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OBJECTIVE: This study assesses musculoskeletal ultrasound (MSUS) knowledge, attitudes, and practices among young rheumatologists in Mexico, aiming to identify barriers and facilitators to its clinical use. METHODS: An online survey distributed to a network of young rheumatologists captured demographics, institutional, and personal MSUS information. Multivariable analysis identified factors associated with positive MSUS attitudes. RESULTS: Ninety-six rheumatologists (39.18% national response rate) completed the survey. Of respondents (54.2% females, median age 35.1 years), 81.2% deemed MSUS necessary in clinical rheumatology. The main barriers included limited training access (56.2%) and required training time (54.1%). Lack of scientific evidence was not a major barrier (60.4%). Positive MSUS attitudes were associated with learning from conferences (p = 0.029) and colleagues (p = 0.005), formal (p = 0.043), and in-person training (p = 0.020), MSUS use in practice (p = 0.027), and use by radiologists in their institute (p < 0.001). Interest in learning MSUS (88.5%) was significantly higher in those with positive attitudes (94.4%, p < 0.001). Elastic net analysis identified key drivers, including learning MSUS from conferences, colleagues, and in residency; using MSUS in practice; respondent-performed MSUS; and MSUS use by radiologists. Statistically significant associations were found with using MSUS for synovitis/inflammatory joint disease (OR = 1.43, 95% CI 1.00-2.05) and MSUS use by radiologists in respondent's institutes (OR = 1.70, 95% CI 1.20-2.90). CONCLUSION: Most young rheumatologists in Mexico recognize the necessity of MSUS in clinical practice. By addressing identified barriers, encouraging rheumatologist-radiologist collaboration, and establishing a regulatory body to certify rheumatologist's MSUS experience, there is an opportunity to empower them with the necessary skills for effective MSUS use, ultimately benefiting patient care.
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Reumatologistas , Reumatologia , Ultrassonografia , Humanos , Feminino , Masculino , Reumatologia/educação , México , Adulto , Inquéritos e Questionários , Conhecimentos, Atitudes e Prática em Saúde , Atitude do Pessoal de SaúdeRESUMO
To evaluate the prevalence of musculoskeletal ultrasonography (MSUS) abnormalities in asymptomatic elderly individuals. A cross-sectional controlled study was conducted and MSUS of 23 joints (wrist, metacarpophalangeal-MCP, proximal interphalangeal-PIP, elbow, glenohumeral, hip, knee, ankle, and metatarsophalangeal-MTP joints) was performed in healthy individuals aged 18-29 (young, n = 32) and 60-80 years-old (elderly, n = 32). Quantitative synovial hypertrophy (SH) was measured in mm and a semiquantitative scoring system (0-3) was used to grade SH, power doppler (PD) and bone erosion (BE). Young and elderly participants were 26.2 ± 3.2 and 65.9 ± 4.4 years-old, respectively. As compared to the young participants, elderly individuals had higher SH values in 35% of the joint surfaces (P < 0.05), higher rates of scores 1-3 for SH at the dorsal surface of the 3rd MCP, palmar surface of the 2nd MCP, 2nd PIP, 3rd MCP and 3rd PIP and subtalar joints (17.2 vs. 1.6%, P = 0.002; 29.7 vs. 6.3%, P = 0.001; 12.5 vs. 1.6%, P = 0.016; 21.9 vs. 6.3%, P = 0.011; 21.9 vs. 7.8%, P = 0.025; and 24.2 vs. 6.3%, P = 0.005, respectively), BE at the radiocarpal, ulnocarpal, dorsal surface of the 2nd MCP and posterior area of the glenohumeral joints (10.9 vs. 1.6%, P = 0.028; 12.5 vs. 0%, P = 0.003; 9.4 vs. 0%, P = 0.012; and 29.7 vs. 10.9%, P = 0.008, respectively) and PD at the dorsal surface of the 2nd and 3rd MCP joints (9.4 vs. 0%; P = 0.012 and 7.8 vs. 0%; P = 0.023, respectively). BE scores ≥ 1 were more frequent in the elderly (P < 0.05) in 22 (88%) of the joint surfaces evaluated. MSUS abnormalities are more frequent in asymptomatic elderly individuals as compared to young subjects.
