OBJECTIVE: To explore effectiveness of musculoskeletal ultrasound combined with Wide-Awake technique in extensor indicis proprius tendon (EIP) transfer for repairing extensor pollicis longus tendon (EPL) rupture. METHODS: A clinical data of 20 patients with EPL spontaneous rupture, who were admitted between January 2019 and June 2024 and met the selective criteria, was retrospectively analyzed. During EIP transfer surgery, the musculoskeletal ultrasound-guided incision marking combined with Wide-Awake technique was used in combination group (n=10) and the tourniquet-assisted surgery under brachial plexus block anesthesia in the control group. There was no significant difference in the baseline data between groups (P>0.05), including gender, age, affected side, cause and location of tendon rupture, and time from injury to hospitalization. The accuracy of preoperative musculoskeletal ultrasound in predicting the actual tendon rupture site was evaluated in the combination group. The operation time, intraoperative blood loss, visual analogue scale (VAS) scores during operation and at 6 hours after operation, total incision length, and postoperative complications were recorded. Surgical outcomes were assessed at 12 months after operation using the specific EIP-EPL evaluation method (SEEM), which included measurements of thumb elevation loss, thumb flexion loss, index finger dorsiflexion loss, and total score. RESULTS: In the combination group, the incision position marked by preoperative musculoskeletal ultrasound positioning was consistent with the actual tendon rupture position. Compared with the control group, the operation time and total incision length in the combination group were significantly shorter and the VAS score at 6 hours after operation was significantly higher (P<0.05). There was no significant difference in intraoperative blood loss or intraoperative VAS score between groups (P>0.05). All incisions in both groups healed by first intention. Two patients in the control group developed swelling and blisters in the tourniquet area, which subsided spontaneously without special treatment. All patients were followed up 12-14 months, with an average of 12.5 months. The thumb dorsiflexion function of all patients recovered to varying degrees. At last follow-up, the thumb elevation loss in combination group was significantly lower than that in control group, and the total score was significantly higher (P<0.05); there was no significant difference in thumb flexion loss or index finger dorsiflexion loss between groups (P>0.05). CONCLUSION Musculoskeletal ultrasound can accurately locate the site of tendon rupture, assist the Wide-Awake technique in implementing precise anesthesia, and adjust tendon tension while reducing tissue trauma, with satisfactory effectiveness.
Humans ; Male ; Tendon Injuries/diagnostic imaging* ; Tendon Transfer/methods* ; Female ; Retrospective Studies ; Adult ; Middle Aged ; Ultrasonography/methods* ; Rupture/surgery* ; Treatment Outcome ; Operative Time ; Tendons/surgery* ; Young Adult

OBJECTIVE: To explore the ultrasonic anatomical characteristics and needle-knife insertion approach of common tendon lesions in knee osteoarthritis (KOA), so as to provide the references for accurate release of KOA by needle- knife along tendon lesions based on meridian sinew theory. METHODS: Sixty patients with one-knee KOA were selected. High-frequency musculoskeletal ultrasound was used to collect sonograms at the anatomical positions of "Hedingci" "Binwaixia" "Binneixia" and "Yinlingshang". The anatomic levels were marked on the sonograms. The anatomic levels and sonographic features of lesions were compared and analyzed, and the relevant data of needle-knife simulation approach was measured. RESULTS: The "Hedingci" lesions were mainly located at the attachment of quadriceps tendon to patella and suprapatellar bursa. The "Binwaixia" and "Binneixia" lesions were mainly located at the attachment of retinaculum patellae laterale and retinaculum patellae mediale to patella and infrapatellar fat pad. The "Yinlingshang" lesions were mainly located at the attachment of goose foot tendon to medial tibial condyle and bursa of goose foot. With "Hedingci" as an example, when the needle-knife entry point was 1 cm above the patella, the attachment of quadriceps tendon to patella was released, and the average depth of needle-knife was (3.60±0.10) cm, and the needle body was perpendicular to the skin. The average depth of needle-knife for releasing suprapatellar bursa was (2.35±0.17) cm, and the needle body was 45° towards head. CONCLUSION The musculoskeletal ultrasound could clearly show the local detailed anatomical level, ultrasonic characteristics and anatomical level of common tendon lesions of KOA, and could improve the accuracy of needle-knife along tendon lesions with non-direct vision, which has important reference value for needle-knife medical standardization and standardized operation.
Humans ; Knee Joint/surgery* ; Meridians ; Osteoarthritis, Knee/surgery* ; Patella ; Tendons/surgery* ; Ultrasonography

