STUDY DESIGN:The shape and orientation of the thoracic and lumbar zygapophyseal facets at the T1-L5 level in children were measured and analyzed.OBJECTIVE:To detect the pattern of zygapophyseal facet asymmetry in the thoracic and lumbar spines in children.SUMMARY OF BACKGROUND DATA:Whereas many studies have defined the pattern of zygapophyseal facet asymmetry in adults, there is insufficient data in children.METHODS:A 3-dimensional digitizer was used to measure zygapophyseal facet size, topography (length, width, concavity, convexity, and lateral interfacet height), and orientation (transverse and sagittal facet angles) at the T1-L5 level. Thirty-two complete, nonpathologic skeletons of children (age range from 4 to 17 years), housed at the Hamman-Todd Human Osteological Collection (Cleveland Museum of Natural History, Cleveland, OH) were assessed. Statistical analysis included paired t tests and analysis of variance.RESULTS:In general, zygapophyseal facet asymmetry in children exists only in the superior facets of the thoracic spine and is independent of age: The right superior facet is significantly shorter than the left in all thoracic vertebrae T1-T12 (up to -2.91 mm at T1), and significantly wider than the left in thoracic vertebrae T1-T9 (T8 excluded) (P < 0.003). The right superior transverse and sagittal facet angles are significantly greater than the left in thoracic vertebrae T1-T11, indicating a lesser inclination (in the sagittal plane) and more frontally positioned facet (in the transverse plane) (P < 0.003). Facet asymmetry was not evident in the superior or inferior facets of the lumbar vertebrae.CONCLUSION:Facet asymmetry in thoracic vertebrae appears in early childhood. The pattern of this asymmetry differs from that reported for adults and may be considered as a possible contributing etiological factor in the development of different types of idiopathic scoliosis.

Background: Musculoskeletal ultrasonography (U.S.) is an important imaging technique in the diagnosis of olecranon bursitis, especially for early manifestation. It allows sensitive detection of small fluid collections as well as for differentiation between soft tissue and bone lesions. U.S. examination allows detection of effusions, synovial proliferation, calcifications, loose bodies, rheumatoid nodules, gout tophi and septic processes.Aim: To assess the role of ultrasonography in the diagnosis and management of patients with olecranon bursitis.Methods: Ultrasound was used in 34 patients with swelling above the olecranon. The opposite asymptomatic side served as a control group.Results: 20 patients demonstrated increased fluid collection in the olecranon bursa. 5 had synovial proliferation, 2 cases showed loose body, 5 patients revealed markedly increased blood flow consistent with inflammation, 2 patients had triceps tendonitis with calcifications.Conclusions: Sonography is an extremely effective tool for the diagnosis of soft tissue lesions in the olecranon area.

Soft tissue masses are amongst the commonest complaints encountered in orthopedic practice. Of these, masses found in the hand and the wrist are presented at higher frequency. They are often painful and may cause limitation of movement.This work describes the prevalence and the nature of soft tissue masses in the hand and wrist encountered in routine practice. This work was performed to assess the characteristics of soft tissue mass in the hand and the effectiveness of ultrasonography in the diagnosis of soft tissue masses and their differentiation from other lesions in the hand and wrist. Orthopedic surgical conditions that involve soft tissue in the hand and wrist may remain a diagnostic challenge when clinical diagnosis is uncertain and standard X-rays are non-diagnostic. High resolution ultrasound is widely available, non-invasive, without damage of radiation, imaging modality that can help the diagnosis.We reviewed retrospectively 25 patients with soft tissue masses. We compared the ultrasound findings with the histological findings in seven operated patients.A substantial majority of these lesions occurred in the right hand: 79% of the lesions were in the dorsal aspect of the hand, of which 37% were distal to the wrist joint, among them 42% at wrist either radial or ulnar; and 21% of the lesions were found in the volar aspect, among them 17% at wrist aspect, either radial or ulnar side. No predisposing factors could be found.The findings of this study reaffirm the utility of ultrasonography as primary diagnostic tool in routine orthopedic practice.

The benefit of adding sonography to the examination of patients suffering from shoulder pain, was examined in this retrospective evaluation. A patient suffering from shoulder pain consults generally his family physician, who sends his patient first to a radiography and not to sonography. In 75% of the patients examined by sonography, shoulder lesions were diagnosed, demonstrated in only 33% of radiographs. Most patients had more than one lesion: 38% had partial or full-thickness tears of the supraspinatus tendon, about one third bicipital tendonitis, 18% irregularities of the humeral greater tuberosity, 10% subdeltoid bursitis and about 10% calcified tendonitis. In about a quarter of the patients, no pathology was found. Many patients had more than one lesion. In conclusion, clinicians encountering shoulder pain should not be content with conventional radiography and are encouraged to make sonographic examinations part of the early diagnostic protocol.

Objective: To describe the prevalence and sonographic appearance of greater tuberosity fractures in patients undertaking shoulder sonography in an outpatient clinic. Methods: We retrospectively reviewed the reports of 854 sonographic shoulder examination and detected 42 patients (26 men, 14 women aged 35–60) with greater tuberosity fractures. Clinical data, sonographic results and plain radiographs correlation were evaluated. Results: 28/42 patients showed discontinuity of the humeral head. 10/42 patients showed gap greater than 2 mm. 4/42 patients showed double line configuration. In 14/2 patients, the fracture was not seen even retrospectively. Conclusions: Greater tuberosity fractures are characterized by sonography as cortical discontinuity, which may appear as a cortical gap or step-off (double line). They can be seen in shoulder sonography examination and should be looked for in every shoulder sonography examination even without clear history of trauma.

Ziel dieser Untersuchung war es, die Wertigkeit der Ultraschalluntersuchung zur Diagnostik schmerzhafter Veränderungen hemiplegischer Schultergelenke nach zerebrovaskulärem Insult zu evaluieren. Es wurden 41 Patienten untersucht, wobei jeweils die kontralaterale Schulter als Kontrollorgan diente. Ultrasonographisch pathologische Veränderungen fanden sich bei 33 hemiplegischen und bei 15 nicht hemiplegischen Schultern, meist als Bizepssehnentendinitis, daneben auch als Supraspinatuseinriss, Kalzifikation, Irregularität am Humeruskopf und Veränderung des AC-Gelenks. Die Ultrasonographie erwies sich dabei als nützliche und effektive Methode zur Diagnostik.

Osteoid osteomas located in the cervical spine are a rare cause of cervical and shoulder pain. However, successful diagnosis of these tumors has become more frequent in the recent years. This is due to more available diagnostic modalities as well as to physician awareness of the possibility that such lesions can cause cervical pain syndrome. Resection of osteoid osteomas located close to the vertebral artery is often technically difficult, and poses significant risk to the patient. We describe resection of such tumors using a posterolateral transpillar approach in three patients. The advantage of this approach is the direct and relatively easy visualization of the tumor, without the need for an extensive dissection. The stability of the cervical spine is not compromised by this approach. However, extension of the operative field is difficult, should the need arise.