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Diagnostic Principles and Clinical Correlates. Enzinger and Weiss's Soft Tissue Tumors: Editorial Reviews Review "This is the first book in this series I have read. It is an interesting way to present pathology diagnosis, by using pattern recognition. The book helps with one of the most difficult dilemmas general pathologists face and need to resolve. Product details File Size: Up to 4 simultaneous devices, per publisher limits Publisher: Saunders; 1 edition January 17, Publication Date: January 17, Sold by: Share your thoughts with other customers.
Write a customer review. Showing of 3 reviews. Top Reviews Most recent Top Reviews. There was a problem filtering reviews right now. Please try again later. A standard reference for differential diagnoses A standard reference for differential diagnoses. Very modern book layout. It is very good and useful book as expectated,necessary in my daily work; I recommend it all pathoiogist and residents.
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Joint and connective tissue ultrasonography--a rheumatologic bedside procedure? Grassi W, Cervini C. Eur J of Ultrasound. Ultrasound should be performed when investigating rotator cuff tears, inflammation, calcific tendinitis and impingement syndrome, frozen shoulder, tennis or golfer elbow, biceps muscle, and distal biceps tendon insertion. Ultrasonography of the rotator cuff.
English Choose a language for shopping. Not Enabled Word Wise: Left knee medial aspect, longitudinal sonogram. Medial meniscus anterior horn. Note the triangle-shaped hyperechoic structure of the normal medial meniscus; B: Note the cleft and irregularity of the torn meniscus. This young football player suffered an acute twisting injury.
Clinically he had pain with mild swelling on the medial aspect, there was a joint effusion with medial line tenderness. Mac-Murray and Apley tests were positive over the medial meniscus; Right knee lateral meniscus lesion. Note the irregularity of the torn lateral meniscus.
Ultrasound examination of patellar and quadriceps tears. Longitudinal ultrasound image obtained in the midline, demonstrating the anterior knee, quadriceps tendon with its insertion to the patella, suprapatellar recess, and the patella. No effusion is visible; B: Complete quadriceps tendon tear.
This year old physician suffered direct trauma to his right knee when falling down stairs; C: Quadriceps tendinitis with calcification of the right knee. This year old man had a contusion with hematoma of the quadriceps muscle one year ago. Right knee Osgood-Schlatter disease. Note the severe irregularity of tibial tuberosity.
This year old football player has severe pain and swelling of the tibial tuberosity,. In medial collateral ligament MCL injury, the combination of sonographic findings with those from a real time sonography valgus stress test can support the clinical diagnosis of an MCL stretch or tear, and pinpoint the exact location of the isolated MCL injury, thus facilitating proper treatment[ 41 ].
Pathologies can be detected by ultrasound at a stage in which plain radiographs still appear normal. Osteoarthritis medial aspect, right knee. Medial joint space narrowing with osteophyte formation and thickening of the medial collateral ligament, measured 0. Lateral joint with normal appearance measured 0. A year old woman with typical findings of osteoarthritic changes. Longitudinal sonogram of the thigh. A young basketball player presented with pain over the anterior aspect of the distal right femur.
Note the irregularity with partial tear of the muscle. Ultrasound examination of patellar tendon. Ultrasound image shows the patellar tendon from its origin in the patella into the tibial tuberosity left knee; B: Note fluid accumulation deep to the patellar tendon. Ultrasound examination of knee cartilage.
Note trochlear cartilage of femur. The hyaline cartilage is a hypoechoic homogenous structure with sharp margins, overlying the bright hyperechoic line of subchondral bone; B: Anterior transverse right knee in flexion, irregularity and narrowing of the hyaline cartilage which is roughened and fibrillated. Ultrasound can provide a dynamic assessment of muscle tear, or of an intermittent muscle hernia or tendon subluxation. As with other soft tissue lesions, ultrasonography is useful for the evaluation of underlying pathologies in patients presenting with achillodynia and ankle pain.
Haglund deformity may be related to Achilles tendon pathology.
The dynamic nature of the ultrasound examination enables tendon movement and visualization from the origin to the insertion of a tendon, as is needed in the evaluation of the Achilles tendon. Diseases of the Achilles tendon include a broad spectrum of pathologies ranging from paratendonitis to complete tendon ruptures. Tendonitis appears as fusiform swelling with hypoechogenicity and, tears and gaps can be measured. Ultrasound examination can detect shrapnel lesions, and contribute to the planning of surgical correction of ruptures in the Achilles tendon[ 47 ].
