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Lee SH, Jang WY, Lee MS, Yoon TR, Park KS. Surgical Excision for Refractory Ischiogluteal Bursitis: A Consecutive Case Series of 21 Patients. Hip Pelvis 2023; 35:24-31. [PMID: 36937219 PMCID: PMC10020732 DOI: 10.5371/hp.2023.35.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 03/21/2023] Open
Abstract
Purpose A response to conservative treatment is usually obtained in cases of ischiogluteal bursitis. However, the time required to achieve relief of symptoms can vary from days to weeks, and there is a high recurrence rate, thus invasive treatment in addition to conservative treatment can occasionally be effective. Therefore, the aim of this study was to examine surgical excision in cases of refractory ischiogluteal bursitis and to evaluate patients' progression and outcome. Materials and Methods A review of 21 patients who underwent surgical excision for treatment of ischiogluteal bursitis between February 2009 and July 2020 was conducted. Of these patients, seven patients were male, and 14 patients were female. Injection of steroid and local anesthetic into the ischial bursa was administered at outpatient clinics in all patients, who and they were refractory to conservative treatment, including aspiration and prescription drugs. Therefore, surgery was considered necessary. Excisions were performed by two orthopedic specialists using a direct vertical incision on the ischial area. A review of each patient was performed after excision, and quantification of the outcomes recorded using clinical scoring systems was performed. Results The results of radiologic evaluation showed that the mean lesion size was 6.2 cm×4.5 cm×3.6 cm. The average disease course after excision was 21.6 days (range, 15-48 days). Measurement of clinical scores, including the visual analog scale and Harris hip scores, was performed during periodic visits, with scores of 0.7 (range, 0-2) and 98.1 (range, 96-100) at one postoperative month, respectively. Conclusion Surgical excision, with an expectation of favorable results, could be considered for treatment of ischiogluteal bursitis that is refractory to therapeutic injections, aspirations, and medical prescriptions, particularly in moderate-to-severe cases.
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Affiliation(s)
- Sun-Ho Lee
- Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Won-Young Jang
- Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Min-Su Lee
- Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Roh YH, Yoo SJ, Choi YH, Yang HC, Nam KW. Effects of Inflammatory Disease on Clinical Progression and Treatment of Ischiogluteal Bursitis: A Retrospective Observational Study. Malays Orthop J 2021; 14:32-41. [PMID: 33403060 PMCID: PMC7752025 DOI: 10.5704/moj.2011.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The symptoms of Ischiogluteal Bursitis (IGB) are often nonspecific and atypical, and its diagnosis is more challenging. Moreover, it is difficult to predict cases of chronic progression or poor treatment response. Therefore, the aim of this study was to investigate the clinical course of IGB patients and identify factors that are predictive of failure of conservative treatment. Materials and Methods: Our study consisted of IGB patients diagnosed between 2010 March and 2016 December who had been followed-up for at least one year. Structured questionnaires and medical records were reviewed to analyse demographic characteristics, lifestyle patterns, blood tests, and imaging studies. We categorized the cases into two groups based on the response to conservative treatment and the need for surgical intervention. Results: The most common initial chief symptoms were buttock pains in 24 patients (37.5%). Physical examinations showed the tenderness of ischial tuberosity area in 59 (92.2%) patients, but no specific findings were confirmed in 5 patients (7.8%). 51 patients (79.7%) responded well to the conservative management, 11 patients (17.2%) needed injection, and 2 patients (3.1%) had surgical treatment performed due to continuous recurrence. There was no difference in demographic and blood lab data between the two groups. However, the incidence of inflammatory diseases (response group: 10.3% vs non-response group: 66.7%, p=0.004) was significantly different between the two groups. Conclusion: The diagnosis of IGB can be missed due to variations in clinical symptoms, and cautions should be exercised in patients with inflammatory diseases as conservative treatment is less effective in them, leading to chronic progression of IGB.
