The hand is a unique structure in human body performing complex activities of daily life making it prone to injuries. While operating on zone VI extensor tendon injury, a surprising entity was observed. The extensor digitorum to the right index finger was absent. This is an extremely rare entity in the literature. Also, all previous studies on the extensor digitorum are cadaveric. Our findings are first of its kind intraoperative, incidental, and confirmed on MRI. Thus, it becomes a case report of special worth mentioning in literature.

• Klíčová slova
• extensor digitorum communis,
• MeSH
• anatomická variace MeSH
• dospělí MeSH
• lidé MeSH
• poranění prstů ruky * chirurgie   diagnóza   MeSH
• poranění šlachy chirurgie   diagnóza   MeSH
• prsty ruky abnormality   chirurgie   diagnostické zobrazování   MeSH
• šlachy * abnormality   chirurgie   diagnostické zobrazování   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: There is no international consensus on an optimal ultrasound score for monitoring of rheumatoid arthritis (RA) on patient-level yet. Our aim was to reassess the US7 score for the identification of the most frequently pathologic and responsive joint/tendon regions, to optimize it and contribute to an international consensus. Furthermore, we aimed to evaluate the impact of disease duration on the performance of the score. METHODS: RA patients were assessed at baseline and after 3 and 6 months of starting/changing DMARD therapy by the US7 score in greyscale (GS) and power Doppler (PD). The frequency of pathologic joint/tendon regions and their responsiveness to therapy were analyzed by Friedman test and Cochrane-Q test respectively, including the comparison of palmar vs. dorsal regions (chi-square test). The responsiveness of different reduced scores and the amount of information retained from the original US7 score were assessed by standardized response means (SRM)/linear regression. Analyses were also performed separately for early and established RA. RESULTS: A total of 435 patients (N = 138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43%; MCP2: 35%/28%; EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p ≤0.003 by GS/PD). The dorsal vs. palmar side of the wrist by GS/PD (p < 0.001) and the palmar side of the finger joints by PD (p < 0.001) were more frequently pathologic. The reduced US7 score (GS/PD: palmar MCP2, dorsal wrist, EDC and ECU, only PD: dorsal MCP2) showed therapy response (SRM 0.433) after 6 months and retained 76% of the full US7 score's information. No major differences between the groups of early and established RA could be detected. CONCLUSIONS: The wrist, MCP2, EDC, and ECU tendons were most frequently pathologic and responsive to therapy in both early and established RA and should therefore be included in a comprehensive score for monitoring RA patients on patient-level.

• MeSH
• lidé MeSH
• mladiství MeSH
• revmatoidní artritida * diagnostické zobrazování   farmakoterapie   patologie   MeSH
• šlachy diagnostické zobrazování   MeSH
• stupeň závažnosti nemoci MeSH
• synovitida * patologie   MeSH
• ultrasonografie MeSH
• zápěstí MeSH
• zápěstní kloub diagnostické zobrazování   patologie   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

This guide to ultrasound examination of the wrist and hand describes the basic scanning planes and contains corresponding high-resolution ultrasound images. The patient and probe positionings are explained in a simplified step-by-step manner using schematic drawings. This standard and simple examination technique seems to be an appropriate way to improve the learning curve of novice musculoskeletal sonographers. In wrist section, an emphasis is placed on the carpal tunnel and extensor tendons evaluation. In the hand region, the scanning of the flexor pulley system and the flexor pollicis longus is described. Key words: hand, wrist joint, ultrasound, tendons, carpal tunnel syndrome, De Quervain disease, trigger finger disorder, hand injuries, musculoskeletal, protocol.

• MeSH
• lidé MeSH
• ruka diagnostické zobrazování   MeSH
• šlachy diagnostické zobrazování   MeSH
• ultrasonografie MeSH
• zápěstí * diagnostické zobrazování   MeSH
• zápěstní kloub * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

This guide to ultrasound imaging of the hip describes the basic scanning planes and contains corresponding highresolution ultrasound images. The patient and probe positionings are explained in a simplified step-by-step manner using schematic drawings. This standard and simple examination technique seems to be an appropriate way to improve the learning curve of novice musculoskeletal sonographers. In this manuscript, an emphasis is put on hip effusion detection and on how to diagnose tendon and muscle injuries. Key words: tendons, hip tendinopathy, hip joint, athletic injuries, musculoskeletal, protocol, ultrasound, adductor tendon, trochanteric bursa, sciatic nerve.

