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Objective: To study the clinical value of three-dimensional ultrasonography (3D-US) in the morphological evaluation of rotator cuff tears (RCTs). Methods: Based on previously published literature, RCT patterns in our study were divided into crescent, L-shaped with the remnant tendon retracted to the anterior rotator cuff (aL-shaped), L-shaped with the remnant tendon retracted to the posterior rotator cuff (pL-shaped), T-shaped (a tear pattern that is a combination of aL-shaped and pL-shaped), U-shaped, and massive type. Two radiologists prospectively assessed the tear patterns using 3D-US as well as magnetic resonance imaging (MRI) and compared these results using arthroscopy to calculate diagnostic accuracy. Result: Fifty-two patients (52 shoulders) were enrolled. The overall diagnostic accuracy of 3D-US in evaluating RCT patterns (82.7%, 43/52; 95% CI: 72.1–93.3%) was significantly higher (p = 0.008) than that of the MRI (57.7%, 31/52; 95% CI: 45.8–73.4%). The accuracy of 3D-US was higher than that of MRI for most types of tears (crescent: 95.0% vs. 55.0%, aL-shaped: 83.3% vs. 77.8%, pL-shaped: 50.0% vs. 25.0%, T-shaped: 75.0% vs. 0.0%, and massive type: 80.0% vs. 100.0%). The accuracies of 3D-US with respect to evaluation by the two radiologists were 84.6% (44/52) and 76.9% (40/52), and there was substantial agreement evident (κ = 0.709). The time taken by the two radiologists to reconstruct the 3D-US images and evaluate the tear pattern was < 5 min. Conclusion: The 3D-US can be used for the preoperative evaluation of RCT patterns, and thus be useful for the correct selection of the surgical repair technique for RCTs. Key Points: • Few studies have been found exploring the value of 3D-US for the morphological evaluation of RCTs and correlated with the arthroscopic findings. • Based on previous studies on the morphological classification, anterior L shape (aL-shaped), and posterior L shape (pL-shaped) were used for the first time to describe the torn patterns of RCT. [ABSTRACT FROM AUTHOR]

The frequency of musculoskeletal system ultrasonography (US) has increased over time. The most common reason for musculoskeletal US is the evaluation of tendons. The superficial location of tendons makes US the most suitable diagnostic tool, and US is generally the initial imaging modality for tendon disorders. The primary advantages of US are its low cost, easy accessibility, rapidity, repeatability, freedom from x‐rays, and enabling of a dynamic inspection. In addition, Doppler US and elastography can be performed simultaneously with US. We aimed to demonstrate the US and elastographic findings of tendon disorders that we frequently encounter in different regions. [ABSTRACT FROM AUTHOR]

On the basis of a comprehensive clinical and radiation study, considering the morphological characteristics of damaged intra-articular structures relative to isolated and combined ruptures of ligaments and menisci, 3 groups of patients were identified: the first group consisted of patients with meniscus injuries, the second group - patients with injuries of the ligamentous apparatus of the knee joint, the third - with combined injuries of the ligaments and menisci. All patients underwent X-ray, ultrasound, MRI, and arthroscopy. The analysis of the results of the study of patients with combined injuries of the ligaments and menisci made it possible to confirm the high diagnostic capabilities of US- and MP-criteria for visualization of ruptures of the ligaments and menisci, demonstrated in groups with their isolated injuries. The results obtained indicate a high efficiency of ultrasound in the diagnosis of synovitis, free fluid in the joint cavity, Baker's cysts, as well as a sufficient efficiency for the diagnosis of isolated meniscus injuries and low efficiency for the diagnosis of cruciate ligament injuries. In this case, it is preferable to use magnetic resonance imaging, which is confirmed by a comparative analysis of the results of MRI and arthroscopy and the data of calculations of the sensitivity and specificity of the method for diagnosing closed injuries of the knee joint. [ABSTRACT FROM AUTHOR]

The aim of this pilot study was to investigate whether the clinical Matthiass test can be objectified by means of dynamic rasterstereography in children. We aimed at discriminating between postural weak and strong children. Dynamic rasterstereography was used to capture sagittal spinal posture changes during the modified Matthiass test (mMT). Primary outcomes were spinal posture changes (trunk inclination, kyphotic and lordotic angles) during the test. Two-step cluster analysis was run jointly on the three primary outcomes. Data of 101 healthy children (10-14 years, 46% girls) were assessed. Cluster analysis identified two groups of participants with significantly different postural performance levels during the mMT (low vs. high performers). Low performers showed a higher increase in backward lean, as well as kyphosis and lordosis (4°-5°, respectively) when compared to high performers. The two performance groups were age-, BMI-, and activity-matched.Conclusion: This pilot study established preliminary normative data on spinal posture changes during the Matthiass test (high performers) and provided corresponding cutoff values for postural weakness (low performers). These results could provide a basis for future longitudinal and interventional studies targeting long-term consequences of childhood postural weakness and the prevention of back pain. What is Known: • The prevalence of postural insufficiencies in children is high. • No consensus exists about the postural assessment in children. • A common clinical test to identify postural insufficiency is the Matthiass test yet criticized for its subjective assessment. What is New: • This pilot study objectified the modified Matthiass test by rasterstereography and statistically identified two groups of healthy children with different postural performance levels. • It established preliminary normative data on spinal posture changes and provided corresponding cutoff values for postural weakness. [ABSTRACT FROM AUTHOR]

Hemorrhage in the central nervous system is the most severe and debilitating manifestation affecting patients with hemophilia A. The spinal epidural space is the most unusual and clinically challenging site of central nervous system hemorrhage in hemophilia A. These patients often show insidious neurological signs and symptoms that delay diagnosis and treatment. We share our experience treating a 4-year-old male patient with severe hemophilia A and high titer inhibitors with a spontaneous spinal epidural hematoma. The patient presented initially with intense headache and neck pain. After blood tests and imaging studies, bypassing agent therapy with recombinant-activated factor VII was used until discharge; this was later replaced with emicizumab. After 18 months, the patient is without neurological sequelae and has not experienced subsequent bleeding episodes. We review the available literature and discuss the relevance of emicizumab compared with standard therapies in the context of spontaneous spinal epidural hematoma., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

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