No abstract

No abstract

Snapping scapula syndrome manifests as an audible or palpable crackling during the sliding movements of the scapula over the rib cage, often perceived during physical or professional activities. It can be caused by morphological alteration of the scapula and rib cage, by an imbalance in periscapular musculature forces (dyskinesia), or by neoplasia (bone tumors or soft tissue tumors). In this pictorial essay, we review the main causes of snapping scapula syndrome, exemplified by a collection of didactic cases.

IntroductionAlthough several imaging options are available for diagnosing syndesmotic injury, a fundamental question that guides treatment remains unanswered. Syndesmotic instability is still challenging to diagnose correctly, and syndesmotic disruption and true syndesmotic instability should be differentiated. Currently, imaging tests quickly diagnose severe syndesmotic instability but have difficulty in diagnosing mild and moderate cases. This study aims to investigate which strategy among an existing CT index test and two new add-on CT index tests with stress manoeuvres more accurately diagnoses syndesmotic instability. The secondary objective is to investigate the participants’ disability outcomes by applying the Foot and Ankle Ability Measure questionnaire.Methods and analysesThis study of a diagnostic accuracy test will consecutively select individuals older than 18 years with a clinical diagnosis of a suspected acute syndesmotic injury. Three strategies of the CT index test (one in the neutral position and two with stress) will examine the accuracy using MRI as the reference standard. The external rotation and dorsiflexion of the ankle will guide the stress manoeuvres. A comparison of measurements between the injured syndesmosis and the uninjured contralateral side of the same individual will investigate the syndesmotic instability, by evaluating the rotational and translational relationships between the fibula and tibia. Sensitivity, specificity, area under the receiver operating characteristic curve and likelihood analyses will compare the diagnostic accuracies of the strategies.Ethics and disseminationThe Internal Review Board and the Einstein Ethics Committee approved this study (registered number 62100016.5.0000.0071). All participants will receive an oral description of the study’s aim, and the choice to participate will be free and voluntary. Participants will be enrolled after they sign the written informed consent form, including the terms of confidentiality. The results will be presented at national and international conferences and published in peer-reviewed journals and social media.Trial registration numberClinicalTrials.gov Registry (NCT04095598; preresults).

No abstract

Syndesmotic instability is a fundamental question that guides treatment; despite the currently available diagnostic imaging tests, its determination is still challenging. Knowledge of the instability degree assists the physician in the decision-making process regarding surgical or nonsurgical treatments. The authors are currently conducting a prospective diagnostic accuracy study by consecutively selecting individuals aged 18 years and older with an orthopaedic clinical examination indicating suspected acute syndesmotic injury. Magnetic resonance imaging is the reference standard used for evaluating the diagnostic accuracy of 3 computed tomography index tests. These tests include the neutral position and 2 ankle stress maneuvers: external rotation and dorsiflexion. Comparative measurements between the injured syndesmosis and the uninjured contralateral side of the same individual evaluate the tibiofibular relationship and investigate syndesmotic instability. This study aims to describe a summarized research protocol for a new technique using computed tomography with stress maneuvers and to show a didactic example of syndesmotic instability diagnosis. Level of Evidence V; Diagnostic Studies; Expert Opinion.

These results suggest that inlet radiographs may be a reliable method of assessing the reduction of the hip after the surgical treatment of DDH. Cite this article: 2017;99-B:697-701.

PolymyositisMagnetic resonance a b s t r a c t Introduction: Although dermatomyositis (DM) and polymyositis (PM) share many clinical features in common, they have distinct pathophysiological and histological features. It is possible that these distinctions reflect also macroscopically, for example, in muscle alterations seen in magnetic resonance images (MRI).Objectives: To compare simultaneously the MRI of various muscle compartments of the thighs of adult DM and PM. Materials:The present study is a cross-sectional that included, between 2010 and 2013, 11 newly diagnosed DM and 11 PM patients (Bohan and Peter's criteria, 1975), with clinical and laboratory activity. They were valued at RM thighs, T1 and T2 with fat suppression, 1.5 T MRI scanner sequences. Results:The mean age at the time of MRI, the time between onset of symptoms and the realization of the MRI distribution of sex and drug therapy were comparable between the two groups (p>0.050). Concerning the MRI, muscle edema was significantly found in DM, and mainly in the proximal region of the muscles. The area of fat replacement was found predominantly in PM. The partial fat replacement area occurred mainly in the medial and distal region, whereas the total fat replacement area occurred mainly in the distal muscles.There was no area of muscle fibrosis.Conclusions: DM and PM have different characteristics on MRI muscles, alike pathophysiological and histological distinctions. quando de uma forma parcial, ocorreu principalmente nos terços médio e distal, enquanto que a forma total transcorreu apenas no terço distal dos músculos. Não houve nenhuma área de fibrose muscular. Conclusões:A DM e a PM apresentam características distintas entre si em RM de músculos, a exemplo de distinções fisiopatológicas e histológicas.