The special kind of wrist overuse injury in sonographer:trapezium stress fracture

Transcription

1 The special kind of wrist overuse injury in sonographer:trapezium stress fracture Poster No.: C-0447 Congress: ECR 2013 Type: Educational Exhibit Authors: D. Park; Suwon/KR Keywords: Education and training, Health policy and practice, MR, Trauma, Musculoskeletal bone DOI: /ecr2013/C-0447 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 15

2 Learning objectives The purpose of this exhibition is 1.To understand about acute onset sonogerapher's wrist pain and overuse injury. 2.To defict characteristic and diagnostic imaging feature of stress fracture in trepezium. 3. To described appopriated time to follow up. Page 2 of 15

3 Background Ultrasonography is the 1st line imaging modality for the all kind of radiologist such as abdomen,cardiovascular,muskuloskeletal and other's many areas. But we did not enough understanding about excessive doing ultrasonography is hurts ultrasonographer's health for example shoulder,elbow,neck,back,eye,wrist pain and etc. we get used to this kind of pain and tenderness,and ignored them. even though they cause severe pain and tenderness and threatened our jobs. this is that I have been suffer from acute onset wrist pain, I think that is usual pain but pain and tenderness are did not subside by rest and medication. it was comformed as trapezium stress fracture by MR. Page 3 of 15

4 Imaging findings OR Procedure details < MR imaging progression> 1.Fig.1 and fig.2 is symptom devepled 1month after MR imaging findings,there is t2fat sat high signal in trapezium. at that time symptom was not correlation with imaging findings,that was thenar area,thumb,and index finger pain and tenderness. I was thinking about detail functional anatomy about wrist. and I was conclude that it is must be due to trapezium bone edema and inflammation infiltrated to flexor carpi radialis tendon and recurrant branch from median nerve. 2. 2month follow up MR finding is fig3. there is unremarkable interval change in trapezium bone. 3. last 3month after MR finding is fig4.and fig5. there is clearly improved t2 fat sat high signal but residual symptom such as thenar muscle pain and thumb pain are remnant state. <clinical symptome pathway> 1.uncontrolled pain in the wrist and 1st 2nd 3rd finger and localized severe tenderness in the thenar muscle area,at that time I was hard for facewashing,mousing and word processing. it was very difficult time in my life. 2. localized pain in index fingure and thumb(figure5). 3.time goes passes pain and tenderness has ben localized in thenar muscle area and I was complain about thumb mortion difficulty. 4. at last now I have localized thenar muscle spot permanent pain and tenderness and easy fatigue in thenar muscle excersied work such as long standing probe holding and word processing(figure6). Page 4 of 15

5 Images for this section: Fig. 1: symptome developed 1month after follow up,there is well defined full filled T2FAT SAT high signal in whole trapezium. Page 5 of 15

6 Fig. 2: flexor capi radialis tendon pass to trapezium. it may be cause index finger symptome. Page 6 of 15

7 Fig. 3: 2month follow up MR image show, no significant interval change. Page 7 of 15

8 Fig. 4: 3 month after MR imaging show,there is no T2FATSAT high signal in trapezium Page 8 of 15

9 Fig. 5: 3month after coronal image showed,there is no abnormal signal in flexor carpi radialis and trapezium. Page 9 of 15

10 Fig. 6: pain was localized thumb and index fingure. Page 10 of 15

11 Fig. 7: permanent injury site Page 11 of 15

12 Conclusion 1.Ultrasonographers are needed not only restrction of amount and duration of ultrasonography exam but also regular check up and MR for their health. 2.Trapezium stress fracture caused by overused,which is approproated follow timing is 3month after follow up is correctable. 3.Long term complication about trapezium stress fracture is thenar muscle atrophy, localized pain,hand work or mortion easy fatigue and many thing you never confronted. 4. Dear colleague keep in mind there is no royal road to recovered trapezium stress fracture by overuse injury,it is only thing you can do is rest and immobilzation. Page 12 of 15

13 References 1)Radiographics October : )Radiographics September-October : )Radiographics September : Page 13 of 15

14 Personal Information I have been work in orthopaedic special hospital in suwon korea. My hospital every day doing many operation about spine, knee,shoulder and wrist. My key role in my hospital are spine surgery post. operation complicated abscess drainage by spinal needle,shoulder ultrasonography and wrist MR imaging. next time if I have chance to exhibition,i would want exhibited about post op. complication imaging in spine surgery. thank you Page 14 of 15

15 Images for this section: Fig. 8: MY PHOTO Page 15 of 15