S152 S290
MSK & SPORTS MEDICINE POSTER HALL: ORIGINAL RESEARCH
Poster 37:
Standard Normal Ultrasound Measurement of the
Supraspinatus Tendon: Establishing Parameters for
the Musculoskeletal (MSK) Ultrasonographer,
Radiologist and Clinicians
Vinicius Tieppo Francio, MD/PhD(c) (USAT College of Medicine MD/PhD
Program, Oklahoma City, OK, United States), Robert Dima, none
Disclosures:
Vinicius Tieppo Francio: I Have No Relevant Financial
Relationships To Disclose.
Objective:
The role of ultrasound (US) technology in musculoskeletal
pathology has been recently emphasized in both diagnosis and treat-
ment of a plethora of conditions. The most common tendon to exhibit
pathology is the supraspinatus tendon (SST) of the rotator cuff.
Although normal measurements of the supraspinatus are available
through various academic sources, there is no definitive standard
measurement of SST thickness with US diagnostic imaging. In an effort
to provide a single, compiled source of information for the musculo-
skeletal diagnosis, this study presents a meta-analysis of academic and
clinical reports on standard normal measurements of the SST and most
importantly new data with an estimate of the population mean in SST
thickness.
Design:
This meta-analysis focuses only on measurements of non-
pathological SST. Statistical analysis of results was completed to
determine a mean value. The student t-table distribution was used to
determine a margin of error.
Setting:
Non applicable.
Participants:
Non applicable.
Interventions:
Non applicable.
Main Outcome Measures:
Non applicable.
Results:
According to our study data analysis of 10 independent
studies measuring SST thickness in the general population, mean
supraspinatus tendon thickness will fall between 5.28 and 5.40 mm, at
a 95% level of confidence. The estimate for SST thickness is 5.3298
0.72. Since 95.4% of a normally distributed population will fall within 2
standard deviation (SD) of the mean, the 2 SD range of 3.8856 to
6.7741 may be used to approximate a given individual SST thickness.
Conclusions:
The SST is frequently interrogated for pathology; how-
ever there are no standard normal measurements due to high vari-
ability among existing studies. This creates a gap for the MSK
sonographers and physicians using US. The authors suggest this metric
to be investigated as a potential parameter to increase confidence in
identifying hypoechoic swelling of the SST in shoulder pathology, and
to establish practice parameters to determine normal versus abnormal
SST appearances.
Level of Evidence:
Level II
Poster 38:
Effectiveness of the Hook Release Ultrasound-Guided
Carpal Tunnel Release: A Pilot Cadaveric Study
Nimish Mittal, MD MBBS (University of Toronto, University Health
Network), Anne Agur, BScOT, MSc, PhD, Harpreet Sangha, MD, FRCPC,
John F. Flannery, MD
Disclosures:
Nimish Mittal: I Have No Relevant Financial Relationships
To Disclose
Objective:
To validate and quantify the extent of completeness of
ultrasound-guided flexor retinaculum release using a hook knife and
assessment of the integrity of the surrounding neurovascular
structures.
Design:
Cadaveric pilot study.
Setting:
Tertiary care academic university institute.
Participants:
13 lightly embalmed cadaveric forearm hand specimens.
Interventions:
We performed ultrasound-guided retrograde percuta-
neous release of the flexor retinaculum using the hook knife via 1mm
proximal wrist incision. The digitized data were reconstructed into 3D
models to show the extent of release of the flexor retinaculum and the
relationship of the release to the surrounding neurovascular structures
after dissection.
Main Outcome Measures:
1. Extent of completeness of flexor reti-
naculum release 2. Integrity of median nerve, recurrent branch of
median nerve, ulnar nerve, ulnar artery, and superficial palmar arch.
3.Mean time required to perform the hook knife release procedure.
Results:
In all cases thus far, ultrasound guided hook release carpal
tunnel release was effective (92.3% release rate) and safe without
signs of intrusion into the superficial anatomy or injury to important
surrounding structures.
Conclusions:
Early data suggest ultrasound-guided hook release is a
safe and effective, relatively quick, alternative technique to fully
release the flexor retinaculum in a minimally invasive manner at an
office-based setting.
Level of Evidence:
Level IV
Poster 39:
Optimal Degree of Knee Flexion that Provides
Greatest Separation Between Medial Femoral
Condyle and Proximal Tibia Under Ultrasound to
Evaluate the MCL During Valgus Stress Test: A Case
Series
Brian Pekkerman, DO (SUNY Downstate, New York, NY, United States),
Puneet Ralhan, DO, Richard G. Chang, MD, MPH
Disclosures:
Brian Pekkerman, DO: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
Musculoskeletal ultrasound has been used to assess knee
pain with studies demonstrating its utility in diagnosing medial
collateral ligament (MCL) injuries. Valgus stress test (VST) is a pro-
vocative test for MCL evaluation. Little quantitative data exists in the
literature regarding the optimal angle to stress the knee in order to
appreciate the greatest laxity. Our goal is to measure gapping of the
medial compartment at selective degrees of knee flexion (KF) in order
to quantify normative data for the VST. To objectively determine the
angle of KF that allows the greatest separation between the medial
femoral condyle (MFC) and proximal tibia (PT) using ultrasound during
VST.
Design:
Case series.
Setting:
Musculoskeletal practice.
Participants:
10 subjects without history of knee pain, injury, or
surgery.
Interventions:
A 12-5 linear array GE Logiq ultrasound probe was used
to measure the distance between the MFC and PT at 0 , 20 and 30 KF.
A Sharper Image manual scale was then used to apply a standardized 5-
pound valgus force at the stated angles and distance was measured to
evaluate displacement.
Main Outcome Measures:
Length of separation between MFC and PR
at neutral and with standardized VST.
Results:
The average distances between the MFC and PT at 0 , 20 and
30 KF were 0.829, 1.031, 1.14 cm, and separations after 5-pounds of
valgus stress were 0.956, 1.213, 1.42 cm, respectively. The average
difference between neutral and five pounds of valgus stress was 0.097,
0.172, 0.201 cm, respectively.
Conclusions:
Greater separation between the MFC and PT was seen
with increasing angles of KF. This distance separated further with
added valgus stress demonstrating the optimal angle to examine laxity
during VST is at 30 of KF, which is consistent with AMA guidelines.
Future studies will be needed with larger sample sizes and comparison
to valgus stress X-rays, but this study provides preliminary data on
normal subjects.
Level of Evidence:
Level V
S152
Abstracts / PM R 9 (2017) S131-S290