Journal of Ultrasonography Feed

Ultrasound-guided therapeutic injection of the surgically transposed ulnar nerve at the elbow: sonographic appearances, technique and clinical follow-up

Tue, 30 Jun 2026 00:00:00 GMT

AimTo evaluate the therapeutic efficacy of ultrasound-guided injection of the transposed ulnar nerve at the elbow.MethodsFifteen patients who underwent injection of a transposed ulnar nerve between 2014–2024 were identified. Sonographic appearances of the injected segment were scored using a Likert grading system for abnormality, and the cross-sectional area (mm2) was measured. Follow-up with respect to clinical response, need for subsequent therapeutic injection or decompressive surgery was recorded.ResultsThe grade of abnormality was mild (n = 4), moderate (n = 5), and severe (n = 3), with the remainder morphologically normal (n = 3). Interrater agreement was 0.91 (95% CI 0.80–1.00) with p <0.001. Cross-sectional area ranged from 8–18 mm2. Fourteen of fifteen patients (93%) experienced relief at the time of injection, decreasing to 12/15 (80%) at short-term follow-up <3 months, and further falling to 7/15 (47%) >3 months. Five patients (33%) underwent subsequent therapeutic injections, and three (20%) proceeded to revision surgery. There were no significant differences in grade between patients who experienced relief at any of the three time-points (p >0.05), nor differences in deformity or cross-sectional area between those who underwent subsequent injection (p >0.05) or surgery (p >0.05).ConclusionUltrasound-guided injection is a viable option for refractory neuropathic symptoms, although relief was often temporary, and 20% eventually required revision surgery.

Photopic (tint) ultrasound in musculoskeletal radiology – a pilot visual-grading/acceptability study

Tue, 30 Jun 2026 00:00:00 GMT

BackgroundWhile grayscale ultrasound is the standard in musculoskeletal imaging, photopic imaging, where the entire image is colorized, may enhance visual perception by leveraging human color discrimination. Despite its theoretical benefits, its clinical value remains underexplored.ObjectiveTo assess the perceived interpretability/helpfulness, image quality, and visual appeal of photopic (tint) ultrasound imaging compared to conventional grayscale (B-mode) imaging in musculoskeletal radiology.MethodsA retrospective analysis reviewed 20 musculoskeletal cases sequentially collected from two centers. B-mode images were recolored using various tints on Siemens Acuson S2000 and GE Logiq Fortis equipment. Two final-year residents specializing in musculoskeletal radiology independently rated image quality, visual appeal, and diagnostic value on a 5-point Likert scale. Inter-rater agreement was assessed using Cohen's Kappa.ResultsTint images received consistently high scores, with a minimum rating of 4 across all categories. The images were rated a mean score of 4 for quality, visual appeal, and diagnostic value by both readers. Median and mode scores were 4 or 5 in all subcategories. High inter-rater reliability (Cohen's Kappa: 0.8) indicated strong agreement between reviewers.ConclusionPhotopic ultrasound imaging demonstrates high image quality, visual appeal, and perceived interpretability/helpfulness in musculoskeletal applications. The technique shows promise as a complementary tool to grayscale imaging, with potential benefits in teaching as well as clinical interpretation, particularly for trainees. Further research with larger cohorts and experienced radiologists is warranted.

Intratesticular varicocele: sonographic diagnosis and clinical impact

Tue, 30 Jun 2026 00:00:00 GMT

Intratesticular varicocele is an uncommon sonographic finding that often coexists with extratesticular varicocele. Its clinical significance remains uncertain, with limited evidence regarding its effect on fertility or testicular function. This commentary discusses the peer-reviewed literature, focusing on the diagnostic features, clinical associations, and management considerations of intratesticular varicocele. Current evidence indicates that isolated intratesticular varicocele is rare and has no proven effect on semen quality or testicular volume. Management should be guided by the presence of concurrent extratesticular varicocele, as there is no established indication for direct treatment of isolated intratesticular varicocele. Further prospective studies may help clarify whether isolated intratesticular varicocele has any independent clinical significance; however, current evidence supports a cautious, observation-based approach when it is encountered in isolation.

