Biomedical subjects

Randall W Culp

Publications and source records attributed to Randall W Culp.

9 recordsLinked to original sources

PubMed2006

Flexor carpi radialis tendinopathy: spectrum of imaging findings and association with triscaphe arthritis.

OBJECTIVE: To present the spectrum of pathology affecting the flexor carpi radialis (FCR), and its anatomical, functional and clinical relationship with conditions affecting the triscaphe or scapho-trapezium-trapezoid (STT) compartment, and particularly osteoarthritis. DESIGN: The study comprised two men and four women aged between 23 and 79 years (mean age, 49 years). Two musculoskeletal radiologists in consensus evaluated MRI findings. RESULTS: Five of the patients showed evidence of triscaphe osteoarthritis. One of the patients showed synovitis and reactive marrow edema at the triscaphe joint without more specific findings of osteoarthritis. Five patients showed evidence of FCR tenosynovitis. Partial-thickness tears were noted in three patients. Two patients showed complete discontinuity of the FCR; one of them had undergone prior tendon harvesting for interposition arthroplasty after trapezectomy. One patient showed a ganglion cyst in connection to the FCR tendon sheath. CONCLUSION: The FCR tendon courses over the volar surfaces of the scaphoid and trapezium in a separate fibro-osseous tunnel. This anatomical and functional relationship explains the coexistence of FCR tendinopathy and STT arthritis demonstrated by MR imaging.

Adult↗

PubMed2005

Reactive carpal synovitis: initial experience with MR imaging.

PURPOSE: To retrospectively evaluate the accuracy of various magnetic resonance (MR) imaging findings in the diagnosis of reactive carpal synovitis. MATERIALS AND METHODS: Institutional review board approval was obtained, and the need for informed consent was waived. This study was compliant with the Health Insurance Portability and Accountability Act. Thirty-five consecutive patients (19 male and 16 female patients; age range, 13-57 years) who underwent arthroscopy and MR imaging within 4 weeks of surgery were evaluated by two reviewers for the following potential findings of synovitis: (a) distention of the pisotriquetral recess by fluid, (b) distention of the radial and/or prestyloid recess, (c) synovial enhancement (in patients who received contrast material), (d) amount of dorsal capsule distention, and (e) the location of bone marrow edema, if any. The chi2 and paired t tests were used to assess these findings in patients with and patients without arthroscopically proved synovitis. The sensitivity, specificity, positive and negative predictive values, and accuracy of these findings in the detection of synovitis were calculated. RESULTS: Fluid in the pisotriquetral recess was seen in nine of the 14 patients with synovitis and five of the 21 patients without synovitis (P = .018). Distention of the radial and/or prestyloid recess was observed in six of the 14 patients with synovitis and two of the 21 patients without synovitis (P = .027). Among the 24 patients who received contrast material, synovial enhancement was seen in seven of eight patients with synovitis and three of 16 patients without synovitis (P = .002). The dorsal capsule measured 1-7 mm (mean, 3.07 mm) in the 14 patients with synovitis and 2-7 mm (mean, 3.76 mm) in the 21 patients without synovitis (P = .193). Although bone marrow edema was seen globally in similar frequencies (nine of 14 patients with synovitis, nine of 21 patients without synovitis), pisotriquetral bone marrow edema was seen only in patients with synovitis (two of nine patients). CONCLUSION: Fluid in the pisotriquetral recess, enhancing synovium, and, less commonly, pisotriquetral bone marrow edema are MR imaging findings that may help in the diagnosis of reactive carpal synovitis.

Adolescent↗

PubMed2004

MRI in the diagnosis of cartilage injury in the wrist.

OBJECTIVE: Our purpose was to evaluate the accuracy of MRI in identifying articular cartilage abnormalities in the distal radius, scaphoid, lunate, and triquetrum of patients with wrist pain. MATERIALS AND METHODS: Eighty-six MRI examinations of the wrist in 85 patients (41 indirect MR arthrograms and 45 unenhanced [nonarthrographic] MR images) were evaluated. The study population consisted of 47 male (54.7%) and 38 female (45.3%) patients with an average age of 37.5 years (range, 7-62 years). Three experienced musculoskeletal radiologists who were unaware of surgical findings retrospectively evaluated the MRI examinations for cartilage abnormalities in the distal radius, scaphoid, lunate, and triquetrum. All patients underwent arthroscopy of the radiocarpal joint with inspection of the articular surfaces of the distal radius, scaphoid, lunate, and triquetrum. The articular cartilage was evaluated on the basis of the 5-point scale of the Outerbridge classification system. RESULTS: When at least two of the three radiologists had concordant interpretations, sensitivity for abnormalities in the distal radius was 27%; the scaphoid, 31%; the lunate, 41%; and the triquetrum, 18%. Specificity for the distal radius was 91%; the scaphoid, 90%; the lunate, 75%; and the triquetrum, 93%. Weighted kappa values among the three observers showed only fair agreement (0.279-0.360). High-grade more extensive cartilage lesions were no more accurately identified than low-grade lesions. Indirect MR arthrograms were not statistically more sensitive, specific, or accurate than unenhanced studies. No bone was more frequently or less frequently graded correctly or incorrectly with statistical significance. The variables of sex, age, and the presence of multiple bones with lesions did not affect accuracy. CONCLUSION: Our findings suggest that MRI of the wrist with the techniques described is not adequately sensitive or accurate for diagnosing cartilage defects in the distal radius, scaphoid, lunate, or triquetrum.