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Sinovite , Ultrassonografia Doppler , Idoso , Humanos , Adulto Jovem , Pessoa de Meia-Idade , Estudos Transversais , Brasil/epidemiologia , UltrassonografiaRESUMO
Abstract Objective: To evaluate musculoskeletal ultrasound (MSUS) as a screening tool for rheumatoid arthritis (RA) and osteoarthritis (OA) patients in a rheumatology-screening program. Patients and methods: To raise awareness for rheumatic diseases, a mobile rheumatology office was deployed in different cities of Germany ("Rheuma-Truck"). Standardized questionnaire assessment, testing for rheumatoid factor and citrullinated peptide antibodies and medical student driven MSUS of the clinically dominant hand/foot including wrist, MCP-II, -III, -V, PIP-II, -III, MTP-II and -V were offered free of charge to the population. In case of suspicious results, a rheumatologist was consulted. Results: In MSUS, 192 of 560 selected volunteers (aged 18-89, mean 52.7 years; 72.9% female) had suspicious findings including synovitis or erosions primarily affecting the MTP-II (11.8%), dorsal wrist (8.9%), and MCP-II (7%). 354 of the 560 volunteers further visited a rheumatologist of whom 76 were diagnosed with RA. According to the 'US7 Score', a sum scores ≥ 5 was significantly predictive for RA (odds ratio (OR) 5.06; confidence interval (CI) 0.83-35.32). 313 volunteers displayed signs of OA including osteophytes, while MCP-II (36.2%), MCP-III (14.8%), and the wrist (10.5%) were mostly affected. Diagnosis of RA was favoured over OA if the wrist (OR 4.2; CI 1.28-13.95), MTP-II (OR 1.62; CI 1.0-2.6), and MCP-V (OR 2.0; CI 1.0-3.8) were involved. Conclusion: Medical student driven MSUS by the 'US7 Score' can facilitate diagnosis of RA in rheumatology-screening programs due to the level of the score and the affected joints. A high rate of unknown OA signs was detected by MSUS. A mobile rheumatology office displays an opportunity to screen patients for RA and OA.
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INTRODUCTION/OBJECTIVES: To evaluate the clinical relevance of high-resolution hand and wrist ultrasound (US) findings and their possible associations with anti-citrullinated peptide antibodies in primary Sjögren's syndrome (pSS). METHODS: Ninety-seven consecutive pSS patients (American-European Consensus Group, 2002) without meeting the American College of Rheumatology (ACR) criteria (1987) for rheumatoid arthritis (RA); 20 RA patients (ACR/European League Against Rheumatism (EULAR) criteria, 2010); and 80 healthy individuals with comparable age, gender, and ethnicity were enrolled in a case-control study. Disease activity was assessed by EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI). US was performed by one expert blinded to anti-CCP, anti-MCV, and IgM rheumatoid factor tested by ELISA. RESULTS: Frequencies of grade 3 synovitis (9.3 vs. 0%, p = 0.004), tenosynovitis (36.1 vs. 3.8%, p < 0.001), and erosions (27.8 vs. 7.5%, p = 0.001) on US were higher in pSS patients than in healthy controls. ESSDAI presented a moderate correlation with the synovitis number (p = 0.001) and tenosynovitis (p < 0.001). Most pSS patients with erosions on US (81.5%) had negative anti-CCP. Nevertheless, anti-CCP ≥ 3× cut-off value was associated with the presence of erosions in pSS (p = 0.026). Erosions in pSS were mainly small size contrasting with moderate/large size in RA (p < 0.001), and positive power Doppler synovitis predominated in RA (p < 0.001). CONCLUSIONS: US identified significant frequencies of grade 3 synovitis, tenosynovitis, and erosions in pSS. Synovitis and tenosynovitis numbers were correlated with ESSDAI. Association between erosions on US and anti-CCP (high titers) in pSS possibly identifies a subgroup with severe arthritis. These findings suggest that US is a useful method for assessing joint involvement in pSS.Key Points⢠US identified significant frequencies of grade 3 synovitis, tenosynovitis, and erosions in pSS patients in comparison with age- and race-healthy individuals.⢠Numbers of synovitis and tenosynovitis on US were correlated with ESSDAI values.⢠Most pSS patients with erosions on US were negative for anti-CCP, but anti-CCP ≥ 3× cut-off value was associated with the presence of erosions in this disease.⢠Erosions in pSS were mainly small size contrasting with moderate/large size in RA, and positive power Doppler synovitis predominated in RA.
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Mãos/diagnóstico por imagem , Síndrome de Sjogren/diagnóstico por imagem , Sinovite/diagnóstico por imagem , Tenossinovite/diagnóstico por imagem , Punho/diagnóstico por imagem , Adulto , Autoanticorpos/imunologia , Estudos de Casos e Controles , Feminino , Mãos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Síndrome de Sjogren/complicações , Síndrome de Sjogren/patologia , Sinovite/complicações , Sinovite/patologia , Tenossinovite/complicações , Tenossinovite/patologia , Ultrassonografia Doppler , Punho/patologiaRESUMO
The aim of this study was to describe a perineural ultrasound-guided infiltration technique for management of radial tunnel syndrome and to report its preliminary results in 54 patients. A mixture of a saline solution, a local anesthetic, and a corticosteroid solution was infiltrated in the perineural region at the arcade of Frohse. Pain was reported in 100% of patients before the procedure versus 1.9% after the procedure. Scratch collapse and Cozen test results were positive in 98.1% and 66.7% of patients before infiltration, respectively, versus 5.6% and 9.2% after infiltration. All variables had statistically significant differences between preprocedure and postprocedure evaluations (P < .01).
