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PubMed2002

Imaging of sports-related muscle injuries.

Muscle derangements in athletes have a wide variety of causes, treatments, and prognoses. Given that the cause and severity of sports-related injuries may be difficult to determine clinically in some cases, MR imaging is utilized increasingly to evaluate muscle injuries in athletes. After reviewing useful MR imaging techniques, this article focuses on MR imaging of the most common causes of muscle pain and disability in athletes, including myotendinous strain, delayed onset muscle soreness, muscle contusion, myositis ossificans, muscle laceration, muscle herniation, and compartment syndrome. The differential diagnosis of various signal intensity abnormalities in muscle also is reviewed.

Athletic Injuries↗

PubMed1998

Malignant tumors of the osteogenic matrix.

This article focuses on major clinical and imaging features that are of practical interest in the diagnosis and management of osteosarcoma, a malignant tumor arising from the osteogenic matrix. The current histologic classification of this tumor is also reported. Different types of osteosarcoma are described, each of them with a definite clinical and radiographic pattern. Conventional radiography is the keystone to diagnosis because it allows analysis of the patterns relevant to the different lesions (location, site, bone destruction, periostal reaction, soft tissue masses). The most common type of osteosarcoma is defined classic or conventional high grade (75%) and it typically involves the medullary cavity. Radiographically, it may be predominantly osteosclerotic or osteolytic, but more frequently it has a mixed (osteoslerotic/osteolytic) pattern. The teleangiectatic osteosarcoma is an aggressive form (5%) characterized by marked vascularization with large blood-filled cystic cavities; its typical radiographic pattern is purely osteolytic. Juxtacortical osteosarcoma (8-10%) indicates a group of osteosarcomas apparently arising on bone surface. The most common type is parosteal osteosarcoma which affects older subjects and has a better prognosis than the classic type. Radiography shows a heavily ossified mass with a broad base attached to the underlying cortex. CT and MRI are useful in the differential diagnosis of osteosarcoma and myositis ossificans or osteocondroma. Rare types of osteosarcoma include the periosteal and high-grade surface variants, as well as secondary and multifocal osteosarcoma (osteosarcomatosis). CT and MRI are the imaging procedures of choice in locoregional staging (intraosseous and extraosseous spread, skip metastases, growth plate and articular involvement). CT of the chest is a useful tool for detecting lung metastases. Also MRI has a role in monitoring the response to chemotherapy and in detecting recurrence. It permits a more accurate study of the tumor volume than other imaging techniques and clinical examination. MRI becomes even more useful when paramagnetic contrast agents are administered because dynamic MRI with contrast enhancement help differentiate postchemotherapy changes from viable tumor--the latter enhancing rapidly and the former slowly. Thus, dynamic MRI allows a precise mapping of any residual tumor activity.

Bone Neoplasms↗

PubMed2002

COX-1 and COX-2 expression in osteoid osteomas.

Osteoid osteoma is a benign bone forming neoplasm that is characterized by its small size (less than 2 cm), self-limited growth, and the tendency to cause extensive reactive changes in the adjacent tissue. The lesion classically presents with severe pain at night that is dramatically relieved by NSAIDs. The tumor has been shown to express very high levels of prostaglandins, particularly PGE2 and PGI2. The high local levels of these prostaglandins are presumed to be the cause of the intense pain seen in patients with this lesion. One generally accepted form of treatment is the prolonged use of NSAIDs. Since the cyclooxygenases are thought to be the source of these prostaglandins, and the central target of NSAIDs, we evaluated the expression of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) in osteoid osteoma tissues from patients following surgery. In the 12 specimens examined we found that the tumor osteoblasts had strong immunohistochemical staining for COX-2, while the staining in the surrounding host osteoblasts in the reactive bone was scant. Significant COX-1 staining was also detected in both tumor and host osteoblasts. For comparison we examined the COX expression in human fracture callus, fibrous dysplasia, osteoblastoma, osteofibrous dysplasia, and myositis ossificans. With the exception of fracture callus, very limited amounts of COX-2 could be detected in these tissues. Taken together, we conclude that the increased production of prostaglandins by osteoid osteomas implicates that COX-2 is one of the mediators of this condition. These findings suggest that the newly selective COX-2 inhibitors could be used to more safely treat osteoid osteomas.

Bone Neoplasms↗

PubMed2003

Parosteal osteosarcoma of the distal ulna. A rare tumour at a rare location: a case report.