Adolescent↗

PubMed2003

Preiser's disease: identification of two patterns.

PURPOSE: A large series of patients with Preiser's disease was reviewed to compare 2 potentially different categories of this disorder: complete versus partial vascular impairment of the scaphoid bone as determined by magnetic resonance imaging (MRI). METHODS: Nineteen patients with Preiser's disease were identified retrospectively from 2 institutions. Using MRI criteria, 2 disease patterns were identified: diffuse necrosis and/or ischemia of the scaphoid (type 1 disease, 11 cases) and segmental vascular impairment of the scaphoid (type 2 disease, 8 cases). Risk factors for osteonecrosis, treatment methods, and serial radiographs were reviewed in all cases. Sixteen patients were examined for the purpose of this study at an average follow-up of 25 months. RESULTS: MRI signal changes of necrosis and/or ischemia involved 100% of the scaphoid in type 1 cases and on average approximately 42% in type 2 cases (range, 33% to 66%). In type 1 cases, regardless of the treatment used, the scaphoid typically fragmented and collapsed. In type 2 cases, scaphoid architecture was altered minimally after similar treatment methods. A history of wrist trauma was significantly more common in type 2 cases, and the results of treatment were generally better in this group of patients (mean Mayo modified wrist scores, 86 vs 58 points). CONCLUSIONS: This study supports the concept of 2 patterns of scaphoid involvement in Preiser's disease. Type 1 cases are characterized by MRI signal changes of necrosis and/or ischemia involving the entire scaphoid bone. Patients in this group have a propensity for scaphoid deterioration. Type 2 cases have MRI signal changes involving only part of the scaphoid. These patients commonly report a history of wrist trauma, show fewer tendencies toward scaphoid fragmentation, and may have a more favorable clinical outcome.

Adult↗

PubMed2003

Internal derangement of the wrist: indirect MR arthrography versus unenhanced MR imaging.

PURPOSE: To compare indirect magnetic resonance (MR) arthrography with unenhanced MR imaging of the wrist for evaluation of the central disk of the triangular fibrocartilage complex (TFCC) and the scapholunate and lunotriquetral interosseous ligaments. MATERIALS AND METHODS: Eighty-six wrists were evaluated at MR imaging (41 indirect MR arthrography and 45 unenhanced MR imaging examinations). Three musculoskeletal radiologists independently evaluated the central disk of the TFCC and scapholunate and lunotriquetral ligaments and compared the results with those of wrist arthroscopy. Sensitivity and specificity were calculated for each of the readers, and the means were obtained. Sensitivities and specificities were compared with the Student t test. RESULTS: Thirty-three tears of the central disk of the TFCC and 13 scapholunate and 18 lunotriquetral ligament tears were identified at arthroscopy. Sensitivities and specificities were 54%-73% and 83%-91%, respectively, in the evaluation of the central disk of the TFCC, with no significant difference between indirect MR arthrography (P =.666) and unenhanced MR imaging (P =.559). Sensitivities and specificities in the evaluation of the scapholunate ligament were 38%-69% and 75%-99%, respectively, with a significant improvement in sensitivity at indirect MR arthrography (P =.017) and no significant difference in specificity (P =.876). Sensitivities in the evaluation of the lunotriquetral ligament were poor, 0%-22%, though the specificities were 88%-99%, with no significant difference between indirect MR arthrography and unenhanced MR imaging (P =.592 and P =.354, respectively, for sensitivity and specificity. CONCLUSION: Indirect MR arthrography significantly improves sensitivity in the evaluation of the scapholunate ligament when compared with unenhanced MR imaging of the wrist but does not significantly improve the ability to evaluate the central disk of the TFCC or the lunotriquetral ligament.

Adult↗

PubMed2002

Surgical treatment of intra-articular fractures of the trapezium.

Eleven patients with intra-articular fractures of the trapezium were evaluated after surgical treatment with a mean follow-up time of 47 months (range, 25-80 mo). There were 6 vertical split and 5 comminuted fractures. All fractures involved high-energy trauma in men. Five resulted from motorcycle accidents. An associated Bennett's fracture occurred in 4 patients. Three fractures went undiagnosed at the time of initial evaluation. At late follow-up evaluation, 8 of 11 patients experienced some pain, mainly at the trapeziometacarpal articulation. There was no statistical difference in thumb motion, wrist motion, or grip and pinch strength between the affected and unaffected extremity. Radiographs revealed degenerative changes at the trapeziometacarpal articulation in 5 of 11 fractures. No patient was disabled and no patient changed occupation as a result of the hand injury. Based on the good results obtained with surgical intervention we advocate open reduction and internal fixation for fractures with either articular displacement >2 mm or carpometacarpal subluxation.

