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Brand: hermes bag history, What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics 2Department of Radiology, Aarhus University Hospital, Aarhus, DenmarkThis is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.This article has been cited by other articles in PMC.AbstractBackground and purpose An acetabular labral tear is hermes yunnan a diagnostic challenge. Various clinical tests have been described, but little is known about their diagnostic sensitivity and specificity. We investigated the diagnostic validity of clinical tests and ultra sound as compared with MR arthrography.Patients and methods We examined 18 patients (18 hips, 2 men, median age 43 (32 years) with impingement test, FABER test, resisted straight leg raise test, ultrasound, and MR arthrography. They had had previous periacetabular osteotomies due to symptomatic, acetabular dysplasia. Ultrasound had a sensitivity of 94%, a positive predictive value of 94%, and was false negative in only 1 case compared to MR arthrography. The impingement test had the best diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of hermes scarf ring 100%. The positive predictive value was 100% while the negative predictive value was 13%.Interpretation The impingement test is helpful in identifying acetabular labral tears. If this test is negative and if a labral tear is still suspected, ultrasound can reliably diagnose most tears of the acetabular labrum. MR arthrography is indicated in cases where ultrasound is negative, but the patient suffers continued, specific symptoms.IntroductionAcetabular labral tearing is frequently encountered in patients with acetabular dysplasia or femoroacetabular impingement, and remains a diagnostic challenge (Byrd and Jones 2003, Wenger et al. 2004). MR arthrography has been the diagnostic gold standard (Chan et al. 2005, Freedman et al. 2006, Toomayan et al. 2006). An investigation of ultrasound has shown poor diagnostic value (Troelsen et al. 2007). Various clinical tests for diagnosing acetabular labral tears are used: the impingement test, the FABER test, and the resisted straight leg raise test (Kelly et al. 2003, Martin et al. 2006). Yet, little is known about their sensitivity and specificity (Mitchell et al. 2003, Narvani et al. 2003). We therefore investigated the diagnostic value of clinical tests and ultrasound and compared it with that of MR arthrography.Patients and methodsClinical examinations, ultrasound, and MR arthrography were performed between December 2006 and June 2007. The study was approved by the regional scientific ethics committee (no. 2003 0021) and informed consent was obtained from all patients. 30 patients who had had periacetabular osteotomies between April 2003 and June 2004 (30 hips) and who visited our institution to participate in another scientific investigation were eligible for inclusion. 1 patient was excluded due to conversion to total hip arthroplasty, 1 had emigrated, 2 were non responders, 7 did not wish to participate, and 1 who did not show up for MR arthrography was excluded after the study was started. Thus, the study group consisted of 18 patients (18 hips, 2 men). Median age was 43 (32 years. Patients had developmental dysplasia of the hip with preoperative center edge angles of 25 (Wiberg 1939). All hip joints had no or only slight signs of radiographic degeneration (T grade 0 preoperatively and at the latest follow up (T 1987).Clinical testingIn the impingement test the hip joint was passively flexed to 90 internally rotated, and adducted (Figure 1). In the FABER test the lower extremity was passively placed in a figure of four position, and slight pressure was applied to the medial side of the knee (Figure 2). In the resisted straight leg raise test, the patient actively flexed the hip joint to approximately 30 with extended knee. This position was held while the examiner applied a downward pressure (Figure 3). The patient response was registered as follows: (1) no pain; (2) groin pain; (3) anterior thigh pain; (4) posterior thigh pain; (5) lateral thigh pain; (6) pain in the buttock; (7) knee pain; (8) lumbarsacral or sacral iliac pain; and (9) pain in other regions. A test was regarded positive by reproduction of groin pain.Figure 1.The impingement test was carried out by passively moving the hip joint in flexion (to 90 internal rotation, and adduction. The test was regarded as being positive on reproduction of groin pain.Figure 2.In the FABER (Flexion, ABduction, External Rotation) test, the hip joint was passively flexed, abducted, and externally rotated with the knee flexed (figure of four position). The ankle was brought to rest just above the contralateral knee and slight.Figure 3.The resisted straight leg raise test. The hip joint was actively flexed to approximately 30 with the knee extended. This position was held by the patient while the examiner applied pressure on the extremity just above the knee, toward the examination.Ultrasound examinationUltrasound examinations were performed using a Hitachi model EUB 8500 (Hitatchi Medical Corporation, Tokyo, Japan) and a 13 (13 6 MHz) linear transducer resolution of 0.1 mm). The transducer was initially placed parallel to the femoral neck, with identification of the femoral head and neck. It was then moved across the hip joint and tilted for evaluation of the labrum in the lateral acetabular quadrants. In addition, the labrum was visualized as the hip was moved passively in flexion, adduction and internal rotation. This dynamic examination was used to reveal labral detachment. The ultra sound examination took 5 minutes. Criteria for labral tears were: (1) displacement or (2) absence of the labrum; (3) hypoechoic cleft through the base of the labrum causing detachment with or without displacement; (4) intra substance hypoechoic linear clefts; intra substance hypoechoic (5) cystic or (6) irregular formations. Mixed echogenicity without definite tearing and irregular margins was interpreted as degenerative changes (Troelsen et al. 2007)MR arthrographyGuided by fluoroscopy, 8 mL of diluted gadolinium contrast medium (Gd DTPA, 2 mmol/L; Magnevist; Bayer AG, Berlin, Germany) was injected into the hip joint. Before injection, the intraarticular position of the needle point was verified by injecting a few drops of iodinated contrast medium. There were no adverse effects. MR arthrographies were performed celine t shirt with a 1.5 Tesla Scanner (Siemens Magnetom Symphony; Siemens, Erlangen, Germany). Initially, 3 scout sequences in the axial, sagittal, and coronal planes were obtained, followed by T1 weighted sequences with fat www.kaleejia.com suppression: true coronal, oblique axial (parallel to the femoral neck), oblique coronal 45 forward angled, and oblique coronal 45 backward angled (TR/TE 376/20, slice thickness 4 mm, field of view 220 220, and matrix 256 256). Finally, a coronal STIR sequence through the entire pelvis was performed (TR/TE 410/27, TI 170, field of view 400 400, and matrix 256 256). Criteria for labral tears were: hermes belt women (1) displacement or (2) absence of the labrum; (3) contrast medium through the Celine cheap base of the labrum causing detachment with or without displacement; intra substance (4) linear, (5) cystic, or (6) irregular presence of contrast medium. Intermediate signal intensity and irregular margins were interpreted as degenerative changes (Troelsen et al. 2007).Figure 4.An acetabular labral tear celine black bag visualized by MR arthrography (coronal view) with contrast medium running through the base of the labrum. hermes bag history There are many A brand-new maturing movement The way in which ought How can you hermes bag history Usually are a lot of these The number of times Could possibly Now i