• MeSH
• kyčelní kloub diagnostické zobrazování   MeSH
• lidé MeSH
• muskuloskeletální nemoci * MeSH
• šlachy diagnostické zobrazování   MeSH
• tendinopatie * MeSH
• ultrasonografie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

This introduction to ultrasound evaluation of the elbow describes the basic scanning planes and contains corresponding high-resolution ultrasound images. The patient and probe positionings are explained in a simplified step-by-step manner using schematic drawings. This standard and simple examination technique seems to be an appropriate way to improve the learning curve of novice musculoskeletal sonographers. In this manuscript, an emphasis is placed on effusion detection, ulnar nerve imaging, and commonly injured tendons assessment. This article also describes some common pitfalls to avoid when starting with musculoskeletal ultrasonography (e.g. positioning issues, unsolicited artifacts). Key words: tendons, elbow tendinopathy, golfer's elbow, tennis elbow, musculoskeletal, protocol, ultrasound, common extensor tendon, common flexor tendon, ulnar nerve.

• MeSH
• lidé MeSH
• loket * MeSH
• loketní kloub * diagnostické zobrazování   MeSH
• šlachy diagnostické zobrazování   MeSH
• ultrasonografie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Axiální spondylartritida (axSpA) je společným názvem pro neradiografickou formu onemocnění i radiografickou axiální spondylartritidu, známou též pod označením ankylozující spondylitida. Onemocnění se typicky manifestuje v mladém věku, je charakterizováno postižením osového skeletu a v nejtěžší formě může vést až k obrazu úplné ankylózy páteře. Etiologie axSpA není doposud rozluštěna, nicméně je zjevný genetický podklad, především vazba na HLA-B27 antigen. Mezi klinickými projevy dominuje chronická bolest zejména dolní části zad vzniklá před 45. rokem věku, u velké části pacientů splňuje charakteristiku tzv. zánětlivé bolesti. Kromě osového skeletu je u axiální spondylartritidy časté i postižení periferního skeletu v podobě entezitidy, artritidy a méně často i daktylitidy. Právě entezitida je v současnosti považována za charakteristický znak celé skupiny spondylartritid. Typická pro axSpA je častá přítomnost mimoskeletálních projevů v podobě uveitid, idiopatických střevních zánětů a psoriázy. V diagnostice axSpA došlo v posledních letech k významnému pokroku zejména v oboru zobrazovacích technik. Pomocí magnetické rezonance lze identifikovat i časné fáze onemocnění ještě před rozvojem strukturálních lézí. Také novější koncept celé skupiny spondylartritid, odvíjející se od klasifikačních kritérií ASAS (Assessment of SpondyloArthritis international Society) z roku 2009, přispěl k časnější diagnostice onemocnění, a to zejména podtržením významu asociace s HLA-B27 antigenem a přítomnosti periferních a mimokloubních projevů. Nesteroidní anti­revmatika a blokátory TNFα (tumor necrosis factor α) jsou účinnou terapií axSpA, která byla nedávno rozšířena o blokádu interleukinu 17.

Axial spondyloarthritis (axSpA) is a common name for the non-radiographic form of the disease and radiographic axial spondyloarthritis, known as ankylosing spondylitis (AS). The disease is typically manifested at a young age, characterized by affection of axial skeleton, and in the most severe form can lead to complete ankylosis of the spine. Etiology of diseases have not yet been clarified, however, the genetic background, especially the binding to HLA-B27 antigen, is obvious. Clinical manifestations are dominated by chronic pain in the lower pain or buttocks that occurred in young age, in a large proportion of patients having the character of so-called inflammatory pain. In addition to the axial skeleton, axSpA there is also common affection of peripheral skeleton in the form of enthesitis, arthritis, and less often dactylitis. At present, enthesitis is considered as a hallmark of the entire spondyloarthritis group. Typical for axSpA is the frequent presence of extraskeletal manifestations in the form of uveitis, idiopathic intestinal inflammation and psoriasis. In the axSpA diagnosis, significant advances have been made in recent years in the field of imaging techniques. Magnetic resonance imaging can also identify the early stage of the disease before the development of structural lesions. Also, the newer concepts of the entire spondyloarthritis group, based on the 2009 ASAS (Assessment of SpondyloArthritis international Society) classification criteria, contributed to early diagnosis of the disease, and in particular to the underlying importance of association with HLA-B27 antigen and the presence of peripheral and non-articular manifestations. Non-steroidal anti-rheumatic drugs (NSAIDs) and TNFα blockers are effective axSpA therapy, which has been recently enhanced by interleukin 17 blockade (IL17).

