Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Lower Extremity Injuries in Children

Epidemiology and Background The prevalence of both acute traumatic and chronic overuse injuries of the lower extremity has increased in children for a number of reasons. Children are participating in athletics at earlier ages and a higher rate than in the past. Data from the last decade indicate that 30 million, or half, of all U.S. children engage in an organized sport, with children's sports injuries…

Imaging of the Forefoot

Imaging Techniques Radiographs are an essential tool in the initial assessment of most conditions affecting the foot, whether they are acute or chronic traumatic lesions or infectious, inflam­matory, or neoplastic conditions. Standard views include anteroposterior, lateral, and external oblique projections. Assessment of developmental or acquired osseous malalignment and evaluation of the arch require radiographs taken with the patient bearing weight on the affected extremity. A sesamoid…

Compressive and Entrapment Neuropathies of the Lower Extremity

Lower Extremity Pelvis/Thigh Piriformis Syndrome Compression of the sciatic nerve by the piriformis muscle is noted in the pelvis. The L4, L5, S1, and S2 nerve roots give contributions to the sciatic nerve. As the nerve exits the greater sciatic foramen, it is composed of the tibial and peroneal divisions, enclosed by a common nerve sheath. The sciatic nerve descends anteriorly to the piriformis muscle in…

Soft Tissue Injury to the Ankle: Osteochondral Injuries and Impingement

Most patients who suffer an ankle sprain return to normal sport and daily living activity. However, chronic pain or instability can limit activity and affect up to 20% to 40% of these patients. Ankle impingement syndromes and osteochondral lesions are the leading causes of chronic pain following ankle sprain. Other important causes of painful sprained ankle pain are peroneal tendon injuries (peroneal tendon split syndrome and…

Soft Tissue Injury to the Ankle : Tendon Injuries

Etiology Ankle tendon injuries most commonly occur as a result of chronic microtearing due to overuse from athletic activity and/or primary degeneration. Systemic diseases such as rheumatoid arthritis, seronegative spondyloarthropathies, gout, hyperparathyroidism, and diabetes can also lead to tendon infiltration or degeneration. Discrete tears of the ankle tendons occur as a result of specific biomechanical forces applied to the tendon that are frequently superimposed on a…

Soft Tissue Injury to the Ankle: Ligament Injuries

General Considerations Prevalence and Epidemiology Ankle ligamentous injury or sprain is the most common type of ankle injury and accounts for 14% of visits to an emergency department, 1.6 million physician office visits, and more than 8000 hospitalizations per year in the United States. In the general U.S. population, the incident rate of ankle sprains is 2.15 per 1000 person-years. Fifteen- to 19-year-olds have the highest…

Acute Osseous Injury to the Ankle and Foot

Overview Of all of the major weight-bearing joints in the body, the ankle is the most frequently injured. In athletes, foot and ankle injuries account for up to one fourth of sports-related injuries, with the ankle ranking first as the most common cause of time lost in sports competition. In otherwise healthy patients, ankle injuries may be complicated by chronic joint instability and pain. Female gender,…

Normal Ankle and Foot

Technical Aspects Conventional Radiography ( eTable 30-1 ) eTABLE 30–1 Radiographic Projections Projection Anatomy/Indication Routine Toe (Coned) Anteroposterior toes only Tufts, subungual, interphalangeal space Anteroposterior foot Intertarsal space, metatarsophalangeal joints Oblique toes only Bone contours, phalanges Lateral toes only Dislocation Sesamoid (coned tangential view) Sesamoids Calcaneus Axial (plantardorsal) Transverse (mediolateral) calcaneus Lateral Anteroposterior calcaneus Foot Anteroposterior (10–15 degrees toward heel) Metatarsals, tarsometatarsal joints, 1st and 2nd…

Internal Derangement of the Knee: Cartilage and Osteochondral Injuries

Prevalence, Epidemiology, and Definitions The term osteochondral lesion is used to describe a defect of the articular surface involving separation of the cartilage and the underlying bone, without making any pretense to etiology. Possible causes of osteochondral lesions are traumatic osteochondral lesions, osteochondritis dissecans, and insufficiency fractures of the subchondral bone. The underlying mechanism in all cases is believed to be repetitive and prolonged overloading or…

Internal Derangement of the Knee: Tendon Injuries

The Extensor Apparatus The extensor apparatus consists of the quadriceps tendon, the patella, the patellar tendon, the infrapatellar fat pad, and the medial and lateral patellar retinacula. Quadriceps Tendon Rupture Anatomy The quadriceps tendon is the conglomeration of the distal tendons of the quadriceps muscle and usually has a striated appearance on sagittal MR images, with the anterior striation representing the contribution from the rectus femoris,…

