المؤلفون: Paul Arnolfo, Yves Maugars, Benoit Le Goff, Jean-Marie Berthelot, Christelle Darrieutort-Laffite, Joëlle Glémarec

المصدر: Joint bone spine. 88(1)

مصطلحات موضوعية: musculoskeletal diseases, medicine.medical_specialty, Lasègue test, Physical examination, Neurological examination, Sitting, 03 medical and health sciences, Sciatica, 0302 clinical medicine, Lumbar, Physical medicine and rehabilitation, Rheumatology, medicine, Humans, Medical history, 030212 general & internal medicine, Range of Motion, Articular, 030203 arthritis & rheumatology, Leg, Lumbar Vertebrae, medicine.diagnostic_test, business.industry, Lumbosacral Region, Test (assessment), medicine.symptom, business, Intervertebral Disc Displacement

الوصف: Diagnosis of sciatica mainly relies on pain reproduction by stretching of the lumbar roots since neurological examination and medical history are usually not sufficient to guarantee diagnosis. The Lasegue test is the most popular method, which starts with the straight leg-raising test (SLR). However it is not perfect, and is not always well performed or interpreted. Passive ankle dorsiflexion at the end of the SLR (Bragard test) is more sensitive, but can also remain normal in some cases of sciatica. Other stretching tests can help to recognise lumbar root damage in patients with poorly defined pain in a lower extremity: firstly, the Christodoulides test, i.e. reproduction of L5 sciatic pain by a femoral stretch test; secondly, the Slump test, performed on a patient in a sitting position, by slowly extending their painful leg then passively bending their neck (or the opposite); and thirdly, the Bowstring test, which requires, at the end of the Lasegue test, once the knee has been slightly flexed, pressing on the course of the peroneal and/or tibial nerves in the popliteal fossea to try and reproduce the exact pain felt by the patient. The combination of all these tests takes less than 2 minutes, and could improve both the sensitivity and specificity of the physical examination for the diagnosis of sciatica. This article is a review of the limitations of the Lasegue/SLR tests and of the efficacy of these other tests for stretching the lumbar roots.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::46a9eab49f1988767c89d527d2609134Test
https://pubmed.ncbi.nlm.nih.gov/32561431Test

المؤلفون: Benoit Le Goff, Lucie Planche, Christelle Darrieutort-Laffite, Géraldine Bart, Yves Maugars, Joëlle Glémarec

المصدر: Joint Bone Spine. 82:356-361

مصطلحات موضوعية: Anesthesia, Epidural, Male, medicine.medical_specialty, Hydrocortisone, Visual analogue scale, medicine.medical_treatment, Anti-Inflammatory Agents, Injections, Epidural, Spinal Puncture, Palpation, law.invention, Sciatica, Lumbar, Rheumatology, Randomized controlled trial, law, medicine, Clinical endpoint, Humans, Single-Blind Method, Prospective Studies, Pain Measurement, Ultrasonography, Lumbar Vertebrae, medicine.diagnostic_test, Epidural steroid injection, business.industry, Lumbosacral Region, Middle Aged, Epidural space, Surgery, Treatment Outcome, medicine.anatomical_structure, Anesthesia, Feasibility Studies, Female, medicine.symptom, business, Low Back Pain

الوصف: Ultrasound (US) is widely used in rheumatology to study and guide injection of peripheral joints. It can also provide useful information about the anatomy of the lumbar spine. Studies have shown that US examination of the spine was a useful tool to help perform epidural anaesthesia. The purpose of the study was to determine if the selection of the optimum puncture level by US may facilitate epidural steroid injection in case of presumed difficult puncture (BMI30 kg/m(2), age60 years or lumbar scoliosis).We performed a prospective randomized controlled study. Eighty patients were randomized in two groups: US group (n=40) which underwent a pre-procedure spinal US to determine the optimal lumbar level for injection or control group (n=40) for which the level of injection was determined by palpation. Primary endpoint was the pain during the procedure assessed using the Visual Analogue Scale (VAS).We found a positive correlation between depth of the epidural space and BMI (P0.001) and a negative correlation between size of the interspinous spaces and age (P0.01). Visibility of the epidural space was not altered by obesity or age. We observed a trend toward a reduction in pain intensity during the procedure in the US group compared to the control group with a mean difference at -0.94 [-1.90; 0.02] but the difference was not significant (P=0.054).US of the lumbar spine was feasible in patients with lumbar conditions even in obese and old ones and allowed the visualization of the epidural space. However, pre-procedure US examination did not reduce pain during the procedure.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::19e267d8a378100ff867b09137e81d59Test
https://doi.org/10.1016/j.jbspin.2015.02.001Test

المؤلفون: B. Le Goff, Christelle Darrieutort-Laffite, D Huguet

المصدر: Poster Presentations.