We report a case of a histologically well differentiated, grade I, parosteal osteosarcoma of the distal ulna. The tumour's radiological and histological features are described, and the patient's course after wide en-bloc resection is detailed. Parosteal osteosarcoma is a rare low-grade malignant neoplasm. It belongs to the group of the osteosarcomas originating from the surface of the bone, representing a distinct tumour entity within this group, with defined histological and radiological features. We describe the radiological and histological characteristics of parosteal osteosarcoma and, based upon these features, present its classification. The differential diagnosis, including parosteal osteoma, myositis ossificans and osteochondroma, is also discussed. Finally, therapy and prognosis are outlined in accordance with the current literature. Wide en-bloc resection represents the mainstay of therapy offering an excellent prognosis with a 5-year survival rate of more than 90%. Incomplete resection, on the other hand, increases the risk of recurrence and dedifferentiation of the tumour. Dedifferentiation induces tumour spread and is associated with a poor prognosis equivalent to conventional osteosarcoma.

Bone Neoplasms↗

PubMed2000

Efficacy of thigh protectors in preventing thigh haematomas.

Thigh haematomas are extremely common in Australian Rules Football (ARF). This is in contrast to contact sports overseas, the likely reason is the increased use of thigh protectors as part of team uniforms in contact sports such as American football. Thigh haematomas can have a significant impact on an athlete's performance, ranging from short term performance impairment, muscle deconditioning and compartment syndromes, to long term problems, such as career threatening myositis ossificans and possibly muscle tears. To assess the efficacy of thigh protectors made for Australian Football, a prospective study was undertaken involving two teams in the elite junior (U 18) VSFL competition in SE Australia. One team wore thigh protectors over the course of the season while the other team acted as controls and did not wear thigh protectors. The control group suffered nine thigh haematomas, while the protected group had none (p<0.01). The possible de-conditioning effect of the haematomas was evidenced by two of the control group suffering torn quadriceps within four weeks of the haematoma. The protectors were generally well tolerated by all but one player, except in hot conditions, when they were uncomfortable.

Australia↗

PubMed1975

Renal secretion of diphosphonates in rats.

Diphosphonates, characterized by a P--C--P bond, are relatively new experimental drugs used for the treatment of myositis ossificans, dental calculus, nephrolithiasis and Paget's disease. These compounds are not metabolized and the fraction which is not taken up by the skeleton is excreted unchanged in the urine. In the present study, the renal clearances of two 14C-labelled diphosphonates, disodium ethane-1-hydroxy-1,1-diphosphonate (CEHDP) and disodium dichloromethylene diphosphonate (CC12MDP) have been measured in conscious rats. The clearances have been found to be higher than the glomerular filtration rate (GFR), Cdiphosphonate/GFR being about 1.5. This observation indicates net tubular secretion of both drugs. High plasma concentration of EHDP or Cl2MDP significantly depressed CEHDP, whereas CEHDP was not influenced by varying urine pH, by infusing NH4Cl or NaHCO3, or by simultaneous administration of high doses of para-aminohippurate (PAH), probenecid, N-methylnicotinamide or Ca-EDTA. High plasma concentration of inorganic phosphate depressed CEHDP and also depressed the in vitro ultrafiltrability of EHDP. In conclusion, these results provide evidence of an active renal transport of diphosphonates which appears distinct from the mechanisms handling organic acids, organic bases and EDTA in the rat kidney.

Aminohippuric Acids↗

PubMed2000

Prospective analysis of hip arthroscopy with 2-year follow-up.

PURPOSE: Numerous indications, but little outcome data, have been reported for hip arthroscopy. The purpose of this prospective study is to report the 2-year results of hip arthroscopy performed on a consecutive series of patients for a variety of disorders. TYPE OF STUDY: Case series. MATERIALS AND METHODS: There were 38 procedures performed on 35 patients who have achieved 2-year follow-up. All patients were assessed with a modified Harris hip score (pain and function) preoperatively and postoperatively at 1, 3, 6, 12, and 24 months or until a subsequent procedure was performed. Variables studied included age, sex, diagnosis, duration of symptoms, onset of symptoms, center-edge angle, Workers' Compensation, and pending litigation. RESULTS: Follow-up was obtained on all patients. The median score improved from 57 to 85 points. This included 10 cases (9 patients) who underwent a subsequent procedure at an average of 10 months (6 total hip arthroplasty, 1 core decompression, 3 second arthroscopy) with an index score of 54 compared with 52 at the time of the second procedure. The median improvement for the following diagnoses was: loose body (34), labral lesion (27), synovitis (26), chondral injury (18), arthritis (14), and avascular necrosis (-11). Of the variables studied, the most statistically significant finding was that older men with longer duration of symptoms did worse. Two complications occurred in 1 patient: partial neuropraxia of the lateral femoral cutaneous nerve and focal myositis ossificans along the anterior portal tract. CONCLUSIONS: Hip arthroscopy can be performed for a variety of conditions (except end-stage avascular necrosis) with reasonable expectations of success and an acceptable complication rate. This is the first report to quantitate the results of hip arthroscopy for a heterogeneous population.