• MeSH
• antirevmatika terapeutické užití   MeSH
• biologická terapie MeSH
• bolesti zad klasifikace   patofyziologie   MeSH
• časná diagnóza MeSH
• diferenciální diagnóza MeSH
• entezopatie MeSH
• klouby diagnostické zobrazování   patologie   MeSH
• komorbidita MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• sakroiliitida diagnostické zobrazování   MeSH
• šlachy diagnostické zobrazování   MeSH
• spondylartritida * diagnóza   klasifikace   patologie   terapie   MeSH
• střevní mikroflóra MeSH
• TNF-alfa antagonisté a inhibitory   terapeutické užití   MeSH
• ultrasonografie dopplerovská využití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

PURPOSE OF THE STUDY The purpose of the prospective randomised study was to assess the benefits of the platelet-rich fibrin (PRF) application during the anatomic anterior cruciate ligament reconstruction (ACLR) for tendon graft healing. MATERIAL AND METHODS The study included 40 patients with an isolated rupture of the anterior cruciate ligament in the knee. The MRI findings on the tendon graft were evaluated at 6 months and 12 months after the surgery in a total of 33 patients, namely in 10 women/23 men (21 right knee/12 left knee), with the mean age of 29.1 years and at the mean follow-up of 15.9 weeks after the injury. The randomisation using envelopes was carried out at the beginning of arthroscopy either in the group with the PRF application (Group 1) (17 patients) or in the group without the PRF application (Group 2) (16 patients). The followed-up patients underwent the ACLR with targeting the femoral tunnel through anteromedial portal using the autografts of m. semitendinosusand m. graciliswith Tightrope femoral fixation and Inion implant in tibia. In Group 1, during the surgery PRF was applied both in the drilled tunnels (intraosseously) and directly to the surface of the tendon graft itself (intraarticular part). The Group 2 was a control group in which the same intervention was performed, however without the PRF application. In the 6 th and 12 th month after the surgery, the signal intensity of the knee and occurrence of the ACL graft failure, bone (marrow) oedema rate near the tunnels were assessed by an independent radiologist using a 3 Tesla MRI. RESULTS In the 6 th and also in the 12 th postoperative month, neither a complete, nor a partial graft failure was found in the group with PRF, whereas in Group 2 a complete or a partial graft failure was observed in 12.5% (p = 0.23). In the 6th month, a bone marrow oedema near the intraosseous parts of the graft was reported in 94.1% of patients in Group 1 and in 81.3% of patients in Group 2, while in the 12 th month it was 23.5% of evaluated patients in Group 1 and 37.5% patients in Group 2. The differences between the two groups were not statistically significant in the 6 th (p = 0.096) or in the 12 th month (p = 0.43). In the 6 th month, a fully ligamentised graft was found in 52.9% of patients in Group 1 and in 37.5% of patients in Group 2 (p = 0.061), a partially ligamentised graft was present in 47.1% of patients in Group 1 and in 50% of patients in Group 2. In the 12 th month, a fully ligamentised graft was seen in 94.1% of patients in Group 1 and in 75% of patients in Group 2 (p = 0.26) and a partially ligamentised graft was present in 5.9% of patients in Group 1 and in 12.5% of patients in Group 2. In the remaining 12.5% of patients in Group 2, the finding was assessed as a graft with no signs of ligamentisation. DISCUSSION We have not encountered a paper in the Czech or world literature which would present results of a similar study, i.e. which would evaluate the potential benefits of the platelet-rich fibrin application in the course of the anatomic anterior cruciate ligament reconstruction. Majority of studies evaluate the benefits of the application of platelet-rich plasma aimed to achieve a positive effect on the LCA graft healing. CONCLUSIONS Our study proved a higher percentage of ligamentisation and healed grafts into the bone as well as a lower occurrence of graft failure in the group with PRF compared to the group without the PRF application, namely both in the 6 th and in the 12 th month. Nonetheless, the differences between the two groups assessed at the same time were not statistically significant. Key words: anterior cruciate ligament, arthroscopy, anatomic ACL reconstruction, magnetic resonance imaging of the graft, platelet-rich fibrin, graft healing, MRI signal intensity of the graft.

