RPS 310 - Selected applications of MSK ultrasound

Author Block: S. A. Jengojan¹, A. Piacentini¹, F. P. Papa¹, V. König¹, D. Albano², Ž. Snoj³, G. Ivanac⁴, G. Bodner¹; ¹Vienna/AT, ²Milan/IT, ³Ljubljana/SI, ⁴Zagreb/HR
Purpose: Palmar fibromatosis (PF), also known as Dupuytren’s disease (DD), is characterized by fibrous nodules and thickening of the palmar fascia, potentially leading to functional impairment of the hand. While its etiology remains unclear, we have observed over and over again in our daily routine that surgical procedures, such as carpal tunnel syndrome (CTS) release may trigger the development of fibromatosis in the palmar Fascia. In this study we investigated whether patients who undergo CTS surgery are more likely to develop palmar fibromatosis nodules, compared to healthy individuals and those with non-operated CTS, using high-resolution ultrasound (HRUS) imaging.
Methods or Background: In this prospective study, we examined 100 patients who had previously undergone CTS surgery, screening for palmar fibromatosis nodules with HRUS. We further evaluated two control groups: 50 healthy volunteers and 30 patients diagnosed with CTS who had not yet had surgery. The prevalence of PF nodules across these groups was documented and compared.
Results or Findings: Out of the 100 patients who had CTS surgery, 35% (n=35) were found to have PF nodules. In contrast, only 1 individual in the group of healthy volunteers had nodules 2% (n=1). None of the patients with non-operated CTS showed evidence of nodules. These findings suggest a highly significant increase in PF among post-CTS surgery patients compared to both healthy controls and those with non-operated CTS.
Conclusion: Our findings suggest that CTS release surgery may be linked to a higher incidence of DD. This raises important questions about the role of surgical intervention in the development of fibromatosis.
Limitations: A limitation of our study is the lack of preoperative imaging, which could not exclude the possibility that the palmar fibromatosis nodules already existed before CTS surgery.
Funding for this study: No funding was needed
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Institutional Review Board. (vote Number 2028/2024) approved the study.

Author Block: J. Peterca, Ž. Snoj, G. Omejec; Ljubljana/SI
Purpose: The objective was to determine the effect of soft tissue compression applied by the US probe on peripheral nerve shear wave velocity (SWV) measurements
Methods or Background: Lower and upper limbs of 20 fresh cadavers were dissected at hip and shoulder region, strapped to inox tray and emerged into the 37°C water bath. The US probe was mounted on robotic arm Yaskawa MH6 (Yaskawa Electric, Fukuoka, Japan). Median nerve at wrist and forearm, and sciatic nerve just proximal to tibial and fibular nerve branching were scanned longitudinally using US Resona R9 (Mindray Bio-medical Electronics, Shenzhen, China) and L14-3WU transducer. The compression of the soft tissue applied by US probe was gradually increased from no contact to 10mm (wrist), 20mm (forearm), and 30mm (posterior thigh) in successive steps of 1, 2, 3, 5, 10, 15, 20, 25 and 30mm. After every successive step, SWV was measured three times and median was used for statistical analysis.
Results or Findings: Average distances between the US probe and peripheral nerve at baseline were 5.4mm for median nerve at the wrist, 18.9mm for median nerve at the forearm, and 24.8mm for sciatic nerve. For median nerve at wrist, significant changes in SWVs were found for compression distances of ≥2mm, and for median nerve at forearm for compression distances of ≥15mm (p <0.05). No changes in SWV were found for sciatic nerve.
Conclusion: The influence of soft tissue compression on SWV measurements depends on the thickness of the soft tissue between the probe and peripheral nerve. No or only minor pressure is advised when measuring SWV of superficial peripheral nerves and more pressure can be applied when measuring SWV of deeper peripheral nerves.
Limitations: Possible small changes in ROI position after robotic arm movement
Funding for this study: The authors report grants from The Republic of Slovenia Research Agency (Grant No. P3-0338 and J3-4507)
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the National Medical Ethics Committee of Slovenia (Nr. 0120-25/2023/3).