Adolescent↗

PubMed1996

Outcome of persistent vegetative state following hypoxic or traumatic brain injury in children and adolescents.

Persistent vegetative state (PVS, apallic syndrome) has become a significant medical and social problem. The outcome of young people with PVS is a matter of great interest. Therefore, we analysed the outcome of 127 children and adolescents who were in PVS for at least 30 days following traumatic (n = 82) or hypoxic (n = 45) brain injury. After 19 months of follow-up, 84% of the patients of the traumatic brain injury (TBI) group, but only 55% of the hypoxic brain injury (HBI) group had left PVS (p < 0.001). The TBI patients regained consciousness earlier. Later than 9 months post trauma less than 5% of the patients of both groups left PVS. Hypoxic brain injury patients had a higher incidence of seizures (p = 0.01) and a higher seizure frequency. They had significantly more complications like pneumonia, gastrointestinal disturbance or myositis ossificans (= heterotopic ossification). Posttraumatic hyperthermia and autonomic dysfunctions were correlated with worse outcome in the TBI group, but not in the HBI group. Thirteen patients (16%) with TBI became independent in everyday life versus only two (4%) with HBI. These results underline the important contribution of hypoxia in severe and permanent brain impairment. They also may help to establish the prognosis of children in PVS.

Activities of Daily Living↗

PubMed1999

Soft Tissue Masses: The Underutilization of Sonography.

For the evaluation of soft tissue masses, sonography (US) has proved to be very accurate in confirming the presence or absence of a lesion, with a very high negative predictive value. Many soft tissue masses result from trauma, inflammation, infection, or cystic changes and are not true neoplasms. In the proper clinical context, US can diagnose a muscular tear, hernia, myositis ossificans, or rhabdomyolysis. Retained foreign bodies are readily identified and localized with US. US differentiates between cellulitis and abscess and can diagnose masses resulting from tendinitis, tenosynovitis, or bursitis. It is the modality of choice for diagnosing cysts, including intact or ruptured BakerÕs cysts and ganglion cysts in the distal extremities. Among benign neoplasms, lipomas and hemangiomas display a wide spectrum of echogenicity. US can diagnose nerve sheath tumors by demonstrating the connection between the mass and the normal nerve. Except for some well-differentiated liposarcomas, which may appear echogenic, the vast majority of malignant tumors in the soft tissues are hypoechoic. Real-time US is ideal for guiding large-core needle biopsy of soft tissue sarcomas. US is extremely sensitive in detecting early recurrences after surgical excision, which are readily confirmed by US-guided fine-needle aspiration. Any nonpalpable mass visualized by US can be conveniently localized pre- or intraoperatively with US guidance. Provided the examination is done by a well-trained operator using state-of-the-art equipment, the cost-effectiveness of US justifies its use as a first-line examination technique in many situations involving soft tissues, with magnetic resonance imaging being the problem-solving tool and staging procedure.

Journal Article↗

PubMedDate not supplied

Value of magnetic resonance imaging in muscle trauma.

While most muscle injuries are recognized clinically, magnetic resonance imaging (MRI) is the ideal noninvasive test to assess their extent and severity, which impacts therapy and influences prognosis. Typical examples of these injuries include muscle contusions, lacerations, sprains, and delayed onset muscle soreness. For other less common traumatic muscle conditions (exertional compartment syndrome, muscle herniation, and traumatic denervation), the clinical findings are often subtle or ambiguous and MRI will indicate the correct diagnosis. In patients with known muscle trauma, MRI can detect complications such as hematoma or seroma development, scarring and fibrosis, and myositis ossificans. This article illustrates the spectrum of muscle injuries, emphasizing the value of MRI in their diagnosis.

Humans↗

PubMed2000

Practical illustrations in tissue engineering: surgical considerations relevant to the implantation of osteoinductive devices.

