[Imaging of a painful shoulder].
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Arthralgia↗
Biomedical subjects
J Ahovuo
Publications and source records attributed to J Ahovuo.
Bone malalignment in acute injuries of the wrist.
The purpose of this study was to analyze radiographic signs of carpal bone instability in patients with an acutely injured wrist. There were 80 patients (52 women and 28 men) with a fall on the outstretched hand. Fifty patients had a fracture of the distal radius, and eight had a scaphoid fracture. The patients with a bone fracture showed a larger scapholunate angle than those without a fracture (P less than 0.001, t-test). However, only four of them showed true carpal bone instability: two patients with a scaphoid fracture and one with a radius fracture had dorsiflexion instability of the wrist and one patient with a radius fracture had dorsal subluxation of the wrist. In addition, one patient without any bone fracture had scapholunate dissociation, one form of carpal bone instability. Although carpal bone instability is not frequent in an acutely injured wrist, its signs should be remembered in the radiographic analysis of the traumatic wrist to prevent subsequent articular disorders.
Acute Disease↗
Resistance of a defect of the supraspinatus tendon to intraarticular hydrodynamic pressure: an experimental study on rabbits.
The healing of a standardized defect of the supraspinatus tendon in a time-related series on rabbits was monitored with arthrography and simultaneous determination of the intra-articular hydrodynamic pressure of the glenohumeral joint. All normal glenohumeral joints produced a biphasic pressure versus volume curve. Rupture of a normal glenohumeral joint occurred at a pressure level of 140-170 mm Hg and was located in the area around the biceps tendon sheath. In joints with a defect of the supraspinatus tendon, leakage of the contrast medium was evident up to the sixth week, at an intra-articular pressure varying from 40 to 100 mm Hg. After week 6, no leakage of the cuff was seen during the determination of the intraarticular pressure. This was in accordance with the histological findings: the defect was covered with solid scar tissue from the ninth week onward. Resistance to hydrodynamic intraarticular pressure proved a reliable method of determining the strength of the healing of the supraspinal defects.
Animals↗
Double-contrast barium examination and endoscopy in the detection of small polyps of the large intestine.
The purpose of this study was to compare double-contrast barium examination (DCBE) and endoscopy in detection of small colonic polyps. In 57 patients DCBE revealed 106 polyps in the large intestine. On total colonoscopy, 62 polyps could be verified. The size of the polyps excised ranged from 2 to 15 mm. Compared with DCBE, colonoscopy verified 48 true positive, 44 false positive and 14 false negative polyps. In revealing a polyp less than 5 mm, DCBE had a sensitivity of 72%, whereas in detection of larger polyps the sensitivity was 81%. Histological verification was available in 52 of the 62 removed polyps. A tubular adenoma was found in 12 of the 29 diminutive polyps verified with histology. DCBE and colonoscopy could not differentiate between adenomas and hyperplastic polyps. Since a polyp less than 5 mm may represent an adenoma, a precancerous lesion, its removal is indicated during colonoscopy after DCBE has detected it.
Adenoma↗
How many projections are really needed in angiographic assessment of the femoral bifurcation?
The purpose of this study was to analyze how many angiographic projections are needed in the diagnosis of hemodynamically significant stenoses of the femoral bifurcation. A total of 134 femoral bifurcations were examined with triplanar angiography in 67 patients (45 men and 22 women). The patients, ranging in age from 42 to 81 years (mean 63), suffered from incapacitating symptoms of peripheral arterial disease. The contralateral posterior oblique projection proved to be the most valuable in the assessment of hemodynamically significant arterial stenoses of the femoral bifurcation. An AP projection added information on stenoses of the inlets of the deep femoral artery in 9% of cases and on stenoses of the inlets of the superficial femoral artery in 6% of cases. An arteriographic examination should be started with a contralateral posterior oblique projection and this view will suffice in most cases.
Adult↗
Subacromial impingement decompressed with anterior acromioplasty.
Symptomatic (Stage II) impingement of the rotator cuff against the coracoacromial arch has been treated with anterior acromioplasty in 60 shoulders in 56 patients. Patient selection is crucial. Arthrography of the shoulder was routinely included in the preoperative diagnostic tools to rule out a tear of the rotator cuff. Since acromial shape may play a role producing a resistant impingement syndrome, special attention should be paid to patients with Type III of acromial inclination. The surgical procedure should include a thorough examination of the subacromial space as a whole, taking notice of all pathologic findings in the subacromial arch as well as in the underlying soft tissues. Restoring subacromial clearance, the patients were relieved of their symptoms. The result, rated according to the functional assessment of Neer, was excellent or satisfactory in 73%. Failure to recognize the associated bony as well as soft-tissue subacromial lesions was, however, a frequent cause of failure of surgical decompression operations.