مصطلحات موضوعية: musculoskeletal diseases, Subluxation, Pathology, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Ultrasound, Arthroscopy, musculoskeletal system, medicine.disease, Biceps, Tendon, medicine.anatomical_structure, Bicipital groove, Medicine, Rotator cuff, Radiology, Tendinopathy, business

الوصف: Background Disorders of the long head of the biceps brachii tendon (LHBt) are commonly recognized as a source of shoulder pain. Ultrasound (US) is thought to be of limited value in the diagnosis of partial-thickness tear and non-tear abnormalities of the LHBt because of the difficulty to assess its intra-articular proximal portion. Brasseur recently described that placing the arm in extension/external rotation increased LHBt intra-articular portion visibility. Objectives The goal of this study was to determine if the systematic assessment of the intra-articular portion of the tendon, from the rotator interval to its glenoid insertion, with the arm placed in extension/external rotation could increase US sensitivity. Methods This was a cross-sectional study. All patients referred for the treatment of a rotator cuff disease (rupture, tendinopathy, calcific deposit) with an available MRI were included. US was performed blinded from the results of the clinical or MRI using a Sonosite Edge with a 6–13 MHz probe. LHBt was studied at different level: in the bicipital groove, at the rotator interval, over the upper pole of the humerus head to its insertion on the superior glenoid tubercule. To increase the visibility of the proximal portion, we placed the arm in extension/external rotation as described by Brasseur [1]. Diagnosis of tendinopathy were tendon enlargement, hypoechogenicity and an increase in the interfibrillar distance. Subluxation or dislocation of the LHBt was defined as a partial or total loss of contact between the tendon and its groove. Tearing of tendon was defined as discontinuity or absence of tendon fibers. Fluid collection was defined as an anechoic ring around the tendon >2 mm. Abnormalities of the LBHt on MRI was retrieved from the report. LBHt abnormalities detected on arthroscopy were used as the gold standard. Results We included 129 patients, 57 female (44%), and mean age 54 years (33–73). Seventy-five (58%) had a rotator cuff tear and 54 (42%) a tendinopathy. Arthroscopy found LHBt pathological changes in 39% of the case. The summary of the findings obtained with MRI, US (distal and proximal) and arthroscopy are summarised in table 1. We calculated the sensitivity/specificity of MRI and US (at the proximal and distal level) in the detection of LHBt changes using arthroscopy as gold standard (Table 2). Conclusions US has a good specificity but a poor sensitivity in the detection of LHB tendon changes even when a systematic and carreful study of the proximal part of the tendon is undertaken. If detection of distal changes of the tendon in the inter-tubercular groove seems feasible with US, the involvement of the more proximal, intra-articular part of the tendon remains challenging. MRI sensitivity remains also poor. Overall, arthroscopy still remains the gold standard to detect LHB tendon intra-articular pathology. References Brasseur, The biceps tendons: from the top and from the bottom. Journal of ultrasound (2012) 15, 29–38. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::054ead33d1d05137cd6dffd0a19438a2Test
https://doi.org/10.1136/annrheumdis-2017-eular.4468Test

المؤلفون: Jean-Marie Berthelot, Christelle Darrieutort-Laffite, Benoit Le Goff, Hubert Desal

المصدر: Joint bone spine. 83(4)