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Corticosteroides/uso terapêutico , Anestésicos Locais/uso terapêutico , Neuropatia Radial/tratamento farmacológico , Solução Salina/uso terapêutico , Ultrassonografia de Intervenção/métodos , Corticosteroides/administração & dosagem , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Radial/diagnóstico por imagem , Neuropatia Radial/diagnóstico por imagem , Estudos Retrospectivos , Solução Salina/administração & dosagem , Síndrome , Resultado do TratamentoRESUMO
Resumen Introducción: Anormalidades ultrasonográficas se describen con cierta frecuencia en articulaciones de sujetos asintomáticos, las cuales generan incertidumbre en el contexto de evaluación y tratamiento de la enfermedad articular inflamatoria; a pesar de ello, en Colombia no existen estudios al respecto y la evidencia disponible es escasa, hecha en un bajo número de participantes y con transductores menores a 18 MHz en su gran mayoría. Objetivos: Describir los hallazgos ultrasonográficos articulares en manos y pies de un grupo de voluntarios asintomáticos, su asociación con las características sociodemográficas y la concordancia intra e interobservador de sus mediciones. Materiales y métodos: Estudio descriptivo y analítico en el que se incluyeron 182 voluntarios asintomáticos. Dos médicos con experiencia en ecografía musculoesquelética evaluaron el aspecto dorsal de 5.460 recesos articulares mediante la escala semicuantitativa de Szkudlarek y la utilización de un transductor lineal de 18 MHz. Resultados: La mediana de edad de los participantes fue de 42 arios, 60,4% de ellos mujeres. En 87% de los voluntarios se identificaron en total 232 hallazgos, el 68,1% correspondió a derrame articular, 29,3% a hipertrofia sinovial, 2,1% a erosiones y 0,4% a Doppler de poder. Los pies mostraron mayores hallazgos que las manos (70,7% vs. 29,3%). Las articulaciones en las que más se identificaron anormalidades fue la primera articulación metatarsofalángica (52%), la tercera metatarsofalángica (15%) y la radiocarpiana (9,5%). Se halló relación positiva entre el derrame articular y la hipertrofia sinovial con la edad, ocupación manual exclusiva y tiempo laboral mayor de 10 años. La concordancia intraobservador fue moderada (Kappa = 0,4591) y la interobservador fue leve (Kappa = 0,2155). Conclusiones: La ausencia de señal Doppler de poder, el no compromiso radioulnar distal, la ausencia de sinovitis acompañada de erosión y una mayor predominancia de alteraciones leves al nivel de las manos, sumado a la ausencia de hallazgos al nivel de la quinta articulación metatarsiana, constituyen hallazgos potencialmente específicos de sujetos asintomáticos que merecen ser confirmados como tal en futuros estudios.
Abstract Introduction: Ultrasound (US) abnormalities have often been described in the joints of asymptomatic subjects, which may lead to uncertainty in the evaluation and treatment of inflammatory joint disease. Despite this, the available evidence is scarce, with few participants, and in the vast majority with transducers less than 18Mhz. In Colombia there are currently no published studies about this topic. Objectives: To describe the ultrasound findings in hand and foot joints in asymptomatic volunteers, their association with sociodemographic characteristics, and intra- and inter-observer concordance of the measurements. Materials and methods: Descriptive and analytical study within 182 asymptomatic volunteers. Two physicians with musculoskeletal ultrasound experience evaluated the dorsal aspect of 5460 articular recesses using the semi-quantitative scale of Szkudlarek using a 18 MHz linear transducer. Results: The median age of the participants was 42 years, including 60.4% women. A total of 232 abnormal findings were identified in 87% of the volunteers, with 68.1% corresponding to joint effusion, 29.3% synovial hypertrophy, 2.1% erosions, and 0.4% positive power Doppler. The feet evaluation showed more findings than the hands (70.7 vs. 29.3%). The joints in which most abnormalities were identified were the first metatarsophalangeal joint (52%), third metatarsophalangeal joint (15%), and radiocarpal joint (9.5%). A positive association was found between joint effusion and synovial hypertrophy with age, exclusive manual activity, and occupation for more than ten years. The intra-observer concordance was moderate (Kappa = .4591) and the inter-observer was low (Kappa = .2155). Conclusions: The absence of power Doppler signal, the absence of abnormalities in distal radioulnar, the absence of synovitis accompanied by erosion, and a greater predominance of mild alterations in the hand joints, added to the absence of findings in the fifth metatarsal joint, can be potential specific findings of asymptomatic subjects and might be confirmed in future studies.