Activities of Daily Living↗

PubMed2002

Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist.

OBJECTIVE: The treatment of peripheral tears of the triangular fibrocartilage complex is radically different from the more typical central, degenerative tears. To our knowledge, no reports in the imaging literature specifically evaluate tears of the ulnar attachment of the triangular fibrocartilage complex. We evaluated the accuracy of MR imaging in these patients. MATERIALS AND METHODS: Eighty-six MR imaging examinations of the wrist (41 indirect MR arthrograms and 45 unenhanced MR images) were evaluated: 20 wrists with surgically confirmed peripheral triangular fibrocartilage complex tears and 66 wrists with surgically documented normal ulnar attachment. These cases were evaluated by three experienced musculoskeletal radiologists, who were unaware of the surgical findings, to assess the presence of peripheral triangular fibrocartilage complex tears or fluid signal at the ulnar attachment of the triangular fibrocartilage complex. RESULTS: The sensitivity for evaluation of the peripheral triangular fibrocartilage complex tear was 17%, with a specificity of 79% and an accuracy of 64%. High signal intensity at the ulnar insertion of the triangular fibrocartilage complex as a marker for tear showed a sensitivity of 42%, a specificity of 63%, and an accuracy of 55%. Weighted kappa values revealed only fair agreement among the three observers. CONCLUSION: MR imaging does not adequately reveal the peripheral attachment of the triangular fibrocartilage complex.

Adolescent↗

PubMedDate not supplied

Potential MR signs of recurrent carpal tunnel syndrome: initial experience.

OBJECTIVE: In nonoperated patients, the MR diagnosis of carpal tunnel syndrome (CTS) is difficult. In the postoperative patient this difficulty is compounded. Consequently, we sought to evaluate for potential MR signs of postoperative CTS. METHODS: At 1.5 T, 41 wrists in 37 patients with previous CTS release were evaluated by two observers for 1) flexor retinacular regrowth; 2) median nerve: a) high T2 signal, b) proximal enlargement, c) fibrous fixation, d) neuroma, and e) entrapment; 3) flexor tenosynovitis; 4) mass, bursitis, accessory muscle, distal belly progression, or excessive deep fat; 5) hamate fracture; and 6) volar nerve migration. Electromyography (EMG), operative findings, and clinical follow-up were used to determine the presence of recurrent CTS. RESULTS: Fifteen of 41 wrists had recurrent CTS. Retinacular regrowth was seen in 4/15 (27%) with and 7/26 (27%) without recurrent CTS (P=0.7). Excessive fat was seen in 1/15 (7%) with and 2/26 (8%) without CTS (P=0.19). No patient had incomplete resection of flexor retinaculum, scarring, neuroma of nerve, or tendon laceration; bursitis, accessory or distal muscle progression of muscle belly, or hamate fracture. Nerve edema with high T2 signal was seen in 4/15 (27%) with and 3/26 (12%) without CTS (P=0.16); proximal enlargement was seen in 6/15 (40%) with CTS and 2/26 (8%) without CTS (P=0.007). Also, 1 patient with recurrent disease demonstrated a mass and 1 other patient without CTS had nerve entrapment. Tenosynovitis was seen in 9/15 (60%) with and 9/26 (35%) without recurrent CTS (P=0.02). Counterintuitively, the nerve was more palmar with recurrent CTS than without (mean 6.9/8.9 mm). CONCLUSION: Only proximal enlargement, tenosynovitis, and the rare mass may help to diagnose recurrent CTS by MR. However, there appears to be a subgroup of patients with recurrent neuropathy related to an excessively superficial median nerve.

Adolescent↗

PubMedDate not supplied

Management of distal biceps and triceps ruptures.

The management of distal biceps and triceps ruptures is reviewed. Epidemiology, clinical presentation, evaluation, surgical management, nonoperative management, and rehabilitation rationale and techniques are presented. Although various surgical repair techniques are used, none has been shown to produce superior clinical outcomes. The literature is lacking information to provide evidence-based decisions regarding rehabilitation strategies. Prospective studies comparing types and timing of repairs and timing and techniques for a postoperative program are needed. As that information is not yet available, the rehabilitation plan outlined in this article is based on timetables for healing tissue, strength of repair, prevention of complications, consideration of patient's medical history and injury history, and review of the literature. Familiarity with the different treatment options assists the surgeon and therapist tailor a therapy program that is optimal for each individual patient.

Arm Injuries↗