Background: Among the most frequent causes of medical attention in the outpatient environment is knee pain or another knee condition. The capacity to guide percutaneous procedures and the fact that ultrasound may be performed anywhere, at any time, for a low price, and with excellent spatial resolution and image quality are all significant advantages of ultrasound. The patient may interact with the US machine in real time, allowing for quick clinical correlation and the opportunity and contrast the affected knee to the unaffected one. Structured assessment of the tendons, ligaments, joint space, osseous structures, peripheral nerves and vasculature, and the knee joint itself is possible by dividing the knee into anterior, medial, lateral, and posterior compartments. Aim of the Work: to assess US's capacity to characterise normal Knee anatomy, to explain US methodologies for thorough examination of the Knee, and to detect US manifestation of frequent pathologic diseases, as well as typical pitfalls/mimics of illness. Patients and Methods: Thirty people experiencing severe knee pain participated in this trial (less than three months duration). The orthopaedic outpatient clinic at Ain Shams University Hospitals and the ultrasonographic Imaging division of the Department of Radiology at Ain Shams University Hospitals collaborated on this work.Results: Regarding the demographic characteristics in the studied patients, it was found that Patients' ages varied widely, from eighteen to 70. with mean ±SD was 42.75± 13.1 years and median was 43.5 years. 18 (60%) patients were males and 12 (40%) of them were females with male to female ratio was 1.5:1. Regarding meniscal degeneration among the studied group, we found that the posterior horn is one of the most common areas for degenerative meniscus. Posterior horn medial meniscus degeneration was found in more than half (53.3%) cases while bone tenderness was found in 43 (95.6%) cases while the. Posterior horn lateral meniscus degeneration was found in eight (26.7%) cases. Conclusion:Ultrasound can help rule out potential causes of knee pain during the first stages of diagnosis. Joint effusion, tears to the posterior horn medial meniscus and the posterior horn lateral meniscus, bursitis of the anserinus, osteoarthritic alterations, cysts of the popliteal artery and duct, and tendinitis of the patellar tendon were the most common abnormalities detected by ultrasound. To verify our findings and assess US's diagnostic accuracy in knee pathology, more investigations are required with bigger sample sizes and longer followup.
Enthesitis is defined as inflammation of the tendon, ligament, or capsule insertion into the bone. It is considered an early and cardinal marker of spondyloarthropathy (SpA) diagnosis. There is a growing demand for more accurate methods to diagnose enthesitis as early as possible for a more efficient treatment delivery. Ultrasound (US) is considered a promising tool for the diagnosis of enthesitis. Our study aimed at assessing the correlation between US and disease activity as well as evaluating the ability of Glasgow Ultrasound Enthesitis Scoring Index (GUESS) and Sonographic Enthesitic Index (SEI) US scores to diagnose the condition. We designed a case-control-based study, in which 11 patients with spondyloarthropathy were included and 10 healthy subjects matched for age and sex were invited to participate. For each included subject, a thorough clinical and US assessment was performed on five different lower limb entheseal sites bilaterally. Results showed that among the 210 examined entheseal sites, 30 sites were for patients with active disease process; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score > 4, whereas 80 sites were with inactive disease process. Hypo-echogenicity and Doppler signal at < 2 mm of bone surface were the only US findings with significant correlation to disease activity with p values≈0.006 and 0.03 respectively. 194 US abnormalities were detected among cases and only 68 abnormalities were found among controls [p value ≈ 0.024]. Most US abnormalities were reported among patients with PsA; 102/194 [52.58%] abnormalities. GUESS and SEI scores were significantly correlated with the underlying diagnosis of enthesitis, with a cut off value of about 0.986 for GUESS and 1 for SEI scores. In conclusion, Ultrasound proved to be a promising tool in assessing disease activity among patients with SpA yet should be combined with other clinical and laboratory data. Application of GUESS and SEI scores can assist in differentiating US findings caused by underlying SpA from those among normal healthy subjects.
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