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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…

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,…