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Classic Signs and Findings in Musculoskeletal Radiology

Condition Absent in posterior dislocation of the shoulder Name of Sign Half-moon sign Description The medial humeral head normally overlaps the posterior glenoid rim on a standard anteroposterior (AP) shoulder radiograph in external rotation, an appearance resembling a half-moon. When a patient has a posterior shoulder dislocation, there is often no overlap (rim sign). Reference Schild H, Muller HA, Klose K: The halfmoon sign. Australas Radiol…

Diseases with Names

A few examples of these are shown here, and the full listing is available online. A Aarskog Syndrome Aarskog syndrome is an extremely rare genetic disorder marked by stunted growth that may not become obvious until the child is about 3 years of age, and also by broad facial abnormalities, musculoskeletal and genital anomalies, and mild mental retardation. Aarskog D. A familial syndrome of short stature…

Fractures with Names

Abstract In general, an eponym can be considered the proper name of the first person or persons describing an anatomical structure, a classification system, a disease, a fracture, a surgical technique, an instrument, and so on. It is believed that the use of eponyms tends to cause confusion and should be avoided. A clear example of this is the Colles fracture, a name applied to many…

Orthopedic Devices

Abstract Plates and Screws Blade Plate and Screws Indications: subtrochanteric and supracondylar femoral fractures ( Fig. 1 ) as well as femoral osteotomies Angled plate configuration Reconstruction Plate Indications: pelvic ( Fig. 2 ) and calcaneal ( Fig. 3 ) fractures Malleable plate that can be appropriately sized and configured for stabilization of fractures with complex bony surfaces Buttress Plate and Screws Also known as periarticular…

Measurements Most Frequently Used in Orthopedic Imaging

Abstract Measuring distances and angles is an important task in daily orthopedic practice. Radiologic measurements are the key to diagnosing certain injuries and defining their prognosis, and they often have a decisive impact on treatment. Radiologic measurements can be used in orthopedics to diagnose certain injuries or to assess progression in some diseases, in particular chronic ones. After a fracture, measurements are useful to quantify displacement…

Ultrasound Procedures

Abstract Indications Ultrasound guidance is the optimum technique for placing needles into soft tissue structures when they are well visualized using this imaging method. In broad terms, ultrasound is used for injections and biopsies, but both the structures to be punctured and those that must be avoided should be visible. Ultrasound imaging has particularly good resolution within the first 5 to 10 cm of soft tissue. Sound…

Percutaneous Intradiskal Therapies

Abstract Percutaneous intradiskal therapies are currently used in the treatment of two distinct medical problems: chronic low back pain and the herniated nucleus pulposus–related radicular syndrome (sciatica). Both conditions lead to substantial medical and economic losses, with low back pain being the major cause of disability in the United States for patients less than 45 years of age. The prevalence of low back pain in the…

Vertebroplasty and Kyphoplasty

Abstract Vertebroplasty was first described by Herve Deramond and his colleagues from Amiens, France, in 1987. They were faced with a patient with an aggressive, destructive, but otherwise benign hemangioma of a C2 vertebral body. There seemed to be no surgical option, and they elected to perform an experimental procedure placing a needle via a transoral route and injecting methylmethacrylate under image-intensifier control. It became apparent…

Discography

Abstract Indications Discography is a diagnostic tool for the diagnosis of cervical, thoracic, or lumbar radicular or referral pain. Although the use of discography as the first-line diagnostic examination is not indicated, it is usually recommended when conservative treatment or noninvasive diagnostic tools fail to establish a reasonable outcome. It is reserved for suspicious abnormalities seen on other tests and when severe symptoms are propelling the…

Spinal Injections

Indications Epidural pain injections are useful in the patient with a wide variety of disorders that could generate back pain, including extruded and bulging disks; foraminal and lateral recess stenoses with nerve compression from facet osteoarthritis, capsular hypertrophy, synovial cyst formation, and scar production; spondylolysis with spondylolisthesis; and congenital and/or acquired central canal stenosis. In addition to these mechanical abnormalities, chemical irritation of the nerves can…