Macrocystic lymphatic malformation of the gluteal region complicated by abscess formation: the crucial role of multimodal imaging in pediatric emergency care – case report and literature review

Tue, 30 Jun 2026 00:00:00 GMT

PurposeTo describe the sequential imaging findings and diagnostic utility of ultrasound and contrast-enhanced magnetic resonance imaging in a rare pediatric case of superinfected macrocystic lymphatic malformation of the gluteal region following minor trauma.Materials and methodsA 2-year-old girl with a pre-existing diagnosis of macrocystic lymphatic malformation in the gluteal region presented with acute onset of severe localized pain, fever, and erythema after sustaining blunt trauma. Laboratory tests demonstrated leukocytosis and elevated C-reactive protein, supporting the clinical suspicion of secondary infection. Initial ultrasound evaluation revealed multiple cystic lesions without internal vascularity, accompanied by surrounding soft-tissue edema. Given the concern for secondary infection, a follow-up ultrasound was performed 72 hours later, demonstrating increased vascularity of the cyst walls and internal echogenic debris consistent with superinfection. Subsequently, contrast-enhanced magnetic resonance imaging confirmed abscess formation, characterized by peripheral contrast enhancement, restricted diffusion, and extensive inflammatory changes in the surrounding soft tissues.ResultsIntegration of sequential imaging findings enabled early and accurate diagnosis of abscess formation within the macrocystic lymphatic malformation. This facilitated prompt initiation of targeted conservative treatment, including intravenous antibiotics and image-guided percutaneous drainage, effectively avoiding emergency surgical intervention and its potential complications.ConclusionIn pediatric patients with macrocystic lymphatic malformations, minor trauma may precipitate secondary infection and abscess development. A stepwise imaging strategy, beginning with ultrasound and supplemented by contrast-enhanced magnetic resonance imaging, is critical for early detection, precise lesion characterization, and guidance of appropriate management to minimize morbidity and improve clinical outcomes.

Factors influencing renal shear wave elastography: effects of probe orientation, respiration, corticomedullary differentiation, and hydration

Tue, 30 Jun 2026 00:00:00 GMT

AimTo assess how probe orientation, respiratory phase, hydration, and corticomedullary differentiation affect renal two-dimensional shear wave elastography.Material and methodsProspective single-center study with four independent sub-studies: (1) probe orientation (long vs. short axis; children, n = 35), (2) respiration (quiet breathing vs. brief mid-expiratory breath-hold; children, n = 20), (3) hydration (adults, n = 12; 700 mL water intake; stiffness at baseline, +20, +40 min), and (4) corticomedullary differentiation with depth assessment (children, n = 29). Shear wave elastography was acquired as five-frame series using 5-mm regions of interest. Sub-studies 1–3 sampled the cortex, whereas sub-study 4 sampled the cortex and renal pyramids at matched depths. Outcomes included per-subject median stiffness (kPa) and interquartile-range-to-median ratio (IQR/M). A quality filter (IQR/M ≤0.30) was applied to all sub-studies except the orientation sub-study. Statistical analysis included the Wilcoxon signed-rank test, Friedman test (hydration), and Spearman's ρ (depth).ResultsLong-axis orientation reduced variability within measurement series (lower IQR/M) compared with short-axis orientation (p <0.05). Stiffness during quiet breathing and mid-expiratory breath-hold was comparable. After water intake, stiffness increased (Friedman p <0.05). The cortex was consistently stiffer than the renal pyramids in the same subjects (p <0.05), and no depth-related effect was detected (Spearman's ρ −0.24 to +0.25; all p ≥0.19).ConclusionsAmong the four evaluated factors, probe orientation and hydration influenced renal shear wave elastography, whereas respiratory phase within the tested range did not. Corticomedullary differences should be explicitly reported when standardizing pediatric renal shear wave elastography.

Diaphragm thickening fraction as a predictor of the need for ventilatory support in the emergency department: an observational pilot study

Tue, 30 Jun 2026 00:00:00 GMT

AimEarly identification of patients likely to require ventilatory support is a key emergency department priority. Bedside diaphragm ultrasound provides a rapid assessment of respiratory muscle function, and the diaphragm thickening fraction quantifies diaphragmatic contraction during tidal breathing.Material and methodsIn this prospective observational pilot study, adults with acute respiratory failure in a single emergency department underwent diaphragm ultrasound within 6 hours of presentation. The primary outcome was initiation of non-invasive ventilation or invasive mechanical ventilation from emergency department presentation through hospitalization.ResultsAmong 56 patients, 22 (39%) required ventilatory support. Diaphragm thickening fraction was lower in those requiring support (median 20.93% vs 29.8%; p = 0.006). Higher diaphragm thickening fraction was associated with lower odds of ventilatory support (OR 0.93 per 1% increase, 95% CI 0.88–0.98; p = 0.008). Discriminative ability was moderate (AUC 0.72, 95% CI 0.58–0.87), and the optimal cutoff was 22.1% (sensitivity 59%, specificity 71%).ConclusionsEarly emergency department assessment of diaphragm thickening fraction may help identify patients at increased risk of requiring ventilatory support.

