increase accuracy, decrease iatrogenic neurovascular damage, minimize wound complications, and improve outcomes.
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Affiliation(s)
- Soichi Hattori
- Department of Sports Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba Prefecture, 2968602, Japan.
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Carlo Antonio D Alvarez
- Department of Sports Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba Prefecture, 2968602, Japan
| | - Stephen Canton
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Macalus V Hogan
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Kentaro Onishi
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
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Alves T, Dong Q, Jacobson J, Yablon C, Gandikota G. Normal and Injured Ankle Ligaments on Ultrasonography With Magnetic Resonance Imaging Correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:513-528. [PMID: 30099744 DOI: 10.1002/jum.14716] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Abstract
Ultrasonography (US) has been increasingly used in the evaluation of ankle ligamentous injuries given its advantages as a dynamic, efficient, noninvasive, and cost-effective imaging method. Understanding the anatomy of the ankle ligaments is critical for correct diagnosis and treatment. This pictorial essay describes and illustrates the US scanning technique and potential pitfalls in evaluating the ankle ligaments and also provides an overview of the US appearance of normal and injured ankle ligaments with magnetic resonance imaging correlation. Highlighted structures include the lateral complex, medial/deltoid complex, spring (calcaneonavicular) ligament complex, and syndesmosis.
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Affiliation(s)
- Timothy Alves
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Qian Dong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Jon Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Corrie Yablon
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Girish Gandikota
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
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Affiliation(s)
- Youngseok Moon
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chong-bin Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hoon Ahn
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
This article reviews the imaging aspects relevant to ligamentous instabilities of the foot and ankle with a focus on MRI and ultrasound imaging. A pictorial review of the anatomy of the medial and lateral ankle ligaments, syndesmosis, spring ligament, Lisfranc complex, hallux sesamoid complex, and lesser toe plantar plate as seen on MRI is presented. Selected cases of ligamentous pathology relevant to foot and ankle instability are presented. The value of imaging in the assessment of foot and ankle instability is reviewed.
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Affiliation(s)
- Peter Salat
- Department of Radiology, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada; Mayfair Diagnostics, 6707 Elbow Drive Southwest 132, Calgary, Alberta T2V 0E3, Canada.
| | - Vu Le
- Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Mark E Cresswell
- Department of Radiology, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
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Lopes R, Noailles T, Brulefert K, Geffroy L, Decante C. Anatomic validation of the lateral malleolus as a cutaneous marker for the distal insertion of the calcaneofibular ligament. Knee Surg Sports Traumatol Arthrosc 2018; 26:869-874. [PMID: 27497693 DOI: 10.1007/s00167-016-4250-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/27/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE An anatomic study was performed to confirm whether the lateral malleolus could serve as a simple and reproducible anatomic reference for the distal insertion of the calcaneofibular ligament (CFL). METHODS Dissection was performed after placement of a Kirschner wire to simulate the calcaneal tunnel for the distal insertion of the CFL. The skin was penetrated 1 cm distal and posterior to the tip of the lateral malleolus. The main information recorded was the distance from the Kirschner wire to the centre of the distal insertion of the CFL. Other elements were noted (characteristics of the CFL, distance between the distal insertion of the CFL-peroneal tubercle, nerve or tendon injuries). RESULTS Thirty ankles were dissected. The mean distance from the Kirschner wire to the centre of the distal insertion of the CFL was 2.4 ± 1.8 mm. Only one case of peroneal injury was noted. The sural nerve was usually located a mean 1.8 ± 1.1 mm from the Kirschner wire. The posterior tibial vascular pedicle was a mean 27.8 ± 3.5 mm from the point of exit of the Kirschner wire. CONCLUSION Using the lateral malleolus as the cutaneous reference for the distal insertion of the CFL seems to be more reliable than the pure arthroscopic technique. This study describes a percutaneous technique to obtain a calcaneal tunnel for distal insertion of the CFL. The sural nerve is at the greatest risk of injury with this technique and requires careful subcutaneous incision to prevent injury. This new percutaneous technique is less invasive than a purely arthroscopic technique and more accurately identifies the location of the tunnel. It can be used to do calcaneal tunnel in clinical practice during anatomic ligament reconstruction for chronic ankle instability.
