Rationale and Objectives Pulley ruptures are the most common injuries in sport climbing. Ruptures of the A2 and A4 pulleys have been studied extensively, and ultrasound has proven to be a highly sensitive and specific tool for their diagnosis. However, the correct diagnosis of A3 pulley ruptures continues to be a challenge. Therefore, we investigated a novel approach to this pathology.
Material and Methods Eighteen fingers from nine different human cadavers were examined using high-resolution, dynamic ultrasound before and after being subjected to different combinations of singular and multiple iatrogenic pulley ruptures in a standardised fashion. Special attention was paid to the behaviour of the volar plate (VP) with respect to the proximal interphalangeal joint (PIP) and the flexor tendons before and after pulley rupture.
Results Injuries to the A2 and A4 pulleys were diagnosed via ultrasound with sensitivities of 90 % and 94 % and specificities of 100 % and 97 %, respectively. A direct visualisation of the A3 pulley was achieved in 61 % of the fingers. The VP became significantly thicker and shorter during finger flexion as well as after A3 pulley rupture. The distance between tendon and VP became significantly more pronounced after A3 pulley rupture. For distances greater than 0.9 mm between VP and tendon, a sensitivity of 76 % and a specificity of 94 % were achieved for determining A3 pulley ruptures.
Conclusion The distance measurement between VP and tendon was found to be a valid indirect method for the diagnosis of A3 pulley ruptures. This approach is the first ultrasound method for accurately diagnosing A3 pulley ruptures.
ObjectivesChanges in the microvascular environment are considered crucial in the pathogenesis of compression neuropathies. Several studies have demonstrated elevated intraneural vascularity in severe neuropathy compared with healthy subjects, where intraneural vascularity is considered predominantly undetectable. The aim of this study was to assess and quantify intraneural vasculature by superb microvascular imaging (SMI) in healthy volunteers in the median, ulnar and common peroneal nerve.MethodsIntraneural vascularity was quantified in 26 healthy volunteers (312 segments overall) by SMI sonography using a 22‐MHz linear transducer. Individual nerve segment vascularity was compared with the mean vascularity using one‐way ANOVA and Kruskal–Wallis tests, respectively. Vendor‐provided quantification and manual vessel count were compared by linear regression analysis.ResultsIntraneural vascularity was detectable in all nerve segments (100.0%). Vessel density was highest in the median nerve at the wrist (1.54 ± 0.44/mm2, P < 0.0001) and lowest in the sulcal ulnar nerve (0.90 ± 0.34/mm2, P < 0.0001). Vendor‐provided automated quantification severely overestimated vascular content compared with manual quantification.ConclusionSuperb microvascular imaging can facilitate the visualisation of nerve vascularity and even detect local variations in vessel density. The pathophysiological implications for peripheral neuropathies, especially compression neuropathies, warrant further investigation, but the absence of visible intraneural vasculature as a negative finding in the diagnostic of compression neuropathies should be interpreted with caution, as the intraneural vascularity may lie beyond the 18 MHz resolution power of a transducer.
Arterial pseudoaneurysms (PSAs) typically occur after (iatrogenic) damage (i.e., puncture) to the arterial wall and are the most frequent complication following percutaneous interventions.In this article we report on successful treatments of two iatrogenic PSAs in two patients (87-year-old male; 69-yearold-female) with a brachial (10 x 7 mm; 10 mm-length “neck”) and radial (17 x 7 mm; 3 mm-length “neck”) artery PSA by US-guided fibrin glue injection (UGFI). Both PSAs were effectively occluded without any complications. To our knowledge this is the first report on successful treatments of upper limb artery PSAs using UGFI, which may represent a valid first-line, minimally invasive treatment option for brachial artery PSA.
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