V m Musculoskeletal Procedures: Diagnostic and Therapeutic Jacqueline C. Hodge a d e m e c u V a d e m e c u m Table of contents 1. Shoulder Arthrography 2. Elbow Arthrography 3. Wrist Arthrography 4. Hip Arthrography 5. Knee Arthrography 6. Ankle Arthrography 7. MR Arthrography 8. Myelography 9. Discography 10. Percutaneous Blocks 11. Epidural Blocks 12. Tenography It includes subjects generally not covered in other handbook series, especially many technology-driven topics that reflect the increasing influence of technology in clinical medicine. The name chosen for this comprehensive medical handbook series is Vademecum, a Latin word that roughly means “to carry along”. In the Middle Ages, traveling clerics carried pocket-sized books, excerpts of the carefully transcribed canons, known as Vademecum. In the 19th century a medical publisher in Germany, Samuel Karger, called a series of portable medical books Vademecum. The Landes Bioscience Vademecum books are intended to be used both in the training of physicians and the care of patients, by medical students, medical house staff and practicing physicians. We hope you will find them a valuable resource. All titles available at www.landesbioscience.com LANDES BIOSCIENCE This is one of a new series of medical handbooks. 13. Bone Biopsies 14. Percutaneous Treatment of Osteoid Osteoma 15. Vertebroplasty 16. Ultrasound Appendix ISBN 1-57059- 600- X 9 781570 596001 LANDES BIOSCIENCE Jacqueline C. Hodge, M.D. Lenox Hill Hospital Department of Diagnostic Radiology New York, New York Musculoskeletal Procedures: Diagnostic and Therapeutic G EORGETOWN , T EXAS U.S.A. vademecum L A N D E S B I O S C I E N C E VADEMECUM Musculoskeletal Procedures: Diagnostic and Therapeutic LANDES BIOSCIENCE Georgetown, Texas U.S.A. Copyright ©2003 Landes Bioscience All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Printed in the U.S.A. Please address all inquiries to the Publisher: Landes Bioscience, 810 S. Church Street, Georgetown, Texas, U.S.A. 78626 Phone: 512/ 863 7762; FAX: 512/ 863 0081 ISBN: 1-57059-600-X Library of Congress Cataloging-in-Publication Data While the authors, editors, sponsor and publisher believe that drug selection and dosage and the specifications and usage of equipment and devices, as set forth in this book, are in accord with current recommendations and practice at the time of publication, they make no warranty, expressed or implied, with respect to material described in this book. In view of the ongoing research, equipment development, changes in governmental regulations and the rapid accumulation of information relating to the biomedical sciences, the reader is urged to carefully review and evaluate the information provided herein. CIP applied for but not received at time of publication. Dedication To my mother Contents Foreword xi 1. Shoulder Arthrography 1 Wilfred C.G. Peh and Jacqueline C. Hodge Introduction 1 Indications 1 Contraindications 1 Equipment 2 Preliminary Radiographs 2 Technique 2 Contrast Agents 4 Post-Puncture Protocol 5 Complications 7 Normal Arthrogram 7 Abnormal Arthrogram 9 Acromio-Clavicular Arthrography 16 Summary 16 2. Elbow Arthrography 20 Clara G.C. Ooi and Wilfred C.G. Peh Introduction 20 Normal Arthrogram 25 Abnormal Arthrogram 26 MR Arthrography 28 3. Wrist Arthrography 32 Isabelle Pigeau, Philippe Valenti, C. Sokolow, Stephane Romano and Philippe Saffar Introduction 32 Pre-Procedure Protocol 33 Post-Procedure Protocol 35 Pitfalls of Arthrography-CT 38 Complications 38 Pathological Aspects 38 4. Hip Arthrography 47 Laurent Sarazin, Alain Chevrot and Jacqueline C. Hodge Indications 47 Prearthrogram Preparation 47 Technique 47 Postarthrogram Protocol 50 Complications 50 The Normal Arthrogram 50 Pathology 53 5. Knee Arthrography 62 Jacqueline C. Hodge Introduction 62 Indications 63 Contraindications 63 Equipment 63 Pre-Arthrography Protocol 63 Technique 63 Normal Anatomy 65 Post-Procedure Protocol 67 Complications 70 Pathology 70 6. Ankle Arthrography 78 Mary-Josee Berthiaume and Jacqueline C. Hodge Introduction 78 Prearthrogram Evaluation 78 Indications 79 Equipment 79 Contrast Agents 79 Technique 79 Postarthrographic Recommendations 80 Complications 81 The Normal Ankle Arthrogram 81 Pathologic Conditions 81 7. MR Arthrography 94 David R. Marcantonio, Robert D. Boutin and Donald Resnick Introduction 94 General Information 94 Specific Joint