STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Rotation:
MSK
Rotation Duration: 4 wks
Month(s): 3
Institution:
Stanford, VA
Call Responsibility: None
Night(s):
Responsible Faculty Member(s):
Chris Beaulieu MD PhD
Kate Stevens MD
Sandip Biswal MD
Garry Gold MD, MSEE
Amelie Lutz, MD
covered by Junior call
Location:
Stanford bone board (one month)
VA/SMOC: (2 months)
Phone Numbers:
Stanford Hospital:
MSK Fellow Pager
14598, 14603
MSK Room SUH
MSK Room Fax
MRT/Claudia
Hosp MR Rd. Rm
Ultrasound SUH
OPD
Blake MRI
14589,
3-6737
4-3275
8-6976
3-6955
3-3498
1-6790
5-9413
North campus (SMOC):
Reading room
1-7370
Reading Room 1
1-7343
Reading Room 2
1-7344
Fluoroscopy
1-7351
VA hospital: 650-493-5000 (+
extension)
Front desk-64489
Reading room-63250
Technologists/Technical Staff:
Aubrey Grey, lead fluoroscopy technologist
Michelle Thomas, lead CT technologist SUH
Teresa Nelson, lead MRI technologist SUH
MRI technologists:
Jill Bingelli
Jorge Castaneda
Martin Chavez
Mark Coleman
Samuel Dong
Greg Dowdall
Training Level:
Years 1-3
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Kim Duong
Eric Gabriel
Tony Galletta
Robert Heriford
Diane Jenuleson
Darwin Jones
William Keirn
Sherrie Lee
Navy Lu
Connie Lund
Michael Ody
Jane Patrick
Leah Pericolosi
Steven Scherer
Jason Smith
Thanh Tang
Kendall Thomas
Carol Torbett
Shannon Walters
Michele Yerondopoulos
Goals & Objectives:
A note about goals and objectives- The goals and objectives outlined in this document are based
upon the six core competencies as defined by the ACGME. As residents gain experience and
demonstrate growth in their ability to care for patients, they assume roles that permit them to
exercise those skills with greater independence. This concept—graded and progressive
responsibility—is one of the core tenets of American graduate medical education. This
document should provide you a framework for the stepwise progression of your knowledge
and skills.
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
MSK Rotation 1-Stanford hospital bone board-first year
By the end of the first year rotation (including Santa Clara Valley), residents are expected to
recognize fractures and dislocations in trauma and to have an approach to further workup (CT, MRI)
of patients as needed. Residents are also expected to have basic understanding of arthritis,
orthopedic hardware, and bone tumors, although these are not likely to be dealt with on call.
Patient Care
Goal:
Residents must be able to provide patient care that is compassionate, appropriate, and effective for
the treatment of health problems and the promotion of health. Residents are expected to:
Knowledge Objectives:
(1) Gain skill in interpretation of digital (and occasional conventional) radiographs of MSK
system.
(2) Understand radiographic positioning for common views of the spine and extremities.
(3) Describe the indications for MSK radiographs, as well as to recognize the limitations of
radiographs, and to know when CT or MRI is necessary.
(4) Learn key principles in interpretation of trauma CT, including description of fractures
affecting the pelvis, knee, ankle and foot, shoulder, elbow, and wrist and hand.
Skill Objectives:
(1) Become facile with GE Centricity PACs, Centricity RIS, Nuance RadWhere voicerecognition dictation, and EPIC. Utilize available information technology to manage patient
information.
(2) Provide concise, accurate reports.
(3) Learn to accurately interpret postoperative and trauma radiographs of the peripheral skeleton
and spine.
(4) As part of pediatric radiology, gain a basic understanding of how to interpret pediatric bone
radiographs, particularly fractures specific to children (e.g. greenstick fractures, torus
fractures, Salter-Harris injuries).
Behavior and Attitude Objectives:
(1) Work with the health care team in a professional manner to provide patient-centered care.
(2) Notify referring clinician for urgent, emergent, or unexpected findings, and document in
dictation.
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Medical Knowledge
Goal:
Residents must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological, and social-behavioral sciences, as well as the application of this knowledge to
patient care. Residents are expected to:
Knowledge Objectives:
(1) Understand basic skeletal development and anatomic subdivisions of the skeleton into
epiphysis, physis, metaphysis, and diaphysis.
(2) Discussed basic bone physiology.
(3) Describe the stages different types of fractures go through in the process of healing.
(4) Know all the bones of the skeletal system, as well as their anatomy.
(5) Identify the common imaging and clinical manifestations of arthritis, bone tumors, bone
infections, and metabolic bone disease.
(6) Describe fracture and joint dislocation nomenclature and their radiographic appearances.
(7) Be familiar with more common orthopedic hardware and hardware complications.
Before the beginning of call, the resident should be familiar with the manifestations and diagnosis of
the disease entities listed in Appendix A:
Skill Objectives:
(1) Establish a general approach to interpretation of plain films in trauma, the postoperative
state, arthritis and infection.
(2) Identify normal and aberrant skeletal anatomy.
(3) Accurately diagnose more common osseous diseases.
(4) Learn a basic approach to solitary bone lesions.
(5) Accurately interpret spine and extremity radiographs.
Behavior and Attitude Objectives:
(1) Recognize limitations of personal competency and ask for guidance when appropriate.
