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Diagnosis and treatment of flexor tendon injuries of the hand: what the radiologist needs to know

Daniels, Steven P; Kirby, David; De Tolla, Jadie
This article reviews the diagnosis and treatment of flexor tendon injuries of the hand highlighting flexor tendon anatomy, important pre-operative imaging findings, surgical options, and post-operative complications. Imaging plays a key role in guiding treatment of these difficult to manage injuries. Thus, it is important for radiologists to have a sound understanding of factors important in treatment decision-making. In the pre-operative setting, accurately identifying the location of the torn proximal tendon stump in subacute and chronic injuries helps dictate whether the patient is a candidate for a primary flexor tendon repair or may require a tendon reconstruction to restore function. In the post-operative setting, the status of the repair and presence of surrounding adhesions help dictate if and when the patient will require subsequent surgery and whether that surgery will be a tenolysis, revision repair, reconstruction, or fusion.
PMID: 37828095
ISSN: 1432-2161
CID: 5604712

Evaluation of Ulnar Sided Wrist Pain

Adenikinju, Abidemi; De Tolla, Jadie
Ulnar sided wrist pain often presents a diagnostic challenge. Creating a meaningful differential diagnosis is possible with a detailed history and systematic physical exam using provocative maneuvers. Targeted imaging studies can allow for further narrowing of the differential and ultimate diagnosis.
PMID: 36821735
ISSN: 2328-5273
CID: 5508932

Perilunate Dislocations: Current Treatment Options

Fisher, Nina D; Bi, Andrew S; De Tolla, Jadie E
➢/UNASSIGNED:Approximately 25% of all patients who sustain perilunate dislocations present in a delayed fashion. ➢/UNASSIGNED:While management of acute injuries is relatively well-described, treatment of chronic injuries can be complex and there is a paucity of scientific evidence to guide management. ➢/UNASSIGNED:Treatment options include open reduction internal fixation, proximal row carpectomy, scaphoid or lunate excision with or without arthrodesis, and total wrist arthrodesis, although indications vary based on chronicity of injury and patient factors. ➢/UNASSIGNED:The purpose of this article was to determine the quality of evidence supporting surgical options for the treatment of these injuries.
PMID: 36413343
ISSN: 2329-9185
CID: 5373782

Nerve Imaging in the Wrist

Daniels, Steven P; De Tolla, Jadie E; Azad, Ali; Petchprapa, Catherine N
Neuropathic symptoms involving the wrist are a common clinical presentation that can be due to a variety of causes. Imaging plays a key role in differentiating distal nerve lesions in the wrist from more proximal nerve abnormalities such as a cervical radiculopathy or brachial plexopathy. Imaging complements electrodiagnostic testing by helping define the specific lesion site and by providing anatomical information to guide surgical planning. This article reviews nerve anatomy, normal and abnormal findings on ultrasonography and magnetic resonance imaging, and common and uncommon causes of neuropathy.
PMID: 35609575
ISSN: 1098-898x
CID: 5283882

Penlight versus Smartphone: Diagnostic Efficacy of Transillumination

Azad, Ali; DE Tolla, Jadie; Ayalon, Omri; Hacquebord, Jacques H; Glickel, Steven Z; Catalano, Louis W
PMID: 35404214
ISSN: 2424-8363
CID: 5205072

Imaging Evaluation of Medial and Lateral Elbow Pain: Acute and Chronic Tendon Injuries of the Humeral Epicondyles

Daniels, Steven P; De Tolla, Jadie E; Azad, Ali; Fritz, Jan
Medial and lateral elbow pain are often due to degenerative tendinosis and less commonly due to trauma. The involved structures include the flexor-pronator tendon origin in medial-sided pain and the extensor tendon origin in lateral-sided pain. Multimodality imaging is often obtained to verify the clinically suspected diagnosis, evaluate the extent of injury, and guide treatment decisions. Image-guided procedures can provide symptom relief to support physical therapy and also induce tendon healing. Surgical debridement and repair are typically performed in refractory cases, resulting in good to excellent outcomes in most cases. In this article, we review and illustrate pertinent anatomical structures of the distal humerus, emphasizing the structure and contributions of the flexor-pronator and extensor tendon origins in acute and chronic tendon abnormalities. We also discuss approaches to image-guided treatment and surgical management of medial and lateral epicondylitis.
PMID: 34706389
ISSN: 1098-898x
CID: 5042572

Musculoskeletal Ultrasonography of the Extremities: Clinical and Ultrasonographic Correlation

