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In this article we study the ligaments and tendons of the posterolateral corner of the knee by anatomic dissection, MR-anatomic correlation, and MR imaging. The posterolateral aspect of two fresh cadaveric knee specimens was dissected. The MR-anatomic correlation was performed in three other specimens. The MR images of 122 patients were reviewed and assessed for the visualization of different posterolateral structures. Anatomic dissection and MR-anatomic correlation demonstrated the lateral collateral, fabellofibular, and arcuate ligaments, as well as the biceps and popliteus tendons. On MR images of patients the lateral collateral ligament was depicted in all cases. The fabellofibular, arcuate, and popliteofibular ligaments were visualized in 33, 25, and 38% of patients, respectively. Magnetic resonance imaging allows a detailed appreciation of the posterolateral corner of the knee.

BackgroundUltrasound imaging (US) is considered an accurate and widely available method to diagnose subacromial disorders. Yet, the frequency of the specific US-diagnosed shoulder disorders of patients with shoulder pain referred from general practice is unknown. We set out to determine the frequency of specific US-diagnosed shoulder disorders in daily practice in these patients and to investigate if the disorders detected differ between specific subgroups based on age and duration of pain.MethodsA predefined selection of 240 ultrasound reports of patients with shoulder pain (20 reports for each month in 2011) from a general hospital (Orbis Medical Centre Sittard-Geleen, The Netherlands) were descriptively analysed. Inclusion criteria were: (i) referral from general practice, (ii) age ≥18 years, and (iii) unilateral shoulder examination. Subgroups were created for age (<65 years and ≥65 years) and duration of pain (acute or subacute (<12 weeks) and chronic (≥12 weeks)). The occurrence of each specific disorder is expressed as absolute and relative frequencies.ResultsWith 29%, calcific tendonitis was the most frequently diagnosed disorder, followed by subacromial-subdeltoid bursitis (12%), tendinopathy (11%), partial-thickness tears (11%), full-thickness tears (8%) and AC-osteoarthritis (0.4%). For 40% of patients, no disorders were found on US. Significantly more full thickness-tears were found in the ≥65 years group. ‘No disorders’ was reported significantly more often in the <65 years group. The supraspinatus tendon was the most frequently affected tendon (72%).ConclusionsCalcific tendonitis is the most common US-diagnosed disorder affecting patients in general practice, followed by subacromial-subdeltoid bursitis, tendinopathy, partial- and full-thickness tears and AC-osteoarthritis. Full-thickness tears were diagnosed significantly more frequently in patients ≥65 years, while ‘no disorders’ was more frequently reported in patients <65 years. Our findings imply that patients can be stratified into diagnostic subgroups, allowing more tailored treatment than currently applied.

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PURPOSE:The objective of this study was to assess the frequencies of ultrasound findings in patients with acute rotator cuff disorders in family medicine. METHODS:In a prospective observational study, 129 patients aged 18 to 65 years with acute shoulder pain in whom the family physician suspected rotator cuff disease underwent ultrasound imaging. RESULTS:Rotator cuff disease was present in 81% of the patients, and 50% of them had multiple disorders. Calcific tendonitis was the most frequently diagnosed specific disorder. An age of 40 years or older was most strongly related to rotator cuff disease. CONCLUSIONS:Ultrasound imaging enables family physicians to rationalize treatment in nearly all patients who are aged 40 years and older with acute shoulder pain. INTRODUCTIONA lthough most patients with acute shoulder pain are cared for in family medicine, 1 physical examinations used to evaluate the extensive spectrum of rotator cuff disease are often inadequate.2 As a result, recommended treatment for all patients in family medicine consists of stepwise treatment regardless of the specific underlying cause. 3,4The disadvantage of this management approach is that it may lead to unnecessary interventions and a delay in specific treatment, with subsequent prolonged recovery. Ultrasound imaging of the shoulder has become an accepted diagnostic modality for evaluating rotator cuff disorders, 5 which potentially allows for more tailored treatment based on diagnostic subgroups. Against this background, it seemed useful to prospectively determine the frequencies of the disorders from the spectrum of rotator cuff disease in patients with shoulder pain in a family medicine setting. The objectives of this study were to assess prospectively the frequencies of specific findings as diagnosed using ultrasound imaging in patients with acute shoulder pain, and to identify possible predictors of shoulder pain. METHODSThe present study was part of the Maastricht Ultrasound Shoulder Pain Trial (MUST) study, a randomized controlled trial among patients in family medicine with acute shoulder pain. The design of the MUST study has been presented in detail elsewhere. 6 We included 129 patients with acute shoulder pain in whom the family physician suspected rotator cuff disease. Patients were eligible if they (1) had shoulder pain upon abduction with painful arc, (2) had symptoms having lasted for fewer than 3 months, (3) had no other episodes of shoulder pain in the previous 12 months, (4) were aged between 18 and 65 years.All ultrasound examinations were obtained in real time using a Phillips IU22 (Phillips Medical Systems) with a 5-12 MHz broadband linear-array transducer (Phillips L12-5). All examinations were performed by experienced musculoskeletal radiologists at the Orbis Medical Centre, The Netherlands, using a protocol-based scanning approach. Standardized ultrasound diagnostic criteria for pathology were used. 6 Ultrasound findings were prospectively evaluated for abnormalities of the rotator cuff, the long head of the...