Ultrasound assessment of cerebrovascular risk via breath-holding index in migraine patients treated with anti-CGRP monoclonal antibodies: a pilot study

Tue, 30 Jun 2026 00:00:00 GMT

AimMigraine is the second most disabling condition worldwide. Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway represent an effective prophylactic treatment; however, their impact on cerebral hemodynamics remains unclear. The aim of this pilot study was to evaluate cerebrovascular risk in patients with migraine without aura treated with these therapies, by calculating the breath-holding index (BHI) of the anterior cerebral circulation using transcranial color-coded Doppler (TCCD) ultrasonography.Material and methodsCerebral vasomotor reactivity to hypercapnia was assessed using the breath-holding test combined with TCCD ultrasonography in 40 patients with migraine without aura undergoing treatment with anti-CGRP monoclonal antibodies and 40 healthy subjects. BHI values and other key cerebrovascular parameters were compared between the groups.ResultsThe BHI values in patients with migraine without aura were not below the threshold predictive of increased cerebrovascular risk (less than 0.69% per second, as referenced in the general population). No significant differences were observed in major cerebrovascular parameters between cases and controls. Additionally, a subanalysis revealed no significant differences based on the specific monoclonal antibody (erenumab, fremanezumab, or galcanezumab) or clinical response status (responders versus non-responders).ConclusionsOur findings suggest that treatment with anti-CGRP monoclonal antibodies is not associated with a BHI indicative of increased cerebrovascular risk. Notably, this is the first study to include galcanezumab and fremanezumab in the evaluation of cerebrovascular risk using ultrasound, highlighting TCCD ultrasonography as a practical and non-invasive tool for the assessment of cerebrovascular reactivity in migraine.

Splenic shear wave elastography beyond portal hypertension: a narrative review of non-portal applications

Tue, 30 Jun 2026 00:00:00 GMT

Shear wave elastography is a non-invasive ultrasound technique that quantifies tissue stiffness with high reproducibility. While its role in assessing portal hypertension is well established, the spleen has recently gained attention as a potential biomarker in non-portal conditions. As a vascular and immune organ, the spleen undergoes structural and functional changes in various systemic diseases, making splenic shear wave elastography a promising diagnostic and prognostic tool. This review summarizes current evidence regarding splenic shear wave elastography in healthy individuals and in diseases beyond portal hypertension. In hematologic disorders, particularly myeloproliferative neoplasms, splenic stiffness correlates with bone marrow fibrosis, extramedullary hematopoiesis, and thrombotic complications. In cardiovascular conditions, splenic congestion reflects systemic venous pressure and has been studied in acute and chronic heart failure, as well as in congenital circulatory alterations such as Fontan physiology. Research in inherited storage diseases, transfusion-dependent anemias, and autoinflammatory syndromes suggests a role for shear wave elastography in detecting parenchymal infiltration and monitoring disease progression. Infectious diseases including brucellosis, schistosomiasis, and HIV-related vasculopathy, further highlight its sensitivity to microvascular and inflammatory changes. Pediatric studies have expanded normative reference ranges and explored applications in systemic infections and splenomegaly. Despite encouraging findings, methodological heterogeneity, variability among ultrasound platforms, and physiological confounders limit comparability across studies. Current evidence remains predominantly based on small, single-center cohorts, and disease-specific cutoff values have yet to be established. In conclusion, splenic shear wave elastography shows potential for broad clinical applicability, but standardization of protocols, multicenter validation, and integration into multiparametric ultrasound frameworks are needed before implementation in routine practice.