This paper provides practical illustrations in the use of osteoinductive devices (biomaterial carriers coupled with osteoinductive morphogens) for bone tissue engineering. We discuss the considerations relative to the implantation of these devices that may induce tissues that are located outside the boundaries of the osteoinductive device as well as outside boundaries of the normal skeletal envelope. Five reports of osteoinductive devices generating such tissues are reviewed. Histologic and radiographic data from a sixth example are presented and compared with histologic and radiographic findings typical of two varieties of myositis ossificans. A theory is advanced that osteoinductive implants may induce ectopic tissues that resemble fibro-osseous pathologies. Finally characteristics of tissue-engineered bone graft substitutes that may contribute to development of these pathologies and device characteristics that may obviate these ectopic tissues are considered.

Animals↗

PubMed1995

Superficial soft-tissue injury.

In 1992, Lee and Opeskin published an article on the little-recognized problem of death related to multiple superficial soft-tissue injuries following an assault. These deaths resulted from an acute assault and were restricted to young aboriginal women with a history of alcoholism. Presented here is a similar case occurring in a 22-year-old Polynesian woman. However, there are some significant differences. Aside from the final acute assault, there was evidence of chronic repeated episodes of superficial soft-tissue injury that resulted in undermining of connections between large areas of different tissue planes. These injuries produced pockets and spaces lined by fibrous tissue and numerous old intramuscular and subcutaneous hematomas, some of which showed secondary infection. There was also dense soft-tissue and subcutaneous fibrosis, and myositis ossificans.

Adult↗

PubMed1994

Primary aneurysmal cyst of soft tissues (extraosseous aneurysmal cyst)

In this report we describe a soft-tissue aneurysmal cyst located in the left shoulder of a 20-year-old woman. Although the tumor initially was clinically considered a myositis ossificans, the microscopic features were identical to those found in classic aneurysmal bone cyst (ABC). Light microscopy showed a lesion composed of a peripheral band of mature trabecular bone surrounding a multicystic central area made up of anastomosing cavernous blood channels separated by fibrous septa that contained osteoid, mineralized myxochondroid material and osteoclastic giant cells. Whereas most bone tumors have an extraosseous counterpart, ABC has been found outside the bone only once, in an artery, but never in soft tissues. Moreover, major reviews state that aneurysmal bone cyst occurs exclusively within bones. This unique case is a very rare occurrence of one of these lesions in the soft tissues.

Adult↗

PubMed1994

Radionuclide imaging in forme fruste of melorheostosis.

Scintigraphy was instrumental in two histologically proven cases of forme fruste melorheostosis. Radionuclide bone scans demonstrated a moderately increased uptake of radiopharmaceutical localized to the "flowing" cortical hyperostosis of melorheostosis observed radiographically. The medullary portion of the affected bones showed no increase in tracer activity. In one case, imaging with Tl-201 chloride demonstrated increased focal activity of the lesion. These scintigraphic findings can help distinguish the mildest manifestation (forme fruste) of melorheostosis from the well-ossified lesions of myositis ossificans and parosteal or periosteal osteosarcoma. The findings of MRI are also described in one patient.

Adult↗

PubMed1975

Pyrophosphate and diphosphonates in skeletal metabolism. Physiological, clinical and therapeutic aspects.

Pyrophosphate and diphosphonates produce striking results on calcium metabolism in experimental animals and man. Compounds containing P-O-P- bonds (e.g. inorganic pyrophosphate [PP-ii1 or P-C-P bonds (diphosponates) inhibit both the formation and dissolution of calcium phosphate crystals in vitro. PP-i may have a physiological function in regulating calcification and bone turnover, and obnormalities in its metabolism may occur in some human diseases notably hypophosphatasia and pseudogout. Diphosphonates inhibit ectopic calcification, and slow down resorption and bone turnover in several experimental systems in vivo. They have helped in studies of various aspects of the regulation of calcium metabolism. The diphosphonate, disodium ethane-1-hydroxy-1,1-diphosphonate (EHDP) has been shown in clinical studies to be effective against ectopic calcification particularly in myositis ossificans progressiva and in disorders of increased bone resorption such as Paget's diseases and some types of osteoporosis. -99mTechnetium complexes of EHDP, PP-i and other polyphosphates have also recently been used successfully as bone scanning agents.

Animals↗

PubMed1992

Comparison of closed reduction and percutaneous pinning versus open reduction and percutaneous pinning in displaced supracondylar fractures of the humerus in children.