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Humanos , Articulações , Sinovite , Radiografia , Ultrassonografia , Doenças AssintomáticasRESUMO
BACKGROUND: Musculoskeletal Ultrasonography (MSUS) is an important tool for the clinical assessment in Juvenile Idiopathic Arthritis (JIA). The objective of this study was to evaluate the reliability of MSUS to detect elementary lesions: synovitis, tenosynovitis, cartilage damage and bone erosions in the wrist and metacarpal (MCP) joints of patients with JIA. METHODS: Thirty children in various subgroups of JIA according to ILAR criteria, were included in this cross-sectional study. Clinical data including painful, swollen and limited joints were recorded. Five rheumatologist ultrasonographers, blinded to the clinical evaluation, evaluated the presence of elementary lesions in the wrist and MCP 2 and 3 joints bilaterally. The synovitis was graded in B-Mode and Power Doppler (PD). In addition to descriptive statistics intra- and inter-observer reliability was calculated using Cohen's kappa according to Landis and Koch. RESULTS: US detected more synovitis than the clinical examination (62% vs 28%, 30% vs 23% and 22% vs 17% in the wrist, second and third MCP joints respectively). The intra-observer concordance for synovitis in all joints was excellent in B-Mode (k 0.84 .63-1.0 p = 0.001), except for MCP 2, where it was good (0.61, IC 95% .34-89, p = 0.001). For both modalities (PD, B-Mode) tenosynovitis, cartilage damage and bone erosions it was also excellent. Regarding synovitis grading the concordance was excellent for all grades (0.83-1.0, IC 95% 0.51.1.0, p = 0.001), except for grade 1 where it was good (0.61, IC 95% 0.43-.83, p = 0.001). Reliability inter-observer for grayscale synovitis (0.67-0.95, IC 95% 0.67-1.0, p = 0.001), tenosynovitis grayscale (0.89, IC 95% 0.78-0.99, p.001), damage cartilage (0.89, IC 95% 0.78-0.99, p = 0.001), PD (0.66, IC 95% 0.39-1.0, p = 0.001). The concordance for grading synovitis was excellent, but for grayscale grade 1 and 2 (.66, IC 95% .53-.74, p = 0.007) and PD grade 1 and 2 (0.63, IC 95% .58-.91, p = 004) was good. CONCLUSIONS: The intra- and inter-observer reliability of MSUS for inflammatory and structural lesions is good to excellent for the wrist and MCP in patients with JIA.
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Artrite Juvenil/diagnóstico por imagem , Articulação Metacarpofalângica/diagnóstico por imagem , Ultrassonografia/métodos , Articulação do Punho/diagnóstico por imagem , Artrite Juvenil/patologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Articulação Metacarpofalângica/patologia , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Articulação do Punho/patologiaRESUMO
Bone fractures in birds are usually diagnosed with the aid of traditional radiography. However, this technique remains limited because of the difficulties associating this examination with real-time procedures. The aim of this study was to describe the use of B-mode ultrasound to assess the long bones of two avian orders. For the study, we used carcases of birds from the orders Falconiformes (n = 9) and Strigiformes (n = 12), with weights ranging from 108 to 1020â g. An ultrasound device with a 5-12â MHz linear probe was employed to produce images of the long bones (humerus, radius, ulna, femur and tibiotarsus). Ultrasound (US) measurements and physical measurements using a caliper were applied to compare the diameter of the bones. Images were also recorded from the US examination performed in two live patients attending the hospital with suspected bone fractures. No statistical difference was found between the two methods of measurement in carcases weighing up to 267â g (P > 0.01). The US examination provided relevant clinical information about the bone cortex and assisted in real-time surgical procedures. RESEARCH HIGHLIGHTS Long bones of Falconiformes and Strigiformes birds were assessed with B-mode ultrasound. Ultrasound analysis is a relevant tool in clinical orthopaedics for avian species. Ultrasound of the bone might be applied for monitoring of healing processes.
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Doenças das Aves/diagnóstico por imagem , Fraturas Ósseas/veterinária , Animais , Osso e Ossos/diagnóstico por imagem , Falconiformes , Fraturas Ósseas/diagnóstico por imagem , Estrigiformes , Ultrassonografia/veterináriaRESUMO
High-resolution musculoskeletal ultrasound (MSUS) has been increasingly employed in daily rheumatological practice and in clinical research. In rheumatoid arthritis (RA), MSUS can be now considered a complement to physical examination. This method evaluates synovitis through gray-scale and power Doppler and it is also able to identify bone erosions. The utilization of MSUS as a marker of RA activity has received attention in recent literature. Current data account for good correlation of MSUS with classical measures of clinical activity; in some instances, MSUS appears to perform even better. Diagnosis of subclinical synovitis by MSUS might help the physician in RA management. With some variation, interobserver MSUS agreement seems excellent for erosion and good for synovitis. However, lack of MSUS score standardization is still an unmet need. In this review, we describe several MSUS scores, as well as their correlation with clinical RA activity and response to therapy. Finally, we look at the relationship of MSUS with synovial tissue inflammation and discuss future perspectives for a better interpretation and integration of this imaging method into clinical practice.