Genicular nerves: ultrasound anatomy, scanning techniques, and clinical implications

Tue, 30 Jun 2026 00:00:00 GMT

The genicular nerves are sensory nerves that innervate the knee joint, playing a crucial role in pain transmission. Because of their small size, they are frequently underappreciated and overlooked during routine ultrasound examinations. With the advent of high-resolution ultrasound, these nerves can be visualized directly, facilitating targeted interventions. A detailed understanding of genicular nerve anatomy, ultrasound landmarks, and characteristic imaging appearances has significant clinical implications for managing knee pain. Given the high prevalence of chronic knee pain due to osteoarthritis and post-operative conditions, ultrasound-guided genicular nerve blocks and radiofrequency ablation are increasingly utilized. Traditionally, genicular nerve procedures, targeting three nerves (the superomedial, superolateral, and inferomedial genicular nerves), were performed under fluoroscopic guidance. However, ultrasound offers distinct advantages, including real-time visualization of soft tissues, the absence of radiation exposure, and precise targeting of anatomical locations using revised landmarks and Doppler signal. These advancements have enabled more comprehensive targeting of five nerves: the superomedial genicular nerve, superolateral genicular nerve, inferomedial genicular nerve, recurrent peroneal genicular nerve, and the infrapatellar branch of the saphenous nerve. Although ablation of the recurrent peroneal genicular nerve carries a risk of injury to the common peroneal nerve, potentially resulting in foot drop, precise localization through ultrasound-guidance may help mitigate this complication. This article provides a comprehensive review of genicular nerve anatomy, ultrasound techniques, and interventional approaches, emphasizing the clinical relevance of ultrasound-guided procedures for managing knee pain and diagnosing nerve pathologies.

Point-of-care ultrasound in trauma: a systematic review of recent literature

Tue, 30 Jun 2026 00:00:00 GMT

Point-of-care ultrasound (POCUS) is a vital diagnostic tool in trauma care, providing rapid bedside imaging to improve critical decision-making. Despite its growing use, a comprehensive understanding of its efficacy remains limited compared with traditional imaging methods, particularly in resource-constrained settings. This systematic literature review aims to synthesize recent research evaluating the diagnostic accuracy and clinical utility of POCUS, and the impact of training and advancements in POCUS technology, highlighting their role in enhancing trauma care practices. Following PRISMA guidelines, a thorough search of databases such as Scopus and Web of Science was conducted, identifying peer-reviewed articles published between 2020 and 2024. A total of 110 studies were selected based on their relevance to trauma applications of POCUS. Data were extracted, analyzed, and categorized into five themes: POCUS in (1) thoracic trauma, (2) abdominal trauma, (3) musculoskeletal trauma, (4) neurological and head trauma, (5) training and technological advances. The findings indicate that POCUS significantly improves diagnostic speed and supports earlier interventions, particularly in settings with limited access to advanced imaging. Furthermore, the review highlights the potential of POCUS to reduce reliance on more invasive procedures, thereby minimizing patient risk. Despite these advantages, challenges remain in standardizing training and ensuring consistent application across varied clinical environments. This review concludes that while POCUS is an effective adjunct to traditional imaging in trauma care, its full potential can be realized only through ongoing training and continued technological advancement. These insights underscore the need for further research to optimize POCUS protocols and expand their adoption in diverse healthcare settings.

Ultrasound-guided intervention techniques in the ankle and foot: a comprehensive guide

Tue, 31 Mar 2026 00:00:00 GMT

Ultrasound-guided interventions in the ankle and foot are safe, accurate, and effective procedures for both diagnostic and therapeutic management of soft-tissue and joint diseases. They are increasingly popular due to advances in ultrasound technology and the increasing availability of ultrasound scanners. These procedures can be performed in an outpatient setting using high-resolution scanners with high-frequency linear probes under sterile conditions, using sterile equipment, supported by standardized pre- and post-treatment protocols. Interventions include simple aspirations of bursae and ganglia; intra-articular, peritendinous, intratendinous, and ligament injections; nerve blocks; injections for Morton’s neuroma; and techniques such as dry needling for plantar fasciitis and stripping or high-volume injections for non-insertional Achilles tendinopathy. While corticosteroids, anesthetics, and hyaluronic acid remain the mainstay, interest is growing in the use of platelet-rich plasma for regenerative therapy to treat ankle and foot tendinopathies, as well as in more sophisticated techniques including radiofrequency ablation and cryoablation. In this comprehensive overview, we present the latest evidence regarding possible injectates and ultrasound-guided techniques for the ankle and foot. Physicians should be aware of the full spectrum of options and supporting data to be able to provide personalized advice and targeted treatment to patients as part of a clinical radiology service.

