Musculoskeletal manifestations of systemic disease.
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Bone Density↗
Biomedical subjects
F Feldman
Publications and source records attributed to F Feldman.
Ankle tendons: evaluation with CT.
Computed tomographic (CT) analysis of 21 clinically suspected ankle tendon injuries was performed in 18 patients. In six of the 21 ankles surgical exploration was done, and in one ankle evaluation was done while the patient was under anesthesia. In all seven cases the CT findings were confirmed and in three the clinical diagnosis was disproved. CT provided additional information and helped guide treatment in the majority of patients studied. Thus CT is an accurate, noninvasive modality for assessing ankle tendon injuries.
Adolescent↗
Bone mineral assessment: new dual-energy CT approach.
Most clinical quantitative computed tomographic (CT) determinations of bone mineral content are hampered by inability to properly account for the various substances contained within the spongiosa (spongy bone). In general, the presence of adipose tissue lowers the CT numbers (Hounsfield units) and leads to underestimation of bone mineral content. Collagen matrix has the opposite effect. A new approach to obtaining data from postreconstruction dual-energy CT scans accounts for five principal constituents of the spongiosa. In addition to bone mineral values, the method also provides the adipose tissue concentration, calcium content, and density of the total trabecular space. Since calcium values are provided, the measurements can be compared with prereconstruction dual-energy data that are acquired simultaneously. A new solid-plastic calibration phantom was utilized in this study, and data were obtained from 26 subjects. Dual-energy data were correlated with single-energy measurements (r greater than .96), and calcium measurements were correlated with the bone mineral determinations (r = .97) in these 26 cases. All measurements of the various vertebral constituents agreed with published values.
Bone and Bones↗
Mixed connective tissue disease.
MCTD is characterized by clinical features that overlap those of several of the classic rheumatic and connective tissue disorders. Although MCTD has been distinguished from them by the presence of antibodies to an RNP and by specific immunoregulatory T cell circuit abnormalities, its definitive placement among the classic disorders remains controversial. Several of its reputed differential clinical, radiographic, and prognostic features have been discussed in this article.
Humans↗
Effect of extracapsular cataract extraction on intraocular pressure.
Intraocular pressure (IOP) was measured in 27 normotensive patients scheduled to undergo uncomplicated extracapsular cataract extraction with insertion of a posterior chamber intraocular lens implant. The measurements were recorded the day before surgery, 3, 6 and 9 hours after surgery and the following morning. Fourteen of the patients had a substantial increase in IOP, to more than 30 mm Hg, on the evening of surgery. Most had normal IOP values the next morning. Ophthalmologists should be aware of this possible effect of extracapsular cataract extraction on IOP.
Cataract Extraction↗
Intra-articular calcaneal fractures: computed tomographic analysis.
Computed tomography (CT) analysis of 21 intra-articular calcaneal fractures categorized according to the Essex-Lopresti classification revealed the following distribution: joint depression-type 57%, comminuted type 43%, tongue-type 0%. The posterior calcaneal facet was fractured and/or depressed in 100% of the cases while the medial facet was involved in only 25% of the cases. CT proved superior to plain films by consistently demonstrating additional fracture components within each major category suggesting subclassifications which have potential prognostic value. CT allowed more expeditious handling of acutely injured patients, and improved preoperative planning, postoperative follow-up, and detailed analysis of causes for chronic residual pain. CT further identified significant soft tissue injuries such as peroneal tendon displacement which cannot be delineated on plain films.
Adolescent↗
Postamputation neuromas and other symptomatic stump abnormalities: detection with CT.
One of the potentially troublesome sequelae of limb amputations is the development of stump neuromas at the severed ends of major nerves. The ability to define them and to distinguish them from other causes of stump pain is of considerable clinical significance. Computed tomography was performed on ten lower limb amputees with stump pain. Five patients had neuromas that were manifest as focal or generalized alteration in the caliber, size, or contour of the nerve trunk in the affected stump. The remaining five patients each had an abnormality detected; these abnormalities included heterotopic bone formation, popliteal artery aneurysm, lipoma, scar tissue, and abscess in the contralateral limb.
Adult↗
Recurrent shoulder dislocation after surgical repair: double-contrast CT arthrography. Work in progress.
Nine cases of recurrent postoperative shoulder instability, resulting from failed surgical repair, were studied with double-contrast computed tomography (CT) arthrography. Repeat operations in seven cases showed excellent correlation between CT and surgical anatomic findings. CT arthrography was useful in confirming the direction of instability, particularly of the posterior and multidirectional types. Capsular laxity, subscapularis muscle and tendon abnormalities, and Bankart lesions that were either recurrent or not identified during previous operations were the most common causes of recurrent dislocations. The precise identification of the soft-tissue and bone abnormalities responsible for shoulder instability augmented clinical evaluation and aided preoperative planning.
Adult↗
Distal tibial triplane fractures: diagnosis with CT.
Distal tibial triplane features, which constitute 6%-10% of epiphyseal injuries, are most accurately delineated and analyzed with computed tomography (CT). This is directly related to the special geometry of these fractures that have important transverse components. CT, with its transaxial orientation, is the only radiographic technique that directly images the otherwise inaccessible, horizontally oriented tibial plafond, the integrity of which largely determines the prognosis. CT is the method of choice for preoperative and postoperative evaluation of these injuries.
Adolescent↗
Peroneal tendon injury associated with calcaneal fractures: CT findings.