OBJECTIVE: To observe the imaging features of focus of knee joint tendon in patients with knee osteoarthritis (KOA) by musculoskeletal ultrasound (MSUS) technique. METHODS: One hundred KOA patients and 100 healthy subjects were included. All the KOA patients were palpated by the sequence of foot RESULTS: The top-5 focus of knee tendon of KOA patients were located in medial inferior patella, medial tibial condyle, inferior patella, Zusanlici and Hedingci. The thickness of ligaments and tendons in extension and flexion positions in KOA patients were thicker than that in healthy subjects ( CONCLUSION The focus of knee joint tendon in KOA patients shows significantly thickened musculoskeletal imaging features.
Healthy Volunteers ; Humans ; Knee Joint/diagnostic imaging* ; Osteoarthritis, Knee/diagnostic imaging* ; Tendons/diagnostic imaging* ; Ultrasonography

No abstract available.
Elasticity Imaging Techniques ; Elasticity ; Tendons ; Ultrasonography

BACKGROUND: This study aimed to determine the effects of single semitendinosus tendon (ST) harvesting for anterior cruciate ligament (ACL) reconstruction by comparing outcomes of single ST and semitendinosus-gracilis tendon (ST-G) harvesting. METHODS: ACL reconstruction with ST-G harvesting (D group, n = 60) or single ST harvesting (S group, n = 60) were included according to inclusion criteria. Subjective assessments included subjective International Knee Documentation Committee score, Lysholm score, and Tegner activity scale score. Objective assessments included isokinetic strength and functional tests. These tests were completed at 36 months of follow-up. Magnetic resonance imaging (MRI) and second-look arthroscopy findings were evaluated. In the S group, regeneration properties were assessed by serial ultrasonography (US). RESULTS: The S group showed significantly less deep flexor strength deficit than the D group (p < 0.001). Deep flexor power deficits showed significant correlation with the shift of musculotendinous junction of the ST. There was significant difference in the cocontraction test between the groups (p = 0.012), and the S group tended to show better results in other functional tests at the last follow-up. There were no significant differences in graft tension and synovial coverage on second-look arthroscopy between the groups. In the S group, the regeneration rates assessed by US at the joint line and distal insertion were 81.7% and 80%, respectively at 6 months of follow-up. CONCLUSIONS: The S group showed significantly less deficit in deep flexor strength and tended to show better clinical results at the last follow-up than the D group. In the S group, more than 80% showed good regeneration at the 6-month follow-up. Hence, single ST harvesting is effective in minimizing flexor weakness and functional deficits and shows great potential for regeneration.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Arthroscopy ; Follow-Up Studies ; Joints ; Knee ; Lysholm Knee Score ; Magnetic Resonance Imaging ; Regeneration ; Tendons ; Transplants ; Ultrasonography

