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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…

Compressive and Entrapment Neuropathies of the Upper Extremities

Upper Extremity Shoulder Suprascapular Nerve Syndrome Impingement of the suprascapular nerve occurs at the scapular notch or spinoglenoid notch. The suprascapular nerve originates from the brachial plexus, and at the scapular notch it branches into the supraspinatus and infraspinatus nerves ( Fig. 17-1 ). Proximal entrapment at the scapular notch results in compression of the suprascapular nerve and denervation of both the supraspinatus and infraspinatus muscles…

Acute Osseous Trauma to the Hand

Prevalence, Epidemiology, and Definitions Acute bony trauma to the hand represents some of the most commonly occurring fractures encountered in daily clinical practice. Whether the etiology is related to sports, occupation, or trauma, the consequences can be devastating and the potential for functional loss often underappreciated. Therefore, it is essential that an accurate diagnosis and treatment plan be implemented to restore full function and form. Injuries…

Internal Derangement of the Wrist

Introduction Wrist anatomy and function is both complex and detailed. Evaluation for internal derangement assumes an understanding of the anatomy, imaging characteristics, biomechanics, and function of key ligaments and cartilaginous structures in the wrist, including the triangular fibrocartilage complex (TFCC), scapholunate ligament, lunotriquetral ligament, and extrinsic ligaments. All of these ligamentous and cartilaginous elements in the wrist function in concert to provide stability and optimal wrist…

Acute Osseous Injury to the Wrist

Prevalence, Epidemiology, and Definitions Acute osseous injury to the wrist may be encountered in a subject who has received direct trauma to the wrist or who has fallen on the outstretched hand (popularly referred to as FOOSH). Radiographic evaluation remains the primary modality for initial assessment. The multiplanar capability of CT and MRI contributes osseous and soft tissue detail useful for complex injuries and occult fracture…

Normal Wrist

Normal Wrist Technical Aspects Conventional Radiography Rationale and Indications Allows visualization of osseous anatomy and pathology, bone contours, and joint alignment Is recommended for any primary evaluation of osseous wrist pathologic processes such as fractures, dislocations or malalignment, infection, and bone tumors ( eTable 13-1 ; eFigs. 13-1 to 13-5 ) eTABLE 13–1 Conventional Radiography Projections Main Visualized Anatomy and Pathology Posteroanterior * (dorsopalmar view) Overview…

Soft Tissue Injury to the Elbow

Prevalence, Epidemiology, and Definitions Musculotendinous Injury Traumatic injury to the musculotendinous units of the elbow may result from acute trauma or repetitive micro-trauma. Furthermore, acute trauma is frequently superimposed on tendinopathy or other chronic injuries. MRI can be highly valuable in the assessment of elbow pain, owing to its superb soft tissue resolution. Even in patients with a clear clinical diagnosis of musculotendinous pathology, MRI can…

Acute Osseous Injury of the Elbow and Forearm

Anatomy (Including Gross Anatomy and Normal Variants) Fat Pads The anterior fat pad is anterior to the olecranon fossa and is routinely seen on the normal lateral view, extending inferior, from the anterior humeral cortex, obliquely. The posterior fat pad lies in the olecranon fossa and is not visible on the normal lateral view ( Fig. 11-1 ). Both fat pads are within the joint, intraarticular,…

Normal Elbow

Introduction Routine radiography, ultrasound, CT, and MR imaging (conventional and arthrography) are the main diagnostic modalities used for diagnosis of abnormalities around the elbow joint. Conventional Radiography Radiography ( Fig. 10-1 ) is used for primary evaluation of any osseous elbow pathology by assessment of the bony contours, joints, and fat pads. Limited soft tissue evaluation and ionizing radiation are major limitations. Generally, plain film series…

Glenohumeral Instability

Prevalence, Epidemiology, and Definitions Shoulder instability and labral tears are a common cause of shoulder complaints, particularly in young athletic individuals. The symptoms can be quite debilitating, and surgery is often required to reduce the pain or stabilize the shoulder. Imaging plays an important role in helping determine who might benefit from surgery. The glenoid labrum has several normal anatomic variants, however, that it is crucial…

Shoulder Impingement Syndromes

Prevalence, Epidemiology, and Definitions The etiology of rotator cuff tendinosis and tears is likely multifactorial, involving both intrinsic and extrinsic factors. Multiple causal factors have been described in association with rotator cuff pathology, including vascular, degenerative, traumatic, and anatomic/mechanical factors. The diagnosis is based on the patient's history and findings on physical examination, supplemented by imaging findings. The modern understanding of shoulder impingement owes much to…

Osseous Injuries of the Shoulder Girdle

Prevalence, Epidemiology, and Definitions Osseous injuries that affect the shoulder girdle are common in adults. The acromioclavicular joint is the primary connection between the arm and the thorax, and the glenohumeral joint is inherently unstable, owing to the disproportionate size of the articular surfaces of this spheroidal joint. The majority of injuries occur either from a direct impact on a focal point on the shoulder or…

Normal Shoulder

Imaging Modalities and Technical Aspects Conventional radiography of the shoulder ( Table 6-1 , Fig. 6-1 ) is recommended for any primary evaluation of suspected pathology, including fractures, dislocations, bone tumors, and infection. It is readily available, inexpensive, and uses minimal ionizing radiation. However, soft tissue evaluation is limited, and patient positioning may be difficult (e.g., due to pain, fracture, ankylosis). TABLE 6–1 Conventional Radiography of…

Injury of the Thoracic Cage and Thoracolumbar Spine

Prevalence, Epidemiology, and Definitions Injuries of the thoracic cage and the thoracolumbar spine are common—not only in patients with severe traumatic injuries following motor vehicle accidents (MVAs) or, for example, those who fall from great heights, but also in daily clinical practice. Collapsed thoracic and lumbar vertebrae are encountered every day in our routine work, often as incidental findings on chest radiographs or CT scans. These…