Acromion↗
Urography with spasmolytics.
The effects of glucagon (1 mg i.v.) and hyoscine butylbromide (Buscopan 20 mg i.v.) and placebo on the visualization of the pyelocalyceal systems and ureters was compared in a routine urography with abdominal compression in a double-blind, randomized trial comprising 189 kidneys and ureters. The visualization of the ureters in the supine position was highly significantly better than in the prone. In the prone position the ureteral visualization with Buscopan was marginally significantly better than with placebo or glucagon. Otherwise, neither Buscopan nor glucagon improved the pyeloureteral visualization. However, with glucagon the pyelocalyceal visualization was highly significantly poorer than with placebo, and marginally significantly poorer than with Buscopan.
Animals↗
Wire-guided biopsies of nonpalpable breast lesions.
The purpose of this study was to review the results of mammographic wire-guided biopsies of nonpalpable breast lesions and the features of the lesions in the preoperative examinations. Sixty women, mean age 50.2 years (range 31 to 74), underwent a wire-guided biopsy of the lesion. Twenty-nine patients had preoperative fine needle aspiration of the lesion. The radiographic diagnosis was correct in 33 patients (55%); 25 had breast cancer and 8 patients had a benign lesion. In 9 of the 14 patients with clustered microcalcifications in mammography and in 13 of the 15 patients with a mass noted in mammography, the cytological examination was correct. Nonpalpable mammographic masses with regular borders and normal fine needle aspiration examination do not require biopsy. In malignant mammographic appearances associated with a normal fine needle aspiration examination, biopsy of the lesion should always be done.
Adult↗
Shoulder arthrography with sodium meglumine metrizoate and iopamidol.
The purpose of this study was to analyze arthrographic imaging of the structures of the shoulder joint when using either sodium meglumine metrizoate or iopamidol as a contrast medium. Two hundred and ten patients underwent single-contrast shoulder arthrography. In patients with a full-thickness tear of the rotator cuff, both contrast agents reliably revealed this lesion. However, in patients with a full-thickness rotator cuff tear, the biceps tendon could be demonstrated more readily with iopamidol, which is a non-ionic contrast medium.
Adult↗
Ultrasonography of the tendons of the shoulder.
The purpose of the present study was to compare ultrasonographic signs with macroscopic and histological findings in lesions of the rotator cuff and the biceps tendon. Twenty-six shoulder joints from 10 male and 3 female cadavers, ranging in age from 40 to 89 years (mean 65.9), were examined with a linear array real-time ultrasonographic scanner provided with a 7.5 MHz transducer. Arthrotomy and histological preparations were made after ultrasonography. Thinning and discontinuity of echogenic homogenicity of the tendons of the rotator cuff were the most reliable ultrasonographic signs of a total tear of the tendon, but focal hyper- and hypo-echogenic changes of the tendons of the rotator cuff were unreliable criteria. Partial tears of the rotator cuff were difficult to determine with static ultrasonograms. Ultrasonography readily revealed discontinuity of echogenic homogenicity of the biceps tendon as a sign of a rupture of the tendon, which was commonly associated with rotator cuff tears.
Adult↗
Double contrast barium meal and acetylcysteine.
In a prospective double blind study, acetylcysteine, a local and systemic respiratory tract mucolytic agent, or a placebo, were given to 100 patients prior to a double contrast barium meal to decrease the gastric mucus viscosity and to make the mucus layer thinner, in order to permit barium to outline the furrows surrounding the areae gastricae instead of the overlying thick mucus. However, acetylcysteine failed to improve either visualization of the areae gastricae or the general quality of the double contrast barium meal.
Acetylcysteine↗
Omnipaque and Gastrografin in gastrointestinal follow-through examinations.
The non-ionic low-osmolar contrast medium Omnipaque was compared with the conventional ionic high-osmolar contrast medium Gastrografin in a randomized, double blind study comprising 71 consecutive gastrointestinal follow-through examinations performed because of suspected ileus or anastomosis control. The patients' reaction were confined to nausea, emesis and diarrhoe being very similar in both groups and related to the patients' illnesses. The taste of Gastrografin was more often judged unpleasant, but the difference was not significant. Omniplaque scored significantly better for contrast medium density and diagnostic visualisation in the small bowel, otherwise the differences were negligible. There were no significant differences in the transit time into the caecum. The high price of Omnipaque restricts its routine use. It may be diagnostically indicated in selected cases where greater accuracy in the delineation of pathologic anatomical details in the small bowel is desired.