A retrospective review of 29 children with displaced supracondylar humerus fractures was performed. Fifteen patients treated with closed reduction and percutaneous pinning and 14 patients treated with open reduction and percutaneous pinning were evaluated at a minimum of 18 months (range 18-80 months). Results were graded according to the criteria of Flynn et al. (Flynn JC, Matthews JG, Benoit RL: Blind pinning of displaced supracondylar fractures of the humerus in children. J Bone Joint Surg [Am] 56:263-272, 1974) using both cosmetic and functional evaluations. Excellent or good results were obtained in 14 of the 15 fractures treated with closed reduction and percutaneous pinning and in 12 of the 14 fractures treated with open reduction and percutaneous pinning. The three fair cosmetic results were associated with inadequate reduction and residual medial angulation. Ten to 15 degrees of motion loss occurred in three older patients. One patient in each group had a minor pintract infection. There were no cases of iatrogenic nerve injury or myositis ossificans. The treatment goal in displaced supracondylar humerus fractures in children is anatomic reduction. If an anatomic reduction cannot be achieved with closed reduction, open reduction is indicated. This can be done without an increased risk of complications.

Bone Nails↗

PubMed2003

Adult distal humeral metaphyseal fractures: epidemiology and results of treatment.

OBJECTIVES: To examine the epidemiology and results of treatment of fractures of the distal humeral metaphysis. DESIGN: Observational cohort study. SETTING: An orthopaedic trauma unit, which provides all the fracture care for a well-defined catchment population. PATIENTS/PARTICIPANTS: A consecutive series of 320 patients with distal humeral fractures admitted to the unit between January 1988 and June 1997. INTERVENTION: We adopted a protocol of open reduction and fixation of all displaced fractures (greater than 5 mm of displacement in any plane) in patients who were medically fit for anesthesia. Postoperative immobilization was a cylinder cast for 6 weeks. Patients with undisplaced fractures or who were medically unfit were also treated nonoperatively in cylinder casts for 6 weeks. MAIN OUTCOME MEASUREMENTS: Epidemiological examination of patient subgroups and the incidence of complications of treatment. RESULTS: The overall incidence of distal humeral fractures in adults during this time was 5.7 cases per 100,000 in the population per year with an almost equal male to female ratio. There was a bimodal age distribution, simple falls were the most common overall cause of fracture, and the majority of the fractures were extra-articular (AO/OTA type A) or complete articular fractures (AO/OTA type C). The risk of complications during treatment was generally low in most patients, and the majority healed their fractures uneventfully. Overall, 90.6% of fractures united within 12 weeks and just under half of the remaining 9.4% patients with union complications healed without requiring further operative intervention by 24 weeks. The risk of union complications was higher following high-energy injuries, open fractures, and nonoperative treatment. Although the AO/OTA classification was not predictive of union complications, the "low" transcondylar (type A2.3 and A3) and simple intercondylar fracture (type C1.3) configuration had a greater risk of union complications than the "high" subtype. The rate of infection, myositis ossificans, and other implant-related complications were higher following operative treatment of type C fractures than type A and B fractures. CONCLUSIONS: The epidemiology of a consecutive unselected series of adult distal humeral fractures is defined in this study. The majority of these fractures are best treated surgically by rigid open reduction and internal fixation, except for "low" Type A and C fractures, which have a higher risk of union complications. The role of total elbow arthroplasty to treat these more complex injuries requires further evaluation.

Adolescent↗

PubMed1983

High school football injuries in Birmingham, Alabama.

To investigate high school football injuries, we analyzed 1,877 injuries (661 game, 1,216 practice) treated from 1976 through 1979 at the Sports Medicine Clinic at the University of Alabama in Birmingham. The common injury types were sprain (32.2%), contusion (24.8%), strain (12.4%), fracture (11.0%), tear (3.8%), dislocation (2.1%), myositis ossificans (1.4%), tendinitis (1.3%), and concussion (1.0%). Position of the player injured was quarterback (8.7%), running back (19.6%), receiver (12.4%), offensive lineman (23.7%), defensive lineman (10.2%), defensive back (9.2%), and linebacker (9.0%). Body areas affected included head/neck (7.6%), shoulder (13.3%), upper arm (1.4%), elbow (3.4%), lower arm (2.0%), wrist (2.9%), hand/fingers (11.9%), chest/ribs (3.4%), back (4.9%), abdomen (0.7%), groin (0.7%), hip (2.4%), upper leg (4.6%), knee (22.2%), lower leg (4.0%), ankle (10.9%), and foot/toes (4.2%). These data are similar to those in previous reports, although subtle differences suggest variations in injury patterns due to rule changes and equipment modification.

Adolescent↗