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Affiliation(s)
- R Lopes
- Department of Orthopaedic Surgery, Breteche Clinic, 3 rue de la Béraudière, 44000, Nantes, France.
| | - T Noailles
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - K Brulefert
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - L Geffroy
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - C Decante
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
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Cai Y, Li S, Chen S, Hua Y, Shan J. An Ultrasound Classification of Anterior Talofibular Ligament (ATFL) Injury. Open Orthop J 2017; 11:610-616. [PMID: 28979580 PMCID: PMC5620408 DOI: 10.2174/1874325001711010610] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 12/26/2022] Open
Abstract
Background: To develop a classification of ATFL injury based on the ultrasonography. Methods: The ultrasound images of 560 cases that had chronic ankle instability were studied from May 2012 to May 2015. All the patients accepted ultrasonography to type the ATFL injury. Results: The ATFL injuries could be divided into six subtypes based on ultrasound imaging: I: Intact ligament; II: Injury at the fibular side; III:Injury at the talar side; IV: Tear at the midsubstance; V:Ligament absorbed; VI:Combined injury. Conclusion: Ultrasound could be used to evaluate and type the injury of ATFL. This kind of classification could be helpful in the preoperative decision of ATFL procedure.
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Affiliation(s)
- Yehua Cai
- Department of sonography, Huashan Hospital, Fudan University, Shanghai, China
| | - Shengkun Li
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jielin Shan
- Department of sonography, Huashan Hospital, Fudan University, Shanghai, China
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22
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McKiernan S, Fenech M, Fox D, Stewart I. Sonography of the ankle: The lateral ankle and ankle sprains. SONOGRAPHY 2017. [DOI: 10.1002/sono.12120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Park JW, Lee SJ, Choo HJ, Kim SK, Gwak HC, Lee SM. Ultrasonography of the ankle joint. Ultrasonography 2017; 36:321-335. [PMID: 28535605 PMCID: PMC5621804 DOI: 10.14366/usg.17008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 12/26/2022] Open
Abstract
Ankle disorders are a relatively common pathological condition, and ankle injuries account for approximately 14% of sports-related orthopedic emergency visits. Various imaging modalities can be used to make a diagnosis in cases of ankle pain; however, ultrasound (US) has several benefits for the evaluation of ankle pain, especially in the tendons, ligaments, and nerves of the ankle. The purpose of this article is to review the common causes of ankle pathology, with particular reference to US features. In addition, the importance of a dynamic evaluation and a stress test with US is emphasized.
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Affiliation(s)
- Jung Won Park
- Department of Radiology and Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sun Joo Lee
- Department of Radiology and Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hye Jung Choo
- Department of Radiology and Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Kwan Kim
- Department of Radiology and Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Heui-Chul Gwak
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung-Moon Lee
- Department of Radiology, Dae Kyung Imaging Center, Daegu, Korea
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Yildizgoren MT, Velioglu O, Demetgul O, Turhanoglu AD. Assessment of the Anterior Talofibular Ligament Thickness in Patients with Chronic Stroke: An Ultrasonographic Study. J Med Ultrasound 2017; 25:145-149. [PMID: 30065479 PMCID: PMC6029297 DOI: 10.1016/j.jmu.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/24/2017] [Indexed: 12/26/2022] Open
Abstract
Background: Patients with equinovarus deformity have an increased risk of fall and ankle ligament injury, because of inappropriate prepositioning of the ankle at the end of the swing phase, and inadequate leg and ankle stability during the stance phase. Accordingly, the aim of this study is to compare anterior talofibular ligament (ATFL) thickness of chronic stroke patients with that of healthy individuals using ultrasonography. Methods: This was a case-control study conducted in a university hospital between July 2015 and July 2016. We included 38 patients [study group; mean age, 59.0 ± 11.1 years; mean body mass index (BMI), 25.4 ±4.3 kg/m2] and a control group of age-, sex-, and BMI-matched healthy individuals. Demographic and clinical characteristics of the patients (i.e., age, weight, height, Brunnstrom motor recovery stage, Functional Ambulation Scale, Ashworth Scale, and duration of hemiplegia) were recorded during their visits. Furthermore, ultrasound image of the ATFL was obtained from each ankle. The thickness of the ATFL was measured at the midpoint of the ligament between the attachments on the lateral malleolus and the talus using ultrasonography. Results: In the study group, the mean thickness of the ATFLs of the affected side (2.75 ± 0.41 mm) was thicker than both the unaffected side (2.42 ± 0.30 mm) and the healthy controls (2.35 ± 0.19 mm; p = 0.007, p < 0.001, respectively). No differences were seen between the two sides of the control group. Conclusion: Chronic stroke patients have a thicker ATFL on both the affected and unaffected sides, compared with healthy individuals. This architectural feature of the ATFL may be a result of equinovarus deformity together with spastic muscles. For this reason, early treatment of deformed ligaments and spastic muscles is needed to prevent equinovarus deformity in patients with stroke.
