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Fourty two patients with tenosynovial giant cell tumour, treated with radical excision, underwent detailed follow-up to evaluate the outcomes and to find early the possible recurrence of disease. Radical excision is the only way to have a complete recovery from disease and total recovery of function. Early diagnosis of recurrence is possible by careful clinical examination, ultrasonography and, in selected cases, magnetic resonance imaging.

Purpose: Ochronotic arthropathy is the articular manifestation of alkaptonuria, a rare hereditary metabolic disease that leads to the deposition of homogentisic acid particularly in the joints where it causes articular degeneration and inflammation. We studied the radiological patterns of the disorder using both traditional X-rays both MRI and comparing the results obtained with the two techniques., Materials and Methods: The study included five patients (4 males, 1 female, mean age 51 years); we studied the most frequently affected sites, the knee, the shoulder and the spine. As regards the conventional study we used a radiographic score which considered the state of the articular space and the presence of calcifications. MRI of the peripheral joints was performed on the most symptomatic site or, if asymptomatic, on the most severely affected site as established by radiography; in all cases T1- and T2-weighted sequences in the axial, sagittal and coronal planes were acquired., Results: Both the X-ray and MRI study revealed the typical alterations of ochronosis in the cases with a known diagnosis: articular space narrowing up to osseous ankylosis, calcifications, osteophytosis, reactive sclerosis of the articular surfaces; MRI was however more accurate in identifying the alterations and revealing lesions not visible at conventional radiology, such as ligament lesions. In the case of newly diagnosed ochronotic arthropathy MRI proved valuable for its ability to detect alterations that are poorly appreciable at conventional radiology., Conclusions: Modern diagnostic imaging, above all MRI, allowed us to identify the peculiar characteristic features of ochronosis and is fundamental both for the diagnosis and for differentiating ochronosis from other articular disorders.

The sterno-clavicular joint covers one remarkable importance in the complex of the shoulder girdle. This review investigates the anatomy, biomechanics, main affections and involvement of this joint in the pathological processes of the shoulder girdle in its complex. Moreover, it focuses on the opportunities offered from the conservative treatment, using in particular the manual therapy. Active and passive, as well as against isometric resistance movements, are discussed. In particular, the passive mobilization is demonstrated effective in the restoration of joint mobility. The sterno-clavicular joint is not structured in order to complete great work loads and has the tendency to become hypermotile or unstable, if subordinate to overload works, becoming painful. In this case, the techniques of passive mobilization and of modulation of the pain turn out effective.

The authors present the case of a patient affected by kidney failure, who had been undergoing dialysis for several years when areas of osteolysis and bone resorption in the proximal femur and pathologic fracture appeared. She was treated surgically by hybrid total hip arthroplasty. The patient also complained of pains in other joints. The bone tissue taken from the osteolytic area was examined histologically. The test showed the presence of an amyloid substance. Microradiography and X-ray diffractometry carried out on the same samples confirmed the lack of mineralisation due to the presence of aluminum ions, presumably derived from dialysis. The high concentration of this element was confirmed by resum assay with spectrophometry in atomic absorption. Considering the results of the aforementioned tests, the patient was put on dialysis using a polymethylmethacrylate filter.

Purpose: To evaluate the diagnostic effectiveness of magnetic resonance (MR) in knee cartilage pathologies of different regions and grades with the aim of establishing the role of MR in treatment choice., Materials and Methods: We enrolled 90 patients who underwent MR and arthroscopy of the knee. To classify cartilage lesions we used a simplified grading system that correlates MR to arthroscopic reports and divides lesions into low and high grades. The MR examinations were performed with a 1.5 T superconducting magnet with a standard protocol to obtain quality images in a short time, using T1-weighted spin-echo sequences, T2* weighted gradient-echo sequences and inversion recovery sequences. The MR diagnostic specificity, sensitivity and accuracy and MR positive predictive value and negative predictive value in identifying and grading the chondral lesions of the femorotibial and patellofemoral compartments were calculated and compared to arthroscopy parameters., Results: The analysis of each grade of chondral lesions reveals an MR accuracy of 94% in high-grade lesions of the femorotibial and patellofemoral compartments and an MR accuracy of 78% in low-grade lesions of patellofemoral compartment and of 70% in low-grade lesions of femorotibial compartment. This result suggests MR is useful for the grading of chondral lesions in clinical practice., Conclusions: MR diagnostic effectiveness substantially changes according to the different location and grade of chondral lesions. While MR seems to be nearly equivalent to arthroscopy for high-grade lesions subject to surgery, it appears to be less accurate in diagnosing low-grade lesions, in particular femorotibial lesions.