Practice-Based Learning and Improvement
Goal:
Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise
and assimilate scientific evidence, and to continuously improve patient care based on constant self2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
evaluation and lifelong learning. Residents are expected to develop skills and habits to be able to:
Knowledge Objectives:
(1) Assess radiographs for quality and suggest methods of improvement.
Skill Objectives:
(1) Demonstrate independent self-study using various resources including texts,
journals, teaching files, and other resources on the internet.
(2) Facilitate the learning of students and other health care professionals.
Behavior and Attitude Objectives:
(1) Incorporate formative feedback into daily practice, positively responding to constructive
criticism.
(2) Follow-up interesting or difficult cases without prompting and share this information with
appropriate faculty and fellow residents.
Systems Based Practice
Goal:
Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of
health care, as well as the ability to call effectively on other resources in the system to provide
optimal health care. Residents are expected to:
Knowledge Objectives:
(1) Understand how their image interpretation affects patient care.
Skill Objectives:
(1) Provide accurate and timely interpretations.
(2) Appropriately notify the referring clinician if there are urgent or unexpected findings and
document such without being prompted.
(3) Practice using cost effective use of time and support personnel.
Behavior and Attitude Objectives:
(1) Advocate for quality patient care in a professional manner, particularly concerning imaging
utilization issues.
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Professionalism
Goal:
Residents must demonstrate a commitment to carrying out professional responsibilities and an
adherence to ethical principles. Residents are expected to demonstrate:
Knowledge Objectives:
(1) Understanding of the need for respect for patient privacy and autonomy.
(2) Understanding of their responsibility for the patient and the service, including arriving in the
reading room promptly each day, promptly returning to the reading room after conferences,
completing the work in a timely fashion, and not leaving at the end of the day until all work
is complete. If the resident will be away from a service (for time off, meeting, board review,
etc.), this must be arranged in advance with the appropriate faculty and/or fellow.
Skill Objectives:
(1) Sensitivity and responsiveness to a diverse patient population, including but not limited to
diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
Behavior and Attitude Objectives:
(1) Respect, compassion, integrity, and responsiveness to patient care needs that supersede selfinterest.
Interpersonal and Communication Skills
Goal:
Residents must demonstrate interpersonal and communication skills that result in the effective
exchange of information and teaming with patients, their families, and professional associates.
Residents are expected to:
Knowledge Objectives:
(1) Know the importance of accurate, timely, and professional communication.
Skill Objectives:
(1) Produce concise and accurate reports on most examinations.
(2) Communicate effectively with physicians, other health professionals.
(3) Obtain informed consent with the utmost professionalism.
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Behavior and Attitude Objectives: Work effectively as a member of the patient care team.
MSK-2nd year / second rotation: VA/SMOC MSK
By the end of this rotation, residents should have advanced their understanding of MSK
radiographs. Although radiographs will be interpreted at SMOC, residents will begin to gain
experience in MSK MRI and CT, as well as basic MSK procedures.
Patient Care
Goal:
Residents must be able to provide patient care that is compassionate, appropriate, and effective for
the treatment of health problems and the promotion of health. Residents are expected to:
Knowledge Objectives:
(1) Continue to build on the knowledge objectives gained in rotation 1.
(2) Increase skill in interpretation of digital (and occasional conventional) radiographs of MSK
system.
(3) Understand radiographic positioning for common and less common views of the spine and
extremities.
(4) Describe the indications for MSK radiographs, as well as to recognize the limitations of
radiographs, and to know when CT or MRI is necessary.
(5) Increase understanding of principles in interpretation of trauma CT, including description of
fractures affecting the pelvis, knee, ankle and foot, shoulder, elbow, and wrist and hand.
(6) Select appropriate imaging modality for a particular patient and disease, including
radiographic, CT, MR, and bone scan.
(7) Protocol MRIs and CT’s for most musculoskeletal indications.
(8) Understand the use and interpretation of CT and MRI in the setting of musculoskeletal
infection.
(9) Understand common indications for musculoskeletal ultrasound.
(10) Learn basic principles of arthrography, including aspiration or injection of the hip and total
joint prostheses.
Skill Objectives:
(1)
(2)
(3)
(4)
(5)
Continue to build on the skills objectives gain in rotation 1.
Perform arthrography for conventional arthrogram or MR arthrogram with supervision.
Learn how to perform basic MSK US of tendons and muscles.
Provide concise, accurate reports on all studies, including MSK MR and CT.
Kate Stevens’ suggested MSK MRI templates can be found at http://www.xrayhead.com.
Behavior and Attitude Objectives:
(1) Work with the health care team in a professional manner to provide patient-centered care.
(2) Notify referring clinician for urgent, emergent, or unexpected findings, and document in
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
dictation.
Medical Knowledge
Goal:
Residents must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological, and social-behavioral sciences, as well as the application of this knowledge to
patient care. Residents are expected to:
Knowledge Objectives:
(1) Continue to build on the knowledge objectives of rotation 1.
(2) Learn detailed anatomy of the knee and shoulder joints through MRI interpretation.
(3) Learn about common musculoskeletal neoplasms, including benign and malignant primary
tumors and metastatic lesions.
(4) Understand applications of MR arthrography, including shoulder, hip, and knee.