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Artrite Reumatoide/diagnóstico por imagem , Sinovite/diagnóstico por imagem , Ultrassonografia/métodos , Humanos , Variações Dependentes do Observador , Medidas de Resultados Relatados pelo Paciente , Exame FísicoRESUMO
Diagnosis of synovitis/tenosynovitis by physical examination can be difficult. Ultrasound (US) can be an effective tool for the evaluation of joint involvement in systemic lupus erythematosus (SLE). This study will describe musculoskeletal findings by US in SLE patients and the evaluation of their correlation with physical examination. SLE patients underwent clinical/sonographic evaluation of hand/wrists. In total, 896 joints were evaluated: at least 1 change on physical examination was found in 136 joints and at least 1 US abnormality was found in 65 of 896 joints. Out of the 65 joints with US changes, only 13 had findings on physical examination. Conversely, 111 joints had tenderness on physical examination with no sonographic abnormalities. Tenosynovitis was statistically significant more frequently with joint edema (41%) (p = 0.0003). US can detect musculoskeletal changes in only a minority of symptomatic SLE patients. Clinical findings may be related to some reasons that cannot be explained using US.
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Mãos/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/complicações , Exame Físico , Sinovite/diagnóstico por imagem , Tenossinovite/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Sinovite/complicações , Tenossinovite/complicações , Punho/diagnóstico por imagemRESUMO
OBJECTIVES: To assess the correlation between inflammatory sonographic findings (grayscale synovial hypertrophy and power Doppler) and clinical and functional assessments in hand osteoarthritis (symptomatic interphalangeal joints) and to correlate the intraobserver and interobserver reliability of these findings. METHODS: A prospective double-blind study of 60 interphalangeal joints was conducted. The joints were assessed 6 times per year by clinician and sonographer observers. RESULTS: A total of 720 measurement recesses were included (360 palmar and 360 dorsal). Small correlations and a few associations were found. Proximal interphalangeal joint quantitative measurements of the dorsal recess showed a statistical correlation with joint swelling (P = .043) and pulp-to-pulp pinch strength (P = .043); in the palmar recess, statistical correlations were seen for joint swelling (P = .007), the Australian/Canadian (AUSCAN) Function Index (P = .044), and grip and finger strength (P = .037, .003, .019, and .017). In dorsal semiquantitative assessments, there were associations between sonographic findings and joint swelling (P = .010) and pinch strength (P = .027, .003, and .014); in the palmar recess, we found associations with the AUSCAN Index (P = .048) and grip and finger strength (P = .031, .006, and 0.041). No correlations or associations were found in distal interphalangeal joints. Power Doppler signals were found in only 1.7% of the sample, precluding statistical analysis. Excluding palmar semiquantitative assessments in distal interphalangeal joints (P = .623), sonographic findings were reliable (intraclass correlation coefficients, 0.474-0.857; κ = 0.390-0.673). CONCLUSIONS: Joint swelling, grip and pinch strength, and the AUSCAN Index were weakly correlated and associated with sonographic findings in proximal interphalangeal joints. Intraobserver and interobserver sonographic assessments were reliable.
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Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/fisiopatologia , Osteoartrite/diagnóstico por imagem , Osteoartrite/fisiopatologia , Ultrassonografia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
OBJECTIVES: The purpose of this study was to determine the association between functionality as assessed by the 6-minute walking test (6MWT), maximal voluntary contraction of the quadriceps (MVCQ), and quadriceps thickness and echo intensity as measured by sonography, in patients with chronic obstructive pulmonary disease (COPD). METHODS: Maximal voluntary contraction of the quadriceps and the thickness and echo intensity of the rectus femoris and vastus intermedius were evaluated in 20 patients with COPD. Functionality was assessed by the 6MWT. Differences between the evaluated muscles were determined by the Student t test. Pearson and Spearman rank correlation coefficients were used to analyze relationships between variables of interest, according to data characteristics. Finally, multivariate regression models were applied. RESULTS: There was a positive correlation between MVCQ and rectus femoris and vastus intermedius thickness (r = 0.427; P = .030; r = 0.469; P= .018, respectively) and a negative correlation between MVCQ and rectus femoris and vastus intermedius echo intensity (r= -0.500; P= .012; r= -0.482; P= .016). No correlation was found between MVCQ and the 6MWT (r = 0.319; P = .085). Multivariate regression analysis showed that the rectus femoris echo intensity, vastus intermedius echo intensity, and vastus intermedius thickness explained 70% of the variance in the distance walked during the 6MWT. CONCLUSIONS: These results indicate that, in patients with COPD, both quadriceps force and exercise capacity are associated with quantitative (thickness) and qualitative (echo intensity) characteristics of the quadriceps. Consequently, comprehensive assessments of peripheral muscles should simultaneously include both measurements.
