RESUMEN
Operators perform physically demanding jobs associated with a variety of overuse and acute musculoskeletal injuries. The current management of musculoskeletal complaints in the Air Force includes plane radiographs and 6 weeks of physical therapy (PT) before consideration of orthopedic consultation and magnetic resonance imaging (MRI); however, MRI shows a clear advantage compared with plane radiographs. We conducted a performance improvement project and conclude that (1) MRI allowed for definitive diagnosis as well as definitive triage for care in a timely manner, (2) guidelines for ordering lumbosacral MRIs should be followed and not ordered for pain that is not progressive and severe or not associated with a neurological finding, and (3) because of the risk of X-ray exposure in patients in their 20 and 30s, X-rays should be avoided in this setting unless definitely indicated.
Asunto(s)
Auxiliares de Urgencia , Imagen por Resonancia Magnética/métodos , Personal Militar , Servicios Médicos de Urgencia/métodos , Humanos , Medicina Militar , Sistema Musculoesquelético/diagnóstico por imagen , Sistema Musculoesquelético/lesiones , RadiografíaRESUMEN
INTRODUCTION: Intraosseous (IO) devices have gained popularity because of TCCC. The ability to gain access to the vascular system when intra venous access is not possible, and techniques such as central lines or cut-downs are beyond the scope of battlefield providers and tactically not feasible, has lead to the increased use of IO access. Since tibias are often not available sites in blast injury patients, the sternum was often used. Recently the humeral head has gained popularity because of ease of access and placement. The optimal needle length has not been defined or studied. METHODS AND MATERIALS: Fifty consecutive shoulder MRIs among 18?40 year old patients were reviewed. Distances from the skin surface to the cortex from anterior and lateral trajectories were simulated and measured. Two different lateral trajectories were studied described as lateral minimum and lateral maximum trajectories, correlating with seemingly less and greater soft tissue. The cortical thickness was also recorded. Mean values and ranges for the measurements were determined. RESULTS: The anterior trajectory represented the shortest distance. Mean anterior, mean lateral minimum and mean lateral maximum distances were 2.3, 3.0 and 4.7cm with corresponding ranges of 1.1?4.1, 1.6?5.7 and 2.8?7.4cm respectively. The cortical thickness was 4mm in all cases. CONCLUSIONS: Although this information was gathered amongst civilians, and many military members may have more soft tissue, these results indicate that needle length generally in the 40?50mm range should be used via the anterior approach. Use of a standard 25mm needle often used in the tibia would be inadequate in over half the cases, and may result in undue tissue compression or distortion.
Asunto(s)
Cabeza Humeral , Agujas , Humanos , Infusiones Intraóseas/instrumentación , Imagen por Resonancia Magnética , TibiaRESUMEN
OBJECTIVE: To describe the embryologic, clinical, sonographic, and magnetic resonance imaging features of polyorchidism and to review the literature on similar cases. METHODS: Over a 5-year period, we encountered 3 patients who were found to have polyorchidism on scrotal sonography. All 3 patients had a painless scrotal mass. Two patients also had magnetic resonance imaging of the scrotum, and the results were correlated with the sonograms. We also performed a literature search for other reports of polyorchidism. RESULTS: One patient had 2 right testicles and a single left testicle. The second patient had 3 left testicles and 1 right testicle. In the third patient, who had 2 left testicles and 1 right testicle, microlithiasis was found in all 3 testes. The supernumerary testes were within the scrotum in all cases. All testicles were identified by sonography. Magnetic resonance imaging in 2 cases provided confirmatory data regarding the presence of an extra testicle but did not add other relevant information. Conservative treatment was chosen in all cases. CONCLUSIONS: Polyorchidism is a rare congenital anomaly. There are characteristic sonographic features of polyorchidism, and the diagnosis is often made on the basis of sonography. Magnetic resonance imaging can be used for confirmation but may be more helpful in cases complicated by cryptorchism or neoplasia. Conservative treatment is advised in uncomplicated cases.