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Affiliation(s)
- Mustafa Turgut Yildizgoren
- Department of Physical Medicine and Rehabilitation, Mustafa Kemal University Medical School, Hatay, Turkey
| | - Onur Velioglu
- Department of Physical Medicine and Rehabilitation, Mustafa Kemal University Medical School, Hatay, Turkey
| | - Ozcan Demetgul
- Department of Neurology, Mustafa Kemal University Medical School, Hatay, Turkey
| | - Ayse Dicle Turhanoglu
- Department of Physical Medicine and Rehabilitation, Mustafa Kemal University Medical School, Hatay, Turkey
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Sconfienza LM, Orlandi D, Lacelli F, Serafini G, Silvestri E. Dynamic high-resolution US of ankle and midfoot ligaments: normal anatomic structure and imaging technique. Radiographics 2015; 35:164-78. [PMID: 25590396 DOI: 10.1148/rg.351130139] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The ankle is the most frequently injured major joint in the body, and ankle sprains are frequently encountered in individuals playing football, basketball, and other team sports, in addition to occurring in the general population. Imaging plays a crucial role in the evaluation of ankle ligaments. Magnetic resonance imaging has been proven to provide excellent evaluation of ligaments around the ankle, with the ability to show associated intraarticular abnormalities, joint effusion, and bone marrow edema. Ultrasonography (US) performed with high-resolution broadband linear-array probes has become increasingly important in the assessment of ligaments around the ankle because it is low cost, fast, readily available, and free of ionizing radiation. US can provide a detailed depiction of normal anatomic structures and is effective for evaluating ligament integrity. In addition, US allows the performance of dynamic maneuvers, which may contribute to increased visibility of normal ligaments and improved detection of tears. In this article, the authors describe the US techniques for evaluation of the ankle and midfoot ligaments and include a brief review of the literature related to their basic anatomic structures and US of these structures. Short video clips showing dynamic maneuvers and dynamic real-time US of ankle and midfoot structures and their principal pathologic patterns are included as supplemental material. Use of a standardized imaging technique may help reduce the intrinsic operator dependence of US. Online supplemental material is available for this article.
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Affiliation(s)
- Luca Maria Sconfienza
- From the Department of Radiology, IRCCS Policlinico San Donato, and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Piazza Malan 1, 20097 San Donato Milanese, Milano, Italy (L.M.S.); School of Specialization in Diagnostic Radiology, Università degli Studi di Genova, Genoa, Italy (D.O.); Department of Radiology, Ospedale Santa Corona, Pietra Ligure, Savona, Italy (F.L., G.S.); and Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy (E.S.)
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26
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Wiebking U, Pacha TO, Jagodzinski M. An accuracy evaluation of clinical, arthrometric, and stress-sonographic acute ankle instability examinations. Foot Ankle Surg 2015; 21:42-8. [PMID: 25682406 DOI: 10.1016/j.fas.2014.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/27/2014] [Accepted: 09/13/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle sprain injuries, often due to lateral ligamentous injury, are the most common sports traumatology conditions. Correct diagnoses require an understanding of the assessment tools with a high degree of diagnostic accuracy. Obviously, there are still no clear consensuses or standard methods to differentiate between a ligament tear and an ankle sprain. In addition to clinical assessments, stress sonography, arthrometer and other methods are often performed simultaneously. These methods are often costly, however, and their accuracy is controversial. The aim of this study was to investigate three different measurement tools that can be used after a lateral ligament lesion of the ankle with injury of the anterior talofibular ligament to determine their diagnostic accuracy. METHODS Thirty patients were recruited for this study. The mean patient age was 35±14 years. There were 15 patients with a ligamentous rupture and 15 patients with an ankle sprain. We quantified two devices and one clinical assessment by which we calculated the sensitivity and specifity: Stress sonography according to Hoffmann, an arthrometer to investigate the 100N talar drawer and maximum manual testing and the clinical assessment of the anterior drawer test. A high resolution sonography was used as the gold standard. RESULTS The ultrasound-assisted gadgetry according to Hoffmann, with a 3mm cut-off value, displayed a sensitivity of 0.27 and a specificity of 0.87. Using a 3.95mm cut-off value, the arthrometer displayed a sensitivity of 0.8 and a specificity of 0.4. The clinical investigation sensitivities and specificities were 0.93 and 0.67, respectively. CONCLUSIONS Different assessment methods for ankle rupture diagnoses are suggested in the literature; however, these methods lack reliable data to set investigation standards. Clinical examination under adequate analgesia seems to remains the most reliable tool to investigate ligamentous ankle lesions. Further clinical studies with higher case numbers are necessary, however, to evaluate these findings and to measure the reliability.
