|Scan the QR-code or click here to view the presentation|
“New, highly advanced technologies, the customizable control panel and interface, the electric lift button are all striking features to the versatility of the Aplio i-series / Prism Edition.”Biography
Aaron Fleming is a Senior Sonographer at Qscan Radiology Red Hill Clinic, in Queensland, Australia – a leading diagnostic medical imaging and interventional practice with a high level of expertise in sport imaging. Aaron has a particular interest in MSK that has evolved from his passion for sport.
He graduated from radiography at Newcastle University in 2009 and completed a post-graduate diploma in Medical Ultrasound at Queensland University of Technology (QUT), Brisbane, Australia, in 2013.
This case features a 49-year-old female patient who sustained an injury at yoga, and was referred for an ultrasound of her right hand. The patient presented with a small lump on the palmar aspect of her right hand, over the second metacarpal. She also had pain associated with flexion and extension of the index finger. Differential diagnosis at the time of referral was Dupuytren’s contracture, a collagen disorder where the fascia in the hands becomes thickened and fibrotic. The abnormal collogen proliferation of this disorder means the condition will often first present as a thickening or nodule in the palm.
The Flexor Digitorum Profundus (FDP) and Flexor Digitorum Superficialis (FDS) tendons of the second finger were seen intact however there were changes to echogenicity of the adjacent lumbrical muscle. The muscle appeared enlarged and heterogenous with anechoic areas consistent with fluid. Increased vascularity was seen with Superb Microvascular Imaging (SMI) using Doppler luminance. These findings are consistent with a partial tear of the first lumbrical muscle of the hand.
An interesting case study of an uncommonly seen lumbrical injury.
Figure 1: The FDP tendon in the longitudinal plane. Changes in echogenicity of the adjacent muscle are clearly demonstrated.
Figure 2: Transverse imaging of the same area shows the FDP and FDS in cross section with surrounding changes of the lumbrical muscle.
Figure 3: Increased vascularity was demonstrated. SMI helps to detect and demonstrate the detail of the fine vessels in the area of interest.
Figure 4: Longitudinal imaging with SMI shows marked hypervascularity to the injured region.
This case study follows a 52-year-old firefighter who pre- sented to his doctor with pain in his left elbow upon pronation and supination. There was no acute injury reported by the patient. Possible distal biceps tendinosis was thought to be the cause of his symptoms.
The scan revealed a high-grade partial tear of the distal biceps at its insertion, predominantly involving the long head of biceps. Some vascularity in the distal biceps was also demonstrated with Superb Microvascular Imaging (SMI). Post diagnosis, it was recommended that the patient return for a Platelet Rich Plasma (PRP) injection into the area to help with tendon repair and alleviate symptoms.
Partial tear findings of the long head of biceps are an import- ant diagnosis to help prevent the possibility of further full thickness tearing. The deep section of the distal insertion of biceps can be difficult to image.
Figure 1: The biceps can be seen at its distal insertion onto the radial tuberosity. The deep portion of the tendon is seen to be heterogenous over an area of 21mm thought to be consistent with a partial tear of this tendon.
Figure 2: SMI shows some increased hyperaemia in the region of interest.
A 29-year-old female AFL player presented with pain in the first metacarpophalangeal joint (MCP) following a hyper-extension injury.
A full thickness tear of the radial collateral ligament (RCL) and an avulsion fracture of the first metacarpal joint were visualised. Ultrasound findings also suggested a partial thickness tear of the ulnar collateral ligament (UCL) without a Stener Lesion.
The ulnar and radial collateral ligaments are the two main supporting structures that traverse the metacarpophalangeal (MCP) joint of the thumb. Forced adduction is the most common cause of injury to the RCL, while forced abduction movements are the cause of most acute injuries to the UCL. The damage sustained to both ligaments were clearly demonstrated in this hyperflexion case.
Figure 1: Imaging of the MCP Joint clearly demonstrates fluid emanating from the joint.
Figure 2: Imaging of the UCL shows and echogenic area at the distal portion of the ligament. Findings are suggestive of a partial tear.
Figure 3: Imaging of the RCL of the thumb shows a 2.5mm echogenic area at the proximal portion of the ligament suggestive of an avulsion fracture.
© CANON MEDICAL SYSTEMS EUROPE B.V.
© CANON MEDICAL SYSTEMS EUROPE B.V.