Intra-articular angioma, or vascular hamartoma, is a tumor-like lesion essentially made up of anomalous blood vessels localized in the joint capsule, in the synovial membrane, or in both structures. There are two anatomical varieties: one circumscribed localized and one extended. There seems to be predilection for the female sex, and age of onset ranges from birth to 20-30 years of age; it occurs more frequently in the knee, less in the elbow, in the wrist and in the ankle. Symptoms, which often begin after local trauma, include joint swelling and pain, both characterized by discontinuity and long duration. Sometimes there is an increase in swelling, repeated episodes of hemarthrosis (or hydrarthrosis), forced position and functional limitation of the joint, increase in skin temperature. Final diagnosis can only be obtained with histological examination, although MRI may be useful and arteriography clearly reveals it, if the harmatoma is extended enough and communicating with the circulation. Histological examination carried out on fragments of tissue taken in loco reveals a labyrinthine agglomerate of fissures and lengthening cavities, with walls that are generally thick and of a venous-like anomalous type. The course of the disease is slow, with periods of remission of local symptoms of varying duration. Treatment is surgical and it consists in complete removal when possible of the angiomas. The results, particularly in the localized form, are satisfactory; recurrence is infrequent and it is generally due to incomplete excision of the neoformation.

Purpose: To report our experience pertaining to three cases of intra-articular osteoid osteoma assessed by means of integrated imaging and review of literature., Materials and Methods: Medical records, radiologic and nuclear medicine findings pertaining to three cases of intra-articular osteoid osteoma were retrospectively evaluated and compared with those of surgery. All the patients (2 males, one female; age range 8-38 ys) affected by intra-articular osteoid osteoma respectively of the elbow, tibio-talar joint and hip were evaluated by means of radiographic examination and Magnetic Resonance Imaging (MRI). SE T1-w and T2-w, GRE T2*-w, GRE 3D T1-w and STIR pulse sequences were used and axial, coronal and sagittal images were acquired. Two patients underwent CT scan. One patient underwent skeletal scintigraphy. All the patients underwent surgery., Results: In 2 out of 3 cases plain radiography allowed the radiologist to suspect the presence of the lesion. In the remaining one, plain radiography failed to detect both the nidus and the perilesional osteosclerosis; nevertheless, a small osteochondral erosion of the humeral condyle suggested the presence of joint inflammation, thus leading to further investigation. CT scan well depicted the presence of the nidus and, in one case, the presence of joint effusion. MRI was always able to detect the nidus, which presented as lesion of low to intermediate signal in T1-w images, low signal in the T2-w images in one patient and high signal in the remaining two; in these latter STIR images showed high intensity nidus and edema of neighbouring cancellous bone. Furthermore, in all patients MRI clearly depicted joint effusion. Skeletal scintigraphy demonstrated both the lesion and the inflammatory involvement of neighbouring soft tissue. In all patients histologic specimen confirmed the diagnosis of osteoid osteoma with joint inflammation and synovitis., Conclusions: According to our results and literature data the pre-surgical diagnosis of osteoid osteoma is very difficult to achieve. Indeed, only the combination of clinical information and radiologic and nuclear medicine findings enables the radiologist to make the right diagnosis.

Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondyloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as erosions, which characterize the process. Moreover, when available, magnetic resonance imaging couple the ability to finely visualize such lesions with the possibility to show early alterations and to characterize the "activity" of the disease, presenting itself as a powerful tool both for diagnosis and follow-up. This review briefly shows the applications of imaging techniques for the evaluation of the anterior chest wall focusing on what has been done in the SAPHO syndrome which can be considered prototypical for this regional involvement since it is the osteo-articular target mainly affected by the disease.

