Radiology Workshop
Extremities
Andrew Haims
Case #1
• This is a 35 year old
male who fell off a
roof and is now
complaining of knee
pain
How would you describe
this injury?
This is a knee dislocation,
click to see the normal
orientation of the tibia and
the femur
What types of injuries do you What is wrong with
worry about with knee
this angiogram?
dislocations?
Hint, bony, vascular or
ligamentous or meniscal?
Vascular is the most
concerning and there is
almost always
ligamentous and
meniscal injuries
What would you do to
evaluate the artery?
First examine for a
pulse, then possibly
an angiogram
The popliteal artery is disrupted
Let’s take a look at some ligaments, can you point out
the normal anterior and posterior cruciate ligaments
on these sagittal sequences? Click for arrows
PCL
ACL
Let’s take a look at some more ligaments, can you
point out the normal lateral and medial collateral
ligaments on these coronal sequences? How about
the medial and lateral menisci? Click for arrows
Lateral Meniscus
Medial Meniscus
LCL
MCL
Let’s now take a look at the anterior and posterior
cruciate ligaments in our trauma patient on these
consecutive sagittal images. Click for another look
at the normals.
These are both torn off their femoral attachments
ACL
stump
PCL
stump
Take a look at our patient’s medial and lateral collateral
ligaments. Do you think they look normal? Click for
normals
The LCL is torn off the fibula and the MCL is torn
proximally, click for arrows.
MCL
disrupted
fibers
LCL
stump
Case 2
• 65 year old female
with a recent history
of fall, now presents
with difficulty
abducting the arm
Can you identify the
humerus, glenoid,
coracoid process,
acromion and clavicle?
(click for answers)
Humerus
Clavicle
Acromion
Glenoid
Coracoid
The patient’s physician did not see any abnormalities on
her plain radiographs and she did not improve with
conservative treatment so she was sent for an MRI to
evaluate her rotator cuff.
These are coronal images from an MR arthrogram (we put
contrast into the shoulder joint). These are consecutive images
which image is the most posterior?
Hint, where are the AC joint and the long head of the biceps tendon?
The left image is the most posterior as the AC joint and bicps are anterior
AC
biceps
Now take a look at the rotator cuff tendons, which one
do we see on the posterior image and which one do we
see on the mostContrast
anterior
2 images?
above
the cuff tendons
Infraspinatus tendon
Supraspinatus tendon
These are the most common rotator cuff tendons to tear. There is no
tear in this patient. Where would you expect
to see contrast if there
contrast
was a tear? Click to see a tear
tear
What are the other 2 rotator cuff tendons (we already
discussed the supraspinatus and infraspinatus tendons?
Teres minor and subscapularis tendons, Can you
Teres Minor
find them on the provided axial images?
Subscapularis
Subscap=internal rotation
By the attachment of these muscles to
Teres minor=external rotation
the humerus can you determine their
function
Can you identify the anterior and posterior labrum
ANTERIOR
Anterior
labrum
POSTERIOR
Posterior
labrum
Now for the diagnosis: on this is a coronal fatsuppressed T2 weighted image do you see an
abnormality?
There is extensive
edema in the greater
tuberosity of the
humerus consistent
with a nondisplaced
fracture.
Try and think why this
would cause supra and
infraspinatus symptoms
without a rotator cuff tear
The supra and infraspinatus
tendons attach to the greater
tuberosity
Case 3
This is a 27 year old
man who fell and
has wrist pain.
Do you seen an
abnormality?
There views look
normal
Can you name the
carpal bones?
Scaphoid
Lunate
?
?
Triquetrum
Pisiform
?
Hamate, do you see ?
?
the hook
Capitate
Trapazoid
Trapezium
?
?
?
This patient subsequently underwent an MRI of the wrist to
evaluate the etiology of his pain. Can you identify the radial and
ulnar arteries on these axial sequences. Hint, palpate your own
pulses to determine where to
look
Can you find the median nerve
Ulnar artery
Radial artery
DORSAL
Radius
Ulna
VOLAR
A common cause of post-traumatic wrist pain is a tear of
the TFCC (triangular fibrocartilage complex). Can you
identify the normal TFCC in this patient on this coronal
image and anatomic drawing.
Now for the diagnosis in this case. This is a coronal fat
suppressed T2 weighted sequence. Do you see an
abnormality?
Hint, look for marrow edema
in one of the carpal bones.
Which bone is this?
This a nondisplaced
fracture of the scaphoid
This is the most common
carpal bone fractured.
Click to see a more
obvious fracture of the
scaphoid on a plain
radiograph
The End