BACKGROUND: Latissimus dorsi (LD) tendon transfer is used as a treatment option for massive irreparable posterosuperior rotator cuff tears, and recently, an arthroscopic-assisted technique was introduced. This study was undertaken to evaluate the clinical and radiological outcomes of arthroscopic-assisted LD tendon transfer for the management of irreparable rotator cuff tears in active middle-aged patients. METHODS: The records of five patients (two males) with irreparable tears involving the supraspinatus and infraspinatus tendons managed by arthroscopic-assisted LD tendon transfer were retrospectively reviewed. Clinical outcomes were assessed using the visual analogue scale (VAS) pain scale, American Shoulder and Elbow Surgeon's (ASES) scores, the University of California Los Angeles (UCLA) scale, and ranges of motion. Postoperative integrities of transferred tendon were evaluated by magnetic resonance imaging in 4 patients and by ultrasound in one. RESULTS: Mean patient age was 55 years (range, 48–61 years), and mean follow-up period was 20 months (range, 12.0–27.2 months). Mean VAS score significantly improved from 6.6 ± 2.6 preoperatively to 1.8 ± 2.5 postoperatively (p=0.009), mean ASES score increased from 67.6 ± 9.2 to 84.6 ± 15.1, and mean UCLA score from 18.0 ± 1.4 to 28.8 ± 8.5 (all p<0.001). Postoperative imaging of the transferred LD tendon showed intact repair in 4 patients. The remaining patient experienced LD transfer rupture and a poor outcome. CONCLUSIONS: Arthroscopic-assisted LD tendon transfer improved shoulder pain and function in patients with massive, irreparable rotator cuff tears, and may be an option for this condition, especially in physically active patients.
California ; Elbow ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Rotator Cuff ; Rupture ; Shoulder ; Shoulder Pain ; Superficial Back Muscles ; Tears ; Tendon Transfer ; Tendons ; Ultrasonography

OBJECTIVE: To compare the elasticity of the supraspinatus tendon (SST) and infraspinatus tendon (IST) in patients with idiopathic adhesive capsulitis of the shoulder (ACS) with those in the control groups and to evaluate the relationship between age and tendon elasticity. MATERIALS AND METHODS: The Institutional Review Board approved this prospective, case-control study, which was conducted between November 2017 and March 2018, and informed consent was obtained from all participants. Control groups comprised healthy individuals or those with asymptomatic contralateral shoulders. Twenty-five shoulders in 20 participants in the ACS group (14 women; 53.5 ± 7.9 years) and 24 shoulders in 18 participants in the control group (6 women; 52.6 ± 10.5 years) were included. Elastography was performed in the oblique coronal plane at the neutral shoulder position. Mean/maximum/minimum velocity and stiffness from the shear-wave ultrasound elastography (SWE) and strain ratio (subcutaneous fat/target-tendon) from the strain ultrasound elastography (SE) of the SST and IST were evaluated. Statistical analyses were performed using the Mann-Whitney U test, receiver operating characteristic (ROC) curve, and Spearman correlation. RESULTS: Both velocity and stiffness in SWE were higher, and the strain ratio in SE was lower in participants with symptomatic shoulders than in those with normal shoulders (p < 0.001). SST- and IST-mean velocity, mean stiffness, and strain ratios showed excellent area under the ROC curve (> 0.970). The elastic modulus was little correlated with age (ρ = −0.340–0.239). CONCLUSION: SWE and SE indicated that SST and IST were stiffer in patients with ACS than in those with normal shoulders regardless of aging.
Adhesives ; Aging ; Bursitis ; Case-Control Studies ; Elastic Modulus ; Elasticity ; Elasticity Imaging Techniques ; Ethics Committees, Research ; Female ; Humans ; Informed Consent ; Prospective Studies ; ROC Curve ; Rotator Cuff ; Shoulder ; Tendons ; Ultrasonography