(5) Understand the MR imaging appearance of tumor, infection, and arthritis.
(6) Learn the pathophysiology and manifestations of the least one half of the disease entities
listed in appendix B.
Skill Objectives:
(1) Continue to build on the skills objectives of rotation 1.
(2) Define findings in most musculoskeletal abnormalities, including soft tissue masses, as well
as benign and malignant bone tumors.
(3) Learn basic interpretation of MRI of the knee and shoulder.
(4) Be able to accurately interpret radiographic studies for arthritis, including degenerative,
inflammatory, and crystal-induced diseases.
Behavior and Attitude Objectives:
(1) Recognize limitations of personal competency and ask for guidance when appropriate.
Practice-Based Learning and Improvement
Goal:
Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise
and assimilate scientific evidence, and to continuously improve patient care based on constant selfevaluation and lifelong learning. Residents are expected to develop skills and habits to be able to:
Knowledge Objectives:
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
(1) Assess radiographs, CT and MR for quality and suggest methods of improvement.
Skill Objectives:
(1) Demonstrate independent self-study using various resources including texts, journals,
teaching files, and other resources on the internet.
(2) Facilitate the learning of students and other health care professionals.
Behavior and Attitude Objectives:
(1) Incorporate formative feedback into daily practice, positively responding to constructive
criticism.
(2) Follow-up interesting or difficult cases without prompting and share this information with
appropriate faculty and fellow residents.
Systems Based Practice
Goal:
Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of
health care, as well as the ability to call effectively on other resources in the system to provide
optimal health care. Residents are expected to:
Knowledge Objectives:
(1) Understand how their image interpretation affects patient care.
Skill Objectives:
(1) Provide accurate and timely interpretations to decrease length of hospital and emergency
department stay.
(2) Appropriately notify the referring clinician if there are urgent or unexpected findings and
document such without being prompted.
(3) Practice using cost effective use of time and support personnel.
Behavior and Attitude Objectives:
(1) Advocate for quality patient care in a professional manner, particularly concerning imaging
utilization issues.
Professionalism
Goal:
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Residents must demonstrate a commitment to carrying out professional responsibilities and an
adherence to ethical principles. Residents are expected to demonstrate:
Knowledge Objectives:
(1) Understanding of the need for respect for patient privacy and autonomy.
(2) Understanding of their responsibility for the patient and the service, including arriving in the
reading room promptly each day, promptly returning to the reading room after conferences,
completing the work in a timely fashion, and not leaving at the end of the day until all work
is complete. If the resident will be away from a service (for time off, meeting, board review,
etc.), this must be arranged in advance with the appropriate faculty and/or fellow.
Skill Objectives:
(1) Sensitivity and responsiveness to a diverse patient population, including but not limited to
diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
Behavior and Attitude Objectives:
(1) Respect, compassion, integrity, and responsiveness to patient care needs that supersede selfinterest.
Interpersonal and Communication Skills
Goal:
Residents must demonstrate interpersonal and communication skills that result in the effective
exchange of information and teaming with patients, their families, and professional associates.
Residents are expected to:
Knowledge Objectives:
(1) Know the importance of accurate, timely, and professional communication.
Skill Objectives:
(1) Produce concise and accurate reports on most examinations.
(2) Communicate effectively with physicians, other health professionals.
Behavior and Attitude Objectives:
(1) Work effectively as a member of the patient care team.
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
MSK-3rd year VA/SMOC-third rotation
By the end of this rotation, residents should have become expert in their understanding of MSK
radiographs. Although radiographs will be interpreted at SMOC, residents will gain further
experience in MSK MRI and CT, as well as more advanced MSK procedures.
Patient Care
Goal:
Residents must be able to provide patient care that is compassionate, appropriate, and effective for
the treatment of health problems and the promotion of health. Residents are expected to:
Knowledge Objectives:
(1)
(2)
(3)
(4)
(5)
(6)
Continue to build on the knowledge objectives of Rotations 1 and 2
Understand the indications for all musculoskeletal imaging, including more complex cases.
Be facile with MSK imaging protocols, including spine and extremities.
Learn to protocol and monitor MSK MRI studies.
Understand common indications for musculoskeletal ultrasound.
Learn basic principles of arthrography, including aspiration or injection of the hip and total
joint prostheses, and injection of the glenohumeral joint.
(7) Learn principles of advanced MSK procedures, including tenography and US-guided
procedures.
Skill Objectives:
(1)
(2)
(3)
(4)
Continue to build on the skills gained in rotations 1 and 2.
Perform arthrography for conventional arthrogram or MR arthrogram with supervision.
Learn how to perform basic MSK US of tendons and muscles.
Provide concise, accurate reports on all studies.
Behavior and Attitude Objectives:
(1) Work with the health care team in a professional manner to provide patient-centered care.
(2) Notify referring clinicians for urgent, emergent, or unexpected findings, and document in
dictation.
Medical Knowledge
Goal:
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Residents must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological, and social-behavioral sciences, as well as the application of this knowledge to
patient care. Residents are expected to:
Knowledge Objectives:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
Continue to build on the skills gained in rotations 1 and 2.
Describe imaging findings of more complex osseous pathology.
Understand applications of MR arthrography, including shoulder, hip, and knee.
Become familiar with basic principles of metabolic bone diseases, including osteoporosis,
osteomalacia and hyperparathyroidism.