Tumor Ablation

Techniques Chemical Ablation with Sclerosing Agents Sclerosing agents act by diffusion into cells and cause immediate dehydration of cytoplasm with subsequent necrosis followed by fibrosis. By entering into the circulation, these agents induce necrosis of endothelial cells and platelet aggregation, causing thrombosis. Radiofrequency Ablation In radiofrequency ablation (RFA), an RF probe is positioned in the patient. The probe is usually monopolar, and large grounding pads are…

Percutaneous Biopsy of the Spine

Percutaneous biopsy of the spine is an effective, reliable, safe, and rapid procedure that can be easily performed in comparison with open biopsy. It may be performed at a lower cost than surgery. This procedure has become routine and is indicated in many cases. Indications Bone Metastases A suspicion of bone metastasis represents the principal indication for percutaneous biopsy of the spine. It is especially helpful…

Percutaneous Biopsy of the Appendicular Skeleton

Percutaneous biopsy of the appendicular skeletal lesion is a minimally invasive, safe, and inexpensive procedure compared with open biopsy. Therefore, this procedure is indicated in many cases. Indications Bone Metastases A suspicion of bone metastasis is the main indication for percutaneous biopsy of skeletal lesions. This procedure is particularly helpful in patients with no known primary bone tumor who present with multiple lesions consistent with metastases…

Biopsy: Soft Tissue

Abstract Indications The incidence of soft tissue sarcomas in the general population is very low, 1.4 to 2.7 per 100,000, increasing for patients 80 years of age and older to 8 per 100,000. The majority (59%) of soft tissue sarcomas occur in the extremities, with the most common types reported to be undifferentiated pleomorphic sarcoma, liposarcoma, leiomyosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor. Although…

Normal Variants

Abstract Normal variants in the skeleton are commonly encountered in the practice of radiology. Kohler was the first to seriously address this subject in his book, Borderlands of the Normal and Early Pathologic Findings in Skeletal Radiology, which was published in 1968 and was limited to the skeletal system. Theodore E. Keats expanded the concept of normal variation to all of the subspecialties of imaging with…

Dental Imaging

Diagnosis of Mandibular and Maxillary Lesions The mandible and maxilla are unique bones in that they both contain teeth and tooth-forming tissues. This fact is responsible for the high rate of inflammatory diseases, such as osteomyelitis and of lesions of odontogenic origin and other possible bone-related diseases. Because of this wide spectrum of disease, the interpretation of diagnostic images of the maxilla and mandible can be…

Temporomandibular Joint

Pathophysiology Anatomy The temporomandibular joint (TMJ) is a diarthrodial joint bounded by the glenoid fossa and articular eminence of the temporal bone above and the mandibular condyle below (see Video 114-1 ). A joint capsule extends from the posterior portion of the temporal bone, glenoid fossa, and the articular eminence superiorly to the neck of the mandibular condyle inferiorly in the form of an inverted pyramid.…

Postoperative Infections

Etiology Postoperative infection of the hip and knee may occur in a myriad of clinical settings, including systemic infection or illness, blunt or penetrating trauma, or following medical intervention. Infection is both a primary complication and a medium through which deleterious effects may impact bone, muscle, neurovascular, and soft tissue as well as implanted materials. Complications may occur if there is delayed diagnosis of an infection,…

Imaging of the Residual Limb after Amputation

Amputation surgery is an ancient procedure dating back to prehistoric times. Although there have been numerous advances in limb salvage techniques, amputation is still performed today and may be the treatment of choice in cases of severe vascular disease, severe trauma, and some malignant neoplasms. In the United States, most amputations are performed in patients with diabetes mellitus and peripheral vascular disease, with amputations in this…

Postoperative Ankle and Foot

More than 200 distinct operations are performed in the ankle and foot. Indications for operative intervention include traumatic, overuse, degenerative, arthritic, congenital, neoplastic, and inflammatory conditions. Procedures unique to the foot and ankle are reviewed here, with emphasis on the imaging techniques used to evaluate successful and complicated operations. Osteosynthesis Description The most commonly performed operations in the foot and ankle—fracture treatment, osteotomies, and arthrodeses—are designed…