Author Block: B. S. Alvarez De Sierra, P. Nieto; Madrid/ES
Purpose: Hamstring injuries are prevalent among football players, necessitating a deeper understanding of muscle stiffness and its implications. This study investigates the differences in hamstring stiffness between dominant and non-dominant legs in athletes using Shear Wave Elastography (SWE).
Methods or Background: A retrospective study was conducted involving 30 football players (15 males, 15 females). Ultrasound SWE was used to measure shear wave velocities (SWV) in the semitendinosus, semimembranosus, and biceps femoris muscles. Data were analyzed based on leg dominance and sex, with statistical significance set at p < 0.05.
Results or Findings: Significant differences were found in semitendinosus stiffness between sexes, particularly in the non-dominant leg (p = 0.02).
Males exhibited higher SWV in the semitendinosus muscle compared to females, with mean SWV of 3.8 m/s (dominant) and 4.1 m/s (non-dominant) for males versus 2.9 m/s (dominant) and 2.8 m/s (non-dominant) for females.
No significant SWV differences were observed in the semimembranosus and biceps femoris muscles between sexes or based on leg dominance.
Conclusion: SWE effectively identifies dominance-related differences in hamstring stiffness, offering valuable insights for optimizing athletic performance and reducing injury risks. Future research should explore the implications of these findings on long-term injury prevention and rehabilitation strategies.
Limitations: The sample size was small (30 players), the exact degree of stiffness remains uncertain without a histological correlation serving as a standard of reference for the hamstrings. Other factors such as muscle geometry, fiber orientation, and intramuscular pressure may influence SWV.
Funding for this study: No funding
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Clinical Research Ethics Committee. CEIC 2024.232

Author Block: E. Faiella, E. Vergantino, D. Santucci, A. Bruno, G. Pacella, R. F. Grasso; Rome/IT
Purpose: Digital mucous cysts (DMCs) are common soft tissue tumors affecting interphalangeal joints. Various treatment options exist, with surgical excision being the standard. Ultrasound-guided cortisone injection into the distal interphalangeal (US-IPI) joint has been proposed as a therapeutic alternative. This study aims to assess the technical success and clinical efficacy of US-IPI in terms of swelling resolution and pain control.
Methods or Background: This study assessed corticosteroid infiltration for mucoid cysts in interphalangeal joints. Fifty-two patients (16 males, 36 females; median age 53, range 45-73) were treated between January 2020 and March 2023. Inclusion criteria included joint swelling, growth, and chronic pain >3 months; infections were excluded. The ultrasound-guided procedure used a 26-gauge needle and Triamcinolone acetonide (Kenacort). Pain and swelling were evaluated via the Numeric Rating Scale (NRS) at 2 weeks, 1 month, 3 months, and 6 months. Statistical analysis was performed using SPSS (v.22)
Results or Findings: The study assessed pain relief from ultrasound-guided corticosteroid infiltration for mucoid cysts. NRS scores decreased significantly from a median of 6.8 pre-procedure to 3.2 at two weeks (p < 0.01) and to 0 by one month (p < 0.01).
Eighty-three percent of patients responded positively; 17% experienced persistent pain (average NRS 6.2). A secondary infiltration reduced their scores to 3.5 at two weeks and 0 by one month (p < 0.01).
For joint swelling, 68% had a 50% reduction within one month, with complete resolution by three months. No recurrences were observed at the six-month follow-up.
Conclusion: Ultrasound-guided injection for digital mucous cysts offers effective pain relief and aesthetic improvement. Future studies should assess long-term outcomes and compare efficacy with other treatments.
Limitations: The lack of extended follow-up beyond one year post-treatment limits the assessment of long-term outcomes.
Funding for this study: No funding.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The study was conducted according to the guidelines of the Declaration of Helsinki. Ethical review and approval were waived for this study due to its retrospective nature.

