Australasian Journal of Ultrasound in Medicine最新文献

Hand injuries are common in amateur and professional boxers and result in time lost from training and competition.^1-3 Injuries to the dorsal hood account for 16% of all hand and wrist injuries in boxers.^{1, 3} ‘Boxer's knuckle’ describes a closed injury to the metacarpophalangeal joint (MCPJ) of the hand and is used synonymously to describe tears of the sagittal bands of the dorsal hood and associated extensor tendon instability.^{4, 5} It can result from a direct blow to the flexed MCPJ, commonly from boxing or punching, or from relatively low-energy repetitive injuries.⁵ Patients typically present with a painful and swollen dorsal MCPJ, and the space between knuckles, with pain associated with forming a closed fist, loss of full extension and snapping of extensor tendons with MCPJ flexion.^{6, 7} Boxer's knuckle soft tissue injuries are less appreciated than boxer's fracture that typically involves a fracture of the fifth or fourth metacarpal neck with volar angulation and can occur from a similar mechanism of injury.⁸

Tears of the sagittal bands of the dorsal hood can be clinically overlooked or underappreciated, as the symptoms can often be non-specific, and the associated tendon subluxation or dislocation may not always be observed.^{9, 10} If not diagnosed and treated adequately and in a timely manner, sagittal band tears can result in long-term persistent pain at the MCPJ and hand function impairment.^11-13 Diagnostic imaging, including sonography, can play an important role in directly imaging the soft tissue structures surrounding the MCPJ and diagnosing sagittal bands tears and tendon instability; however, an appreciation of the mechanism of injury, sonographic anatomy, sonographic technique, and normal and abnormal sonographic appearances is required.

The anatomy of the extensor (dorsal) mechanism of digits 2–5 of the hand is complex and often overwhelming. It combines an array of dorsal soft tissue structures including extensor tendons, the dorsal plate and the dorsal hood (extensor expansion).¹⁴ The dorsal hood is interrelated with intermetacarpal and palmar hand structures which aid in producing finger movement and MCPJ stability.¹⁵ The intermetacarpal structures include collateral ligaments, lumbrical and interosseous muscles and their associated tendons. Palmar structures of the hand around the MCPJ include the palmar plate, A1 pulley, flexor tendons, the deep transverse metacarpal ligament (DTMCL) and the associated neurovascular structures.¹⁵ The dorsal, intermetacarpal and palmar structures surrounding the MCPJ all need to be sonographically assessed in cases of suspected sagittal band tears.

Extension of the proximal interphalangeal joint (PIPJ) and distal in

I have recently returned from ASUM's annual New Zealand conference and am surprised by two things – how diverse ultrasound practice is and how much I enjoyed listening to presentations outside my speciality area. This is because some of the challenges we face in terms of developing an evidence base for our practice of, and justification for, our scanning approaches are similar. Many of us are facing the pressure of ‘getting through lists’: some are advocating for reducing scanning protocols or performing targeted examinations; others are advocating for extending scopes of practice outside traditional boundaries; whilst some are even advocating for skipping ultrasound and moving straight to other imaging modalities.

Whatever your innovative idea is, it should be evidence-based and proven to alleviate the problem at hand; whether it be workforce shortages, time poverty or a long waitlist. In this issue of AJUM, we focus on the areas of innovation and research that could enhance practice if adopted widely. And as you read these articles, I challenge you to think about whether similar issues exist in your speciality areas. Are there innovations that could be introduced? Or are there teaching tips that could enhance everyone's practice? Is there a way to streamline our practice and training? One of the key strategic goals of ASUM is to deliver evidence-based standards and research, and this issue of our society's journal should tick a continuing education box for many of you. I'm hopeful it will also stimulate you to undertake your own research in your area or practice.

Rocha et al.¹ present an analysis of a large cohort of women investigated for endometriosis in which they evaluated the anatomical distribution of endometriosis with ultrasound and tested a recommended prediction model that used a patient-administered questionnaire from the World Endometriosis Research Foundation. They found the performance of the questionnaire added little clinical value and suggested further refinement of the questionnaire may be needed.

Samet et al.² present a small study where they investigated the difference between supine and prone patient positioning for identifying the popliteal fossa sciatic nerve and found supine positioning allowed for quicker identification with the potential to improve ultrasound-guided nerve block. Often, patient positioning is seen as a sonographer or patient preference, but quantifying one position's impact and potential benefit over another is useful and can inform future practice.

Another variation in practice is the choice of transducer. Lung ultrasound can be performed with either a curvilinear or phased array transducer, and preference may simply come down to which one is available at the time of the scan. There are reasons why operators may prefer one over the other, such as rib spaces or frequency, but many regard them as interchangeab

Pseudoaneurysms are frequent vascular anomalies. This review article aims to describe the unique specific aspect of pseudoaneurysm (PSA) that allows to make the diagnosis using different modalities: colour Doppler ultrasound, computed tomographic angiography, magnetic resonance angiography and conventional angiography. It is essential to know the various aetiologies of PSA: iatrogenic, traumatic, dissecting and anastomotic; different locations and the possible complications, information to help clinicians choose the best treatment. Our review is supported by illustrated series of cases.