Purpose: To assess MR potentials in the evaluation of superior glenoid labrum disease and possible associated conditions of the rotator cuff and of the anterior mechanism of the shoulder., Material and Methods: We retrospectively evaluated 51 patients (age range 18 to 53 years) with a diagnosis of anteroposterior lesion of the superior glenoid labrum. MR examinations were performed with a 0.2 T permanent magnet and a dedicated coil, using T1- and T2-weighted SE sequences on mostly coronal-oblique planes. Slice thickness was 4 mm. In 8 cases, the examination was completed with intra-articular injection of contrast agent. Twenty-eight patients were submitted to surgery (arthrotomy in 7 cases; arthroscopy in 21 cases)., Results: We considered only the cases with surgical confirmation and divided them into 2 groups: 15 patients with isolated alteration of the superior glenoid labrum and 13 patients with an anteroposterior lesion of the glenoid labrum associated with disease of the rotator cuff or of the anterior mechanism of the shoulder. MRI demonstrated 5 cases of superior labrum irregularities at the level of its glenoid insertional portion (type I lesion); 6 cases of detachment of the superior portion of the labrum (type II); 9 cases of bucket handle tear of the superior labrum with involvement of the insertional portion of the long head of the biceps tendon (type III); 8 cases of superior labrum tear extending within the long head of the biceps tendon (type IV). In the patients with associated disease MRI demonstrated supraspinatus tendon tear in 5 cases, lesion of the labrum also in its anteroinferior portion in 1 case, Hill-Sachs intraspongious fracture with involvement of the inferior glenohumeral complex in 1 case, and complete tear of the rotator cuff in 7 cases. Subsequent surgery always confirmed the presence of associated lesions, while the superior labrum lesion was not confirmed in 3 patients. In 4 cases, surgical findings provided a different classification of the lesion type than MRI., Discussion: In the presence of a type I anteroposterior lesion of the superior glenoid labrum, coronal MRI can depict the loss of the triangular shape of the labrum. Type II lesions show detachment of the labrum, which appears on the MR images as a high signal intensity band passing through the labrum with caudocranial orientation. A superior glenoid labrum tear with a low signal intensity area within the joint indicates a type III lesion. Complete tear of the superior glenoid labrum with involvement of the long head of the biceps tendon demonstrated on the coronal T1-weighted SE and T2-weighted GE sequences is a sign of a type IV lesion., Conclusions: MRI can be a valuable diagnostic technique in type III and IV lesions of the superior glenoid labrum. It often provides important information about the possible presence of associated diseases, especially of the rotator cuff, which are helpful for treatment planning.

Part II of this paper reviews the clinical and laboratory methods to diagnose the neurological, vascular and osteoarticular components of the hand-arm vibration syndrome. The prognosis and reversibility of vibration-induced neurological and vascular disorders after cessation of vibration exposure or the introduction of powered tools equipped with vibration isolation systems are discussed on the basis of the results of follow-up clinical investigations and longitudinal epidemiologic studies. Finally, the review debates some of the methodological aspects connected with the health surveillance of vibration-exposed workers and considers the possible medical contra-indications for prolonged exposure to hand-transmitted vibration.

Part I of this paper presents an overview of the medical aspects of the hand-arm vibration syndrome, as well as the relationship between occupational exposure to hand-transmitted vibration and the vascular, neurological, and musculoskeletal disorders occurring in the upper limbs of workers who use vibrating tools. There is epidemiologic evidence for an increased occurrence of peripheral sensorineural and vascular disorders in occupational groups using a great variety of vibrating tools. An excess risk for wrist osteoarthrosis and elbow arthrosis and osteophytosis has been reported in workers exposed to shocks and low frequency vibration of high magnitude from percussive tools. To date, the available epidemiologic data are insufficient to outline an exposure-response relationship for both sensorineural disturbances and bone and joint disorders caused by hand-transmitted vibration. The association between vibration white finger (VWF) and exposure to hand-transmitted vibration has been clearly established in both cross-sectional and longitudinal studies of vibration-exposed workers. A proposal of exposure-response relationship for VWF is included in an annex to ISO 5349 (1986). However, the shape of the relationship between vibration exposure and VWF is not yet fully understood. The results of several epidemiologic studies seem to indicate that the current ISO frequency-weighting may be inappropriate for all types of vibration and for all kinds of vibration injury. Alternative exposure-response relationship for VWF have been suggested in recent epidemiologic investigations. Regarding exposure limits for hand-transmitted vibration, the findings of clinical and epidemiologic studies have shown that the vibration exposure levels proposed by the European Directive for physical agents are sufficiently protective for the safety and health of workers exposed to hand-transmitted vibration.