Ultrasound examination of achilles tendon. Longitudinal view, left ankle posterior aspect. Complete tear of Achilles tendon with retraction. A year old man felt a sudden sharp pain in the left Achilles tendon while running. Physical examination revealed absence of plantar flexion and a positive Thompson test; B: Ankle sprain can demonstrate partial or complete tears.
The most common torn ankle ligament is the anterior talofibular. Ligaments may appear hypoechoic with fluid, or discontinuous. Similarly, ultrasound allows the appearance of the calcaneo fibular and deltoid ligaments to be seen. Ultrasound examination of tibialis anterior tendon. Anterior longitudinal view, ankle.
Tibiotalar joint with normal appearance of tibialis anterior tendon; B: Left ankle, longitudinal view. Tear of tibialis anterior tendon. This year old male suffered from pain in the anterior aspect of the left ankle after much walking. No trauma had occurred. Sonography can be effective in evaluating cases of tibial stress fractures[ 53 ]. Routine ultrasound examination includes the anterior tibial, posterior tibial, peroneal and Achilles tendon and the tibiotalar joint is evaluated for effusion or loose bodies.
Tendinitis is visualized in ultrasound as hypoechogenicity of the tendon with increased interfibrillar distance. Partial tears indicate intrasubstance defects extending toward one surface of the tendon. Tendon discontinuity may indicate the proximal and distal stumps of the tendon. Insertion tendinopathy is seen as a hypoechoic enlargement of the tendon with fluid in the area inserted in the bone.
Left ankle retro-calcaneal bursitis. Note the large amount of fluid in the retro-calcaneal bursa. Longitudinal view, distal right leg. Swelling of soft tissue with fluid. Note increased echogenicity and thickening of the subcutaneous fat in the inflamed region. Ultrasound examination of left ankle. Longitudinal sonogram, left ankle, demonstrates a wooden foreign body; B: Transverse view, left ankle.
Note the hypervascularity in the inflamed area; C: Corresponding X-ray of left ankle. Note the swelling on the lateral aspect. No foreign body is visible. Ultrasound is useful in the assessment of foot lesions such as plantar fasciitis, plantar fascial tears, fibromatosis, morton neuroma, Jones fractures, and fractures of sesamoids and the 5th metatarsal bone[ 54 ].
Only rarely can a small effusion of the hip joint be detected by clinical examination. Thus, ultrasound, with its effectiveness in detecting effusion and synovitis, is generally used in the early assessment of hip pathology[ 55 ]. Detection of an effusion allows direct aspiration to decrease the pressure and to evaluate the fluid for possible septic arthritis[ 56 ]. Prompt aspiration in suspected cases of septic arthritis obviates the need for lengthy workups, and guides further treatment[ 57 ].
Clinical assessment of the newborn hip is routinely performed in the first days of life. Static and dynamic scanning by ultrasound enhances the rate of early detection of hip abnormalities[ 60 ]. Ultrasound follow-up is part of the routine management of hip dysplasia.
Assessment of the echogenic surface of bone and the acoustic shadow behind it can reveal abnormalities. Although sonography is not generally the examination of choice for the diagnosis of bone pathology, it should not be ignored, since significant pathologies, including fractures, bone erosions and lytic lesions, are occasionally detected. Ultrasound can be used to detect subperiosteal collections of fluid in early osteomyelitis, as well as fractures[ 61 ], osteophyte, and bone tumors with bone damage.
It provides excellent anatomical detail of the cortical surface of superficial bone. In cases of exostosis, it may be used to measure the thickness of the cartilage cap.
The use of ultrasound for the diagnosis of fractures is gaining more and more interest. When ultrasound evaluation is targeted and combined with an orthopedic examination of the pathological area, precise demonstration of cortical disruption, soft tissue damage, and hematoma are possible. Knowledge of bone anatomy is essential for complete ultrasound evaluation of the musculoskeletal system. Muscle pathologies such as rupture, calcification, myositis ossificans, hemorrhage can be also assessed by ultrasound. During recent years, musculoskeletal ultrasound has become recognized as an effective imaging technique for the diagnosis and follow-up of patients with rheumatic diseases[ 62 - 67 ].
While most commonly used in the assessment of soft tissue disease or detection of fluid collection, ultrasound can also be used to visualize other structures, such as cartilage and bone surfaces[ 62 , 68 , 69 ]. Ultrasound is an invaluable diagnostic technique in orthopedic practice.