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Affiliation(s)
- Ulrich Wiebking
- Department of Trauma Surgery, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Tarek Omar Pacha
- Department of Trauma and Orthopaedic Surgery, Klinikum Neustadt am Rübenberge, Lindenstr. 75, 31535 Neustadt am Rübenberge, Germany
| | - Michael Jagodzinski
- Department of Trauma Surgery, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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27
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Draghi F, Gregoli B, Bortolotto C. Absence of elevation of fibular tendons during dorsal hyperflexion of the foot: a sign of loss of the calcaneofibular ligament. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1307-1308. [PMID: 24958420 DOI: 10.7863/ultra.33.7.1307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Ferdinando Draghi
- Institute of Radiology Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo University of Pavia Pavia, Italy
| | - Bettina Gregoli
- Institute of Radiology Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo University of Pavia Pavia, Italy
| | - Chandra Bortolotto
- Institute of Radiology Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo University of Pavia Pavia, Italy
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28
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Lee KT, Park YU, Jegal H, Park JW, Choi JP, Kim JS. New method of diagnosis for chronic ankle instability: comparison of manual anterior drawer test, stress radiography and stress ultrasound. Knee Surg Sports Traumatol Arthrosc 2014; 22:1701-7. [PMID: 24067992 DOI: 10.1007/s00167-013-2690-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 09/16/2013] [Indexed: 12/26/2022]
Abstract
PURPOSE To diagnose chronic ankle instability, clinicians frequently use manual anterior drawer test and stress radiography. However, both exams can yield incorrect results and do not reveal the extent of ankle instability. The use of stress ultrasound during a manual anterior drawer stress procedure might enable the diagnosis of chronic ankle instability. METHODS Seventy-three patients with chronic ankle pain or laxity after remote ankle sprain were included. The study population included 41 males and 32 females. The mean age of the patients at the time of the operation was 29 years. A standardized physical examination (manual anterior drawer test), stress radiography and stress ultrasonography were performed to assess the anterior talofibular ligament (ATFL). Ultrasound images were taken in the resting position and the maximal anterior drawer position. The statistical significance of stress ultrasound among the three groups according to manual anterior drawer test and a specific degree (5 mm) of anterior translation of stress radiography were analysed. Correlation coefficients between stress ultrasound, stress radiography and manual anterior drawer test were calculated. RESULTS There was a significant difference for ATFL length (ATFL stress) and ATFL ratio (ATFL stress/ATFL resting) among the three groups (both p < 0.001). However, there was no significant difference for anterior translation of stress radiography among three groups according to manual anterior drawer test (p = 0.159). There was a significant difference for ATFL length (ATFL stress) and ATFL ratio between two groups with 5-mm anterior translation of stress radiography (p = 0.002 and p = 0.011, respectively). The mean value of grade of manual anterior drawer test between the two groups also differed (p = 0.021). There was a moderately positive linear relationship between stress ultrasound and manual anterior drawer test. Also, there was a positive linear relationship between stress ultrasound and stress radiography. CONCLUSION The results suggest that the value of ATFL length (ATFL stress) and ATFL ratio of stress ultrasound could be used for diagnosis of chronic ankle instability in addition to manual anterior drawer test and stress radiography.
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Affiliation(s)
- Kyung Tai Lee
- Foot and Ankle Service, KT Lee's Orthopedic Hospital, Seoul, Korea
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Cheng Y, Cai Y, Wang Y. Value of ultrasonography for detecting chronic injury of the lateral ligaments of the ankle joint compared with ultrasonography findings. Br J Radiol 2014; 87:20130406. [PMID: 24352708 DOI: 10.1259/bjr.20130406] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the accuracy of ultrasonography in the diagnosis of chronic lateral ankle ligament injury. METHODS A total of 120 ankles in 120 patients with a clinical suspicion of chronic ankle ligament injury were examined by ultrasonography by using a 5- to 17-MHz linear array transducer before surgery. The results of ultrasonography were compared with the operative findings. RESULTS There were 18 sprains and 24 partial and 52 complete tears of the anterior talofibular ligament (ATFL); 26 sprains, 27 partial and 12 complete tears of the calcaneofibular ligament (CFL); and 1 complete tear of the posterior talofibular ligament (PTFL) at arthroscopy and operation. Compared with operative findings, the sensitivity, specificity and accuracy of ultrasonography were 98.9%, 96.2% and 84.2%, respectively, for injury of the ATFL and 93.8%, 90.9% and 83.3%, respectively, for injury of the CFL. The PTFL tear was identified by ultrasonography. The accuracy of identification between acute-on-chronic and subacute-chronic patients did not differ. The accuracies of diagnosing three grades of ATFL injuries were almost the same as those of diagnosing CFL injuries. CONCLUSION Ultrasonography provides useful information for the evaluation of patients presenting with chronic pain after ankle sprain. ADVANCES IN KNOWLEDGE Intraoperative findings are the reference standard. We demonstrated that ultrasonography was highly sensitive and specific in detecting chronic lateral ligments injury of the ankle joint.
