Ulnar collateral ligament (UCL) injuries have a high prevalence however; these are usually being missed in the initial clinical evaluation. Depending on the chronicity of the injury there are two acronyms for UCL tear. One is the skier's thumb and the other is the gamekeeper's thumb. If the UCL of the first metacarpophalangeal joint (MCP joint) has a complete tear with entrapment of aponeurosis of adductor pollicis muscle between the MCP joint and torn ligament, is called a Stener’s lesion. This is a rare clinical entity that requires early surgical correction because of entrapment. The mechanism of injury is the coerced abduction of the thumb from the index finger, causing ligament tears or sprain with or without ensuing avulsion fracture. The incidence of Stener’s lesions associated with UCL rupture has been reported to be up to 52% per intra-operative finding. In Stener’s lesions, the UCL tears from the base of the proximal phalanx (PP) then retracts proximally and displaces superficial to the adductor pollicis. Here we are presenting four cases of Stener’s lesions, with the usefulness of magnetic resonance imaging (MRI) in diagnosing this entity, which can prevent possible long-term complications such as chronic pain, joint degeneration, and joint instability.
Background The detection of thyroid nodules has recently increased due to widespread use of ultrasonography. The main concern in the evaluation of thyroid nodules is the detection of malignancy. Ultrasonography is a widely accepted imaging modality for the initial assessment of thyroid nodules and helps in differentiating benign from malignant nodules. FNAC is considered as a reliable and effective method in differentiating benign and malignant nodules. Thyroid nodules show a highly diverse pattern on ultrasonography and there is an overlap between the ultrasound features of various thyroid lesions which causes difculty in classication of these nodules into benign and malignant categories. There is lack of a unied system to classify thyroid lesions clearly into benign and malignant categories. Horvath et al proposed an evaluation system for thyroid nodules called TIRADS (Thyroid Imaging Reporting and Data System). Objectives 1. To evaluate thyroid nodules using B-Mode and color Doppler ultrasound. 2. To classify these nodules based on TIRADS. 3. To correlate the ndings of ultrasound with ne needle aspiration cytology / histopathology. Materials and methods Patients who were referred to department of radiodiagnosis for USG investigation of thyroid in Pacic Institute of Medical Sciences, Udaipur, Rajasthan, over the time period from 1st March, 2021 to 30th September, 022.Thyroid nodules were evaluated for various ultrasound features and categorized using the TIRADS. These ndings were correlated with histopathology/ cytopathology ndings. Results Out of 118 patients, 101 were benign and 17 nodules were malignant. The nodules were evaluated for ultrasound features like hypo echogenicity, lobulated or poorly dened margins, micro calcications, taller than wider shape, central or predominant, central pattern of vascularity and solid composition; which showed a statistically signicant association with malignancy (p<0.05). The TIRADS classication has high sensitivity, specicity, and diagnostic accuracy in differentiating benign and malignant thyroid nodules. The risk of malignancy in our study for the TIRADS categories 2, 3, 4A, 4B, 4C and 5 were 0%, 1.5%, 4.8%, 63%, 100% and 100% respectively. Conclusion B mode ultrasound with colour Doppler is the most sensitive and specic imaging modality for initial assessment of thyroid nodules. Using ultrasound; TIRADS helps in differentiating benign and malignant thyroid nodules and standardizes the evaluation of thyroid nodules.
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