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Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Músculo Quadríceps/diagnóstico por imagem , Músculo Quadríceps/fisiopatologia , Ultrassonografia , Idoso , Teste de Esforço , Feminino , Humanos , Masculino , Contração Muscular/fisiologiaRESUMO
For the past two decades, musculoskeletal ultrasonography (MSKUS) has developed exponentially and has become an essential tool in rheumatology practice. This development has been far more limited in pediatric rheumatology which is partially related to deficits in the evidence base. Many studies have shown that MSKUS is more sensitive than the clinical examination for detecting synovitis and enthesitis in adults. At the same time, there is a lack of studies demonstrating its validity, reliability, and reproducibility in pediatric rheumatology. In addition, clear definitions for the normal pediatric joint and enthesis as well as various findings in pathology associated with juvenile idiopathic arthritis (JIA) and juvenile spondyloarthritis (JSpA) have only started to emerge. Most of this work is being done through the Outcome Measurement in Rheumatology Clinical Trials (OMERACT) ultrasound pediatric task force but the Pan American League of Associations for Rheumatology (PANLAR) US Pediatric Task Force is also working on validating MSKUS in children. In addition, several MSKUS courses for pediatric rheumatologists have been offered in Latin American countries; these will not only complement the scientific work pediatric-specific ultrasonography training, but also represents an essential component for the successful implementation of this technique into daily practice as well.
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Pediatria/educação , Reumatologia/educação , Ultrassonografia/estatística & dados numéricos , Artrite Juvenil/diagnóstico , Artrite Juvenil/terapia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Pesquisa Biomédica/tendências , Criança , Ensaios Clínicos como Assunto , Educação de Pós-Graduação em Medicina , Humanos , América Latina , Mentores , Músculo Esquelético/diagnóstico por imagem , Pediatria/métodos , Médicos , Reumatologia/métodos , Sociedades Médicas , Ultrassonografia/métodosRESUMO
The objective of this study was to describe a perisciatic ultrasound-guided infiltration technique for treatment of deep gluteal syndrome and to report its preliminary clinical results. A mixture of saline (20 mL), a local anesthetic (4 mL), and a corticosteroid solution (1 mL) was infiltrated in the perisciatic region between the gluteus maximus and pelvitrochanteric muscles. Relative pain relief was achieved in 73.7% of the patients, with average preprocedural and postprocedural visual analog scale scores of 8.3 and 2.8, respectively. Fifty percent of patients reported recurrence of discomfort, and the average duration of the therapeutic effect in these patients was 5.3 weeks.
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Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Síndrome do Músculo Piriforme/diagnóstico por imagem , Síndrome do Músculo Piriforme/tratamento farmacológico , Nervo Isquiático/ultraestrutura , Ciática/diagnóstico por imagem , Ciática/tratamento farmacológico , Ultrassonografia de Intervenção/métodos , Adulto , Feminino , Humanos , Masculino , Medição da Dor/efeitos dos fármacos , Projetos Piloto , Reprodutibilidade dos Testes , Nervo Isquiático/efeitos dos fármacos , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
OBJECTIVES: The aim of this study was to test a sonographic technique used to view the anterior bundle of the ulnar collateral ligament (UCL), describe its sonographic characteristics in healthy volunteers, and verify these characteristics by determining interobserver variability and their correlations in cadavers. METHODS: Sonographic studies of the anterior bundle of the UCL were performed on 48 elbows of asymptomatic healthy volunteers. The participants were examined by 3 experts, who identified the insertion sites of the anterior bundle and subjectively evaluated its echogenicity and echo texture. A sonographic examination of the anterior bundle of the UCL in a cadaveric elbow was performed, and the same aspects were evaluated. RESULTS: In all cases, the anterior bundle of the UCL appeared as a triangular structure in the coronal plane and had a hyperechoic homogeneous echo texture in most of these cases. The cadaveric elbow had the same sonographic characteristics as the volunteers. CONCLUSIONS: As shown by examining the interobserver variability and determining the correlation with cadaveric tissue, sonography proved to be a reliable tool for evaluating the normal aspects of the anterior bundle of the UCL.
Assuntos
Ligamentos Colaterais/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Aumento da Imagem/métodos , Posicionamento do Paciente/métodos , Ulna/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Cadáver , Ligamentos Colaterais/anatomia & histologia , Articulação do Cotovelo/anatomia & histologia , Feminino , Humanos , Aumento da Imagem/normas , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/normas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ulna/anatomia & histologia , Ultrassonografia/normasRESUMO
OBJECTIVES: To determine the feasibility and accuracy of sonographically guided posterior subtalar joint (PSTJ) injections performed through the sinus tarsi. METHODS: A single experienced operator completed 10 sonographically guided PSTJ injections via the sinus tarsi on 10 unembalmed cadaveric ankle-foot specimens. Injections were performed using a 17-5-MHz linear transducer, a 25-gauge, 50-mm needle, and an out-of-plane, anterior-to-posterior needle trajectory parallel to the calcaneal surface. Sonographic assessment for fluid in the posterior and lateral PSTJ recesses, sinus tarsi, and peroneal tendon sheath was performed before and after injections of 2 and 4 mL of tap water. Two additional specimens were injected with a contrast agent: 1 via the sonographically guided approach and another by a computed tomographically guided approach. RESULTS: All 10 sonographically guided PSTJ tap water injections were accurate, distending both the posterior and lateral PSTJ recesses. In addition, all 10 specimens showed posterior recess distension by 2 mL, whereas only 2 specimens (20%) showed lateral recess distension at this volume. By 4 mL, both recesses were clearly distended in all specimens. Both contrast agent injections produced similar PSTJ computed tomographic arthrograms and patterns of recess distension similar to the sonographically guided tap water injections. No sonographically guided PSTJ injection placed fluid in the peroneal tendon sheath. CONCLUSIONS: Sonographically guided PSTJ injections via the sinus tarsi can accurately and specifically deliver injectate into the PSTJ while monitoring injectate flow within the posterior recess. The sinus tarsi approach may be used as an alternative technique to perform sonographically guided PSTJ injections when clinically appropriate.