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Affiliation(s)
- Y Cheng
- Department of Ultrasound in Medicine, Fudan University Affiliated Huashan Hospital, Shanghai China
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Hsu CY, Chiang YP, Liao CT, Hong YC. Sonographic diagnosis of a medial talar avulsion fracture. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:570-573. [PMID: 22886466 DOI: 10.1002/jcu.21977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 07/13/2012] [Indexed: 06/01/2023]
Abstract
Occult talus fractures can be easily misdiagnosed as simple ankle sprains, resulting in painful nonunion, arthrosis, avascular necrosis, and long-term disability. We present a case of ankle injury with medial talar fracture that was negative on plain radiography but was diagnosed with sonography. Sonography is a valuable tool in screening ankle sprains and may assist clinicians in diagnosing the nature of ankle injury, thus guiding the most appropriate therapeutic strategy.
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Affiliation(s)
- Chia-Yu Hsu
- Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taipei, Taiwan
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Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins JT, Nussbaum E, Poppy W, Richie D. National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train 2013; 48:528-45. [PMID: 23855363 PMCID: PMC3718356 DOI: 10.4085/1062-6050-48.4.02] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. BACKGROUND Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. RECOMMENDATIONS The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.
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Affiliation(s)
- Thomas W Kaminski
- National Athletic Trainers’ Association, Communications Department, 2952 Stemmons Freeway, Dallas, TX 75247, USA
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Imaging Evaluation of Traumatic Ligamentous Injuries of the Ankle and Foot. Radiol Clin North Am 2013; 51:455-78. [DOI: 10.1016/j.rcl.2012.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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34
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Musculoskeletal ultrasonography of the lower extremities in infants and children. Pediatr Radiol 2013; 43 Suppl 1:S8-22. [PMID: 23478916 DOI: 10.1007/s00247-012-2589-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 11/08/2012] [Accepted: 11/15/2012] [Indexed: 12/26/2022]
Abstract
Ultrasonography is a powerful diagnostic imaging tool for evaluating lower extremity anatomy and pathology in children. Indications for pediatric musculoskeletal lower extremity sonography include developmental dysplasia of the hip, hip joint sonography for the child with a painful hip, evaluation and characterization of superficial soft-tissue masses, evaluation for deep venous thrombosis, and foreign body localization, characterization and removal. This review highlights these established indications, but primarily focuses on additional US applications for evaluation of the lower extremities, including diagnosis and characterization of arthritis and monitoring of therapy, evaluation of tendon tears and muscle strain injuries, characterization of soft-tissue masses and evaluation of certain congenital abnormalities of the lower extremities. Techniques for optimal utilization of musculoskeletal US in children are also discussed.