Injury to the peroneal tendons is one of the major long-term complications of intraarticular calcaneal fractures and heretofore has been difficult to diagnose by noninvasive radiography. Retrospective review of CT scans of 24 intraarticular calcaneal fractures, obtained shortly after injury, identified 22 cases (92%) of acute peroneal tendon abnormalities. In most of these cases, multiple findings were present. These included lateral displacement in 14 (58%) of 24, impingement by bony fragments in eight (33%), subluxation or dislocation in six (25%), soft-tissue masses around the tendons representing hematomas or early scar tissue in five (21%), and entrapment of the tendons in three (13%). In 10 cases with long-term follow-up, impingement on the tendons by bony fragments correlated well with the subsequent development of peroneal tenosynovitis, while hematoma around the tendons or lateral displacement of the tendons was clinically insignificant. Thus, CT in the immediate postfracture period, can be used to detect and categorize acute peroneal tendon injuries as well as possibly to predict the likelihood and nature of subsequent development of peroneal tenosynovitis.
Calcaneus↗
CT arthrographic patterns in recurrent glenohumeral instability.
CT double-contrast arthrograms were performed on 54 shoulders in 53 patients with recurrent dislocation or subluxation to detect responsible underlying bony or soft-tissue abnormalities. Lesions of the anterior labrum in 52 (96%) of 54 cases and of the capsuloligamentous complex in 42 (78%) of 54 cases were the two most common abnormalities. There was no difference in the degree or number of labral lesions between subluxations and dislocations. However, more severe capsular lesions, subscapularis tendon tears, and widened subscapularis bursae were consistently found among patients with dislocations. Subsequent clinical, arthroscopic, and surgical findings showed that the use of CT double-contrast arthrograms resulted in improved definition of the multiple lesions associated with glenohumeral dysfunction.
Adolescent↗
Primary bone tumors of the hand and carpus.
This discussion has attempted to outline a fundamental approach to the radiographic analysis of solitary lesions of the hand and wrist skeleton. The initial evaluation invariably relies on the routine radiograph, using the conventional film-screen combination to obtain a sense of the lesion in its gross anatomic setting. Decisions to use ancillary procedures and the selection of their type and sequence can also best be based on an initial general evaluation. On the basis of an overall view so obtained, and by using a body of general roentgenographic criteria, one can arrive at the most likely diagnostic probabilities. However, in addition to careful study of the lesion, close cooperation between the clinician, the pathologist, and the radiologist cannot be overemphasized. Only by means of such collaboration is it possible to reach a truly valid diagnosis and a rational plan for treatment.
Adult↗
The radiology of total shoulder prostheses.
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Adult↗
Elbow joint: assessment with double-contrast CT arthrography.
The elbow joint was evaluated by means of computed tomography (CT) immediately following double-contrast arthrography. Normal baseline anatomy and representative abnormal studies are illustrated. Intraarticular abnormalities, such as osteocartilaginous bodies, hyperplastic synovium, fracture fragments, and osteophytes, were identified and precisely located on postarthrography CT scans. This technique, which enabled such abnormalities to be seen, has provided an anatomic and mechanical basis for seemingly idiopathic instances of limited elbow motion.
Adolescent↗
"Missing" femoral condyle: an unusual sequela to neonatal osteomyelitis and septic arthritis.
Growth deformities of the distal femur and unusual gait disturbances were observed in four girls who had had neonatal osteomyelitis and septic arthritis. In each case apparent absence or hypoplasia of one of the femoral condyles, as seen on plain radiographs, was associated with marked genu varum or genu valgum. Arthrography showed the apparently missing condyle to be present in a cartilaginous form, with preservation of the articular surfaces. Based on these findings, surgical treatment was limited to corrective osteotomy.
Arthritis, Infectious↗
Peroneal tendon injuries: CT analysis.
Computed tomographic (CT) evaluation of the peroneal tendons was obtained in 25 normal ankles and 30 abnormal ankles studied for trauma. The tendons and associated soft-tissue and bony structures, such as the calcaneofibular ligament, superior and inferior peroneal retinacula, fibular groove, and peroneal tubercle, which have heretofore evaded documentation on routine radiographs, are illustrated and discussed. Special attention is given to normal variations such as convex fibular tip and enlarged peroneal tubercle, which predispose the peroneal tendons to abnormal mechanical stresses. Examples of CT-established peroneal tendon abnormalities in the 30 cases examined are also demonstrated. These abnormalities include subluxation, dislocation, entrapment, and tenosynovitis of the peroneal tendons. The authors believe CT has proved to be an extremely useful and relatively noninvasive imaging tool for the evaluation of peroneal tendon injuries.
Adolescent↗
Effect of topical indomethacin and timolol maleate on intraocular pressure in normal subjects.
In a prospective randomized double-masked crossover study in ten healthy volunteers, conducted to determine if the intraocular hypotensive effect of timolol eyedrops was significantly affected by the concomitant use of the topically administered prostaglandin inhibitor, indomethacin, we found that significant ocular hypotension was achieved with timolol alone. This was not changed by the concurrent administration of indomethacin. The results provide further evidence that prostaglandins are not involved in the control of normal intraocular pressure.
Double-Blind Method↗
Triplane fractures of the adolescent ankle--a report of three cases.
Three cases of triplane fractures of the distal end of the tibia are presented. There are usually two or three fragments and it occurs in adolescents in whom there is little growth potential left; hence there is little growth disturbance despite premature closure of the physis. The key to successful treatment is to assess the degree of articular deformity and to restore articular congruity.
Adolescent↗