0:01

This is an interesting case that I shared with Don prior

0:04

to our, our sit down today,

0:07

and I wanted to share it with you.

0:09

Um, I'm sure you're all struck by the heterogeneous

0:14

signal in the ERUs fibrosis.

0:17

Uh, Las Erti was not originally injured in this case.

0:21

This patient had a, a rupture.

0:24

They chose to have a repair with a

0:27

bioresorbable anchor and suture.

0:30

Now sometimes, uh,

0:32

they will actually put a little block on the other side

0:35

of the radius and then they'll tie the sutures

0:37

into that block.

0:39

One of the problems with that, as we'll see on day five, is

0:43

that you can end up

0:44

with posterior interosseous nerve impingement syndrome.

0:48

Otherwise they'll just pull the sutures through

0:50

and tie them, which is what they've done here.

0:53

Unfortunately, the patient has reacted very adversely, uh,

0:57

to the materials that have been placed

0:59

and produced this large pseudo mass.

1:01

There wasn't a discreet, uh, injury

1:05

and this turned out to be inflammatory

1:07

and granulomatous material

1:09

and it dissected back into the ERUs fibrosis.

1:13

So I'm not sure that this patient isn't worse off than they

1:16

were, uh, prior to, prior to the surgery.

1:20

Another risk, by the way, of the, this surgery,

1:23

and I've seen it, uh, especially in a dear friend of mine,

1:25

is RSD of the hand.

1:27

Um, any comments on this one?

1:29

Well, I just, uh, a general comment

1:31

and I think that for, for all postoperative uh, cases,

1:36

because there are variations in the surgical procedure

1:40

that are used, I think it becomes very, very important

1:43

that you try to get operative notes

1:46

before you try to interpret the mr.

1:49

And, uh, I do a lot of the teleradiology for UCSD now

1:54

and it sometimes does hold up the case for 24 hours or so,

1:59

but I'm never disappointed if we get them because, uh,

2:03

and I read them because as I say, you, you really need

2:06

to know what they did

2:08

before you really can figure out

2:10

what went wrong if there is an abnormality.

2:13

So, so I just would advise people listening that

2:17

whenever possible, I don't want you to lose your business,

2:20

but whenever possible, if you can,

2:23

you don't have the operative note

2:25

that you should, uh, ask for it.

2:27

'cause I think it'll make analysis a lot. Uh,

2:30

Well, I would be your biggest cheerleader on that front.

2:33

And the folks that are in the room know

2:35

that we have an entire team that is dedicated to

2:38

just tracking down the postoperative results or the op notes

2:42

or the notes that are in the physician's office.

2:45

And I do read them, I don't read every word,

2:48

but I stay with the relevant areas as they relate to the,

2:52

to, to the case at hand.

2:53

And I'll usually go through, you know, pretty quickly in,

2:57

in less than 30 seconds, the h and p if it's available.

3:00

And I find it very valuable.

3:02

Yeah. And I always make one, particularly,

3:04

I'm not talking about menisci in, in this particular, uh,

3:08

course, but, uh, whenever I read an MR of the knee, whether

3:12

or not they say the patient's had prior surgery

3:16

or not, I will always study this.

3:19

The first thing I do, the anterior soft tissues in the

3:23

region of, of the fat pad

3:25

to see if I see postoperative changes.

3:27

'cause a lot of times they will in fact, uh, not indicate

3:31

that or rarely they say there has been surgery

3:35

and yet there's no imaging evidence that there had been.

3:38

So I just think it's so critical it changes so much

3:42

of the way we interpret these exams.

3:45

And when I first started doing MRI, you know, the fellows

3:47

and I would go to arthroscopy

3:49

and, uh, you know,

3:50

there would be some very interesting orthopedic surgeons

3:53

that would be dancing around the room to music

3:56

and they would be taking meniscii down right and left.

3:59

Uh, that, that approach has changed fortunately,

4:03

but the meniscii 20 years ago were considered a disposable

4:06

item.