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Kwon DR, Park GY. Differences in lateral ankle ligaments between affected and unaffected legs in children with spastic hemiplegic cerebral palsy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:313-317. [PMID: 23341388 DOI: 10.7863/jum.2013.32.2.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To investigate the architectural alterations of the lateral ankle ligaments in spastic hemiplegic cerebral palsy. METHODS Eight children (5 male and 3 female; mean age ± SD, 5.2 ± 2.7 years) with spastic hemiplegic cerebral palsy were recruited. A modified Ashworth scale and passive ankle dorsiflexion angle were evaluated. Sonograms of the anterior talofibular ligament and calcaneofibular ligament were obtained to measure ligament thickness, and the anterior talofibular/calcaneofibular ligament thickness ratio was calculated. Two sonographic measurements were taken to check for intra-rater reliability. RESULTS The interclass correlation coefficients of the repeated anterior talofibular ligament and calcaneofibular ligament thickness measurements in the unaffected/affected legs were 0.960/0.945 and 0.922/0.933, respectively. The anterior talofibular ligament thickness in the affected legs was significantly greater than that in the unaffected legs (2.50 ± 0.35 versus 1.40 ± 0.28 mm; P = .011), but the calcaneofibular ligament thickness in the affected legs was significantly less than that in the unaffected legs (0.80 ± 0.18 versus 1.28 ± 0.31 mm; P = .021). The anterior talofibular/calcaneofibular ligament thickness ratio in the affected legs was significantly greater than that in unaffected legs (2.10 ± 0.81 versus 1.03 ± 0.13; P = .012). The ratio was positively correlated with the modified Ashworth scale and age but negatively correlated with the passive ankle dorsiflexion angle in the affected legs. CONCLUSIONS This study revealed an increased anterior talofibular ligament thickness and a decreased calcaneofibular ligament thickness in the affected legs compared with the unaffected legs. These architectural features of the lateral ankle ligaments may contribute to the equinovarus deformity of the ankle together with spastic leg muscles in children with spastic hemiplegic cerebral palsy.
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Affiliation(s)
- Dong Rak Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
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Hua Y, Yang Y, Chen S, Cai Y. Ultrasound examination for the diagnosis of chronic anterior talofibular ligament injury. Acta Radiol 2012; 53:1142-5. [PMID: 23051639 DOI: 10.1258/ar.2012.120171] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Anterior talofibular ligament (ATFL) injury is a commonly seen sports-related injury and a major underlying pathology of chronic ankle instability. However, it is difficult to accurately identify chronic injury of the ATFL. PURPOSE To investigate the value of ultrasound (US) examination in identifying chronic ATFL injury. MATERIAL AND METHODS We evaluated 83 consecutive patients who underwent US examination for diagnosis of the ATFL injury and subsequent ankle arthroscopy. The arthroscopic findings were used as the reference standard. RESULTS Forty-four patients were found to have ATFL injury on arthroscopy. The accuracy of US examination for the detection of ATFL injury was 95.2%, with sensitivity of 97.7%, specificity of 92.3%, positive predictive value of 93.5%, negative predictive value of 97.3%, positive likelihood ratio of 12.7, and negative likelihood ratio of 0.025. CONCLUSION US examination is a reliable and accurate method to evaluate chronic ATFL injury.
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Affiliation(s)
- Yinghui Hua
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai
| | - Yongming Yang
- Department of Sonography, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai
| | - Yehua Cai
- Department of Sonography, Huashan Hospital, Fudan University, Shanghai, China
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Stufkens SAS, van den Bekerom MPJ, Knupp M, Hintermann B, van Dijk CN. The diagnosis and treatment of deltoid ligament lesions in supination-external rotation ankle fractures: a review. Strategies Trauma Limb Reconstr 2012; 7:73-85. [PMID: 22767333 PMCID: PMC3535131 DOI: 10.1007/s11751-012-0140-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 06/20/2012] [Indexed: 12/26/2022] Open
Abstract
The supination–external rotation or Weber B type fracture exists as a stable and an unstable type. The unstable type has a medial malleolus fracture or deltoid ligament lesion in addition to a fibular fracture. The consensus is the unstable type and best treated by open reduction and internal fixation. The diagnostic process for a medial ligament lesion has been well investigated but there is no consensus as to the best method of assessment. The number of deltoid ruptures as a result of an external rotation mechanism is higher than previously believed. The derivation of the injury mechanism could provide information of the likely ligamentous lesion in several fracture patterns. The use of the Lauge-Hansen classification system in the assessment of the initial X-ray images can be helpful in predicting the involvement of the deltoid ligament but the reliability in terms of sensitivity and specificity is unknown. Clinical examination, stress radiography, magnetic resonance imaging, arthroscopy, and ultrasonography have been used to investigate medial collateral integrity in cases of ankle fractures. None of these has shown to possess the combination of being cost-effective, reliable and easy to use; currently gravity stress radiography is favoured and, in cases of doubt, arthroscopy could be of value. There is a disagreement as to the benefit of repair by suture of the deltoid ligament in cases of an acute rupture in combination with a lateral malleolar fracture. There is no evidence found for suturing but exploration is thought to be beneficial in case of interposition of medial structures.