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Affiliation(s)
- Y H Roh
- Department of Orthopaedics, Jeju National University Hospital, Jeju City, Republic of Korea
| | - S J Yoo
- Department of Orthopaedics, Jeju National University Hospital, Jeju City, Republic of Korea
| | - Y H Choi
- Department of Orthopaedics, Jeju National University Hospital, Jeju City, Republic of Korea
| | - H C Yang
- Department of Orthopaedics, Jeju National University Hospital, Jeju City, Republic of Korea
| | - K W Nam
- Department of Orthopaedics, Jeju National University Hospital, Jeju City, Republic of Korea
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Abstract
Musculoskeletal (MSK) conditions are growing in prevalence. Ultrasound (US) is increasingly used for managing MSK conditions due to its low cost and ability to provide real-time image guidance during therapeutic interventions. As MSK US becomes more widespread, familiarity and comfort with US-guided interventions will become increasingly important. This article focuses on general concepts regarding therapeutic US-guided injections of corticosteroids and platelet-rich plasma and highlights several of the US-guided procedures commonly performed, involving the pelvis and lower extremity.
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Swaine JM, Breidahl W, Bader D, Oomens C, O'Loughlin E, Santamaria N, Stacey MC. Ultrasonography Detects Deep Tissue Injuries in the Subcutaneous Layers of the Buttocks Following Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 24:371-378. [PMID: 30459500 PMCID: PMC6241223 DOI: 10.1310/sci17-00031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Ultrasonography may have potential as an effective diagnostic tool for deep tissue injury (DTI) in tissues overlying bony prominences that are vulnerable when under sustained loading in sitting. Methods: Three cases of DTI in the fat and muscle layers overlying the ischial tuberosity of the pelvis in 3 persons with spinal cord injury (SCI) with different medical histories and abnormal tissue signs are described. Conclusion: There is a need for prospective studies using a reliable standardized ultrasonography protocol to diagnose DTI and to follow its natural history to determine its association with the development of pressure injuries.
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Affiliation(s)
- Jillian M. Swaine
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Perth, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - William Breidahl
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Perth, Western Australia, Australia
- Perth Radiological Clinic, Mirrabooka, Western Australia, Australia
| | - D.L. Bader
- Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
| | - C.W.J. Oomens
- Biomedical Engineering Department, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Edmond O'Loughlin
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Department of Health, Government of Western Australia, Perth Business Centre, Perth, Western Australia, Australia
| | - Nick Santamaria
- Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Michael C. Stacey
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Perth, Western Australia, Australia
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Beyond the greater trochanter: a pictorial review of the pelvic bursae. Clin Imaging 2016; 41:37-41. [PMID: 27764718 DOI: 10.1016/j.clinimag.2016.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/08/2016] [Accepted: 09/22/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Review the MRI appearance of different bursae located throughout the pelvis, including the pertinent osseous and musculotendinous anatomy. MATERIALS AND METHODS Bursae are potential spaces that reduce friction between opposed moving components which can become inflamed, clinically mimicking internal derangement. RESULTS This series illustrates the most common as well as lesser-known pelvic bursae. Common causes of bursitis including overuse, trauma, and infection are presented. CONCLUSION Multiple bursae are located throughout the pelvis. It is important for radiologists to recognize bursitis as a potential etiology of pain and be familiar with their anatomical locations in order to guide appropriate management.
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Akins JS, Vallely JJ, Karg PE, Kopplin K, Gefen A, Poojary-Mazzotta P, Brienza DM. Feasibility of freehand ultrasound to measure anatomical features associated with deep tissue injury risk. Med Eng Phys 2016; 38:839-44. [DOI: 10.1016/j.medengphy.2016.04.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/01/2016] [Accepted: 04/28/2016] [Indexed: 11/28/2022]
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Abstract
This article describes the techniques for performing ultrasound-guided procedures in the hip region, including intra-articular hip injection, iliopsoas bursa injection, greater trochanter bursa injection, ischial bursa injection, and piriformis muscle injection. The common indications, pitfalls, accuracy, and efficacy of these procedures are also addressed.
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Yukata K, Nakai S, Goto T, Ikeda Y, Shimaoka Y, Yamanaka I, Sairyo K, Hamawaki JI. Cystic lesion around the hip joint. World J Orthop 2015; 6:688-704. [PMID: 26495246 PMCID: PMC4610911 DOI: 10.5312/wjo.v6.i9.688] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/13/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments.
