Paediatric Musculoskeletal Disease - part 1 ppt

Paediatric Musculoskeletal Disease With an Emphasis on Ultrasound With Contributions by G... IV ContentsDavid Wilson, FRCP, FRCR Department of Radiology Nufﬁ eld Orthopaedic Centre NHS

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Contents I

MEDICAL RADIOLOGY

Diagnostic Imaging

Editors:

A L Baert, Leuven

K Sartor, Heidelberg

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Contents III

David Wilson (Ed.)

Paediatric

Musculoskeletal

Disease

With an Emphasis on Ultrasound

With Contributions by

G Allan · S Bianchi · R Cheung · C Groves · C Martinoli · P J O’Connor

P Thomà · M Valle · D Wilson

Foreword by

A L Baert

With 88 Figures in 141 Separate Illustrations, 11 in Color and 3 Tables

123

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IV Contents

David Wilson, FRCP, FRCR

Department of Radiology

Nufﬁ eld Orthopaedic Centre

NHS Trust

Windmill Road, Headington

Oxford OX3 7LD

UK

Medical Radiology · Diagnostic Imaging and Radiation Oncology

Series Editors: A L Baert · L W Brady · H.-P Heilmann · M Molls · K Sartor

Continuation of Handbuch der medizinischen Radiologie

Encyclopedia of Medical Radiology

Library of Congress Control Number: 2003060242

ISBN 3-540-66828-4 Springer Berlin Heidelberg New York

This work is subject to copyright All rights are reserved, whether the whole or part of the material is concerned, speciﬁ -cally the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on microﬁ lm or

in any other way, and storage in data banks Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always

be obtained from Springer-Verlag Violations are liable for prosecution under the German Copyright Law.

Springer is part of Springer Science+Business Media

http//www.springeronline.com

쏘 Springer-Verlag Berlin Heidelberg 2005

Printed in Germany

The use of general descriptive names, trademarks, etc in this publication does not imply, even in the absence of a speciﬁ c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained

in this book In every case the user must check such information by consulting the relevant literature.

Medical Editor: Dr Ute Heilmann, Heidelberg

Desk Editor: Ursula N Davis, Heidelberg

Production Editor: Kurt Teichmann, Mauer

Cover-Design and Typesetting: Verlagsservice Teichmann, Mauer

Printed on acid-free paper – 21/3150xq – 5 4 3 2 1 0

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Contents V

Dedication

To all your children and

to the young people in our family:

Emma, Phil, Iain, Neil, Rachael, Siân, Natalie and Jack.

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Contents VII

During recent years the important role of ultrasound in the diagnosis and management of musculoskeletal diseases has become well established The speciﬁ c strengths of this modal-ity become quite evident in the examination of children because of the absence of ionising radiation and the close interaction between examiner and patient

This volume highlights the role of ultrasound as a primary or adjuvant diagnostic modal-ity in a range of musculoskeletal disorders and describes its contribution for problem solving and for better patient management

The eminently readable text is completed by superb illustrations

The editor, D Wilson, is a world-renowned expert in the ﬁ eld with a great dedication and interest in paediatric ultrasound The authors of individual chapters were invited to partici-pate because of their long-standing experience and major contributions to the radiological literature on the topic

I would like to thank the editor and the authors and congratulate them most sincerely for their superb efforts that have resulted in this outstanding volume

This book will be of great value not only for general and paediatric radiologists but also for paediatricians and paediatric orthopaedic surgeons It will provide all of these specialists with state-of-the-art information on a narrow but fascinating medical ﬁ eld

I am conﬁ dent that it will meet the same success with readers as previous volumes in this series

Foreword

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Contents IX

Preface

When I started examining patients with ultrasound for musculoskeletal disorders we were still using static “B” scanners CT was a new invention and MRI did not exist Whilst my contemporaries were enthusiastically specialising in the use of nuclear medicine and ultra-sound, I chose to take an interest and eventually a full-time specialisation in a system rather than a machine The principal strength of this choice is that I use all imaging methods and hopefully have insight into their advantages and weaknesses in each potential application It does mean that I have little knowledge of what goes on in the abdomen, chest or brain and that, for better or worse, I will have to work with orthopaedic surgeons and rheumatologists for the remainder of my career

Reading textbooks on imaging I am struck by the sometimes tortuous reasoning that others employ to explain why their preferred technique is useful to make a diagnosis in all illnesses They are at times blinkered to the strengths of a rival method and often overlook the potential for correlation of the signs on more than one technique My view is that mus-culoskeletal radiologists should be skilled in the interpretation of plain ﬁ lms, ultrasound, nuclear medicine, CT and MRI To miss out one of these is to be like a gardener with a fork and rake but no spade There is no place for rivalry as all are needed to carry out an accurate, safe and effective practice