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Affiliation(s)
- Sjoerd A S Stufkens
- Department of Orthopaedic Surgery, Academic Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands,
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Abstract
MRI and ultrasound are now widely used for the assessment of tendon and ligament abnormalities. Healthy tendons and ligaments contain high levels of collagen with a structured orientation, which gives rise to their characteristic normal imaging appearances as well as causing particular imaging artefacts. Changes to ligaments and tendons as a result of disease and injury can be demonstrated using both ultrasound and MRI. These have been validated against surgical and histological findings. Novel imaging techniques are being developed that may improve the ability of MRI and ultrasound to assess tendon and ligament disease.
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Affiliation(s)
- R J Hodgson
- Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
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Choudhary S, McNally E. Review of common and unusual causes of lateral ankle pain. Skeletal Radiol 2011; 40:1399-413. [PMID: 20972871 DOI: 10.1007/s00256-010-1040-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 09/15/2010] [Accepted: 09/19/2010] [Indexed: 02/02/2023]
Abstract
Lateral ankle pain is a common clinical presentation having several important causes, including lateral ligament injury, peroneal tendon injury, sinus tarsi syndrome, and nerve entrapments. However, other causes should be kept in mind in patients with unusual patterns of pain or intractable symptoms. We present a review of common and some unusual causes of lateral ankle pain including a review of post-operative imaging findings following surgery for lateral ankle ligament and peroneal tendon injuries.
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Affiliation(s)
- Surabhi Choudhary
- Musculoskeletal Radiology, Nuffield Orthopaedic Centre NHS Trust, Oxford, UK.
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40
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Ultrasonographic Findings and Clinical Characteristics of Two Patients With Talar Osteochondritis Dissecans. J Med Ultrasound 2011. [DOI: 10.1016/j.jmu.2011.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mansour R, Jibri Z, Kamath S, Mukherjee K, Ostlere S. Persistent ankle pain following a sprain: a review of imaging. Emerg Radiol 2011; 18:211-25. [DOI: 10.1007/s10140-011-0945-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 02/21/2011] [Indexed: 12/26/2022]
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Blankstein A. Ultrasound in the diagnosis of clinical orthopedics: The orthopedic stethoscope. World J Orthop 2011; 2:13-24. [PMID: 22474631 PMCID: PMC3302037 DOI: 10.5312/wjo.v2.i2.13] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/11/2011] [Accepted: 02/15/2011] [Indexed: 02/06/2023] Open
Abstract
Ultrasonography has advantages over other imaging modalities in terms of availability and comfort, safety, and diagnostic potential. Operating costs are low compared with both computed tomography (CT) and magnetic resonance imaging (MRI). The portable equipment is accessible at locations distant from medical centers. Importantly, ultrasonography is performed while patients lie in a comfortable position, without pain or claustrophobia. Ultrasonography is a totally safe noninvasive imaging technique. In contrast to CT and X-rays, it does not emit ionizing radiation. Unlike MRI, it is safe for all patients, including those with cardiac pacemakers and metal implants, without any contraindications. Of the many indications for musculoskeletal ultrasonography, the evaluation of soft tissue pathology is particularly common. In addition, ultrasonography is useful for the detection of fluid collection, and for visualization of cartilage and bone surfaces. Color or power Doppler provides important physiological information, including that relating to the vascular system. The capability of ultrasonography in delineating structures according to their echotextures results in excellent pictorial representation. This imaging principle is based on physical changes in composition, as compared to imaging with MRI, which is based on changes in chemical composition. This article reviews the contribution of sonography to the evaluation of the musculoskeletal system.
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Oae K, Takao M, Uchio Y, Ochi M. Evaluation of anterior talofibular ligament injury with stress radiography, ultrasonography and MR imaging. Skeletal Radiol 2010; 39:41-7. [PMID: 19685050 DOI: 10.1007/s00256-009-0767-x] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 07/05/2009] [Accepted: 07/07/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to clarify the efficacy of stress radiography (stress X-P), ultrasonography (US), and magnetic resonance (MR) imaging in the detection of the anterior talofibular ligament (ATFL) injury. METHODS Thirty-four patients with ankle sprain were involved. In all patients, Stress X-P, US, MR imaging, and arthroscopy were performed. The arthroscopic results were considered to be the gold standard. The imaging results were compared with the arthroscopic results, and the accuracy calculated. RESULTS Arthroscopic findings showed ATFL injury in 30 out of 34 cases. The diagnosis of ATFL injury with stress X-P, US, MR imaging were made with an accuracy of 67, 91 and 97%. US and MR imaging demonstrated the same location of the injury as arthroscopy in 63 and 93%. CONCLUSION We have clarified the diagnostic value of stress X-P, US, and MR imaging in diagnosis of ATFL injury. We obtained satisfactory results with US and MR imaging.
