Introduction Adhesive capsulitis (AC), which is characterised by shoulder pain and a limited range of motion (ROM), is usually diagnosed on the basis of clinical suspicion, with imaging only being used to exclude other causes of similar symptoms. The aim of this study was to identify and describe the typical ultrasound (US) features of AC in a group of patients with shoulder pain and stiffness. Methods This was a cross-sectional study of 1486 patients with AC in which two experienced US specialists examined the axillary pouch (AP), the coracohumeral ligament (CHL), the superior glenohumeral ligament (SGHL), and the long head of the biceps tendon (LHBT), and dynamically visualised the infraspinatus tendon during passive external rotation (PER) during a US evaluation of shoulder ROM . Results AC was confirmed in 106 patients (7.1%). Thickening of the AP of more than 4 mm was observed in 93.4% of the patients, whereas 6.6% showed AP thickening of less than 4 mm but more than 60% of the thickening in the contralateral shoulder. Effusion within the LHBT sheath was detected in 71% of the patients, and thickening of the CHL or SGHL in 88%. The dynamic study of the infraspinatus tendon showed reduced sliding with folding towards the joint capsule in 73% of cases, thus changing the tendon’s profile from flat to concave during PER. The reduced tendon sliding was associated with a bouncing movement that returned the tendon to its baseline resting position in 41.5% of cases. Conclusions We believe a sufficiently experienced US specialist can confirm a clinical diagnosis of AC by carrying out a comparative study of APs, evaluating the thickness of the CHL and SGHL, and detecting reduced sliding of the infraspinatus tendon. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00413-w.

Objectives To assess the value of ultrasonography in studies of the ligaments within the sinus tarsi (ST) in healthy subjects. Materials and methods We examined 20 healthy volunteers using a 12-MHz transducer with THI and compound imaging. With the foot in inversion, the following structures were examined with coronal and transverse scans: (1) the root of the inferior extensor retinaculum (RIER); (2) the interosseous talocalcaneal ligament (ITCL); (3) the cervical ligament (CL); (4) the bifurcate ligament (BL); (5) the synovial recesses, which were examined for possible distention (distended synovial recesses, DSR). The sonographic features, orientation, and thickness of each ligament were assessed. Results The easiest structure to identify (visualized in 20/20 subjects) was the RIER, which formed a semiarch. The two deeper layers were hypoechoic, the superficial layer hyperechoic. The ITCL was situated posteriorly and deep with an oblique course. It appeared hypoechoic with a mean thickness of 4.06 mm ± 0.7. It was visualized in 18/20 (90 %) subjects. The CL (isoechoic/hyperechoic) was located more anteriorly at an intermediate depth. The orientation was almost vertical. It was visualized in 17/20 (85 %) subjects, with a mean thickness of 2.28 mm ± 0.34. The BL appeared hypoechoic. It was visualized in 19/20 (95 %) subjects with transverse (anterior end of the ST) and longitudinal scans. The calcaneonavicular and calcaneocuboid components displayed mean (SD) thicknesses of 2.09 mm ± 0.37 and 2.7 mm ± 0.32, respectively. The ITCL and RIER were visualized in the same scan as a semiarch. DSR was observed in 4/20 (20 %) subjects. Conclusions The present study shows that, in patients with suspected ST pathology, the anatomic structures that make up this recess can be adequately examined with ultrasonography performed with ordinary 12-MHz transducers.Keywords Musculoskeletal ultrasound Á Sinus tarsi Á Harmonic imaging Á Compound imaging Sommario Obiettivi indagare la capacità degli ultrasuoni (US) di identificare le strutture legamentose del seno del tarso (ST) in un gruppo di soggetti sani. Materiali e Metodi abbiamo studiato 20 volontari sani, utilizzando sonde da 12 MHz, Compound e THI attivati. Sono stati indagati con piede in inversione: (1) 123J Ultrasound (2016) 19:107-113 DOI 10.1007/s40477-014-0145-y retinacolo inferiore degli estensori (RIER) (2) legamento interosseo (ITCL) (3) legamento cervicale (CL) (4) legamento biforcato (BL) (5) eventuali distensioni di recessi sinoviali (DSR), con scansioni coronali e trasversali, valutando ecostruttura, orientamento e spessore dei legamenti. Risultati (1) la RIER, repere ecografico, è stata la struttura di più agevole identificazione: con decorso a semiarco, ipoecogena nei 2 strati profondi, iperecogena in quello superficiale, visualizzata in 20/20 soggetti (2) il ITCL in situazione posteriore e profonda, con andamento obliquo ha presentato spessore medio di 4.06 mm ± 0.7, ipoecogeno, visualizzato in 18/20 (90 %); (3) il CL, più anteriore e orientamento qua...