Pathology 96 Summary 103 8. Myelography 105 Jacqueline C. Hodge Introduction 105 Pre-Myelogram Preparation 105 Lumbar Puncture 106 Cervical Puncture 108 Contrast Agents 110 Post-Puncture Protocol 111 Post-Procedure Protocol 115 Complications 118 Pathology 118 9. Discography 124 Jacqueline C. Hodge Introduction 124 Lumbar Discography 125 Thoracic Discography 134 Cervical Discography 134 Post-Procedure Care 137 Interpretation 137 10. Percutaneous Blocks 140 Jacqueline Hodge Facet Blocks 140 Synovial Cysts 145 Sacroiliac Joint Block 146 Interspinous Ligament Blocks 148 C1-2 Block 148 Miscellaneous Blocks 149 11. Epidural Blocks 152 Jim Sloan Introduction 152 Epidural Injections 152 Nerve Blocks 155 12. Tenography 163 Jacqueline C. Hodge Introduction 163 Patient Management 168 Pathology 169 13. Bone Biopsies 175 Jacqueline C. Hodge Introduction 175 Biopsy Instruments 179 Pre-Biopsy Considerations 183 Post-Biopsy Care 183 Specimen Handling 185 Complications 185 Additional Considerations 185 MR-Guided Intervention 186 14. Percutaneous Treatment of Osteoid Osteoma 189 Jacqueline C. Hodge Introduction 189 Percutaneous Drill Resection 189 Percutaneous Radio-Frequency Ablation 190 Post-Procedure Care 190 15. Vertebroplasty 193 Jacqueline C. Hodge Introduction 193 Methyl Methacrylate 194 Pre-Procedure Protocol 194 Post-Procedure Protocol 201 Assessing Your Intervention 201 Common Side Effects 202 Complications 202 Future Developments in Vertebroplasty 203 16. Ultrasound 204 Patrice-Etienne Cardinal and Rethy Chhem Introduction 204 Pre-procedure Preparation 204 Pathological Conditions 205 Appendix 211 Contrast Reactions 211 Prophylaxis for Contrast Reactions 213 Selecting a Contrast Medium 213 Index 217 Contributors Jacqueline C. Hodge, M.D. Lenox Hill Hospital Department of Diagnostic Radiology New York, New York JHodge@LENOXHILL.net Chapters 1, 4-6, 8-10, 12-15 Mary-Josée Berthiaume Département de Radiologie Hôpital Notre Dame Université de Montréal Montréal, Québec, Canada email: mjb3gb@sympatica.ca Chapter 6 Robert D. Boutin University of California, San Francisco San Mateo, California, U.S.A. email: rboutin@stanfordalumni.org Chapter 7 Patrice-Etienne Cardinal Département de Radiologie Hôpital Saint-Luc Université de Montréal Montréal, Québec, Canada email: etienne.cardinal@videotron.ca Chapter 16 Alain Chevrot Groupe Hospitalier Cochin Service de Radiologie B Paris, France email: alain.chevrot@cch.ap-hop-paris.fr Chapter 4 Rethy Chhem Diagnostic Radiology Department National University Hospital National University of Singapore Singapore email: dnrckr@nus.edu.sg Chapter 16 Maryse Guerin Montreal General Hospital Montreal, Quebec, Canada Foreword David R. Marcantonio Division of Musculoskeletal Radiology University of Texas Southwestern Medical Center Dallas, Texas, U.S.A. email: dmarca@mednet.swmed.edu Chapter 7 G. Clara Ooi Department of Diagnostic Radiology Queen Mary Hospital The University of Hong Kong Hong Kong email: cgcooi@hkucc.hku.hk Chapter 2 Wilfred C G Peh Department of Radiology Singapore General Hospital Queen Mary Hospital Singapore email: gdrpcg@sgh.gov.sg Chapters 1, 2 Isabelle Pigeau Département de Radiologie Clinique Des Lilas–CEPIM Les Lilas, France Chapter 3 Editor Donald Resnick Department of Diagnostic Radiology University of California, San Diego Department of Veterans Affairs Medical Center San Diego, California, U.S.A. email: asuptuesat@hotmail.com Chapter 7 Stephane Romano Institut Français de Chirurgie de la Main Clinique du Trocadero Paris, France Chapter 3 Philippe Saffar Institut Français de Chirurgie de la Main Clinique du Trocadero Paris, France Chapter 3 Laurent Sarazin Groupe Hospitalier Cochin Service re Radiologie B Paris, France email: laurent.sarazin@cch.ap-hop-paris.fr Chapter 4 Jim Sloan McGill University Department of Anaesthesia The Royal Victoria Hospital Montreal, Quebec, Canada Chapter 11 C. Sokolow Institut Français de Chirurgie de la Main Clinique du Trocadero Paris, France Chapter 3 Philippe Valenti Clinique Jouvenet c/o Clinique du Trocadero Paris, France Chapter 3 [...]