Ultrasound of the common peroneal nerve at the knee: a structured scanning protocol

Tue, 31 Mar 2026 00:00:00 GMT

The common peroneal nerve is one of the most frequent sites of neuropathy around the knee. Owing to its superficial course, it is highly vulnerable to both trauma and mechanical compression. High-frequency ultrasonography enables real-time, dynamic evaluation of the common peroneal nerve along its entire trajectory from the popliteal fossa to the exit from the peroneal tunnel. This article presents a stepwise, structured ultrasound protocol for the assessment of the common peroneal nerve in the peri-knee region. Supported by illustrative images and videos, the protocol is expected to facilitate practical applicability in daily practice and improve diagnostic accuracy. Furthermore, the guiding role of ultrasonography in interventional planning is highlighted.

Static and dynamic ultrasound assessment of peripheral meniscal lesions: diagnostic value and clinical applications

Tue, 31 Mar 2026 00:00:00 GMT

Meniscal injuries are frequent findings in clinical practice and may arise from acute trauma, progressive degeneration, or joint instability. While MRI remains the gold-standard modality for identifying these lesions, ultrasound has emerged as a valuable complementary technique thanks to its accessibility, low cost, real-time capability, and ability to perform dynamic assessments at the point of care. Increasingly, clinicians and radiologists are relying on ultrasound to detect and characterize subtle meniscal abnormalities that might otherwise be missed or underestimated. This review summarizes the principal static and dynamic sonographic features associated with meniscal tears, complex disruptions, and unstable flap fragments. Particular attention is given to the identification of ramp lesions, which involve the meniscocapsular junction and can be challenging to diagnose using conventional imaging alone. The article also discusses the evaluation of meniscal extrusion, a key indicator of structural compromise and a predictor of osteoarthritic progression. By highlighting characteristic ultrasound patterns and demonstrating how dynamic maneuvers can enhance diagnostic confidence, this work underscores the expanding role of ultrasound as an efficient, patient-centered imaging tool that complements MRI and supports a more comprehensive assessment of meniscal mechanical pathology. These insights ultimately contribute to more accurate treatment planning and improved patient outcomes.

Microvascular flow imaging in musculoskeletal ultrasound: from technical innovation to clinical integration

Tue, 31 Mar 2026 00:00:00 GMT

Recent advances in Doppler ultrasound have led to the development of microvascular flow imaging, a technique designed to overcome the limitations of color and Power Doppler in detecting slow, small-vessel flow. This narrative review summarizes the technical foundations, clinical applications, and emerging perspectives of microvascular technologies in musculoskeletal ultrasound, emphasizing their role as a bridge between morphological and functional imaging. Microvascular flow imaging employs spatiotemporal clutter-suppression algorithms and high-frame-rate acquisition to visualize low-velocity blood flow within capillaries smaller than 100 µm, without the need for contrast agents. The method enhances detection of microvascularity in tendons, synovium, and peripheral nerves, providing early indicators of inflammatory or degenerative activity. Proprietary vendor implementations share the same physical principles but differ in algorithmic filtering and signal rendering. Clinically, microvascular flow imaging has demonstrated superior sensitivity compared with Power Doppler for detecting subclinical synovitis, assessing tendinopathies, and evaluating entrapment neuropathies, offering both quantitative and prognostic insights. Although microvascular flow imaging improves diagnostic sensitivity and supports dynamic, contrast-free assessment of tissue perfusion, its routine implementation remains limited by the absence of standardized acquisition protocols, validated quantitative metrics, and inter-vendor harmonization. Ongoing research into AI-based vascular quantification and portable point-of-care systems may enhance reproducibility, accessibility, and integration into everyday musculoskeletal imaging. Overall, microvascular flow imaging represents a pivotal step toward functional musculoskeletal ultrasound, with expanding diagnostic, prognostic, and theranostic potential.