Learn the pathophysiology and manifestations of the least one half of the disease entities
listed in the appendix of this document.
Understand the MR imaging appearance of tumor, infection, and arthritis.
Recognize pertinent musculoskeletal anatomy, particularly knee, hip, and shoulder, and
identify common abnormalities of these regions.
Be able to interpret basic MRI of post-operative joints.
Learn how to interpret MSK CT in the setting of orthopedic hardware.
Learn how to perform multiplanar and 3D rendering of MSK studies.
Have a comprehensive approach to differential diagnosis and workup of solitary bone
lesions.
Gain a basic understanding of various syndromes and developmental and dysplastic
syndromes affecting the MSK system.
Learn the pathophysiology and manifestations of all of the disease entities listed in the
appendix of this document.
Learn the pathophysiology and manifestations of the least one half of the disease entities
listed in appendix B.
Skill Objectives:
(1) Continue to build on the skills gained in rotations 1 and 2.
(2) Learn basic interpretation of MRI of the hip, ankle, elbow, and wrist.
(3) Be able to accurately interpret radiographic studies for arthritis, including degenerative,
inflammatory, and crystal-induced diseases.
Behavior and Attitude Objectives:
(1) Recognize limitations of personal competency and ask for guidance when appropriate.
Practice-Based Learning and Improvement
Goal:
Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise
and assimilate scientific evidence, and to continuously improve patient care based on constant self2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
evaluation and lifelong learning. Residents are expected to develop skills and habits to be able to:
Knowledge Objectives:
(1) Assess radiographs, CT and MR for quality and suggest methods of improvement.
Skill Objectives:
(1) Demonstrate independent self-study using various resources including texts, journals,
teaching files, and other resources on the internet.
(2) Facilitate the learning of students and other health care professionals.
Behavior and Attitude Objectives:
(1) Incorporate formative feedback into daily practice.
(2) Follow-up interesting or difficult cases without prompting and share this information with
appropriate faculty and fellow residents.
Systems Based Practice
Goal:
Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of
health care, as well as the ability to call effectively on other resources in the system to provide
optimal health care. Residents are expected to:
Knowledge Objectives:
(1) Understand how their image interpretation affects patient care.
Skill Objectives:
(1) Provide accurate and timely interpretations.
(2) Appropriately notify the referring clinician if there are urgent or unexpected findings and
document such without being prompted.
(3) Practice using cost effective use of time and support personnel.
Behavior and Attitude Objectives:
(1) Advocate for quality patient care in a professional manner, particularly concerning imaging
utilization issues.
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Professionalism
Goal:
Residents must demonstrate a commitment to carrying out professional responsibilities and an
adherence to ethical principles. Residents are expected to demonstrate:
Knowledge Objectives:
(1) Understanding of the need for respect for patient privacy and autonomy.
(2) Understanding of their responsibility for the patient and the service, including arriving in the
reading room promptly each day, promptly returning to the reading room after conferences,
completing the work in a timely fashion, and not leaving at the end of the day until all work
is complete. If the resident will be away from a service (for time off, meeting, board review,
etc.), this must be arranged in advance with the appropriate faculty and/or fellow.
Skill Objectives:
(1) Sensitivity and responsiveness to a diverse patient population, including but not limited to
diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
Behavior and Attitude Objectives:
(1) Respect, compassion, integrity, and responsiveness to patient care needs that supersede selfinterest.
Interpersonal and Communication Skills
Goal:
Residents must demonstrate interpersonal and communication skills that result in the effective
exchange of information and teaming with patients, their families, and professional associates.
Residents are expected to:
Knowledge Objectives:
(1) Know the importance of accurate, timely, and professional communication.
Skill Objectives:
(1) Produce concise and accurate reports on most examinations.
(2) Communicate effectively with physicians and other health professionals.
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Behavior and Attitude Objectives:
(1) Work effectively as a member of the patient care team.
MSK written curriculum: posted online at http://xray.stanford.edu
Kate Stevens’ MSK MRI templates: http://www.xrayhead.com
Duties and Workflow:
General Guidelines
1. Plain Radiographs: Report to Bone reading room no later than 8:45 AM and begin reviewing
plain films. If you cannot arrive by this time, you must page the bone attending. By 9:00 to 9:30
AM, you should be ready to read out with the bone attending. Note that attendings may not arrive
until 9:00 AM, but should be available by pager by 8:30 AM.
“Wet Reads” are radiographic exams where the referring physician has requested immediate review
by a radiologist, and a call or fax back with results. These exams are brought to us throughout the
day, and need to be reviewed by a faculty person before the report is called or faxed back.
Particularly important are studies performed on Stanford Athletes ("team players"), which require
timely reading and attending review. Residents should also prioritize films from the Vaden student
healthcare center, to allow prompt referral for fractures.
2. ER/Trauma Coverage: The ER extremity MSK films are periodically read during the day,
typically at least twice each morning and afternoon. Wet reads are entered into the PACs throughout
the day until 5 PM when the junior resident takes over. Coverage is from 8:30 AM to 5 PM, except
during noon conference. A trauma pager is available in the bone room to alert us that a major trauma
is arriving.