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Affiliation(s)
- Kazunori Oae
- Department of Orthopaedics, Shimane University School of Medicine, 89-1, Enya-cho, Shimane Izumo, 693-8501, Japan.
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Abstract
OBJECTIVE This article will compare and contrast image interpretation, accuracy, observer variability, economic impact, and education with regard to musculoskeletal ultrasound and MRI because these factors will influence the growth of musculoskeletal ultrasound and the impact on MRI. CONCLUSION The use of musculoskeletal ultrasound continues to grow and there are a number of factors that impact MRI. The development of less expensive portable ultrasound machines has opened the market to nonradiologists, and applications for musculoskeletal ultrasound have broadened. Selective substitution of musculoskeletal ultrasound for MRI can result in significant cost saving to the health care system. Although this change could decrease the use of MRI, issues related to accuracy, variability, education, and competence must be addressed.
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Chen PY, Wang TG, Wang CL. Ultrasonographic examination of the deltoid ligament in bimalleolar equivalent fractures. Foot Ankle Int 2008; 29:883-6. [PMID: 18778665 DOI: 10.3113/fai.2008.0883] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lauge-Hansen supination-external rotation Stage IV ankle injuries may simulate a Stage II or Stage III injury radiographically if the medial disruption occurred through the deltoid ligament instead of the medial malleolus, making it difficult to determine whether an operation is indicated. MATERIALS AND METHODS Seventeen patients presented with radiographically isolated lateral malleolar fractures at the syndesmotic level. They were examined with ultrasonography for evaluation of the integrity of the deltoid ligament. Patients in whom ultrasonography showed complete rupture of the deltoid ligament received operative fixation of the ankle fracture, with exploration and repair of the deltoid ligament at the same time. Patients without complete rupture of the deltoid ligament were treated conservatively with a short leg cast for 6 weeks followed by an ankle brace for another 6 weeks. Nine male and six female patients completed the final clinical and radiographic evaluations. RESULTS Ultrasonography showed complete rupture of the deltoid ligament in six patients. Exploration of the deltoid ligaments confirmed the sonographic findings in all these patients. In the remaining nine patients, the deltoid ligaments were not completely ruptured on ultrasound. These fractures were treated conservatively, and all healed uneventfully. All the 15 patients had good or fair results on the final evaluation. CONCLUSION Ultrasonography is a convenient and accurate diagnostic tool to differentiate unstable bimalleolar-equivalent ankle fractures from an isolated lateral malleolar fracture. Thus, it can be helpful in the decision process for the treatment of choice for different fracture patterns.
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Affiliation(s)
- Pei-Yu Chen
- Department of Orthopedic Surgery, Taipei City Hospital, Taipei, Taiwan
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48
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Müller MA, Wildermuth S, Bohndorf K. Traumatic Injuries: Imaging of Peripheral Muskuloskeletal Injuries. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hsu CC, Tsai WC, Chen CPC, Chen MJL, Tang SFT, Shih L. Ultrasonographic Examination for Inversion Ankle Sprains Associated with Osseous Injuries. Am J Phys Med Rehabil 2006; 85:785-92. [PMID: 16998425 DOI: 10.1097/01.phm.0000237875.90254.4e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The study attempted to evaluate the value of ultrasonography in determining the therapeutic strategy for patients with osseous injuries caused by ankle sprains. DESIGN A 10-MHz compact linear-array ultrasound transducer was used to assess patients with inversion ankle sprains. Eleven female and 12 male patients who had fractures detected by sonograms were included in the study. All 23 patients underwent radiographic examination for identification of fractures. Bone scintigraphy was performed for those who had negative x-ray findings. RESULTS Eighteen patients had distal fibular tip fractures, three patients had the fifth metatarsal base fractures, one patient had a talar neck fracture, and one patient had a navicular fracture. These fractures were all detected by ultrasonography and then proved even by radiography or by bone scans. All the 23 patients had anterior talofibular ligament injuries. Among these patients, 11 had anterior ankle-joint recess effusion, and two had additional anterioinferior tibiofibular ligament injuries. Six weeks of immobilization with the ankle fracture brace was prescribed for all the patients after the identification of fractures. Their ankle pain symptoms soon improved. CONCLUSIONS Ultrasonography is valuable in evaluating tiny foot and ankle fractures and coexistent soft tissue injuries. It can guide the treatment for patients with osseous injuries caused by ankle sprains.
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Affiliation(s)
- Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan
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