Ultrasound of the distal tibiofibular syndesmosis

Fri, 20 Mar 2026 00:00:00 GMT

PurposeTo review the anatomy, biomechanics, ultrasound technique, and imaging features of the distal tibiofibular syndesmosis, and to highlight the role of ultrasound relative to MRI in evaluating syndesmotic injuries.MethodsA literature-based narrative review was performed, focusing on normal and pathologic ultrasound findings of the syndesmotic ligaments and their MRI correlation.ResultsThe anterior inferior tibiofibular ligament is the most commonly visualized and injured structure. It is best seen in an oblique axial plane, extending from the tibial to the fibular tubercle. It appears as a thin, well-defined, fibrillar, echogenic band crossing the syndesmotic interval. The posterior inferior tibiofibular ligament is best seen posteriorly, slightly deeper and thicker, extending between the posterior tibia and fibula. Ultrasound examination of acute ligament injury shows ligament thickening, loss of normal fibrillar pattern, fiber discontinuity, or the presence of small, avulsed bone fragments. Ultrasound of chronic ligament injury shows thinning, irregularity, or heterogeneous scarring. Hypoechoic fibrotic changes or calcification at insertion sites can also be seen. Ultrasound provides high-resolution, real-time imaging capable of detecting ligament tears and assessing tibiofibular instability under stress. Dynamic ultrasound demonstrates good correlation with MRI for identifying acute syndesmotic disruptions, particularly in athletic or acute trauma settings.ConclusionUltrasound is a valuable and accessible modality for evaluating distal tibiofibular syndesmotic injuries. It complements MRI by providing immediate, functional assessment, aiding in timely diagnosis and management of high ankle sprains. Ultrasound should be considered in the imaging algorithm for suspected syndesmotic injuries, especially in sports and trauma settings.

Ultrasound imaging of small peripheral nerves – a primer for radiologists

Fri, 20 Mar 2026 00:00:00 GMT

High-resolution imaging has transformed the evaluation of small superficial peripheral nerves, enabling earlier detection of neuropathies, traumatic injuries, and entrapments. Among available modalities, ultrasound is particularly well suited for this purpose owing to its high spatial resolution, dynamic assessment capabilities, and ability to guide interventions. Normal nerves can be recognized on ultrasound by their fascicular architecture and characteristic honeycomb appearance, which helps distinguish them from adjacent tendons, vessels, and connective tissue. High-frequency transducers allow improved delineation of fascicular detail, while small-footprint probes enable imaging of nerves in anatomically constrained regions, establishing ultrasound as a reliable and cost-effective tool for evaluating peripheral nerve injuries. Because of spatial resolution limitations, magnetic resonance imaging has restricted ability to evaluate submillimeter-sized nerves; high-resolution ultrasound is therefore particularly effective in localizing pathological nerves – both in terms of the exact site of involvement and the length of the affected segment. This review article highlights in detail the sonographic techniques, pitfalls, and key anatomic landmarks for visualizing small peripheral nerves in the upper and lower extremities, with particular emphasis on nerves that are frequently under-evaluated in routine clinical practice yet often contribute to allodynia. Normal anatomical appearance on ultrasound is provided for better understanding along with examples of pathologies affecting these nerves.

Aponeurotic expansion of the supraspinatus tendon: sonographic spectrum and proposed classifications

Tue, 17 Mar 2026 00:00:00 GMT

AimThe aponeurotic expansion of the supraspinatus tendon is a recognized but underappreciated anatomical structure of the shoulder. Its sonographic appearance may mimic or coexist with pathology of adjacent tendons, particularly the long head of the biceps tendon, creating diagnostic challenges. Although described in prior literature, many atypical variants remain insufficiently documented. This study aimed to characterize atypical sonographic manifestations of the aponeurotic expansion of the supraspinatus tendon and to propose new classifications based on its relationship with the supraspinatus tendon, its position within the rotator interval, and its association with the long head of the biceps tendon.Material and methodsBetween October 2018 and September 2025, a total of 3,600 shoulder ultrasound examinations were performed. Nineteen patients (15 women, four men; mean age 60.7 years, range 24–82 years) with pathologically altered aponeurotic expansions were retrospectively identified. Each case was evaluated for structural and positional changes in relation to the supraspinatus, long head of the biceps, and subscapularis tendons.ResultsThe most frequent supraspinatus–aponeurotic expansion relationship was minor intrasubstance tearing (31.6%), followed by complete supraspinatus tears with retraction (21.1%). At the rotator interval, subluxation was observed in 36.8% of cases. Regarding interactions with the long head of the biceps tendon, aponeurotic expansion dislocation with preserved intragroove biceps alignment was most common (31.6%). Several theoretical subtypes were not observed.ConclusionsUltrasound enables detailed assessment of the aponeurotic expansion of the supraspinatus tendon. The proposed classifications provide a structured framework for clinical practice and may guide future research into the diagnostic and functional significance of this complex region.