3. MRI Interpretation: MRI readouts now occur at SMOC in Redwood City. During the 2nd and
third-year rotations, the resident on service will be expected to drive to SMOC on Monday and
Friday after morning conference (Tuesday, Wednesday and Thursday at the VA). Cross sectional
imaging studies will be allocated to the MSK fellows and residents, who are expected to preview the
case prior to readout with the attending. Teleconferencing is set up at SMOC to enable the resident
to participate in the resident conference at noon. MSK ultrasound cases are also done at SMOC, and
the resident will be given the opportunity to participate in these.
4. Procedures: Up to 5 arthrograms, tenograms and ultrasound-guided interventions are scheduled
throughout the day at SMOC, usually commencing at 10am, with emergency cases added on as
needed. Resident participation in these procedures is on a case-by-case basis, but it is expected that
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
the resident will learn how to perform conventional hip and shoulder arthrograms. Note that we have
an agreement that only attending physicians can perform procedures on Stanford and Professional
Athletes, though residents and fellows may assist with these cases.
4. Teaching Cases: Interesting cases will be added to teaching folders on the PACS system, and the
MSK fellows will also document interesting cases for presentation at bone rounds (every Thursday
at 5:15 PM in the ballroom).
5. MSK Conference: Residents are encouraged to present cases during at least one conference
during the month. This requires background reading on the disorders. Bone residents are expected to
attend all morning conferences related to musculoskeletal imaging during their rotation, and are
encouraged to attend bone rounds on Thursday afternoon at 5.15pm.
6. Pathology and other Clinical Consultations. Pathology residents will page you when tumor
biopsy cases need radiographic/pathologic correlation. Coordinate time to meet with the pathologist
and a bone radiology attending. Many of these cases are excellent additions to the teaching file or
for AFIP.
7. Clinical conferences. Generally, these are attended by faculty and the fellow but residents are
welcome to attend also. Orthopedics Grand Rounds with Radiology/Pathology sessions Wed
AM’s at 0730 hrs. Arthroscopy conference, 0700 hrs, one Monday per month at SMOC.
Rheumatology case conference, third Tuesday of the month at 1200 hrs, run by Dr. Stevens.
Preparing Films
Readouts occur on the 2 PACS workstations in the bone room. Cases should be read directly from
the SMOC work list. In addition, in the afternoon cases are read out from the MSK 1 work list. At a
minimum all films taken before 2 pm on the SMOC work list must be read out on the same day, but
obviously if it is a slow day, reading out more films is desirable. Occasionally there can be glitches
in the system, and cases inadvertently do not make it to the work list that day, and are then added the
subsequent day. The MSK fellow will independently read cases on the MSK 3 work list, time
permitting, and if this is not possible the MSK fellow will alert the bone attending accordingly.
What to do during readout
Case reviewed with attending, resident takes notes and dictates later. There are a number of
“canned” dictation examples printed out in the reading room, which can be helpful as a guideline.
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Conference Schedule/Format
Title
Wednesday
Time
Location
MSK resident
conference
Wednesday
7:30 AM weekly
Lucas
Orthopedics grand
rounds
Wednesday
7:30 AM
Medical School
(opposite canteen)
Thursday
5:15 PM weekly
Ballroom
Rheumatology cases
Third Tuesday of
month
Noon
Bone room
Sarcoma tumor board
Friday
7 AM
Cancer center
Bone rounds
Method of Assessment of Performance:
 Written evaluation of resident by responsible faculty member monthly
 Verbal feedback to resident by faculty
 ACR In-Training Service Exam annually
Recommended reading during your 1st yr rotation includes:
1. Helms, C: “Fundamentals of Musculoskeletal Radiology”
This is an excellent introductory text for first year residents.
2. Brower, A: “Arthritis in Black and White”
Excellent review of features of the main types of arthritis. A book that is very useful to
review again before boards.
3. Harris, J: "Radiography of Acute Cervical Spine Trauma".
4. Greenspan, A. “Orthopedic Radiology”.
Websites and Electronic Resources:
-
University of Virgina Skeletal Trauma Tutorial
http://www.med-ed.virginia.edu/courses/rad
MSK MRI Atlas
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
-
http://www.freitasrad.net
ACR Skeletal Radiology CD-ROM
Good resource for cases
http://www.wheelessonline.com/
Suggested supplementary reading :
1. Keats, T.: “Atlas of Normal Roentgen Variants”
This is a book you need to know how to use, so that you can quickly find the information you are
looking for. Particularly useful for ED reads and on-call. If in doubt about a developmental
variant eg. accessory ossicles, nutrient channels, weird looking bones → look it up in Keats!
2. Rogers, L.: “Radiology of Skeletal Trauma”
Describes the common fracture and dislocation patterns in different body parts. Crucial for
handling cases in the ER!
3. Keats, T.: “Emergency Radiology”
This is an excellent and readable text for first year residents prior to taking ER call.
4. Kaplan, PA., Helms, C., Dussault, R., Anderson, MW. “ Musculoskeletal MRI”
Comprehensive textbook on MRI of the musculoskeletal system. Extremely useful to read this
book when you are on the MSK MRI rotation.
5. Stoller, D., Tirman, P., Bredella, M. “Diagnostic Imaging: Orthopaedics”
Excellent supplementary text for reading up around specific MRI pathology and considering
differential diagnoses. Contains easy to understand illustrations and high quality MR images,
with bullet points summarizing each condition.