OBJECTIVE: To evaluate the relationship between the palmar cutaneous branch of median nerve (PCBMN) and surrounding anatomical structures by using high-resolution ultrasound (HRUS) to assess the risk of PCBMN injury. METHODS: The PCBMN course and the characteristics of bilateral distal forearms and wrists of 30 healthy volunteers were identified. The distance between PCBMN and other anatomical structures at three different levels along its course were measured using HRUS. Moreover, the depth of PCBMN from skin and its cross-sectional area (CSA) were measured. RESULTS: HRUS showed the PCBMN in all subjects. PCBMN branched off from the radial aspect of the median nerve (MN) at 4.69±0.89 cm proximal to the bistyloid line (BSL) and extended radially toward the flexor carpi radialis (FCR) tendon. PCBMN was within the ulnar edge of FCR tendon sheath, and became more superficial and perforated the antebrachial fascia between the FCR tendon laterally and the palmaris longus (PL) tendon medially. PCBMN was located at 4.08±0.72 mm on the ulnar aspect of the FCR tendon and 4.78±0.36 mm radially on the PL tendon at BSL. At the distal wrist crease level, the PCBMN was located at 5.68±0.58 mm on the ulnar side of the FCR tendon. The PCBMN depth from skin at BSL and its branching point was 1.92±0.41 and 7.95±0.79 mm, respectively. The PCBMN CSA was 0.26±0.15 mm² at BSL. CONCLUSION: HRUS can be used to identify PCBMN and its relationship with other anatomical structures. Our data can be used to predict PCBMN location, and prevent complications associated with invasive procedures involving the wrist.
Carpal Tunnel Syndrome ; Fascia ; Forearm ; Healthy Volunteers ; Median Nerve ; Risk Assessment ; Skin ; Tendons ; Ultrasonography ; Wrist

The shoulder is the third most common region in which musculoskeletal pain occurs, involving symptoms that cause a decrease in quality of life and a reduced ability to perform activities of daily life if untreated. Many lesions cause shoulder pain; therefore, we included those commonly encountered in primary care clinics. We aimed to describe the diagnosis and non-operative or conservative treatment modalities of rotator cuff tendinopathy, impingement syndrome, rotator cuff tear, adhesive capsulitis, biceps tendonitis, and acromioclavicular arthritis. Exercise has been reported to be effective for the treatment of impingement syndrome, and the effect of exercise has been shown to reduce pain. Both home-based self-exercise and exercise supervised by professionals are equally effective. Types of exercise should include stretching, active, active-assistive, and resistive exercise. Ten repetitions per set for 3 sets of each exercise should be prescribed initially post-injury. Repetition and resistance should be increased as strength grows. The use of ultrasonography for the diagnosis of shoulder pain has increased recently. Corticosteroid injection under ultrasonographic guidance is effective in reducing pain.
Arthritis ; Bursitis ; Diagnosis ; Muscle Stretching Exercises ; Musculoskeletal Pain ; Primary Health Care ; Quality of Life ; Rotator Cuff ; Shoulder Pain ; Shoulder ; Tears ; Tendinopathy ; Tendons ; Ultrasonography

PURPOSE: This study aimed to evaluate the diagnostic characteristics and clinical results after surgical repair of traumatic superimposed posterior rotator cuff tear in the setting of preexisting retracted supraspinatus tendon tear.METHODS: A total of 20 patients (mean age, 62.1 years) were included and all patients had significant traumatic events mean 3.7 weeks prior to the surgery. Preoperative acromiohumeral distance (AHD, mean 3.2 mm) and arthritis change were analyzed on plain radiograph and magnetic resonance imaging was evaluated for the nature and extent of torn tendon, and fatty degeneration (FD) of all cuff muscles to validate if the tears were traumatic or chronic.RESULTS: Complete repairs were achieved in 15 patients and partial repair including posterior cuff in five. Functional and radiographic results were statistically evaluated and repair integrities were assessed with ultrasound at average 17.3 months. Overall functional outcome scores were significantly improved and 17 patients (85%) were satisfied with their symptoms. AHD was significantly recovered (mean, 6.7 mm), but two patients showed progression of arthritic change. Retears after the complete repair were three patients (20%), who showed poor outcome, with advanced preoperative FD of posterior cuff muscles. Five patients with partial repair of posterior cuff revealed improved functional score with no sign of retear of posterior cuff on ultrasound.CONCLUSION: Early recognition of traumatic superimposed posterior cuff tears and surgical repair can reliably restore shoulder function, and partial repair of posterior cuff also can be expected favorable outcomes in supraspinatus tear with advanced FD.
Arthritis ; Humans ; Magnetic Resonance Imaging ; Muscles ; Rotator Cuff ; Shoulder ; Tears ; Tendons ; Ultrasonography