Technological developments in resolution quality have increased the diagnostic possibilities while improvements in picture quality have increased clinical applications. Muscoskeletal sonography is safer and more informative than X-rays for evaluating soft tissues pathology. Compared with MRI, it is accessible to all patients, without contraindications, and provides real time dynamic assessment. Musculoskeletal ultrasonography is indicated for evaluation of soft tissue damage, particularly in sports injuries.
The most practical uses are the evaluation of tendon structures, dynamic examination in motion, and the assessment of articular structures and diseases.
Bursal disease with synovitis can be easily detected. Ultrasound should be performed when investigating rotator cuff tears, inflammation, calcific tendinitis and impingement syndrome, frozen shoulder, tennis or golfer elbow, biceps muscle, and distal biceps tendon insertion. Other indications include carpal tunnel syndrome, cysts of the wrists, pathology of tendon of the hands, retained foreign bodies, joint effusion, diseases of the knee, meniscal cysts, Baker cyst, ligament and osteoarthritis changes, Osgood Schlatter, and patella bipartite.
In the ankle, ultrasound can detect tibio talar effusion, pathology of tibialis anterior, posterior, peroneal tendons, Achilles tendon, plantar fasciitis, and Morton neuroma. Musculoskeletal sonography should be performed by an experienced operator with extensive knowledge of anatomy. Investment in training is justified in light of the contribution of this technology to diagnostic and therapeutic orthopedics and its accessibility to patients due to safety, non- ionizing radiation, low operating costs, lack of contraindications, and availability in locations distant from medical centers.
I would like to particularly thank Professor Avraham Ganel, Head of Pediatric Orthopedics, Sheba Medical Center, for his great help in guiding us in the writing of this review article. Also, a very special thank to Lydia Diamant, ultrasound technician, for her help and assistance in coordinating the ultrasound figures. National Center for Biotechnology Information , U. Journal List World J Orthop v.
Published online Feb Author information Article notes Copyright and License information Disclaimer. Blankstein A contributed wholly to this paper. This article has been cited by other articles in PMC. Abstract Ultrasonography has advantages over other imaging modalities in terms of availability and comfort, safety, and diagnostic potential. Ultrasound, Orthopedic surgery, Safety, No radiation, Soft tissue. Open in a separate window.
WRIST Ultrasound can be helpful in differentiating synovial and teno-synovial pathology, and in examining pathological and morphostructural changes of the median nerve in carpal tunnel syndrome. KNEE While, clinical examination of the knee joint is relatively easy, very small effusions and synovitic proliferations may be missed. Longitudinal view, right patella with fracture. Acknowledgments I would like to particularly thank Professor Avraham Ganel, Head of Pediatric Orthopedics, Sheba Medical Center, for his great help in guiding us in the writing of this review article.
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US depiction of partial-thickness tear of the rotator cuff. Farin PU, Jaroma H. Acute traumatic tears of the rotator cuff: Ultrasonography of the rotator cuff. A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am. Detection of greater tuberosity fractures by sonography. Ultrasonographic diagnosis in the evaluation of shoulder pain. Sonography of the Shoulder. Ultrasonography as a diagnostic modality in acromioclavicular joint pathologies. Isr Med Assoc J. Septic arthritis of the sternoclavicular joint.
Septic arthritis of the acromioclavicular joint. Arch Orthop Trauma Surg. Dudkiewicz I, Blankstein A. A highly efficient modalilty for diagnosis of Hill-Sachs lesions. Ultrasonographic imaging in hemiplegic shoulders of stroke patients. Dynamic ultrasonography of rotator cuff muscles. A comparative study of ultrasonography and arthrography in evaluation of the rotator cuff. Clin Orthop Relat Res. Sonography of the elbow, wrist and hand. Ultrasound of the elbow. Lateral epicondylitis of the elbow: Ultrasonographic findings in patients with olecranon bursitis.
Characteristics of soft tissue mass in the hand by ultrasonographic examination. Occult dorsal carpal ganglion: The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand Surg Eur Vol.
Ultrasonography as a diagnostic modality and therapeutic adjuvant in the management of soft tissue foreign bodies in the lower extremities. Localization, detection and guided removal of soft tissue in the hands using sonography. Greenstick fractures of distal radius followed-up by ultrasound - A prospective study. Sonographic imaging of mallet finger. Sonographic findings in patients with anterior knee pain. A highly efficient modalilty for anterior knee pain diagnosis.