6. Resnick, D: “Diagnosis of Bone and Joint Disorders”
The musculoskeletal radiology (5 volume) bible! Useful as reference when you want to find
out more about a certain topic, but not to be attempted to read from cover to cover unless you are
a complete masochist! An "abbreviated (“baby”) Resnick" (1 volume) is also available for
residents.
Most of these books and a collection of other MSK radiology books are located in the locked
cabinets in the bone reading rooms at Stanford and SMOC and can be used by the resident on the
MSK and MSK MRI rotations. If you do borrow books for the evening please ensure that books are
returned to the bone room. In the past books have been borrowed and not returned. This spoils it for
residents subsequently on the rotation, as we cannot afford to keep replacing them.
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Appendix A: knowledge objectives in rotation one in preparation for call.
Pre-call
1 Acetabular Fracture
2 Achilles Tendon Tear & Tendinopathy
3 Acromioclavicular Dislocation
4 Acute Osteomyelitis: Child
5 Anterior Glenohumeral Dislocation
6 Avulsive Injury, Knee
7 Bisphosphonates, Complications
8 Calcaneus Fracture, Intraarticular
9 Carpal Dislocation
10 Charcot (Neuropathic)
11 Child Abuse: The Extremities
12 Chondrosarcoma
13 Finger Fracture and Dislocation
14 Distal Radius Fracture
15 Gout
16 Greater Tuberosity Fracture
17 Hydroxyapatite Deposition Disease
18 Hip Dislocation
19 Hip Implant
20 Insufficiency Fractures, Appendicular
21 Juvenile Distal Forearm Fractures
22 Malleolar Fracture
23 Medial Condylar Fracture, Elbow
24 Metacarpal Fracture and Dislocation
25 Metatarsal Fracture
26 Osteonecrosis, Hip
27 Osteosarcoma, Conventional
28 Osteosarcoma, Parosteal
29 Pathologic Fracture
30 Pelvic Fracture, Unstable
31 Pilon Fracture
32 Pyrophosphate Arthropathy
33 Radial Head/Neck Fracture
34 Salter-Harris Fracture, Ankle
35 Scaphoid Fracture
36 Septic Arthritis
37 Sickle Cell Anemia: MSK Complications
38 Slipped Capital Femoral Epiphysis
39 Stress Fracture, Adult
40 Tibial Plateau Fracture
41 Transcondylar Fracture, Elbow
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Appendix B: knowledge objectives for the remainder of the rotations.
Musculoskeletal Acute and Chronic Injury
General/systemic Injury
42 Complications of Paraplegia
Soft tissue, non-specific location, extraarticular
43 Hematoma
44 Myositis Ossificans/Heterotopic Ossification
Muscle injury, non-specific location
45 Muscle Injury
Neural injury
Periosteum
Joint
Fracture healing
Fractures with other contributing etiologies (other than acutely traumatic)
Fractures, Pediatric
46 Physeal Injury (Salter-Harris)
47 Incomplete Fractures
Other
48 Lead Poisoning
49 Chronic Repetitive Trauma
Injury to joint & adjacent osseous structures, shoulder girdle & humerus
Sternoclavicular joint & clavicle
Acromioclavicular joint
50 Os Acromiale
51 Traumatic Osteolysis, Distal Clavicle
Osseous structures, glenohumeral joint & humerus
52
53
54
55
Posterior Glenohumeral Dislocation
Humeral Head/Neck Fracture
Little Leaguer's Shoulder
Osteochondral Injury, Shoulder
Muscle injury, shoulder
56 Parsonage-Turner Syndrome
57 Pectoralis Injury
Rotator Cuff tendons
58
59
60
61
62
63
Rotator Cuff Tendinopathy
Rotator Cuff Partial Thickness Tear
Calcific Rotator Cuff Tendinopathy
Subscapularis Tear
Rotator Cuff Full Thickness Tear
Rotator Interval Tear
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STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Biceps Tendon/anchorLabrum/Capsule
64
65
66
67
68
69
70
71
72
73
74
Biceps Tendinopathy, Shoulder
Normal Labral Variants
Biceps Tendon Tear, Intraarticular
Biceps Tendon Dislocation
Posterior Labral Tear, Shoulder
Inferior Glenohumeral Ligament Injury
Bankart Lesion
Perthes Lesion
Multidirectional Instability, Shoulder
GLAD/GARD Lesion
SLAP Tear
Neural impingement
75 Rotator Cuff Denervation Syndromes
76 Suprascapular and Spinoglenoid Notch Cysts
Injury to joint & adjacent osseous structures, elbow & forearm
Tendons
77
78
79
80
Biceps Tendon Injury, Elbow
Common Extensor Tendon Injury, Elbow
Common Flexor/Pronator Tendon Injury, Elbow
Triceps Tendon Injury, Elbow
Ligaments
81 Radial Collateral Ligament Injury
82 Ulnar Collateral Ligament Injury
Soft tissue abnormalities, other
83 Bicipioradial Bursitis
84 Olecranon Bursitis
Osseous Trauma
85
86
87
88
89
90
Capitellum Fracture
