title: Bedside ultrasonography of musculoskeletal complications in brain injured patients.
abstract: BACKGROUND
  The aim of this study was to evaluate the role of bedside ultrasonography (US) in early diagnosis of musculoskeletal complications (MSC) of acquired brain injuries, to describe its incidence and US features in a neurorehabilitation setting.
  
  
  METHODS
  All 163 patients admitted in tertiary-level neurorehabilitation unit with diagnosis of stroke or severe brain injury (SBI), with symptoms or signs of musculoskeletal pathology, underwent bedside US.
  
  
  RESULTS
  MSC were diagnosed in 51.5%. In 86.9% US clarified diagnosis and/or modified therapeutic approach. Shoulder pain was observed in 27.6%. US showed a shoulder subluxation in 73.3% and a frozen shoulder in 8.8% of painful shoulders. In all the cases rotator cuff abnormalities were noted. Wrist-hand syndrome was observed in 29.4%. US showed mild effusion in wrist joints and tendon sheaths and subcutaneous edema without significant vascularity. Neurogenic heterotopic ossification was observed in 1.8%. US demonstrated the "zone phenomenon" or heterogeneously hypoechoic mass with low resistance vessels within the lesions. Contractures and spasticity were observed in 18.4%. US allowed reliable guidance for Botulinum toxin A injection. Relapsing osteoarthritis and acute arthritis were diagnosed in 15.3% and 7.3% respectively. Patients with MSC had lower Functional Independence Measurement (FIM) and Katz index scores in discharge (p < 0.04 and p < 0.0294 respectively) and more length of hospital stay (p = 0.0024).
  
  
  CONCLUSIONS
  Musculoskeletal pathology frequently complicates the course of acquired brain injuries and it delays functional recovery. Bedside US is a cheap and sensitive diagnostic tool and it can aid clinicians to define diagnosis and to choose therapeutic approach.
authors: Neurorehabilitation Unit, Department of Rehabilitation, Local Health Unit (AUSL) 8, S. Donato Hospital, Arezzo, Italy.
authors: P
authors: P
authors: Falsetti
authors: C
authors: C
authors: Acciai
authors: F
authors: F
authors: Carpinteri
authors: R
authors: R
authors: Palilla
authors: L
authors: L
authors: Lenzi
keywords: Acquired brain injury; Musculoskeletal pathology; Power Doppler ultrasonography; Stroke
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