Ultrasound evaluation of the ulnar nerve in cubital tunnel syndrome: anatomy, normal and abnormal findings, and postoperative aspects

Fri, 13 Mar 2026 00:00:00 GMT

Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb after carpal tunnel syndrome and results from entrapment of the ulnar nerve around the elbow. High-resolution ultrasound has become a central diagnostic modality because of its excellent spatial resolution, capacity for dynamic assessment, and broad availability in clinical practice. This review offers an integrated and updated overview of the ultrasonographic evaluation of the ulnar nerve in cubital tunnel syndrome, detailing relevant anatomy, characteristic normal and pathological appearances, and key considerations in postoperative follow-up. The ulnar nerve may be compressed at several anatomical sites, including the arcade of Struthers, the retrocondylar groove, Osborne’s ligament within the cubital tunnel, and the aponeurosis between the two heads of the flexor carpi ulnaris. Typical sonographic abnormalities include focal or segmental nerve enlargement, disruption or loss of the normal fascicular architecture, and changes in echogenicity. Dynamic maneuvers during ultrasound examination can further identify nerve subluxation, dislocation, or snapping over the medial epicondyle, all of which may contribute to clinical symptoms. Postoperative ultrasound evaluation is increasingly important for detecting complications or persistent compression following in-situ decompression, medial epicondylectomy, or anterior transposition. A standardized and reproducible ultrasound protocol is therefore essential for accurate diagnosis, appropriate management, and follow-up. Radiologists play a pivotal role in this multidisciplinary approach by providing detailed imaging assessments that guide surgical decision-making and help optimize patient outcomes.

Ultrasound in inflammatory conditions of subcutaneous and articular adipose tissue in the extremities

Tue, 10 Mar 2026 00:00:00 GMT

Adipose tissue of the extremities has been largely neglected in musculoskeletal ultrasound (US), beyond the assessment of superficial nodules or the exclusion of deep complications in superficial infections. Three developments have brought it to the fore: a more refined understanding of its anatomy and function − recognizing adipose tissue not merely as a passive fat store but as a metabolic and endocrine organ and a regulator of inflammation; advances in US technique; and the wider adoption of US across medical specialties, particularly dermatology and plastic surgery. Panniculitis refers to inflammation of the subcutaneous tissue and encompasses numerous disorders with considerable clinical overlap. Patients typically present with painful nodules in the extremities and often require histopathological confirmation. Histologically, panniculitides are classified according to the predominant site of involvement − septal, lobular, or mixed. US correlates strongly with these patterns. This review describes the principal sonographic appearances of the most frequent panniculitides and highlights key clinical and pathological features that help narrow the differential diagnosis. Entities that may mimic panniculitis on US are also discussed. Beyond diagnosis, ultrasonography supports disease assessment and monitoring, and it reliably guides targeted biopsy. Finally, the US features of inflammation in articular and periarticular adipose tissue are summarized, with emphasis on findings that should be considered during routine joint US examinations, as such involvement often accompanies internal derangement and may also represent the primary source of patient-reported symptoms.

Agreement between sonographic and pathoanatomic classifications of pediatric urachal remnants

Wed, 31 Dec 2025 00:00:00 GMT

AimUltrasound is the favorite method for follow-up of urachal remnants when conservative management is chosen instead of surgical resection. However, the success of conservative management depends on the type of urachal anomaly, and the agreement between sonographic and pathoanatomic diagnoses has not yet been assessed.Material and methodsWe retrospectively included all minors treated for a urachal anomaly at two German pediatric surgical centers between January 2008 and December 2020. Ultrasound examinations were conducted by specialized pediatric radiologists and compared with pathoanatomic reports following resection of the urachal anomaly, with respect to its type.ResultsWe included 15 patients with a median age of 0.2 years. The crude agreement between ultrasound and pathoanatomic diagnosis was 70%, and Cohen's κ was 0.66 (95% confidence interval: 0.3 – 1, z = 3.83, p <0.001).ConclusionsUltrasound identified the type of urachal anomaly with sufficient accuracy in this cohort; however, these findings should be corroborated by a substantially larger study.