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Lee RKL, Griffith JF, Ng AWH, Hung ELK. Sonographic examination of the buttock. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:546-555. [PMID: 23949925 DOI: 10.1002/jcu.22088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 04/20/2013] [Accepted: 07/03/2013] [Indexed: 06/02/2023]
Abstract
The buttock is a common site of pathology and ultrasound and is often the first-line imaging modality to examine soft tissue lesions of the buttock region. This review describes the ultrasound technique used, the relevant ultrasound anatomy, and the sonographic appearances of common and uncommon pathological conditions found in the buttock region.
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Affiliation(s)
- Ryan Ka Lok Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong
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Ultrasound-guided Ischial Bursa Injection: Technique and Positioning Considerations. PM R 2013; 6:56-60. [DOI: 10.1016/j.pmrj.2013.08.603] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 08/04/2013] [Accepted: 08/17/2013] [Indexed: 11/13/2022]
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McAlindon T, Kissin E, Nazarian L, Ranganath V, Prakash S, Taylor M, Bannuru RR, Srinivasan S, Gogia M, McMahon MA, Grossman J, Kafaja S, FitzGerald J. American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. Arthritis Care Res (Hoboken) 2013; 64:1625-40. [PMID: 23111854 DOI: 10.1002/acr.21836] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Friedman T, Miller TT. MR imaging and ultrasound correlation of hip pathologic conditions. Magn Reson Imaging Clin N Am 2012; 21:183-94. [PMID: 23168191 DOI: 10.1016/j.mric.2012.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Magnetic resonance (MR) imaging has become the workhorse in the imaging evaluation of the painful or clinically abnormal hip. It provides an excellent anatomic overview and demonstration of the bony structures, articular surfaces, and surrounding soft tissues. Conversely, sonography can also demonstrate superficial intraarticular structures and the periarticular soft tissues, is quickly performed, allows dynamic evaluation of tendons and muscles, and can guide percutaneous procedures. These two modalities are complementary, and this article concentrates on the MR imaging-sonographic correlations of several entities about the hip.
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Affiliation(s)
- Talia Friedman
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021, USA
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15
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Smith J, Finnoff JT. Diagnostic and Interventional Musculoskeletal Ultrasound: Part 2. Clinical Applications. PM R 2009; 1:162-77. [DOI: 10.1016/j.pmrj.2008.09.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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Ischiogluteal bursitis: a report of three cases with MR findings. Rheumatol Int 2008; 29:455-8. [DOI: 10.1007/s00296-008-0680-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 08/01/2008] [Indexed: 10/21/2022]
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Affiliation(s)
- Ba Duong Nguyen
- Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, AZ 85259, USA.
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Crundwell N, O'Donnell P, Saifuddin A. Non-neoplastic conditions presenting as soft-tissue tumours. Clin Radiol 2007; 62:18-27. [PMID: 17145259 DOI: 10.1016/j.crad.2006.08.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Revised: 07/28/2006] [Accepted: 08/02/2006] [Indexed: 12/27/2022]
Abstract
Review of referrals to our unit over the last 7 years showed that of approximately 750 cases referred as soft-tissue tumours, 132 were subsequently diagnosed as non-neoplastic lesions. The imaging characteristics of these lesions are presented to differentiate them from neoplasms. The most common diagnoses were myositis ossificans, ganglion cyst, abscess/infection, bursitis and synovitis. The imaging features of other rarer conditions will also be discussed.
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Affiliation(s)
- N Crundwell
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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Blankenbaker DG, De Smet AA. The Role of Ultrasound in the Evaluation of Sports Injuries of the Lower Extremities. Clin Sports Med 2006; 25:867-97. [PMID: 16962429 DOI: 10.1016/j.csm.2006.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Donna G Blankenbaker
- Division of Musculoskeletal Radiology, Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/311 CSC, Madison, WI 53792-3252, USA.