مصطلحات موضوعية: Adult, medicine.medical_specialty, Vena Cava, Inferior, Lumbar vertebrae, Inferior vena cava, Multimodal Imaging, Sensitivity and Specificity, Varicose Veins, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Rheumatology, Medicine, Humans, Ultrasonography, Doppler, Color, Ultrasonography, Interventional, 030203 arthritis & rheumatology, Varix, Lumbar Vertebrae, medicine.diagnostic_test, business.industry, Ultrasound, Magnetic resonance imaging, medicine.disease, Low back pain, Magnetic Resonance Imaging, medicine.anatomical_structure, medicine.vein, Female, Radiology, medicine.symptom, business, Venous malformation, Tomography, X-Ray Computed, Low Back Pain, 030217 neurology & neurosurgery

الوصف: Ultrasonography is currently widely used in the rheumatology practice. Although mainly performed to study peripheral joint, several articles have underlined its interest to study spinal anatomy. However, its ability to provide diagnostic features is unknown. We studied the case of a 25-year-old woman having low back pain. Three different imaging modalities (Computed Tomography [CT], Magnetic Resonance Imaging [MRI] and Ultrasound) were used to explore it. CT and MRI showed a foraminal dilation of the lombo-ovarian vein at the L3-L4 level with a scalloping of the lateral edge of L3. We were able to detect it with Color Doppler Ultrasound and a malformation of the inferior vena cava was also found. We showed for the first time that Color Doppler Ultrasound can detect venous malformation of the spine. This imaging modality could help us in the diagnosis of atypical lesions of the spine to confirm their vascular origin.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0783278b2a1d4075b4af21126ec53d8aTest
https://pubmed.ncbi.nlm.nih.gov/27068620Test

المؤلفون: Christelle Darrieutort-Laffite, Catherine Ansquer, Jean-Marie Berthelot, Françoise Bodere, Benoit Le Goff, Yves Maugars

المصدر: Joint bone spine. 82(6)

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Arthritis, Gastroenterology, Rheumatology, Predictive Value of Tests, Internal medicine, Spondylarthritis, medicine, Humans, Oligoarthritis, medicine.diagnostic_test, business.industry, Tumor Necrosis Factor-alpha, Sacroiliitis, Magnetic resonance imaging, Middle Aged, medicine.disease, Confidence interval, Bone scintigraphy, Positron emission tomography, Predictive value of tests, Positron-Emission Tomography, Sodium Fluoride, Female, Radiology, Radiopharmaceuticals, business

الوصف: Objectives To determine whether 18F-NaF positron-emission tomography (PET) contributes to the diagnosis of spondyloarthritis and whether observed uptakes predict the response to TNFα antagonist therapy. Methods We studied patients who had suspected spondyloarthritis but did not meet ASAS criteria and who were referred for an assessment of eligibility for TNFα antagonist therapy. 18F-NaF PET was offered instead of bone scintigraphy. TNFα antagonist therapy was given if the clinician's level of confidence in the diagnosis of spondyloarthritis based on 18F-NaF PET findings was ≥ 50/100. Results Thirty-one patients accepted to undergo 18F-NaF PET. Their mean age was 39.9 ± 11.7 years; 22% were HLA-B27-positive and none had evidence of sacroiliitis by magnetic resonance imaging. Of the 31 patients, 30 had abnormal 18F-NaF PET findings. However, of the 312 high-uptake foci, only 123 (39.4%) matched sites of pain. TNFα antagonist therapy was given to 16 patients. The treated group and untreated group (n = 15) were not significantly different for the mean number of high-uptake foci per patient (11.7 ± 8.1 vs. 8.3 ± 5.1, respectively) or for the proportion of patients with high uptake by the sacroiliac joints (13/16 [81%] vs. 8/15 [53%], respectively). In the treated group, 5 patients met ASAS response criteria after 3 months. These 5 patients were among the 9 treated patients who met Amor's modified criteria (arthritis instead of asymmetrical oligoarthritis). In the 5 responders, the 18F-NaF uptake scores were nonsignificantly lower than in the 11 nonresponders (9.0 ± 8.5 vs. 13.0 ± 6.4, respectively). In the patients for whom the 18F-NaF PET findings increased the level of confidence in the diagnosis of spondyloarthritis, this effect was short-lived. Discussion The positive predictive value of 18F-NaF PET for diagnosing spondyloarthritis or predicting a response to TNFα antagonist therapy seems very low. This finding is probably ascribable to poor specificity.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::cf47f82fb7d205248180fc44ca7c185dTest
https://pubmed.ncbi.nlm.nih.gov/26431930Test

