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      Lesiones tendinosas del tobillo en resonancia magnética: análisis retrospectivo en 548 estudios Translated title: Tendinous lesions of the ankle in MRI: retrospective review in 548 exams

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          Abstract

          Objetivo: Determinar la prevalencia de las diversas lesiones tendinosas del tobillo y sus características iconográficas típicas en los pacientes sometidos a Resonancia Magnética (RM). Material y métodos: Se efectuó un análisis descriptivo, retrospectivo y de corte transversal, de 548 estudios de RM de tobillo durante un período de 18 meses (entre enero de 2006 y junio de 2007), que contabiliza el total de los exámenes obtenidos en resonadores de campo cerrado en Diagnóstico por Imágenes Adrogué y en las sedes Hospital Fiorito de Avellaneda y Fundación Científica del Sur. Resultados: Del total de exámenes (n=548), el 40.3% fueron realizados a pacientes de sexo femenino (n=221) y el 59.7% a pacientes de sexo masculino (n=327), con una edad promedio de 47.6 ± 17 años. El 60.5% de los estudios (n=331) no reveló alteraciones en ningún grupo tendinoso del tobillo, mientras que el 39.5% (n=217) demostró la presencia de algún tipo de patología tendinosa. Asimismo, 64 estudios (11.7%) revelaron alteraciones en el tendón tibial posterior; 47 (8.6%) en el tendón de Aquiles; 34 (6.2%) en el tendón peroneo lateral corto; 27 (4.9%) a nivel del tendón del flexor propio del hallux; 26 (4.7%) en el tendón peroneo lateral largo; 10 (1.8%) en el tendón flexor común de los dedos; 6 (1.1%) en el tendón tibial anterior; y 3 (0.5%) en el tendón extensor común de los dedos. Conclusiones: La RM constituye una excelente herramienta en la valoración de las diversas patologías tendinosas debido a su capacidad multiplanar y a su alto contraste tisular.

          Translated abstract

          Purpose: To determine the prevalence of several tendinous lesions of the ankle, and the MR imaging features that characterize these lesions. Materials and methods: MR images in 548 exams of ankle were retrospectively reviewed. These studies were performed during a 18-months period of time in 3 MR scanners at Hospital Fiorito (Avellaneda), Diagnóstico por Imágenes Adrogué, and Fundación Científica del Sur Avellaneda. Results: The ankle MR images (n=548) were taken from 221 women, and 327 men; median age, 47.6 years. In 60.5% studies (n=331), no pathologic images were identified. Sixty four exams (11.7%) showed some kind of tendon injury in the tibialis posterior tendon, 47 (8.6%) in the Achilles tendon, 34 (6.2%) in the peroneus brevis tendon, 27 (4.9%) in the flexor hallucis longus tendon, and 26 (4.7%) in the peroneus longus tendon. Additional findings included lesions in the flexor digitorum longus tendons (n=10), in the tibialis anterior tendon (n=6), and in the extensor digitorum longus tendons (n=3). Conclusions: The high-quality soft-tissue contrast resolution, noninvasive nature, and multiplanar capabilities of the MR images make it an excellent tool for the detection and evaluation of a variety of tendon disorders in the ankle.

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          Most cited references42

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          MR imaging of disorders of the Achilles tendon.

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            Effect of tendon orientation on MR imaging signal intensity: a manifestation of the "magic angle" phenomenon.

            To determine whether orientation in the static field may be responsible for the frequent occurrence of increased signal intensity within normal tendons at magnetic resonance (MR) imaging, seven healthy volunteers were imaged by means of a 1.5-T unit and standard clinical pulse sequences. The wrist, ankle, and shoulder regions were evaluated with local coils. Imaging was performed with tendon orientations ranging from 0 degree to 90 degrees in relation to the constant magnetic induction field (B0). Markedly increased intratendinous signal intensity was observed at the "magic angle" of 55 degrees, intermediate signal intensity was observed at 45 degrees and 65 degrees, and no signal intensity was observed at 0 degree and 90 degrees. Signal intensity was evident only when a short echo time was used. The authors believe that tendon orientation greatly affects tendon signal intensity in vivo. Increased signal intensity due to the magic angle effect may be misdiagnosed as tendinous degeneration, tendinitis, or frank tear.
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              Common overuse tendon problems: A review and recommendations for treatment.

              There is a common misconception that symptomatic tendon injuries are inflammatory; because of this, these injuries often are mislabeled as "tendonitis."' Acute inflammatory tendinopathies exist, but most patients seen in primary care will have chronic symptoms suggesting a degenerative condition that should be labeled as "tendinosus" or "tendinopathy." Accurate diagnosis requires physicians to recognize the historical features, anatomy, and useful physical examination maneuvers for these common tendon problems. The natural history is gradually increasing load-related localized pain coinciding with increased activity. The most common overuse tendinopathies involve the rotator cuff, medial and lateral elbow epicondyles, patellar tendon, and Achilles tendon. Examination should include thorough inspection to assess for swelling, asymmetry, and erythema of involved tendons; range-of-motion testing; palpation for tenderness; and examination maneuvers that simulate tendon loading and reproduce pain. Plain radiography, ultrasonography, and magnetic resonance imaging can be helpful if the diagnosis remains unclear. Most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months, and outpatient treatment should consist of relative rest of the affected area, icing, and eccentric strengthening exercises. Although topical and systemic nonsteroidal anti-inflammatory drugs are effective for acute pain relief, these cannot be recommended in favor of other analgesics. Injected corticosteroids also can relieve pain, but these drugs should be used with caution. Ultrasonography, shock wave therapy, orthotics, massage, and technique modification are treatment options, but few data exist to support their use at this time. Surgery is an effective treatment that should be reserved for patients who have failed conservative therapy.
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                Author and article information

                Journal
                rar
                Revista argentina de radiología
                Rev. argent. radiol.
                Sociedad Argentina de Radiología (SAR) y Federación Argentina de Diagnóstico por Imágenes y Terapia Radiante (FAARDIT) (Ciudad Autónoma de Buenos Aires, , Argentina )
                1852-9992
                March 2009
                : 73
                : 1
                : 071-083
                Affiliations
                [01] Avellaneda orgnameHospital Fiorito
                [02] orgnameFundación Científica del Sur orgdiv1Diagnóstico por Imágenes Adrogué
                Article
                S1852-99922009000100006 S1852-9992(09)07300100006
                83ec5fbf-8bc2-4ed1-8ce6-e40fc37fc61a

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : September 2008
                : May 2008
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 40, Pages: 13
                Product

                SciELO Argentina

                Categories
                Osteo-articular

                Resonancia Magnética,MR imaging,Ankle,Tendinous lesions,Tobillo,Lesiones tendinosas

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