Author Block: A. De Grandis¹, C. D'Alessandro¹, G. Sussan¹, A. Crimì¹, D. Coraci¹, S. Masiero¹, R. Ragazzi², E. Quaia¹, F. Crimì¹; ¹Padova/IT, ²Venice/IT
Purpose: Ultrasound-guided percutaneous treatments are a recognized and effective option for calcific tendinopathy of the shoulder. In this study, we enhanced the standard double-needle technique with a closed-circuit irrigation system and evaluated the clinical/radiological outcomes of the procedure.
Methods or Background: We prospectively enrolled 24 patients (14 females; median age 54years, IQR:50-62) with painful calcific tendinopathy of the shoulder between October 2023 and March 2024. All patients had a calcification >5 mm treated with ultrasound-guided closed-circuit irrigation, and the procedure duration was recorded. Ultrasound, radiography evaluation, and OSS and SPADI clinical questionnaires were administered before and 3 months after the procedure.
Results or Findings: After the procedure, there was a significant reduction in the size of the calcifications (12 mm, IQR:10-20 mm vs. 5.5 mm, IQR:2-10 mm; p=0.0001). The median duration of the procedure was 41 minutes (IQR:39-45 minutes). After the procedure, none of the patients experienced infections while two developed bursitis. There was a significant improvement in the OSS score 3 months after the procedure (16.5, IQR:10-23 vs. 32, IQR:36-45.5; p<0.0001) and a significant reduction in SPADI scores: pain (88, IQR:74-95 before vs. 13, IQR:4-24; p<0.0001), disability (72, IQR:60-90 before vs. 8, IQR:4-20; p<0.0001), and total score (78, IQR:66-91 before vs. 11, IQR:4-20; p<0.0001). The improvement of SPADI total score was higher, although not significantly (p=0.2891), compared to a 2015 review.
Conclusion: The closed-circuit double-needle barbotage for calcific tendinopathy of the shoulder is an effective treatment that improves both shoulder pain and function with a very low risk of short-term complications.
Limitations: No limitations were identified.
Funding for this study: No founding were received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: CET-ACEV code: 471n/AO/24

Author Block: V. Burulday¹, S. Ceylan Durmaz², A. Gungunes³, A. Tezcan¹; ¹Malatya/TR, ²Ankara/TR, ³Kirikkale/TR
Purpose: This study aims to evaluate the plantar fascia and Achilles tendon in patients with diabetic foot ulcers using two elastosonography methods: strain elastography (SE) and shear wave elastography (SWE). The goal is to identify biomechanical changes in these structures, which may predict the risk of diabetic foot ulcer development. This study is the first in the literature to evaluate both the Achilles tendon and plantar fascia together using both SE and SWE methods.
Methods or Background: Twenty-five patients with type 2 diabetes and diabetic foot ulcers, along with 30 healthy individuals, were evaluated. B-mode ultrasound, SE, and SWE methods were used to assess the thickness and stiffness of the Achilles tendon and plantar fascia. Diabetic foot ulcers were staged, and measurements were performed by a single experienced radiologist. The study compared patients with diabetic ulcers to those without, analyzing changes in tissue stiffness and structure.
Results or Findings: The study found significant increases in Achilles tendon thickness and stiffness in diabetic foot patients compared to the control group (p<0.0001). Plantar fascia stiffness was also significantly higher in diabetic patients (p<0.0001). Subgroup analysis revealed that patients with foot ulcers had even greater Achilles tendon and plantar fascia stiffness than those without ulcers. No significant difference in plantar fascia thickness was observed between groups (p=0.539), but stiffness changes were evident.
Conclusion: The elastosonographic evaluation of the Achilles tendon and plantar fascia provides valuable insights into the biomechanical changes in diabetic foot patients. Both SE and SWE are complementary methods that may help predict the development of diabetic foot ulcers. Early detection of stiffness and tissue changes through these methods can be crucial in preventing ulcer formation.
Limitations: Operator dependence, lack of MRI comparison, small sample size, absence of reliability assessment
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Decision number 15/03 dated 01.10.2018