Introduction The accuracy of ultrasonography has been reported to be high in diagnosing full thickness rotator cuff tears if measurements are made in both in the coronal and sagital planes. The purpose of this study is to determine how well pre-operative shoulder ultrasound rotator tear measurements when performed only in the coronal plane, the common practice in Israel, predicts the intra-operative surgical findings.

Materials and Methods Fifty consecutive patients who underwent open rotator cuff repairs were included in the study. All patients underwent a pre-operative ultrasound by the same experienced musculoskeletal ultrasoundist. Rotator cuff tears were measured in the coronal plane only. This was compared with the tear size measured intra-operatively. Regression analysis was done between the two variables.

Results The mean size of rotator cuff tears as determined by ultrasonography was 15.56±8.07mm and the measure size of the tears intraoperatively was 27.94±9.8 mm. The result of the regression analysis of the two variables was R2= 0.268405 for the first 25 patients and R2= 0.310309 for the second 25 patients.

Discussion Using ultrasound it is easy to visualize the extent of rotator tears in the coronal plane, but more time consuming to measure the extent in the sagital plane, where the tear may have its greatest extension. Ultrasound measurements tear measurements in this study, made only in the coronal plane correlated poorly with intraoperative findings and only minimally improved over the time course of the study.

Conclusion Proper assessment of a possible candidate for a rotator cuff repair should include an ultrasound with the tear size measured specifically in both the coronal and sagital planes.

Background: The Achilles tendon is the strongest and thickest tendon in the human body, it is very commonly injured with significant clinical implications. The treatment of Achilles tendon rupture is a matter of controversy in orthopedics and sports medicine. Surgical repair compared with conservative treatment is debated constantly in the literature, without a conclusive decision. The diagnosis of Achilles tendon rupture is based usually on clinical examination, and may be reinforced by ultrasound or magnetic resonance imaging. The present study has been conducted in order to determine whether an ultrasound examination performed at the time of injury could be useful in deciding how to treat the patient.

Patients: Over a period of 5 years we treated 26 patients who had a clinical presentation of ruptured Achilles tendon with ultrasound diagnosis of either a partial tear or a full tear. Patients who were diagnosed by ultrasound as having a full tendon tear were operated on, and were not included in this study. Eight patients had partial tear of the tendon, six had a tear of the musculotendinous region, and twelve had a proximal tear. All patients were treated by means of a cast or a dressing, with limitation of weight bearing. The follow-up period ranged between six months to three years after the injury, and included up-to-date functional evaluation.

Results: Eighteen patients were available for evaluation. Excellent functional results were reported by five patients, twelve patients reported good results, and one patient complained of a bad result. None of our patients needed delayed surgery, and only one suffered from re-rupture of the tendon during his rehabilitation, and was treated conservatively with good results. No correlation was found between the location of the tear and the functional results.

Conclusions: 1. Ultrasound is an important and accurate tool in the diagnosis of Achilles tendon tear and is helpful in choosing the appropriate treatment. 2. Partial tear of Achilles tendon is not an indication for operative treatment, even when the clinical examination (Thompson test) is positive. The outcome of conservative treatment in this situation is as good or even better than surgical treatment.

Reports of spondylolysis in vertebrae other than those of the lower lumbar spine are rare. We report 32 patients with upper lumbar spondylolysis who have been studied clinically, radiologically and scintigraphically. Twenty patients had bilateral lesions, and seven of those with unilateral lesions had structural changes or anomalies in the opposite posterior arch. Positive scans were found to be associated with a short clinical history, and indicated stress-related lesions. Our findings suggest that mechanical factors may play a role in the aetiology of spondylolysis in the upper lumbar spine similar to that which they play in the lower lumbar spine, and that local structural anomalies may contribute to abnormal loading of these vertebrae.

1. Three cases of osteochondromatosis of the hip joint are described.

2. Attention is drawn to the diagnostic importance of erosions at the junction of head and neck of the femur, and the conical shape of the femoral neck.

3. Arthrography is of particular value in diagnosis when the loose bodies are radio-translucent.