Assuntos
Articulação Talocalcânea/diagnóstico por imagem , Ultrassonografia de Intervenção , Idoso , Idoso de 80 Anos ou mais , Cadáver , Meios de Contraste , Estudos de Viabilidade , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Reprodutibilidade dos TestesRESUMO
OBJECTIVES: To describe quantitative and semiquantitative sonographic joint measurements in healthy adults and compare them with demographic parameters. METHODS: A cross-sectional study was conducted. Bilateral sonographic measurements of small, medium, and large joints were performed in 130 healthy volunteers, stratified into 5 age groups (A, 18-29; B, 30-39; C, 40-49; D, 50-59; and E, 60-80 years). Quantitative synovial hypertrophy measurements and semiquantitative synovial hypertrophy, power Doppler, bone erosion (score 0-3), and articular cartilage (score 0-4) measurements were performed by a blinded radiologist using a 6-18-MHz linear array transducer. The sonographic measurements were correlated with demographic parameters. The significant P value was set at .05. RESULTS: A total of 6500 joint recesses were studied; the mean age ± SD of the participants was 44.8 ± 14.6 years, and 76.9% were women. The highest quantitative synovial hypertrophy values were found in the hip (6.4 mm) and talonavicular joint (2.6 mm). The joint recesses with a greater frequency of hypothetical pathologic semiquantitative scores were second metatarsophalangeal (78.8%) and first metatarsophalangeal (69.3%) for synovial hypertrophy, radiocarpal (17.7%) and first metatarsophalangeal (15.8%) for power Doppler, and posterior glenohumeral (23.1%) and ulnocarpal (4.2%) for bone erosion. The highest quantitative synovial hypertrophy values and the lowest semiquantitative synovial hypertrophy, power Doppler, bone erosion, and articular cartilage scores were observed in age group E (P < .046). There were positive correlations between the sonographic measurements and height, age, weight, and body mass index in 30.4%, 34.8%, 43.5%, and 47.8%, respectively, of all the joint recesses studied. CONCLUSIONS: Sonographic changes in healthy peripheral joints were observed predominantly in the oldest group.
Assuntos
Envelhecimento/fisiologia , Articulações/diagnóstico por imagem , Articulações/fisiologia , Ultrassonografia/estatística & dados numéricos , Ultrassonografia/normas , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
The acromial origin of the deltoid is a target structure of ankylosing spondylitis and related spondyloarthritis, which are often overlooked and underdiagnosed as causes of posterior shoulder pain. The objective of this article is to review the roles of sonography and magnetic resonance imaging in detecting deltoideal acromial enthesopathy and their importance for optimizing management in individuals with posterior shoulder pain. Adequate awareness of such enthesopathy as a potential manifestation of inflammatory rheumatic disorders is critical for early diagnosis of spondyloarthritis.
Assuntos
Doenças Reumáticas/diagnóstico , Doenças Reumáticas/etiologia , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Espondilartrite/complicações , Espondilartrite/diagnóstico , Ultrassonografia/métodos , Acrômio/diagnóstico por imagem , Acrômio/patologia , Músculo Deltoide/diagnóstico por imagem , Músculo Deltoide/patologia , Reações Falso-Negativas , Humanos , Imageamento por Ressonância MagnéticaRESUMO
This study characterized the normal musculoskeletal anatomy of the cervical segment of the spine of dogs by means of B-mode ultrasonography. The objective was to establish the role of B-mode ultrasonography for the anatomical evaluation of the cervical spine segment in dogs, by comparing the ultrasonographic findings with images by computed tomography and magnetic resonance imaging. The ultrasound examination, in transverse and median sagittal sections, allowed to identify a part of the epaxial cervical musculature, the bone surface of the cervical vertebrae and parts of the spinal cord through restricted areas with natural acoustic windows, such as between the atlanto-occipital joint, axis and atlas, and axis and the third cervical vertebra. The images, on transverse and sagittal planes, by low-field magnetic resonance imaging, were superior for the anatomical identification of the structures, due to higher contrast between the different tissues in this modality. Computed tomography showed superiority for bone detailing when compared with ultrasonography. As for magnetic resonance imaging, in addition to the muscles and cervical vertebrae, it is possible to identify the cerebrospinal fluid and differentiate between the nucleus pulposus and annulus fibrosus of the intervertebral discs. Although not the scope of this study, with knowledge of the ultrasonographic anatomy of this region, it is believed that some lesions can be identified, yet in a limited manner, when compared with the information obtained mainly with magnetic resonance imaging. The ultrasound examination presented lower morphology diagnostic value compared with the other modalities.
