Faculty Bibliography

PURPOSE: To retrospectively assess magnetic resonance (MR) imaging features of radial tunnel syndrome. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived for the retrospective HIPAA-compliant study. MR images of 10 asymptomatic volunteers (six men, four women; mean age, 30 years) and 25 patients (11 men, 14 women; mean age, 49 years) clinically suspected of having radial tunnel syndrome were reviewed for morphologic and signal intensity alterations of the posterior interosseous nerve and adjacent soft-tissue structures. MR images of the asymptomatic volunteers were reviewed to establish the normal appearance of the radial tunnel. MR images of the symptomatic patients were evaluated for the following: signal intensity alteration and morphologic alteration of the posterior interosseous nerve; the presence of mass effect on the posterior interosseous nerve such as the presence of bursae, a thickened leading edge of the extensor carpi radialis brevis, or prominent radial recurrent vessels; signal intensity alteration within the depicted forearm musculature such as edema or atrophy; and signal intensity changes at the origin of the common extensor and common flexor tendons, which would suggest a diagnosis of epicondylitis. RESULTS: All images of volunteers demonstrated normal morphology and signal intensity within the posterior interosseous nerve and adjacent soft tissues. Two volunteers had borderline thickening of the leading edge of the extensor carpi radialis brevis. Thirteen patients (52%) had denervation edema or atrophy within muscles (supinator and extensors) innervated by the posterior interosseous nerve. One patient had isolated pronator teres edema. Seven (28%) patients had the following mass effects along the posterior interosseous nerve: thickened leading edge of the extensor carpi radialis brevis (n = 4), prominent radial recurrent vessels (n = 1), schwannoma (n = 1), or bicipitoradial bursa (n = 1). The rest of the patients had either normal MR imaging findings (n = 4) or lateral epicondylitis (n = 2). CONCLUSION: Muscle denervation edema or atrophy along the distribution of the posterior interosseous nerve is the most common MR finding in radial tunnel syndrome

Varus or valgus malalignment of the knee may be either a cause or a consequence of unicompartmental knee arthritis in young, active adults. Proximal tibial osteotomy for the varus knee and distal femoral osteotomy for the valgus knee have been used for decades to manage this condition; however, their use has decreased significantly in recent years as the popularity of unicompartmental and total knee arthroplasty has grown. With the advent of biologic resurfacing techniques for focal full-thickness articular cartilage injury, combined or staged high tibial osteotomy is becoming increasingly popular. In addition, in the face of cruciate ligamentous instability with or without posterolateral corner instability coupled with varus malalignment, high tibial osteotomy with and without ligament reconstruction provides a solution to complex orthopedic problems. Recent long-term follow-up studies have concluded osteotomy allows for improved function and pain relief in properly selected young patients

Persistent shoulder pain is a very common condition that often has a multifactorial underlying pathology and is associated with high societal cost and patient burden. In 2000, the direct costs for the treatment of shoulder dysfunction in the United States totaled $7 billion. Persistent shoulder pain can result from bursitis, tendinitis, rotator cuff tear, adhesive capsulitis, impingement syndrome, avascular necrosis, glenohumeral osteoarthritis (OA), and other causes of degenerative joint disease or from traumatic injury, either in combination or as a separate entity. Rotator cuff disorders, adhesive capsulitis, and glenohumeral OA are all common causes of persistent shoulder pain, accounting for about 10%, 6%, and 2% to 5%, respectively, of all shoulder pain. All 3 conditions have complex etiologies, but they can be diagnosed in the majority of patients on the basis of medical history, focused physical examination, and plain film radiographs. This brief review and the following articles in this supplement focus on persistent shoulder pain associated with rotator cuff disorders, adhesive capsulitis, and glenohumeral OA

This article describes an effective and safe method of motorized shaver placement during hip arthroscopy without the use of a conventional cannula. With this technique, the arthroscopist has greater freedom in maneuvering the shaver in and around the hip joint. This method allows for reproducible placement of the shaver in all 3 portals of the hip

MR imaging is an invaluable method for the workup of a painful hip. It is showing increased sensitivity and specificity for many of the soft tissue and bony abnormalities of the hip, especially with the addition of intra-articular contrast(MR arthrography). Chondral injuries of the femoral head and acetabulum remain an area in MR imaging that should continue to improve with new gradient protocols

A painful condition known as snapping hip may prevent athletes from attaining peak performance, and it presents diagnostic and treatment challenges to the sports medicine physician as well. Three types of snapping hip (external, internal, and intra-articular) are known, and each has a distinct pathomechanic cause, specific symptoms, and classic clinical presentation. History and physical exam are coupled with a variety of imaging modalities to help distinguish the three types. Nonoperative approaches are the mainstay of treatment, but, if unsuccessful, operative treatments also achieve good results. Patients may resume their activities when pain subsides

A retrospective review of 42 patients in whom a rotator cuff injury was diagnosed and who subsequently underwent surgery with the superior acromion-spitting approach technique was conducted. The average size of the tear was 4.2 cm with an average tear retraction of 4.1 cm. Thirty-seven (38 shoulders) of the 42 patients underwent a physical examination, interview, and radiographs at an average followup of 33.4 months (range, 15 to 66). Using the University of California, Los Angeles Shoulder Rating Scale, 27 shoulders were graded as excellent or good, and 11 shoulders were graded as fair or poor. Radiographic examination demonstrated bony union in 29 shoulders. The remaining 9 shoulders had evidence of fibrous union that could be characterized as clinically asymptomatic. Twenty patients had computed tomography scans that demonstrated decompression where the bony or fibrous union had occurred. In addition, some increased decompression in several patients with fibrous union indicated that the anterior acromion sought its appropriate level. Based on the results of this study, the acromion-splitting approach, used as an extension of the miniapproach for rotator cuff tears, can be successfully used when a large or massive rotator cuff tear is identified

Although device failure in intramedullary (IM) nailing of subtrochanteric fractures is uncommon, breakage of the nail can occur. Following a review of the literature on this subject, a case is reported that illustrates the surgical and biomechanical factors that can lead to nail failure

Twenty-nine cases of operative arthroscopy of the ankle were done between 1985 and 1989 for synovial impingement of the ankle. The average age of the patients was 37 years. All patients (17 men, 12 women) reported an earlier history of injury, with 24 of the patients (83%) noting chronic ankle pain after an inversion injury and 5 of the patients (17%) reporting a previous ankle fracture. Physical examination elicited anterolateral tenderness at the ankle in all cases with associated anteromedial pain in 4 patients. A demonstrable 'click' was evident in 6 of the patients (21%) on forced dorsiflexion of the ankle. All patients failed conservative treatment including physical therapy and nonsteroidal antiinflammatory drugs. Surgery was performed at an average of 36 months postinjury. Ankle arthroscopy revealed extensive hypertrophic synovial thickening and scar tissue anterolaterally, indicating synovial impingement in all patients. Associated chondromalacia of the distal tibia was seen in 21% of the patients. Operative arthroscopy included partial synovectomy and debridement of the hypertrophic tissue and partial shaving chondroplasty of the tibia when indicated. Postoperatively, patients were weightbearing as tolerated. Results were assessed subjectively and objectively. At 25-month followup 26 patients had excellent or good results and 3 had fair results; there were no poor results. There were no major complications, including infection or neurovascular compromise. The 3 patients with associated ankle instability comprised the 'fair' result group and eventually required lateral ankle reconstruction. Thus, chronic ankle pain due to synovial impingement can be safely, predictably, and effectively treated by operative ankle arthroscopy