Genetic haemochromatosis is a HLA-linked disease characterized by a high and inappropriate gastrointestinal iron absorption; the excess iron is stored in parenchymal cells, provoking the failure of the involved organs. The common target organs of genetic haemochromatosis are liver, heart, pancreas, pituitary, joints and skin. The disease is inherited in an autosomal recessive manner with predilection for male sex and penetration conditioned by age, sex and food habits. The first clinical manifestation of genetic haemochromatosis, whose onset is typically between ages 40 and 60, is represented by arthropathy in 45% of the cases; the articular features are unfortunately often misdiagnosed and it is known that the diagnosis delay heavily compromises the outcome; vice-versa the early identification of the disease, and the consequent suitable treatment give back a normal life expectancy to these patients. The articular features of genetic haemochromatosis are of two types: 1) progressive degenerative arthropathy, characterized by pain without inflammatory signs, morning stiffness and functional impairment involving hands, wrists, shoulders, hips, knees and feet; 2) chondrocalcinosis with its typical proteiform clinical manifestations. The aim of this report is to underline that the patients with premature osteoarthritis or unexplained chondrocalcinosis must be screened for genetic haemochromatosis in order to formulate the correct diagnosis before the development of severe internal organ involvement.

Sarcoidosis (S) is a systemic disease affecting above all lymph nodes and lung tissue. Skeletal involvement is reported to occur in 14% of patients, the most common manifestations is cystoid osteitis, an asymptomatic lesion localized to the small bones of hand and feet. Lytic lesions are rare and usually accompanied by visceral involvement, the lesions may be detected in vertebral bodies and in long bones, pelvis and scapulae. MRI may be a good diagnostic tool, but open biopsy is often necessary. Joints are involved in about 89% of patients with acute sarcoidosis. Arthritis is localized more frequently to knees and ankles, is polyarticular, a little painful, migratory and transient, often accompanied by erythema nodosum. Clinical manifestations disappear in a few weeks, chronic and erosive disease is rare and always associated with systemic involvement. In these patients it may be useful to perform gallium citrate 67 scintigram and evaluation of serum ACE. Synovial biopsy lacks of specificity and sensibility, and in some cases it is necessary to perform open biopsy. S is a disease that may spontaneously regress and therapy may be unnecessary. In some cases, methotrexate may be useful in addition to prednisone. Chloroquine and hydroxychloroquine are effective in cases of skeletal involvement.

