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Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS), formerly referred to as reflex sympathetic dystrophy (RSD) or causalgia, is a complex clinical entity. Most authors consider it a neuropathic pain disorder with some autonomic features and without a single pathognomonic test or marker. Nevertheless, the definition of neuropathic pain has been questioned lately because there are many mechanisms proposed for this disease, as we explain in this chapter. CRPS…

Muscle Injury and Sequelae

Prevalence, Epidemiology, and Definitions Injury of muscle, whether contusion, laceration, or strain, is one of the most frequently encountered injuries in athletes. Strain injury accounts for 90% of sports injuries of muscle and may result in significant disability. Muscle injuries are not limited to athletes, however, and the interpreting radiologist must be comfortable with recognizing their radiologic presentation. Normal muscle activity relies on innervation and perfusion;…

Complications of Osseous Trauma

There are many complications of skeletal trauma, although in most cases fracture healing is uncomplicated. Complications can result from direct trauma to bone and soft tissue or from the treatment of the fractures. Complications may be systemic or local and involve the bones or the adjacent soft tissues and joints. In this chapter an overview is presented of the various complications in which radiology plays a…

Radiation Effects in the Musculoskeletal System

History and Radiation Sources Since the discovery of X-rays by Wilhelm Conrad Roentgen in 1895 and the discovery of radioactivity by Henri Becquerel in 1896, many medical uses of radiation have been developed, both diagnostic and therapeutic. Patients can be exposed to radiation by external or internal sources. External radiation sources include imaging exams like conventional radiography, computed tomography and fluoroscopy, as well as external radiation…

Stress Injury

Prevalence, Epidemiology, and Definitions Stress injuries are a common cause of pain and morbidity and have become commonplace among the members of our increasingly active society. There is some confusion regarding the numerous terms used to describe these injuries, and the clinical diagnosis of stress fractures can be difficult: Symptoms are often vague, and soft tissue injuries may mimic bony abnormalities. Stress injuries represent a wide…

Skeletal Manifestations of Pediatric Nonaccidental Injury

Prevalence, Epidemiology, and Definitions Nonaccidental injury (NAI; child abuse) is a widespread social problem of special concern to pediatricians. It is present worldwide but has different manifestations in differing cultures with increased awareness in Western societies. The presentation varies from neglect, thermal injury, sexual abuse, bruising to physical neurocranial and skeletal injury. The true prevalence is hard to obtain because it frequently occurs behind closed doors,…

Upper Extremity Injuries in Children

Prevalence, Epidemiology, and Definitions Patterns of injury in children are different from those of adults, partly because of the unique structure of the pediatric skeleton. Injuries of the upper extremity account for 65% of all fractures and dislocations in children and often are the result of a fall on an outstretched hand. The distal radius, the supracondylar elbow, and the clavicle are among the most common…

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…