Accuracy of knee effusion diagnosis is improved with US, particularly in patients with elevated BMI or small effusions, and is useful for arthrocentesis planning, and is useful for arthrocentesis planning.
Abstract
To assess the accuracy of physical examination tests for knee effusion using ultrasound (US) as the reference standard, and to explore whether BMI affects test performance.
Consecutive consenting patients with knee pain were recruited from an academic Rheumatology clinic. Each had a knee US and clinical exam, including inspection, bulge sign (BS), balloon/cross-fluctuance (CF), and patellar tap (PT) tests by an experienced rheumatologist. The sonographer was blinded to the clinical findings. Based on published literature, a pathologic knee effusion was defined as a hypoechoic collection measuring >3.2 mm in the lateral recess with quadriceps contraction.[1]
Patients (N=125) had a mean age of 54 + 16 years and 75% were female. Most patients had RA (45%), other inflammatory arthritis (19%), or CTD (14%). Replaced knees (N=4) were excluded. Clinical evidence of effusion was present in 92/246 knees, including 77 with a CF test, either alone (N=42) or in combination with a BS (N=19) or PT (N=16). In 14 knees with a BS alone, 9 were false positive. One knee had a PT alone which was false positive. The prevalence of pathologic knee effusion on US was 35% (87/246). The physical exam (BS, CF &/or PT + for effusion) had moderate sensitivity 71% (95% CI 61, 81), specificity 81% (95% CI 74, 87), PPV 67% (95% CI 57, 77) and NPV 84% (95% CI 77, 89), with an overall accuracy of 78%. False positive results (N=30) were significantly more frequent in patients with BMI > 25 (83%). False negative results occurred mainly with smaller effusions (<6.6 mm). The CF test had the highest agreement (80%) with US (kappa 0.54, p<0.00005) and the best overall performance (ROC area) compared to the BS and PT (p<0.05). The agreement between the physical exam and US was lower if BMI > 25 (kappa 0.44) compared to BMI <25 (kappa 0.64).
The physical exam had moderate diagnostic accuracy for knee effusion. The CF test had the best overall performance in detecting knee effusions in patients with rheumatic diseases, a finding that has not previously been reported. The PT did not add value to the clinical exam in this study. Elevated BMI was associated with reduced accuracy and PPV of the physical exam. Accuracy of knee effusion diagnosis is improved with US, particularly in patients with elevated BMI or small effusions, and is useful for arthrocentesis planning.
[1.] Terslev L. Ultraschall Med 2012;33:E173-E178.
Its strong concordance with MRI supports its use as a first-line diagnostic tool, particularly for full-thickness tears, and remains essential in equivocal cases or when detailed pre-operative assessment is required.
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USG provides improved detection of osteophytes and offers additional information on soft-tissue and early structural changes in knee OA and serves as a valuable, accessible adjunct to conventional radiography for comprehensive evaluation and early diagnosis of knee OA.
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High specific index tests and exploratory clusters showed diagnostic accuracy for identifying gymnasts without degenerative disc disease, disc herniation, and pars oedema/spondylolysis.
L. Fawcett, James Martin, S. James et al.· Physical Therapy in Sport· 0 citations
BACKGROUND
Musculoskeletal ultrasound is widely used to assess joint and bursal effusions, yet the impact of moderate-distance running on fluid accumulation in asymptomatic individuals remains unclear. Previous studies have shown mixed results depending on exercise type and timing, highlighting a gap in understanding transient physiological responses to common physical activity such as running.
OBJECTIVE
To determine whether a 5-km run induces detectable changes in fluid presence within selected joints and bursae in healthy adults, as assessed with musculoskeletal ultrasound.
DESIGN
Prospective observational trial.
SETTING
Institutional setting at a university hospital.
PARTICIPANTS
Thirty healthy adults (17 female, 13 male; ages 20-47 years) without musculoskeletal symptoms or recent injuries were recruited. All participants completed the study.
INTERVENTIONS
Not applicable.
MAIN OUTCOME MEASURE(S)
Binary (yes/no) presence of fluid in the tendon sheath of the long head of the biceps brachii, deep infrapatellar bursa, retrocalcaneal bursa, and talocrural joint were assessed bilaterally with ultrasound at baseline, immediately post run, and 24 hours post run.