• MeSH
• artroskopie MeSH
• autologní transplantace MeSH
• dospělí MeSH
• femur chirurgie   MeSH
• fibrin bohatý na krevní destičky fyziologie   MeSH
• kolenní kloub diagnostické zobrazování   patologie   chirurgie   MeSH
• lidé MeSH
• ligamentum cruciatum anterius patologie   MeSH
• magnetická rezonanční tomografie metody   MeSH
• plazma bohatá na destičky fyziologie   MeSH
• poranění předního zkříženého vazu diagnostické zobrazování   chirurgie   MeSH
• prospektivní studie MeSH
• rejekce štěpu patologie   MeSH
• rekonstrukce předního zkříženého vazu metody   MeSH
• ruptura patologie   MeSH
• šlachy diagnostické zobrazování   transplantace   MeSH
• tibie chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Česká republika MeSH

PURPOSE OF THE STUDY When treating tears of the distal biceps brachii muscle tendon, we repeatedly noticed a difference between the preoperative ultrasound findings and the operative findings. The aim of the study was to retrospectively correlate these findings in order to determine the sensitivity of the ultrasound examination in everyday orthopaedic practice. Moreover, we compared the results and complications of surgical treatment through two operative techniques used at our department. MATERIAL AND METHODS In the 2004-2016 period 20 patients underwent a surgery at our department for total tear of the distal tendon of the biceps brachii muscle. In 18 patients an ultrasound examination was performed preoperatively. In 3 patients it was repeated. Therefore, there were a total of 21 ultrasound observations made in this group of patients. Excluded were the cases of chronic tendinoses or inveterated tears. The group was divided into two sub-groups. The first sub-group was composed of patients in whom the preoperative ultrasound examination was performed by a radiologist-specialist in the musculoskeletal system, the second sub-group was composed of patients examined by a non-specialist. The ultrasound findings were compared with the operative findings. With the use of a formula for the calculation of sensitivity of the test, the sensitivity of the ultrasound examination was determined for proper recognition of a complete tear of the tendon concerned. Also, we compared the results and complications of the two operative methods applied: the technique using bone anchor vs. the Boyd-Anderson technique of transosseous reinsertion. RESULTS The sensitivity of the ultrasound examination was 91% in examinations performed by a radiologist-specialist and 40% in examinations performed by no-specialists. Both the surgical techniques brought very good results in our group of patients. The reported complications included 2 cases of temporary radial nerve palsy, 1 case of formation of heterotopic ossifications. DISCUSSION The sensitivity of ultrasound is adequate according to the literature. In our group of patients, the same applied only to examinations performed by a radiologist-specialist in the musculoskeletal system. This is because the ultrasound examination of the distal biceps tendon is a highly specialised examination. When performed by a non-specialist, the result of examination obtained in our observations is rather misleading, thus could lead to an improper method of treatment. Partial tears of this tendon are very rare according to the literature. Indirect signs of the partial tear presence at this location detected by ultrasound resulted in most cases in an incorrect diagnosis, therefore the description of a partial tear visualised by the ultrasound should be reserved exclusively for cases when intact fibrils are clearly detected during the examination. For unclear cases, the MRI scan is indicated. The results of both the surgical techniques of reinsertion applied were very good. The method using the bone anchors is technically easier to perform. Nonetheless, it has its specifics. CONCLUSIONS To diagnose correctly the tear of the distal biceps muscle tendon it is essential to perform a thorough clinical examination and to obtain the medical history of the patient, especially the mechanism of injury. Sonography can be beneficial only provided the examination is carried out by a specialist in the musculoskeletal system, with the use of appropriate device and under standard conditions. For surgical treatment of this injury we prefer the technique using a bone anchor, namely particularly since it is technically easier to perform. The functional results are very good. Key words: distal biceps tendon, elbow, tendon tear, ultrasound, suture anchors.