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Cho KH, Lee SM, Lee YH, Suh KJ, Kim SM, Shin MJ, Jang HW. Non-infectious ischiogluteal bursitis: MRI findings. Korean J Radiol 2006; 5:280-6. [PMID: 15637479 PMCID: PMC2698173 DOI: 10.3348/kjr.2004.5.4.280] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective We wished to report on the MRI findings of non-infectious ischiogluteal bursitis. Materials and Methods The MRI findings of 17 confirmed cases of non-infectious ischiogluteal bursitis were analyzed: four out of the 17 cases were confirmed with surgery, and the remaining 13 cases were confirmed with MRI plus the clinical data. Results The enlarged bursae were located deep to the gluteus muscles and postero-inferior to the ischial tuberosity. The superior ends of the bursal sacs abutted to the infero-medial aspect of the ischial tuberosity. The signal intensity within the enlarged bursa on T1-weighted image (WI) was hypo-intense in three cases (3/17, 17.6%), iso-intense in 10 cases (10/17, 58.9%), and hyper-intense in four cases (4/17, 23.5%) in comparison to that of surrounding muscles. The bursal sac appeared homogeneous in 13 patients (13/17, 76.5%) and heterogeneous in the remaining four patients (4/17, 23.5%) on T1-WI. On T2-WI, the bursa was hyper-intense in all cases (17/17, 100%); it was heterogeneous in 10 cases and homogeneous in seven cases. The heterogeneity was variable depending on the degree of the blood-fluid levels and the septae within the bursae. With contrast enhancement, the inner wall of the bursae was smooth (5/17 cases), and irregular (12/17 cases) because of the synovial proliferation and septation. Conclusion Ischiogluteal bursitis can be diagnosed with MRI by its characteristic location and cystic appearance.
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Affiliation(s)
- Kil-Ho Cho
- Department of Diagnositic Radiology, Yeungnam University College of Medicine, Nam-gu, Daegu, Korea.
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Floemer F, Morrison WB, Bongartz G, Ledermann HP. MRI Characteristics of Olecranon Bursitis. AJR Am J Roentgenol 2004; 183:29-34. [PMID: 15208103 DOI: 10.2214/ajr.183.1.1830029] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our aim was to describe the MRI characteristics of septic and nonseptic olecranon bursitis. MATERIALS AND METHODS MRI contrast-enhanced examinations (n = 19) of 35 patients with olecranon bursitis (septic, n = 14; nonseptic, n = 21) were jointly reviewed by two musculoskeletal radiologists. We evaluated bursa size, extent of marginal lobulation, septation, concomitant elbow joint effusion, soft-tissue edema, rim enhancement, soft-tissue enhancement, degree of fluid complexity, definition of bursa margins, presence of edema, thickening of the triceps tendon, and bone marrow edema. RESULTS Comparison of septic and nonseptic bursitis yielded the following results: marginal lobulation, 79% (11/14) versus 48% (10/21), p = 0.14; bursa septation, 64% (9/14) versus 57% (12/21), p = 1.0; moderate or marked complexity of bursa fluid, 64% (9/14) versus 29% (6/21), p = 0.15; poorly defined margins, 64% (9/14) versus 67% (14/21), p = 1.0; elbow joint effusion, 86% (12/14) versus 52% (11/21), p = 0.12; moderate to marked soft-tissue edema, 64% (9/14) versus 33% (7/21), p = 0.1; edema of the triceps, 57% (8/14) versus 48% (10/21), p = 0.73; thickening of the triceps, 43% (6/14) versus 14% (3/21), p = 0.21; bone marrow edema, 29% (4/14) versus 5% (1/21), p = 0.13; rim enhancement, 100% (11/11) versus 75% (6/8), p = 0.31; soft-tissue enhancement, 100% (11/11) versus 63% (5/8), p = 0.1. CONCLUSION Septic and nonseptic olecranon bursitis present with a considerable overlap of MRI findings without statistically significant differences. Septic olecranon bursitis can be excluded in the absence of bursal and soft-tissue enhancement.
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Affiliation(s)
- Frank Floemer
- Universitätsinstitut für Radiologie, Universitätsspital Basel, Petersgraben 4, Basel 4031, Switzerland
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