RESULTS
Significant increases in fluid were observed 24 hours post-run in the retrocalcaneal bursa (left: p < .001, g = 0.46; right: p < .001, g = 0.40) and talocrural joint (left: p = .001, g = 0.36; right: p = .002, g = 0.33). long head of the biceps brachii showed transient changes (left: p = .002 next day). No significant changes were found in the deep infrapatellar bursa (all p > .05).
CONCLUSIONS
A short 5-km run can produce delayed increases in fluid at the ankle region, with the largest changes observed at 24 hours. Clinicians should account for recent physical activity when performing and interpreting ultrasound findings, as exercise may increase the prevalence of detectable fluid at certain sites. However, as the final assessment was performed at 24 hours, the full time course of these changes remains to be determined.
Jakub Jačiško, A. Busch, N. Procházková et al.· PM & R : the journal of inju...· 0 citations
PURPOSE
To present a series of 37 cases diagnosed with ultrasound (US) of symptomatic hydroxyapatite deposition disease (HADD) involving the wrist and hand.
MATERIALS AND METHODS
Reports from two institutions were searched using the keywords "HADD hand/wrist" or "calcium deposit hand/wrist". The US examinations were performed with a similar standardized approach, focusing on the region of pain. B-mode and Doppler sonograms were acquired. Each author reviewed the cases to ensure that only cases consistent with HADD were included.
RESULTS
A total of 37 patients were identified, mostly women (81% of the cases). The mean age was 50 years old. Calcifications usually showed resorptive stage features (type III). Follow-up clinical data were available in 16 patients, mostly with at least a partial resolution of symptoms.
CONCLUSION
US is a useful imaging technique to diagnose HADD of the hand and wrist, especially in the correct clinical context (e.g., acute non-traumatic symptoms in women, with progressive improvement in pain). Conventional radiography may help to confirm the calcific deposit. Advanced imaging modalities are usually not required, but may be considered in selected cases. Follow-up to confirm an improvement over time is suggested.
Marco Becciolini, R. Picasso, Antonio Corvino et al.· Journal of Clinical Ultrasou...· 0 citations
Knee osteoarthritis (KOA) is a prevalent degenerative joint disease characterized by progressive structural and functional impairment. While magnetic resonance imaging (MRI) is regarded as the reference standard for assessing joint pathology, ultrasonography (US) offers a cost-effective, accessible, and dynamic alternative. This study aimed to evaluate the concordance between US and MRI findings in assessing key structural features of KOA.
In this prospective cross-sectional study, 320 patients fulfilling the American College of Rheumatology (ACR) criteria for KOA underwent both standardized US and MRI of the affected knee. Imaging assessments included cartilage integrity, meniscal extrusion, marginal osteophytes, and joint effusion. MRI served as the reference imaging modality for calculating the diagnostic performance of US. Cohen’s kappa (κ), Spearman correlation, intraclass correlation coefficients (ICC), and Bland–Altman analyses were applied to evaluate agreement between modalities, while sensitivity, specificity, and diagnostic accuracy of US were calculated using MRI as the reference standard.
Good agreement was observed between US and MRI for osteophytes (κ = 0.79), joint effusion (κ = 0.67), and meniscal extrusion (κ = 0.52–0.72), whereas cartilage grading showed moderate agreement (κ = 0.52). US demonstrated high diagnostic performance for joint effusion (sensitivity = 98.7%, specificity = 100%) and strong correlations for quantitative meniscal extrusion (ρ = 0.79–0.96; ICC = 0.84–0.93, 95% CI: 0.600–0.957). Bland–Altman analysis demonstrated minimal measurement bias and narrow limits of agreement between the two imaging modalities.
US provides a reliable, noninvasive, and accurate assessment of structural alterations in KOA, demonstrating strong agreement with MRI in evaluating joint effusion, osteophytes, and meniscal extrusion. These findings support the use of US as a valuable complementary imaging modality in the comprehensive evaluation of knee osteoarthritis, particularly when standardized imaging protocols are applied.
H. Majidi, Shima Sharifi, F. Roodposhti et al.· BMC Musculoskeletal Disorder...· 0 citations