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The costotransverse joints (CTJs) are small arthrodial joints which articulate with the costal tuberosity on the transverse process of the thoracic vertebrae. CTJs are composed of oval-shaped facets with a major axis, vertical at the upper vertebrae and almost horizontal at the lower vertebrae. This position explains the different movements of the ribs: the cranial ribs move on the sagittal plane and the caudal ribs on the transverse plane. Movements in directions other than these usual CTJ spatial planes can cause inflammation resulting in a stinging pain in the space between the scapula and thoracic spine. We studied 15 subjects with paravertebral pain compatible with CTJ pathology. Mean age was 29 years, 11 females/4 males. In 12 patients, the non-dominant limb was affected. US imaging was carried out using linear 12 MHz and 9 MHz probes. Scanning was performed following the long axis of the rib (transverse plane) and the short axis (sagittal plane). Sagittal scanning is the method of choice for detection of possible joint effusion and comparison with undamaged joints above and below. US identified joint effusion correlating with the site of pain in all patients. Thickening of the posterior costotransverse capsular ligament was detected in six patients mainly affecting the first thoracic vertebrae. Power Doppler showed intraarticular hypervascularization in four patients. US imaging should be performed as a first-line examination in the evaluation of patients with stinging pain in the paravertebral region. US evidence of effusion within the joints is a sure sign of involvement of these structures.

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Introduction: Assessment of US ability to identify subcutaneous nodular lesions using conventional B mode imaging (CBMI) and tissue second harmonic imaging (THI). Materials and Methods: Three different types of equipment were used (Philips Envisor HDC, Philips HD 11 XE and GE Logic E) with 12e13 MHz probes and THI probes with variable frequency. One experienced operator studied 31 patients (24 women, 7 men, mean age 49 AE 15) with 52 subcutaneous nodular lesions of which 43 were palpable and 9 were nonpalpable. Statistical analysis was carried out using chi-square test. Results: 19/52 subcutaneous nodular lesions were hyperechoic, 10/52 were isoechoic and 23/ 52 were hypoechoic. Of the hyperechoic nodules, 8/19 (42%) (p < 0.005) were not detected using THI, as they "disappeared" when THI was activated. Of the isoechoic nodules only 1/ 10 was not detected using THI, and of the hypoechoic nodules only 2/23 were not detected. Of the nodular lesions detected using CBMI and also using THI (41/52), 16/41 were shown more clearly using THI than using BMCI. No nodule was detected with the exclusive use of THI. Conclusions: The statistical significance of the "disappearing" lesions (p < 0.005), mainly hyperechoic (42%), at the activation of THI must lead to a reconsideration of routine activation of THI during the entire US examination in the evaluation of subcutaneous lesions in order to avoid the risk of missing important lesions. The present results suggest that both BMCI and THI should be used in the study of subcutaneous lesions.Sommario Introduzione: È stata indagata la capacità di identificare con l'ecografia lesioni nodulari del sottocute sia con l'utilizzo dell'imaging convenzionale B mode (BMCI) che con la Tissutal Harmonic Imaging (THI). Materiali e Metodi: Sono state utilizzate tre apparecchiature (Philips Envisor HDC, Philips HD 11 XE, e GE Logic E) con sonde da 12e13 MHz e THI a frequenza variabile. Da unico operatore esperto sono stati studiati 31 pazienti (24F, 7 M, età 49 AE 15) con 52 lesioni nodulari del sottocute di cui 43 palpatoriamente evidenti e 9 non evidenti. È stato utilizzato il test del Chi Quadro per l'analisi statistica. Risultati: 19/52 lesioni nodulari del sottocute hanno presentato ecostruttura iperecogena, 10/ 52 isoecogena e 23/52 ipoecogena. Dei noduli iperecogeni, 8/19 (p < 0.005), 42%, non sono stati evidenziati con il THI, di fatto 'scomparendo' all'attivazione dell'armonica tissutale; degli isoecogeni solo uno non è stato individuato con il THI, e degli ipoecogeni solo 2/23. Delle lesioni nodulari evidenti anche con il THI (41/52) 16/41 erano evidenziate con maggiore nitidezza con l'utilizzo del THI vs BMCI (p < 0.002). Nessuna lesione nodulare è stata scoperta con l'utilizzo esclusivo della THI. Conclusioni: La significatività statistica della 'scomparsa' delle lesioni (p < 0.005) soprattutto iperecogene (il 42%) con l'utilizzo della seconda armonica (THI) porta a riconsiderare l'utilizzazione di un preset con THI inserito per tutta la durata dell'esame nella valutazione ...