Introduction: Hoffa's fat pad disease is characterized by chronic knee pain mostly under the patella. Acute cases are generally post-traumatic; the clinical picture consists of especially anterior pain and functional impairment mimicking a ligament injury, often in the presence of a bulky effusion even with blood from mucous ligament arteriole rupture. In chronic cases, recurrent episodes of hydrarthrosis are reported, together with joint weakening and subpatellar discomfort. At clinical examination, Hoffa's sign is difficult to observe but can be highly specific. Extending a bent knee putting pressure on the patellar tendon margins elicits a strong pain, an antalgic block and a defensive behavior of the patient. MRI clearly depicts Hoffa's infrapatellar fat pad and its findings may suggest the frequently ignored diagnosis of Hoffa's syndrome, alone or associated with other local or systemic conditions. This is really important for a complete and correct surgical planning, since the classic anterolateral arthroscopy and arthrotomy never visualize the pad itself and, at any rate, give no information on the possible changes., Material and Methods: June 30, 1995, to June 30, 1997, one hundred and ninety-three arthroscopies were performed at the Service of Orthopedics of Argenta Hospital. The present retrospective study excluded 107 patients (65.45%) who had not undergone MRI. In the remaining 86 patients (44.55%) who underwent MRI, the surgical, arthroscopic and nonarthroscopic patterns of Hoffa's pad were studied and 17 patients selected for surgical curettage of Hoffa's pad which was the site of isolated or associated conditions. All 17 MR examinations were reviewed to assess the patterns of the various pad abnormalities in the light of the surgical picture and of the latest indications from the international literature., Results: T1-weighted sequences showed the fibrotic trabeculae of the pad thanks to the contrast offered by hyperintense fat and T2-weighted sequences demonstrated liquid infiltration in the pad and various synovial recesses. Despite the limitations of a retrospective study, MRI had high sensitivity in Hoffa's fat pad studies in our 17 patients; its specificity depended on the condition. MRI was particularly reliable in acute (Hoffa's pad rupture-detachment) and chronic conditions with aspecific hypertrophy (chondromatosis, pigmented villonodular synovitis), as well as in systemic disorders (rheumatoid arthritis)., Conclusions: Accurate studies of Hoffa's fat pad are mandatory because different pad injuries may require a different arthroscopic approach from the classic ones. MRI was a useful tool in the study of Hoffa's fat pad, whose local and systematic involvement is an often ignored cause of anterior knee pain.

Purpose: In the cranial humeral end, osteochondral injuries localize in a circular crown including part of the humeral head and part of the major and minor tuberosities. Since this region is easy to depict with US, we investigated the potentials of this technique in detecting osteochondral injuries., Materials and Methods: Seventy-five osteochondral injuries found at 492 US examinations performed in 12 months with a 7.5 MHz linear probe were retrospectively reviewed. Clinical history taking was focused on the following: a) previous trauma or b) luxation-instability and c) if the patient was a sportsman devoted to activities requiring forced abduction-external rotation or adduction-internal rotation. Since the site of the head's humeral injury is an important clue for diagnosis, we subdivided the humeral circle into four ideal quadrants by two perpendicular lines with the main line passing through the bicipital groove. Then, each injury was ascribed to a quadrant. All patients were also submitted to radiography (at least two films) and to MRI; CT was performed in 12 patients. Ten patients underwent surgery., Results: We found 34 Hill-Sachs lesions, 15 traumas, 9 arthrotic lesions, 7 cases of anterointernal and 4 of posterosuperior impingement, 4 cases of infraspinatus enthesopathy and 2 erosions due to perihumeral calcifications. In our experience, US was an accurate tool in the identification of humeral head conditions, which were confirmed at CT and/or MRI in all patients (no false positives). As for the injury nature, US diagnosis was confirmed in all Hill-Sachs lesions (34/34 cases), traumas (15/15 cases) and 50% of the cases of posterosuperior impingement (2/4 cases). These conditions made up about 2/3 of the whole cases (51/75 cases). US failed to establish the injury nature in the 9 arthrotic lesions, 7 cases of anterointernal impingement, 4 cases of infraspinatus enthesopathy and 2 erosions due to perihumeral calcifications., Conclusions: US can be suggested as the method of choice in the study of the osteochondral lining of the humeral head.

One of the possible atraumatic causes of recurring hemarthrosis of the knee is constituted by the association of a lesion of the lateral meniscus with severe gonarthrosis of the lateral compartment. In the case described we were able to determine the cause of frequent bleeding (12 times in 15 months) in a traction caused by the injured meniscal tissue on the terminal branches of the geniculated arteries in the area of the popliteal hiatus. Thus, this clinical manifestation cannot be attributed to a synovial pathology. Total arthroscopic meniscectomy solved the problem.