Diatrizoate Meglumine↗
Arthrotomography of the unstable shoulder.
Thirty-seven patients suffering from clinically verified subluxation of the shoulder joint underwent double-contrast arthrotomography. Sixteen of these patients were operated on, 4 of whom after arthroscopy, and 1 patient had only arthroscopy. Arthrotomography readily revealed lesions of the glenoid labrum, most of them small, and also redundancy of the anterior joint capsule. The method can be recommended in the examination of the glenoid labrum in patients suffering from anterior subluxation of the shoulder.
Adolescent↗
Arthrography of the biceps tendon.
The purpose of this study was to analyse the factors having an influence on the arthrographic imaging of the biceps tendon. The study comprised 174 patients suffering from chronic shoulder pain. They underwent conventional shoulder arthrography with sodium meglumine metrizoate or metrizamide as a contrast medium. In the patients with a full-thickness tear of the rotator cuff, the biceps tendon sheath failed to fill with contrast medium more often than in those with an intact tendinous cuff. Metrizamide filled the biceps tendon sheath more readily than sodium meglumine metrizoate in patients with a full-thickness tear of the rotator cuff. The volume of the contrast medium injected had no influence on the imaging of the biceps tendon.
Arthrography↗
Surgical repair of the rotator cuff and surrounding tissues. Factors influencing the results.
The surgical pathology and clinical results of 78 reconstructions of chronic rotator cuff tears were reviewed retrospectively. The predominant complaint preoperatively was chronic pain with impaired shoulder function, resistant to repeated conservative treatment. Results according to a functional assessment were excellent or satisfactory in 71% of the patients, unsatisfactory in 12%, and failed in 17%. Relief of pain including night pain and pain with activity was obtained. Surgery should include a thorough exploration of the rotator cuff and the adjacent tissues. Accompanying problems, including biceps tendon disorders or impingement factors, must be recognized and treated at the time of the reconstruction procedure. Repair of the torn rotator cuff and treatment of concomitant lesions are effective operative procedures when symptoms are persistent and fail to respond to conservative treatment.
Adult↗
The intraarticular pressure during shoulder arthrography. A diagnostic aid in rotator cuff tear.
The intraarticular pressure was determined in 24 shoulders during glenohumeral joint arthrography. As the contrast volume increased, the pressure stayed low in the shoulders with a tear of the rotator cuff and rose along a characteristic biphasic curve in intact shoulders. Simultaneous monitoring of the intraarticular pressure can improve the diagnostic value of arthrography.
Adult↗
Diagnostic value of sonography in lesions of the biceps tendon.
Lesions of the biceps tendon have been studied with plain radiographs and arthrograms of the intertubercular groove. Sometimes, however, especially when the rotator cuff has a full-thickness tear anteriorly, the sheath of the biceps tendon fails to fill with contrast medium, thus preventing diagnosis of dislocation of the tendon. To solve this problem the authors have tried sonography of the biceps tendon. The suitability of sonography for examining the intertubercular groove and the biceps tendon was assessed in ten volunteers. Thirty patients with chronic shoulder pain were subsequently studied by radiography, arthrography, and sonography. The observations made with these examinations were compared, and in 21 of the patients who were treated by operation with the surgical observations as well. Sonography seemed to provide accurate information about the configuration of the intertubercular groove and the position of the biceps tendon. The technique could be used to show dislocation of the tendon in cases in which the tendon sheath is not visualized in arthrography. Tenderness and the site of this in relation to the anterior upper end of the humerus could also be verified with sonography.
Adult↗
Radiographic diagnosis of biceps tendinitis.
The radiographic findings and arthrographic image of the intertubercular groove and the biceps tendon were analysed in 143 patients with chronic shoulder pain. Forty-eight patients had been operated on, and of these 33 had tendinitis, caused by attrition in a narrow intertubercular groove in 17 cases, by medial dislocation of the biceps tendon in 11 cases, and by impingement associated with rupture of the rotator cuff in five cases. Plain radiographs revealed degenerative changes in the walls of the groove in half of the patients with biceps tendinitis. A shallow groove was seen in cases of medial dislocation of the biceps tendon, but also in many with a normal tendon. The arthrogram, however, showed whether a shallow groove was associated with dislocation of the tendon. In patients with attrition tendinitis the groove had a depth of 4.8 mm or more or an inclination of the medial wall of 58 degrees or more. Radiographic measurements of the dimensions of the intertubercular groove may provide valuable information on the state of the biceps tendon.
Adolescent↗