I was asked to edit a text on paediatric musculoskeletal imaging I have chosen to empha-sise the role of ultrasound, which is very well suited to the examination of children, who commonly will not lie still, require reassurance by personal contact and need a non-invasive and comfortable method of examination We are all aware of the dangers of ionising radia-tion and the potential for fear and anxiety when inside the bore of an MR system However,

CT and MRI are powerful means of making a diagnosis, and sedation or anaesthesia are practical options

Clinicians, therapists and diagnosticians need to understand the strengths and weak-nesses of each imaging method with knowledge of the alternative methods

This book describes a range of practical problems in diagnosis and therapy where ultra-sound has a signifi cant role to play In some circumstances ultraultra-sound is the most effective means of diagnosis, as in the assessment of developmental dysplasia or stress-testing the integrity of a tendon We consider the support ultrasound lends to other methods, perhaps confi rming a diagnosis, for example the detection of infl ammatory synovitis in juvenile arthropathy Lastly, we discuss where ultrasound is a weaker alternative to other more com-prehensive methods, such as in the detection of periosteal reaction over an area of osteomy-elitis

We do not cover those areas of musculoskeletal practice where ultrasound has no current role For example, CT and MRI are the most effective means of making a diagnosis of hind-foot coalition, but ultrasound cannot show us the deep structures

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X Contents

Ultrasound machines vary widely in their ability to realise images of superﬁ cial lesions

In musculoskeletal applications most lesions are near the surface and care must be taken

to select the best equipment Even the latest machines may fail in this area, and thorough knowledge of the technology is important to guide our patients to effective diagnosis and treatment

Ultrasound, CT and MRI demand a wide knowledge of anatomy, including variations of normal Ultrasound is a dynamic examination, and the examiner must also understand the biomechanics and function of the regions studied

The authors of the chapters in this book are all renowned musculoskeletal imaging spe-cialists They have been briefed to discuss all the imaging appropriate to a suspected diagno-sis, and we hope that the reader will gain an understanding of where each method ﬁ ts into a modern practice

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Contents XI

1 Congenital and Developmental Disorders

David Wilson and Ruth Cheung 1

1.1 Introduction 1

1.2 Developmental Dysplasia of the Hip 1

1.2.1 Clinical Background 1

1.2.2 Role of Imaging in Detection 2

1.2.3 Role of Imaging in Treatment 4

1.2.4 Potential Developments 5

1.3 Focal Defects 7

1.3.2 Role of Imaging 8

1.4 Talipes Equinovarus 9

1.5 Neural Tube Defects 10

References and Further Reading 16

2 Trauma and Sports-related Injuries Philip J O‘Connor and Clare Groves 19

2.1 General Principles 19

2.1.1 Biomechanics 19

2.1.2 Imaging 20

2.2 Acute Trauma 20

2.2.1 Acute Fracture Patterns 20

2.2.2 Foreign Bodies 24

2.2.3 Haematoma 25

2.2.4 Muscles and Tendons 26

2.3 Chronic Trauma 28

2.3.1 Chronic Fracture Patterns 28

2.4 The Osteochondroses 32

2.4.1 Osteochondritis Dissecans 32

2.4.2 Panner’s Disease 33

2.4.3 Medial Epicondylitis (Little League Elbow) 34

Contents

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XII Contents

2.5 Accessory Ossicles 34

2.6 Bursae 34

2.7 Summary 37

3 Ultrasonography of Tendons and Ligaments Maura Valle, Stefano Bianchi, Paolo Tomà, and Carlos Martinoli 39

3.1 Introduction 39

3.2 Normal Anatomy 39

3.2.1 Tendons 39

3.2.2 Ligaments 40

3.3 Examination Techniques and Normal Imaging Findings 40

3.3.1 US 40

3.3.2 MR imaging 42

3.4 Tendon Abnormalities 43

3.4.1 Overuse Injuries 43

3.4.2 Avulsion Injuries 43

3.4.3 Snapping Hip 46

3.4.4 Degenerative and Inﬂ ammatory Conditions 47

3.5 Ligament Abnormalities 50

3.6 Conclusion 51

4 Inﬂ ammatory Disorders David Wilson 53

4.1 Introduction 53

4.2 Irritable Hip 53

4.2.4 Management Protocol 57

4.3 Synovitis 58

4.4 Osteomyelitis and Soft-tissue Infection 59

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