المؤلفون: B. Le Goff, Joëlle Glémarec, Christelle Darrieutort-Laffite, Y. Maugars, A. Colombey

المصدر: Annals of the Rheumatic Diseases. 75:854.1-854

مصطلحات موضوعية: musculoskeletal diseases, 0301 basic medicine, medicine.medical_specialty, Facet (geometry), Immunology, General Biochemistry, Genetics and Molecular Biology, Facet joint, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Rheumatology, Iodinated contrast, Joint capsule, medicine, Immunology and Allergy, Fluoroscopy, 030203 arthritis & rheumatology, medicine.diagnostic_test, business.industry, Surgery, Vertebra, 030104 developmental biology, medicine.anatomical_structure, Arthrogram, Nuclear medicine, business

الوصف: Background Facet joint-mediated pain has been identified as a common cause of lumbar pain. Steroid injections are currently made to treat them, they are usually performed under fluoroscopy or computed tomography guidance. Ultrasound (US) is also appropriate to study facet joints and some studies showed feasibility and efficacy of facet joint injections performed under US-guidance through a transversal approach. On a longitudinal view, facet joints are easy-to-identify as a series of lumps with the joint capsule appearing as a thin hypoechoic line that envelops the joint. Objectives Considering the good visibility of these joints and their capsule on the longitudinal view, we studied the feasibility of US-guided facet joint injections using a longitudinal inline approach. Methods Patients referred to our rheumatology department to receive facet joint injections under fluoroscopy were included. To realize the injection, we first located the accurate lumbar level on a longitudinal median view going through the spinous processes. Facet joints were identified as previously described placing the probe 2–3 cm away from the median line. Then, the needle was inserted to reach the hypoechoic line corresponding to the capsule or, if not visible, the top of the lump formed by the inferior articular process of the superior vertebra overlying the superior articular process of the vertebra below it. When we obtained the bone contact, we injected iodinated contrast medium followed by cortivazol. Finally, we made a lumbar X-ray to analyze the needle position and the quality of the arthrography. The first objective was to assess the number of injections realized in front of the joint. For secondary objectives, we assessed the number of accurate arthrography, the duration of the procedure and the occurrence of adverse events. During US examination, the visibility of the capsule and the presence of osteophytes were collected. Results Thirty-eight patients have been included by two operators. We excluded four patients because of a poor visibility of the spinal structures. Mean age was 58,4 years (range, 30–82) and mean BMI was 25,2 kg/m 2 (range, 18–34). US showed osteophytes in 42% and the joint capsule was inconstantly visible (25%). One-hundred and forty-four injections were performed (72 at the L4-L5 level and 72 at the L5-S1 level) and 141 X-ray were analyzed. One-hundred and twenty-three injections (87%) were accurately realized in front of the joint, i.e. in front of the inferior articular process of the superior vertebra. However, a proper arthrogram was obtained in only 35 cases (25%). Mean procedure duration was 8.5 minutes for four injections. Six patients (18%) reported transient pain exacerbation and no severe complication occurred during the first month after the procedure. Conclusions With a longitudinal inline approach, US-guided facet joint injections were feasible and 87% injections were realized right in front of the joint. However, we obtained a correct arthrogram in only 25%. The depth of the target-point, the inconstant visualization of the capsule and the obliquity of the needle probably explain this result. Additional studies will be necessary to improve the accuracy of the technique. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::fa34206a99abef4991856bc5249a2c58Test
https://doi.org/10.1136/annrheumdis-2016-eular.3648Test

المؤلفون: Lucia Perez, Frédérque Chouet-Girard, Emmanuelle Dernis, Christelle Darrieutort-Laffite, Claire Lassalle

المصدر: Joint Bone Spine. 80:226-227

مصطلحات موضوعية: Pathology, medicine.medical_specialty, biology, medicine.diagnostic_test, business.industry, interests, Magnetic resonance imaging, biology.organism_classification, Body piercing, Rheumatology, Medicine, Immunocompetence, business, Candida albicans, interests.hobby

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::66eed3fef97747a5b6960c5d778482edTest
https://doi.org/10.1016/j.jbspin.2012.07.013Test