Internal Derangement of the Knee: Ligament Injuries

Anterior Cruciate Ligament Prevalence, Epidemiology, and Definitions Injury to the anterior cruciate ligament (ACL) represents the most important ligament injury around the knee. It is relatively uncommon in the general population but is an important cause of injury in individuals involved in sports. Prevalence data are difficult to acquire, but more than 100,000 ACL reconstructions are performed per year in the United States. This suggests a…

Internal Derangement of the Knee: Meniscal Injuries

Normal Anatomy The menisci are C-shaped disks of fibrocartilage located between the articular surfaces of the femoral condyles and the tibia. The peripheral margin of each meniscus is thick and convex and tapers to a thin margin at the free edge. The menisci are composed of collagen bundles that are longitudinal in orientation ( Fig. 26-1 ). Compressive or axial loading causes an extrusive force that…

Acute Osseous Injury to the Knee

Prevalence, Epidemiology, and Definitions The imager's role in diagnosis and treatment of knee trauma is not only to accurately identify specific injuries, but also to recognize patterns of imaging findings that suggest that further investigation is warranted. It may be difficult for a primary care or emergency department provider to accurately choose which patients complaining of knee pain need further imaging after a radiographic series based…

Normal Knee

Imaging Techniques Technical Aspects Standard radiographs of the knee are performed as the first-line examination in knee disorders. Radiographs include anteroposterior and lateral views of the entire knee, as well as axial views of the patellofemoral joint ( eFig. 24-1 ). More specialized views include tunnel views, standing views, and axial patellofemoral views in different degrees of flexion. On anteroposterior views, the medial and lateral femorotibial…

Internal Derangement of the Hip and Proximal Femur

Anatomy of the Hip Joint The hip is a ball-and-socket joint allowing a wide range of motion in all directions. Active movements (flexion, extension, adduction, abduction, circumduction, and medial and lateral rotations) are possible. The femoral head is nearly completely covered by the spherical acetabular socket, except for a small inferior medial aspect, the so-called acetabular notch, where there is no socket. The transverse acetabular ligament…

Acute Osseous Injury to the Hip and Proximal Femur

Radiologic Anatomy of the Proximal Femur A thorough knowledge of radiologic anatomy and anatomic variations of the proximal femur is required for interpreting hip studies. Although excellent descriptions of femoral anatomy are readily available in classic textbooks, volume-rendered multidetector computed tomography (MDCT) images provide an optimal opportunity for reviewing the topic. The proximal femur is formed by the head, the neck, the greater and lesser trochanters,…

Athletic Pubalgia

Pelvic Anatomy in Relation to Pubalgia The pubic symphysis is a nonsynovial, amphiarthrodial joint formed by the confluence of the two pubic bodies with an intervening articular disk ( Fig. 21-1 ). The medial surface of the body forms the articular surface and is ovoid, covered by a thin layer of hyaline cartilage and composed of undulating transversely oriented ridges and grooves that can help dissipate…

Acute Osseous Injury to the Pelvis and Acetabulum

Fractures of the pelvic ring and acetabulum are a common consequence of high-speed collisions, usually related to motor vehicle accidents. They may also be caused by minor falls and occupational accidents. These injuries are associated with significant morbidity and mortality, derived from associated injuries (cardiovascular, gastrointestinal, respiratory, and genitourinary) and complications. In many cases the definitive treatment of pelvic ring and acetabulum fractures is surgical. Stress…

Normal Pelvis and Hip

Technical Aspects Techniques and Relevant Aspects Conventional Radiography Rationale and Indications For visualization of osseous anatomy and pathology, bone contours, and joint alignment. Recommended for any primary evaluation of suspected hip pathology, including fractures, dislocations, bone tumors, and infection. Gluteal, iliopsoas, and obturator fat pads. Advantages Readily available. Inexpensive. Limitations Limited soft tissue evaluation. Patient positioning difficult if there is limited motion for any reason (pain,…

Soft Tissue Injuries of the Hand and Wrist

Hand and wrist pain and restricted movement are common disabling complaints that may be caused by a broad spectrum of soft tissue disorders. These injuries may be the result of a single incident, such as falling on an outstretched hand, or the result of repeated overuse, such as in ongoing athletic or occupational activities. Clinical diagnosis and management is challenging. Findings are usually nonspecific, and similar…