Elbow Dislocation
Lateral Condylar Fracture, Elbow
Monteggia Injury
Valgus Stress Mechanism/Little Leaguer's Elbow
Forearm Fractures
Neural Impingement
91 Radial Nerve Injury
92 Median Nerve Injury
Injury to joint & adjacent osseous structures, wrist & hand
Ligaments, +/- carpal instability
93 Intrinsic Ligament Tear, Wrist
94 Carpal Instability
Tendons
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STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
95 Extensor Tendon Injury, Wrist and Fingers
96 Extensor Carpi Ulnaris Tendinitis
97 Tenosynovitis, Wrist & Hand
Soft tissue abnormalities, other
Distal radius & ulna: osseous trauma
98 Trauma-related Osteolysis in Children
Carpus: osseous trauma
99 Carpal Fracture, Other than Scaphoid
100 Carpal Impaction Syndromes
Distal Radioulnar Joint
Triangular Fibrocartilage Complex
101 Triangular Fibrocartilage Complex Injury
Fingers
102 Collateral Ligament Injury, Fingers and Thumb
103 Flexor Tendon Injury, Wrist and Fingers
104 Carpometacarpal Fractures
Neural impingement
105 Nerve Entrapment Syndromes, Wrist
Injury to joint & adjacent osseous structures, spine
106 Scheuermann Disease
Injury to joint & adjacent osseous structures, pelvis
Osseous trauma
107
108
109
110
111
Pelvic Fracture, Stable
Pelvic Stress and Insufficiency Fracture
Osteitis Pubis, Nontraumatic Origin
Pelvic Avulsion Fracture/Apophysitis
Osteitis Pubis, Post-Traumatic
Tendons
Ligaments
Neural impingement
Soft tissue abnormalities, other
112 Adductor Insertion Avulsion Syndrome
113 Sports Hernia
Injury to joint & adjacent osseous structures, hip & femur
Osseous trauma
114
115
116
117
118
Stress Injury, Leg
Femoral Head Fracture
Femoral Neck Fracture
Subtrochanteric and Femoral Shaft Fracture
Trochanteric and Intertrochanteric Fracture
Labroligamentous Pathology
119 Femoral Acetabular Impingement
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STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
120 Hip Labral Trauma, Postoperative
121 Acetabular Labral Tear
Musculotendinous Injury
122
123
124
125
Proximal Hamstring Injury
Hip Flexor Injury
Hip Adductor Injury
Hip Internal and External Rotator Injury
Ligaments
Neural impingement
Soft tissue abnormalities, other
126 Bursitis, Hip and Pelvis
Injury to joint & adjacent osseous structures, knee & leg
Osseous trauma
127
128
129
130
131
Patellar Fracture
Subchondral Fracture, Knee
Osteochondral Injury, Knee
Transient Patellar Dislocation
Blount Disease
132
133
134
135
136
137
138
139
140
141
Discoid Meniscus
Parameniscal Cyst
Meniscal Ossicle
Meniscal Radial Tear
Other Displaced Meniscal Tears
Meniscal Pitfalls and Variants
Meniscal Vertical Longitudinal Tear
Meniscal Horizontal Tear
Meniscal Bucket-Handle Tear
Meniscocapsular Separation
Menisci
Anterior Cruciate ligament
142 Anterior Cruciate Ligament Injury
143 Anterior Cruciate Ligament: Postoperative Imaging
Posterior cruciate ligament
144 Posterior Cruciate Ligament Injury
145 Posterior Cruciate Ligament, Postoperative
Medial supporting structures
146 Medial Collateral Ligament, Knee
147 Posteromedial Corner Injury
148 Pes Anserine Bursitis
Lateral supporting structures
149 Lateral Collateral Ligament Complex, Knee
150 Posterolateral Corner Injury
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
151 Iliotibial Band Friction Syndrome
Extensor mechanism
152
153
154
155
Patellar Tendon Tears & Tendinosis
Osgood-Schlatter Disease
Quadriceps Injury
Patellar Malalignment
Cartilage
156 Chondral Injury, Knee
157 Articular Cartilage: Postoperative Imaging
Neural impingement
158 Peroneal Nerve Injury
Muscle injury, leg
159 Gastrocnemius Soleus Strain
Soft tissue abnormalities, other
160
161
162
163
Intercondylar Notch Cyst
Prepatellar and Pretibial Bursitis
Popliteal Cyst
Popliteus Myotendinous Injury
Injury to joint & adjacent osseous structures, ankle & foot
Tendons
164
165
166
167
168
Posterior Tibial Tendon Tear and Tendinopathy
Plantaris Tendon Injury
Extensor Tendon Tear and Tendinopathy, Ankle
Peroneal Tendon Tear and Tendinopathy
Tears of Intrinsic Foot Muscles and Plantar Fascia
169
170
171
172
173
174
Ankle Sprain
Syndesmosis Ligament Injury, Ankle
Lisfranc Ligament Injury
MTP Ligament Injury, Digit 1
Deltoid Ligament Injury
Anterior Impingement Syndrome, Ankle
Ligaments
Neural impingement
Soft tissue abnormalities
175 Plantar Fasciitis
176 Superficial Fibromatoses
Overuse syndromes
177