Este estudo caracterizou a anatomia musculoesquelética normal do segmento cervical da coluna vertebral de cães por meio da ultrassonografia modo B. O objetivo do trabalho foi estabelecer o papel da ultrassonografia modo B na avaliação anatômica do segmento cervical de cães, comparando os achados ultrassonográficos com imagens por tomografia computadorizada e ressonância magnética. O exame ultrassonográfico, em cortes transversais e sagitais mediano, permitiu a identificação de parte da musculatura epaxial do pescoço, superfície óssea das vértebras cervicais e medula espinhal em áreas restritas com janelas acústicas naturais, como entre a articulação atlantoccipital, áxis e atlas, e áxis e terceira vértebra cervical. As imagens, em planos transversais e sagitais, por ressonância magnética de baixo campo foram superiores na identificação anatômica das estruturas, devido ao maior contraste entre os diferentes tecidos nessa modalidade. A tomografia computadorizada se mostrou superior no detalhamento ósseo da região quando comparada ao exame ultrassonográfico. Já a ressonância magnética, além dos músculos e vértebras cervicais, permitiu a identificação do líquido cefalorraquidiano, e diferenciar núcleo pulposo e anel fibroso dos discos intervertebrais. Embora não seja objetivo direto deste estudo, com o conhecimento da anatomia ultrassonográfica dessa região, acredita-se que algumas lesões possam ser identificadas, contudo de maneira restrita, quando comparadas as informações obtidas, principalmente na imagem por ressonância magnética. O exame ultrassonográfico apresentou valor morfológico inferior.
Assuntos
Animais , Cães , Atlas Cervical/anatomia & histologia , Cães/anatomia & histologia , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X/veterinária , Ultrassonografia , Coluna Vertebral , Fenômenos Fisiológicos MusculoesqueléticosRESUMO
This study characterized the normal musculoskeletal anatomy of the cervical segment of the spine of dogs by means of B-mode ultrasonography. The objective was to establish the role of B-mode ultrasonography for the anatomical evaluation of the cervical spine segment in dogs, by comparing the ultrasonographic findings with images by computed tomography and magnetic resonance imaging. The ultrasound examination, in transverse and median sagittal sections, allowed to identify a part of the epaxial cervical musculature, the bone surface of the cervical vertebrae and parts of the spinal cord through restricted areas with natural acoustic windows, such as between the atlanto-occipital joint, axis and atlas, and axis and the third cervical vertebra. The images, on transverse and sagittal planes, by low-field magnetic resonance imaging, were superior for the anatomical identification of the structures, due to higher contrast between the different tissues in this modality. Computed tomography showed superiority for bone detailing when compared with ultrasonography. As for magnetic resonance imaging, in addition to the muscles and cervical vertebrae, it is possible to identify the cerebrospinal fluid and differentiate between the nucleus pulposus and annulus fibrosus of the intervertebral discs. Although not the scope of this study, with knowledge of the ultrasonographic anatomy of this region, it is believed that some lesions can be identified, yet in a limited manner, when compared with the information obtained mainly with magnetic resonance imaging. The ultrasound examination presented lower morphology diagnostic value compared with the other modalities.(AU)
Este estudo caracterizou a anatomia musculoesquelética normal do segmento cervical da coluna vertebral de cães por meio da ultrassonografia modo B. O objetivo do trabalho foi estabelecer o papel da ultrassonografia modo B na avaliação anatômica do segmento cervical de cães, comparando os achados ultrassonográficos com imagens por tomografia computadorizada e ressonância magnética. O exame ultrassonográfico, em cortes transversais e sagitais mediano, permitiu a identificação de parte da musculatura epaxial do pescoço, superfície óssea das vértebras cervicais e medula espinhal em áreas restritas com janelas acústicas naturais, como entre a articulação atlantoccipital, áxis e atlas, e áxis e terceira vértebra cervical. As imagens, em planos transversais e sagitais, por ressonância magnética de baixo campo foram superiores na identificação anatômica das estruturas, devido ao maior contraste entre os diferentes tecidos nessa modalidade. A tomografia computadorizada se mostrou superior no detalhamento ósseo da região quando comparada ao exame ultrassonográfico. Já a ressonância magnética, além dos músculos e vértebras cervicais, permitiu a identificação do líquido cefalorraquidiano, e diferenciar núcleo pulposo e anel fibroso dos discos intervertebrais. Embora não seja objetivo direto deste estudo, com o conhecimento da anatomia ultrassonográfica dessa região, acredita-se que algumas lesões possam ser identificadas, contudo de maneira restrita, quando comparadas as informações obtidas, principalmente na imagem por ressonância magnética. O exame ultrassonográfico apresentou valor morfológico inferior.(AU)