Azad, Ali; De Tolla, Jadie; Walter, William; Paksima, Nader; Melamed, Eitan
Ultrasonography as a diagnostic and therapeutic tool has become a resource for musculoskeletal injuries. It can be a useful imaging modality for clinical correlation of physical examination findings as well as an aid for image-guided procedures. Understanding the settings in which it is a helpful adjunct will have implications on efficiency and cost utility. The objectives of this chapter are to provide a background of ultrasonography as a musculoskeletal imaging modality, provide clinical correlation for ultrasonographic findings for common upper extremity pathology, review the diagnostic efficacy of ultrasonography for image-guided procedures, and provide insight into the cost utility of ultrasonography guidance for therapeutic injections.
PMID: 33438941
ISSN: 0065-6895
CID: 4746862

Necrotizing Infections of the Hand and Wrist: Diagnosis and Treatment Options

Choueka, Jack; De Tolla, Jadie E
Necrotizing infections of the hand and wrist are important clinical entities because of their rapidly progressive and potentially lethal nature. These infections encompass a spectrum of diseases with overlapping signs and symptoms, which can be subtle and nonspecific. If the brief prodromal period of these infections goes unrecognized, a local area of devitalized tissue can evolve into fulminant infection, multiorgan failure, and potentially death. Early recognition and treatment including administration of broad-spectrum antibiotics and surgical débridement are paramount to improving patient outcomes.
PMID: 31403486
ISSN: 1940-5480
CID: 4041852

A Systematic Review of All Smart Phone Applications Specifically Aimed for Use as a Scoliosis Screening Tool

Naziri, Qais; Detolla, Jadie; Hayes, Westley; Burekhovich, Steven; Merola, Andrew; Akamnanu, Chibukem; Paulino, Carl B
The scoliometer is an inclinometer commonly used in scoliosis screening. The device is used during an Adam's forward bend test, in which a patient bends forward at the hips to measure deformity of the rib cage and spinal column. If a sufficient angle of rotation is measured, then the appropriate referrals and x-rays can be made and taken. This ubiquitous screening tool allows for a quick and simple scoliosis screening and is a mainstay of scoliosis management. With the advent and rapid improvement of smart phone technology, many scoliometer applications have become readily accessible. Our study was designed to test the accuracy, precision, and calibration of several scoliometer applications available on both the Apple iPhone and Samsung Galaxy platforms. Application cost was also analyzed to assess the plausibility of using a smartphone scoliometer application in place of a traditional scoliometer in a traditional scoliosis screening. Our data show that available smart phone applications can be used effectively and that, in a controlled environment, some applications performed better than a traditional scoliometer. Application price was not correlated with effectiveness; the cost-free application performed better than the for-purchase application.
PMID: 29772989
ISSN: 1940-4379
CID: 3164972

Irreducible Galeazzi Fracture-Dislocations

Yohe, Nicholas J; De Tolla, Jadie; Kaye, Marc B; Edelstein, David M; Choueka, Jack
BACKGROUND:Fractures of the radial shaft with disruption of the distal radial ulnar joint (DRUJ) or Galeazzi fractures are treated with reduction of the radius followed by stability assessment of the DRUJ. In rare instances, the reduction of the DRUJ is blocked by interposed structures requiring open reduction of this joint. The purpose of this study is to review all cases of irreducible Galeazzi fracture-dislocations reported in the literature to offer guidelines in the diagnosis and management of this rare injury. METHODS:A search of the MEDLINE database, OVID database, and PubMed database was employed using the terms "Galeazzi" and "fracture." Of the 124 articles the search produced, a total of 12 articles and 17 cases of irreducible Galeazzi fracture-dislocations were found. RESULTS:The age range was 16 to 64 years (mean = 25 years). A high-energy mechanism of injury was the root cause in all cases. More than half of the irreducible DRUJ dislocations were not identified intraoperatively. In a dorsally dislocated DRUJ, a block to reduction in most cases (92.3%) was secondary to entrapment of one or more extensor tendons including the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum communis, with the remaining cases blocked by fracture fragments. Irreducible volar dislocations due to entrapment of the ulnar head occurred in 17.6% of cases with no tendon entrapment noted. CONCLUSIONS:In the presence of a Galeazzi fracture, a reduced/stable DRUJ needs to be critically assessed as more than half of irreducible DRUJs in a Galeazzi fracture-dislocation were missed either pre- or intraoperatively.
PMID: 29185351
ISSN: 1558-9455
CID: 2980262