Subcoracoid impingement syndrome pain is elicited by some positions of the upper limbs, i.e., adduction and inward rotation, whenever coracohumeral space reduces. Although acquired or congenital malformations of the humeral head and/or coracoid apophysis are the most common causes of painful syndromes, repeated flections and inward rotations of the upper limbs, typical of some sports, such as swimming and tennis, and of some sports, such as swimming and tennis, and of some kinds of work, are predisposing factors. The subcoracoid impingement syndrome exhibits on pathogenomonic signs at clinics and the specificity of diagnostic methods is low, which calls for reliable radiologic assessment of this condition. Fifteen patients with subcoracoid impingement syndrome underwent X-ray, US, CT and MR studies. Plain radiography detected no specific signs of this syndrome, but yielded useful information regarding other painful syndromes of the shoulder, such as anatomical variants of the acromion and degenerative changes. US yield was poor because of the acoustic window of the coracoid apophysis, but supraspinatus tendon changes were demonstrated in 2 cases. CT and MRI proved to be the most reliable and accurate diagnostic methods, the former thanks to its sensitivity to even slight bone changes and to its capabilities in measuring coracohumeral distance and acquiring dynamic scans and the latter because it detects tendon, bursa and rotator cuff changes. To conclude, in our opinion, when the subcoracoid impingement syndrome is clinically suspected, plain X-ray films should be performed first and followed by MR scans.

Impingement syndrome is caused by a conflictual status between rotator cuff, subacromial bursa and anatomic and functional acro-mioclavicular arch. The clinical signs of this syndrome include pain and functional disability in abduction and extrarotation of the shoulder. This study was aimed at verifying Magnetic Resonance Imaging (MRI) capabilities in showing the critical points of impingement and their incidence. Fifty-four cases of impingement syndrome were studied. The best visualization of functional acromioclavicular arch was obtained using a new study technique. All patients had critical points of impingement. In 65% of cases, acromioclavicular arthritis induced impingement on the supraspinatus tendon and in 35% of cases on the muscle. In 46% of the patients, impingement between coracoacromial ligament, partially thickened in 25% of the cases and totally thickened in 75%, and supraspinatus tendon was observed. In 7% of the whole of shoulders, the acromion had an uncinatus shape. MRI, thanks to its multiplanar imaging, allowed the complete evaluation of the articular structures with complex anatomy. The assessment of different types of impingement points can be considered a valuable approach to the therapeutic stage.

Stickler syndrome is a hereditary connective tissue disease transmitted by AD pattern. It is characterized by peculiar facies with bone and ocular anomalies. Heart anomalies (except mitral valve prolapse) are an uncommon features that may be associated. The authors report on a 4 months patient affected by this syndrome who had hypertrophic cardiomyopathy. Pathogenetic mechanism of this anomaly is discussed.

A total of 107 temporomandibular joints (TMJ) were examined with two superconductive MR units at 1T and 1.5T. In 73 TMJs, MR revealed 55 disk displacements, 7 disk perforations, 10 joint space adhesions, 33 osteoarthrities, 3 avascular necroses of the mandibular condyle, and 25 joint effusions. These abnormalities are described and discussed. In spite of some limitations--e.g., motion artifacts and patients' claustrophobia--MR imaging is the procedure of choice in abnormal TMJs, because it yields useful information as to therapeutic choice (conservative versus surgical). Arthrography can be used as a complementary study technique in the patients with marked disagreement between clinical and MR findings. Arthroscopy should be used as a surgical procedure in abnormal TMJs selected by previous MR studies.

Sarcoidosis is a granulomatous disorder of unknown etiology with a multi-disciplinary interest. However, a multiple organ involvement is not always clearly presented. A case of a 62-year-old woman with cutaneous, pulmonary, ocular, cardiac, bone and articular involvement is described.

The authors describe embryology and anatomy of synovial plica of the knee joint. They propose a clinic and pathogenic classification and after examining the diagnostic problem of plica syndrome, analyze their long-term results after surgical treatment.

After a brief introduction on Adie's disease, or pseudotabes, a rare case of pseudotabetic arthropathy which, in addition to the classical signs of Adie's syndrome, presented signs of a recurrent arthrosynovitis of the knee, is reported. This rare syndrome should be borne in mind in differential diagnosis with recurrent arthrosynovitis of other nature.

