Clinical Cases / News
Carpal Tunnel syndrome.
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The video demonstrates a significant change in the left median nerve cross-sectional area proximal too and at the level of the flexor retinaculum. In keeping with a degree of median nerve entrapment.
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The video demonstrates the median nerve as we move from proximal to distal.
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Point of care ultrasound for assessment of Osseous injury.
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A 49 year old lady visited clinic 360 with well localised dorsal sided mid-foot pain that began 2 weeks prior. She was a keen runner. An x-ray had already been organised which was reported as normal.
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The sonographic images show a clear discontinuity of the chondral surface of the 2nd MTP shaft with adjacent hyperaemia, in keeping with a stress fracture.
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Though there are limitations in the assessment of bony pathology with ultrasound, this imaging modality is highly sensitive at assessing for chondral injuries that can easily be missed on plain radiograph.
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MRI images (Axial and Coronal views) of the left shoulder in a young athlete who developed gradual shoulder pain and stiffness who presented to clinic 360.
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The appearances are those of established osteoarthritis with numerous intra-articular bodies and a small joint effusion with some associated synovitis.
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Unusual presentation in a young athlete.
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Some recent reviews by a handful of patients our team has seen over the last month.
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We know making medical appointments can be daunting. Our team is on hand to answer any questions or concerns you may have before making an appointment with us.
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Our aim is to provide a first class level of care to every patient that we see.
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Osteoarthritis is one of the most prevalent long term conditions that effects the musculoskeletal system
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Activity modification and appropriate graded exercise can allow the majority of patients to manage the problem
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Unfortunately there are times where these conservative measures don’t provide the intended benefit. Though there is no cure for osteoarthritis there are other effective management strategies
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Ultrasound guided injections are an effective management option. They allow patients to better manage their symptoms and adhere to graded exercise. The clinicians at clinic 360 are experienced musculoskeletal practitioners that can make you aware of all the management strategies available to you.
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Sonographic images demonstrating Quadriceps tendinopathy.
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The tendon is hypoechoic, heterogeneous and thickened with increased vascularity.
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Mainstay of treatment was activity modification and progressive rehab for this athlete to improve exercises capacity and tolerance.
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Ultrasound will help guide return to play for this athlete.
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Ultrasound guided joint aspiration (Arthrocentesis)
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A medical procedure whereby synovial fluid is removed from a joint for diagnostic (inflammatory/non inflammatory/ infectious causes) and therapeutic benefit.
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In the case of this elderly gentleman who had a swollen knee for many months and confirmed joint osteoarthritis on X-ray. The aspiration of clear serous fluid (shown in the images) prior to injecting the knee joint with steroid provided an immediate reduction in pain.
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Sonographic appearance of an ultrasound guided glenohumeral (shoulder) joint injection.
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Typical indications for this procedure include adhesive capsulitis and glenohumeral osteoarthritis.
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An often challenging structure to image clearly with ultrasound is the distal attachment of the biceps tendon at the elbow.
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The orientation of its distal tendon fibres onto the radial tuberosity make it susceptible to anisotropy.
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The image shown is a clear, artifact free example of a healthy distal biceps tendon in the longitudinal plane with its clear attachment onto the radial tuberosity.
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Image guided injections.
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Ultrasound enables us to clearly visualise and accurately place medication into a joint space such as the hip joint as shown in this image.
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Point of care ultrasound.
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This patient was a professional boxer and suffered a hyperextension injury to the elbow while fighting. He was struggling to continue to throw a punch due to pain. He had a normal X-ray prior to his visit.
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Clinically there was no obvious deformity or swelling, good range of movement of the elbow but with pain into end of range extension.
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The first image shows the sonographic appearance of the anterior elbow. On the left is the gentleman’s unaffected elbow. On the right there was an obvious joint effusion within the coranoid fossa lifting the fat pad from the chondral surface. The cortical margins of the capitulum was also irregular (not seen in image)
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The second image is a sagittal fat suppressed MRI image showing an area of high signal consistent with subchondral oedema within the capitulum reported as a small stable osteochondral defect.
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The history and sonographic images raised the suspicion of a chondral injury, though further imaging was required to confirm this, ultrasound proved an immediate and helpful resource.
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