• MeSH
• dospělí MeSH
• korelace dat MeSH
• kosterní svaly * patologie   patofyziologie   MeSH
• kotvící implantáty * MeSH
• lidé MeSH
• neuropatie nervus radialis * diagnóza   etiologie   MeSH
• paže diagnostické zobrazování   patofyziologie   MeSH
• pooperační komplikace * diagnóza   etiologie   MeSH
• poranění šlachy * diagnóza   patofyziologie   chirurgie   MeSH
• senzitivita a specificita MeSH
• šlachy diagnostické zobrazování   MeSH
• tenodéza * škodlivé účinky   přístrojové vybavení   metody   MeSH
• ultrasonografie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Muskuloskeletální (MSK) ultrazvuk slouží k zobrazení struktur muskuloskeletálního systému – svalů, šlach, kloubů, kostí, periferních nervů a cév. V posledních dvou dekádách roste množství publikací a studií, prokazujících využitelnost ultrazvuku v diagnostice různých neurologických chorob. Neméně důležitou oblastí, kde lze MSK ultrazvukovou diagnostiku uplatnit jsou intervenční výkony v neurologii – obstřiky periferních nervů, lokální nervové blokády, punkce cév, lumbální punkce, svalové biopsie. Ultrazvukové vyšetření je rychlou, široce dostupnou, relativně levnou, neinvazivní a pro pacienta pohodlnou vyšetřovací metodou použitelnou při diagnostice a diferenciální diagnostice muskuloskeletálního aparátu včetně periferních nervů. Navíc umožňuje také dynamické vyšetření tkání. Je to vhodná diagnostická metoda první volby.

Musculoskeletal (MSK) ultrasound is used to visualize the structures of the musculoskeletal system, i.e. muscles, tendons, joints,bones, peripheral nerves, and vessels. In the last two decades, there have been a growing number of publications and studiesdemonstrating the applicability of ultrasound in diagnosing various neurological diseases. An equally important field where MSKultrasound diagnosis can be utilized is interventional neurology procedures – local peripheral nerve anaesthesia, local nerve blocks,vessel puncture, lumbar puncture, and muscle biopsy. Ultrasonography is a rapid, widely available, relatively inexpensive, non-invasive,and patient-comfortable method used in the diagnosis and differential diagnosis of the musculoskeletal system includingthe peripheral nerves. In addition, it allows dynamic examination of the tissues. It is a suitable diagnostic method of first choice.

• MeSH
• duplexní dopplerovská ultrasonografie * MeSH
• intervenční ultrasonografie MeSH
• kostra diagnostické zobrazování   patologie   MeSH
• lidé MeSH
• muskuloskeletální nemoci diagnóza   MeSH
• muskuloskeletální systém * diagnostické zobrazování   MeSH
• periferní nervy * diagnostické zobrazování   MeSH
• šlachy diagnostické zobrazování   patologie   MeSH
• svaly diagnostické zobrazování   patologie   MeSH
• ultrasonografie MeSH
• Check Tag
• lidé MeSH

Muskuloskeletální sonografie je moderní zobrazovací metoda umožňující precizní vizualizaci kloubního aparátu. Významnou mírou přispívá k diagnostice časných forem zánětlivých revmatických onemocnění, slouží k citlivější monitoraci jejich aktivity, k posouzení účinnosti zavedené terapie a umožňuje časněji se vyjádřit k strukturální progresi. Autoři v tomto přehledovém článku předkládají čitateli novinky o této průlomové zobrazovací metodě, nabízející cennou pomoc v každodenní revmatologické praxi. Zaměřují se na přínos ultrasonografie konkrétně u dvou nejčastěji se vyskytujících zánětlivých revmatických chorob, a to u revmatoidní artritidy a u skupiny chorob označovaných jako spondyloartritidy.

Musculoskeletal ultrasonography is a modern imaging method that enables precise visualization of intra- and peri-articular structures. Ultrasonography contributes to a large extent in early diagnosis of inflammatory rheumatic diseases, to a more sensitive monitoring of disease activity, to assessing drugs efficacy and structural progression. Authors inform about innovative imaging tool that offers a valuable aid in a daily clinical praxis. They specify a role of ultrasonography in two the most often occurring inflammatory rheumatic diseases: rheumatoid arthritis and spondyloarthropathy.

• Klíčová slova
• entezitida,
• MeSH
• entezopatie diagnostické zobrazování   MeSH
• klinická studie jako téma MeSH
• klouby diagnostické zobrazování   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• prediktivní hodnota testů MeSH
• revmatoidní artritida * diagnostické zobrazování   MeSH
• šlachy diagnostické zobrazování   MeSH
• spondylartritida * diagnostické zobrazování   MeSH
• synovitida diagnostické zobrazování   MeSH
• ultrasonografie dopplerovská * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH
• srovnávací studie MeSH