MR imaging was employed in 232 patients with traumatic or degenerative lesions of the shoulder. MR diagnosis was compared with arthrotomic findings in 19 cases, and with arthroscopic results in 3 cases. MR technique is here presented and the choice of scanning planes is discussed, together with the sequences of image acquisition and with the features of the surface coil employed. Axial, sagittal, and coronal scans were used in all cases. Both sagittal and coronal planes were performed obliquely on the basis of precise anatomical structures. T1-weighted sequences were used for they are reliable in locating the various anatomical structures and efficient in defining the several different pathologic conditions. The role of T2-weighted sequences was complementary, and they were employed in selected cases only. A surface coil is presented with a particular configuration of easy clinical use and with such technical features as to allow reduced fields to be imaged, with good spatial resolution. MR imaging could demonstrate with equal accuracy both skeletal-cartilage components and capsulo-ligamentous structures, thus defining associated lesions and small tears. In both degenerative and traumatic lesions of the rotator cuff, MR imaging showed both extent and entity of the pathologic process, with high accuracy in defining the impingement syndrome. MR imaging allowed the depiction of the anterior and posterior glenoid labra, even without intraarticular contrast media. Moreover, MR imaging made it possible to recognize both fractures and degenerative processes within the glenoid labrum on the basis of their signal intensities. This preliminary experience allows the authors to conclude that MR imaging is an accurate and non-invasive diagnostic method for the study of traumatic lesions and of degenerative changes of the shoulder.

After description of etiopathogenetic, anatomopathological and clinical aspects of the disease, the authors relate about a case of ochronotic arthropathy, lining on its typical radiological patterns. Scintigraphic study with 99mTc-pertechnetate and with 99mTc-pyrophosphate, excluding any phlogistic component, agree with dysmetabolic and degenerative nature of this arthropathy.

A simple new symptomatological technique is described with the emphasis on its great value in the diagnosis of joint pathologies.

The author reports his experience with arthroscopy under local anesthesia for the diagnosis of affections of the knee. He emphasises the criteria that must be used to guide the surgeon in his choice, illustrates the method commonly used, and reports the positive results obtained in a group of patients. The author concludes by suggesting that arthroscopy under local anesthesia for joint pathology of the knee is a safe and indispensable method to be used by knee surgeons.

The authors present a comparison between the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in the articular pathologies of the knee. CT and MRI were performed in 30 patients who subsequently underwent surgery. CT and MRI results were compared on three bases: technique, definition of normal anatomy, and diagnostic accuracy. CT allowed a standardization of the technique, while MRI was superior in defining normal anatomy--especially in the study of capsulo-ligamentous structures. In all cases the use of both CT and MRI allowed a correct diagnosis, showing the site, extent and gravity of the lesion. CT proved to be superior to MRI in 4 cases, while MRI corrected CT diagnosis in 11 cases; in 15 patients both techniques had the same diagnostic accuracy. Meniscal tears were better identified by CT, while MRI was superior in the detection of ligamentous lesions and in the characterization of PVNS and tendinitis of the patellar tendon. In conclusion, MRI should be performed in selected cases only, or when CT cannot be trusted; on the other hand, it might also be used as a first-choice diagnostic procedure for synovial pathologies and acute lesions of the anterior cruciate ligament.

The paper reports an echographic study of the popliteal region designed to assess the utility of ultrasonography in the differential diagnosis of the various popliteal pathologies. In a year, 459 soft tissue samples were examined; 250 concerned the knee 138 patients gave negative results, while 112 cases presented this pathology with the following diagnosis: 94 cysts (21 appeared duplicated and monolateral, 28 duplicated and counterlateral), 2 aneurysms, 3 hematomas, 10 solid tumefactions (9 were benign, 1 malignant), 1 venous thrombosis and 2 chondromatosis. Of these 112 cases, 25 had been operated on, and the surgical reports quoted 15 cysts, 9 benign and 1 malignant neoplasm. The results of the study, when compared with the existing literature, highlight the essential role of ultrasound in the diagnostic approach to the pathology of the popliteal region.