... imaging Musculoskeletal Procedures: Diagnostic and Therapeutic, edited by Jacqueline C Hodge ©2003 Landes Bioscience 2 Musculoskeletal Procedures: Diagnostic and Therapeutic Equipment 1 • • • • • • • • • • • • • Radiographic unit, ideally with a small focal spot Fluoroscopic unit, ideally with an overcouch X-ray tube Sterile trolley 22-gauge short-bevelled 9 cm lumbar puncture needle Syringes (1-10 ml) and. .. consult and in which we rapidly find clear answers to specific problems or suddenly arising queries Musculoskeletal Procedures: Diagnostic and Therapeutic belongs to this category of books With the valuable collaboration of a select group of young dedicated musculoskeletal radiologists, the editor has revisited all of the chapters of her previous book, Musculoskeletal Imaging: Diagnostic and Therapeutic. .. glenohumeral ligament (white arrows), and the superior (black arrowheads) and inferior (black arrows) glenoid labra more clearly Normal sublabral sulcus is arrowed (small white arrows) 1 10 1 Musculoskeletal Procedures: Diagnostic and Therapeutic Fig 1.6 Normal MR shoulder arthrogram—Oblique sagittal T1-WI, at A) midand B) medial humeral head levels, show the muscles and tendons comprising the rotator... cartilaginous labra and stripping 1 12 Musculoskeletal Procedures: Diagnostic and Therapeutic Fig 1.9 CT arthrography showing a full-thickness supraspinatus tear A) Axial section at level of the coracoid process shows air and contrast within the subdeltoid bursa (arrowheads) B) Oblique coronal reformatted image depicts air and contrast in the supraspinatus tear gap (arrowheads), and contrast media in... radio-capitellar joint is not involved 24 2 Musculoskeletal Procedures: Diagnostic and Therapeutic Fig 2.3 Normal double contrast elbow arthrogram (A) Lateral view shows the coronoid and epiradial recesses filled with air and contrast (B) Frontal projection shows that the articular cartilage of the radio-capitellar and ulnatrochlear joints are of uniform thickness and have smooth outlines either to the... arthrographic Musculoskeletal Procedures: Diagnostic and Therapeutic, edited by Jacqueline C Hodge ©2003 Landes Bioscience Elbow Arthrography 21 films are obtained, followed by films taken with an overhead tube for superior image detail Availability of conventional tomography facilitates visualization of loose bodies, osteochondritis dessicans and the articular surfaces of the trochlea and ulna.6,7... resistance to percutaneous and medical therapy.50 In these cases, fluoroscopic, CT, or ultrasound-guided percutaneous corticosteroid administration, and/ or aspiration of soft tissue calcifications, is recommended.51,52 1 14 Musculoskeletal Procedures: Diagnostic and Therapeutic 1 Fig 1.12 Severe changes following recurrent anterior shoulder dislocation CT arthrogram at (a) mid- and (b) distal humeral... Other intra-articular structures which may be depicted are the three glenohumeral ligaments and the long head of biceps tendon In my 1 8 Musculoskeletal Procedures: Diagnostic and Therapeutic 1 Fig 1.4 Normal CT shoulder arthrogram at mid-glenoid level The triangular-shaped anterior glenoid labrum (straight arrow) and more rounded posterior labrum (curved arrow) are seen The long head of the biceps tendon... tissue structures The rotator cuff and other muscles and tendons are exquisitely demonstrated on T1-weighted images (WI) The bone marrow, intra- and inter-muscular fat and subcutaneous fat are also well seen with this sequence T2-WI are useful for detection of soft tissue edema or other lesions, bone edema, contusion or other lesions, and fluid in the subacromial bursa and acromio-clavicular joint Fat-suppression... prolongs the examination, where there may be an expected delay in 2 22 Musculoskeletal Procedures: Diagnostic and Therapeutic 2 Fig 2.1 Elbow arthrography puncture technique A) The position of the needle entry point (cross) is marked over the radio-capitellar joint on the lateral view B) The pathway of the needle, perpendicular to the skin and joint, is indicated on the frontal view transporting the patient . 781570 596001 LANDES BIOSCIENCE Jacqueline C. Hodge, M.D. Lenox Hill Hospital Department of Diagnostic Radiology New York, New York Musculoskeletal Procedures: Diagnostic and Therapeutic G EORGETOWN ,. N D E S B I O S C I E N C E VADEMECUM Musculoskeletal Procedures: Diagnostic and Therapeutic LANDES BIOSCIENCE Georgetown, Texas U.S.A. Copyright ©2003 Landes Bioscience All rights reserved. No. Canada CHAPTER 1 CHAPTER 1 Musculoskeletal Procedures: Diagnostic and Therapeutic, edited by Jacqueline C. Hodge. ©2003 Landes Bioscience. Shoulder Arthrography Wilfred C.G. Peh and Jacqueline C. Hodge Introduction Arthrography