178
179
180
Accessory Ossicles, Ankle and Foot
Os Peroneum Syndrome
Os Trigonum Syndrome
Sesamoid Dysfunction
Osseous trauma
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
181
182
183
184
185
186
187
188
189
190
Calcaneus Fracture, Nonarticular
Talus Neck and Head Fracture
Talus Dislocation
Stress and Insufficiency Fracture, Ankle and Foot
Chopart Dislocation
Talar Body and Process Fracture
Ankle Dislocation
Osteochondral Injury, Ankle
Navicular Fracture and Dislocation
Lisfranc Fracture-Dislocation
191
192
193
194
195
196
197
198
199
200
201
Arthroplasty Loosening & Dislocation
Arthroplasty Component Wear/Particle Disease
Arthrodesis, Postoperative Appearance
Wrist Arthrodesis/Other Postoperative Appearances
Cement & Bone Fillers
Arthroplasty Implant/Periprosthetic Fx
Miscellaneous Hardware
Anchoring Devices
Revision Arthroplasty
Knee Implant
Shoulder Implant
202
203
204
205
206
207
208
209
210
211
Paget Disease
Chronic Recurrent Multifocal Osteomyelitis
Necrotizing Fasciitis
Brucellosis
Soft Tissue Infection
Spinal Infections
Acute Osteomyelitis, Adult
Acute Osteomyelitis, Child
Chronic Osteomyelitis
Tuberculosis
212
213
214
215
216
217
218
219
Focal Marrow Infiltration and Replacement
Thalassemia
Extramedullary Hematopoiesis
Increased or Decreased Marrow Cellularity
Myelofibrosis
Mucopolysaccharidoses
Diffuse Marrow Infiltration and Replacement
Gaucher Disease
Post-operative Findings
Infection
Bone Marrow
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
220
221
222
223
224
225
Bone Infarct
Transient Bone Marrow Edema
Osteonecrosis of Knee
Legg-Calvé-Perthes
Osteonecrosis of Wrist
Osteonecrosis of Shoulder
Arthritis
Erosive pattern
Rheumatoid arthritis
226
227
228
229
230
231
232
Rheumatoid Arthritis of Axial Skeleton
Rheumatoid Arthritis of Ankle and Foot
Rheumatoid Arthritis of Knee
Rheumatoid Arthritis of Shoulder and Elbow
Robust Rheumatoid Arthritis
Rheumatoid Arthritis of Wrist and Hand
Rheumatoid Arthritis of Hip
Non-rheumatoid arthritis, erosive
233 Juvenile Idiopathic Arthritis (JIA)
Productive pattern
Osteoarthritis
234
235
236
237
238
Osteoarthritis of Axial Skeleton
Osteoarthritis of Shoulder and Elbow
Osteoarthritis of Hip
Osteoarthritis of Knee
Osteoarthritis of Wrist and Hand
Non-joint based
239 DISH
240 OPLL
Mixed erosive and productive
241
242
243
244
Ankylosing Spondylitis
Psoriatic Arthritis
Chronic Reactive Arthritis
Inflammatory Bowel Disease Arthritis
Connective tissue disorders
245 Systemic Lupus Erythematosus
246 Progressive Systemic Sclerosis
247 Inflammatory Myopathy
Arthritis due to biochemical disorders and depositional disease
248 Amyloid Deposition
Miscellaneous joint disorders
249 Pigmented Villonodular Synovitis (PVNS)
250 Synovial Osteochondromatosis
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
251 Hypertrophic Osteoarthropathy
Metabolic bone disease
252
253
254
255
256
257
Hyperparathyroidism
Primary Osteoporosis
Disuse Osteoporosis
Osteomalacia and Rickets
Renal Osteodystrophy
Dialysis-Related Disease, Spondyloarthropathy
Drug-induced & nutritional MSK conditions
258
259
260
261
262
Steroids, Complications
Scurvy
Radiation-Induced Non-neoplastic Marrow & Soft Tissue Abnormalities
AIDS Drug Therapy, Complications
Complications of Prostaglandins
263
264
265
266
Radiation Osteonecrosis
Radiation-Induced Osteochondroma
Radiation-Induced Sarcoma
Radiation-Induced Complications of the Skeleton
267
268
269
270
Osteoma
Osteoid Osteoma
Enostosis (Bone Island)
Osteoblastoma
Venomous-induced conditions
Radiation induced conditions
Osseous tumors
Bone-forming tumors
Benign
Malignant
271 Osteosarcoma, Secondary
272 Osteosarcoma, Periosteal
273 Osteosarcoma, Telangiectatic
Cartilage-forming tumors
Benign
274
275
276
277
278
279
Enchondroma
Osteochondroma
Multiple Hereditary Exostoses
Chondroblastoma
Chondromyxoid Fibroma
Periosteal Chondroma
Malignant
280 Chondrosarcoma, Dedifferentiated
Fibrous tumors
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Benign
281 Desmoplastic Fibroma
Malignant
282 Fibrosarcoma
283 Malignant Fibrous Histiocytoma of Bone
Fatty tumors
284 Intraosseous Lipoma
Giant Cell tumor
285 Giant Cell Tumor
Epithelioid tumor
286 Adamantinoma
Vascular tumors
287 Angiosarcoma, Osseous
Neural tumors
288 Chordoma
Marrow tumors
Myeloma
289 Multiple Myeloma
290 POEMS
291 Plasmacytoma
Non-myelomatous marrow tumors
292 Ewing Sarcoma
293 Leukemia: Osseous Manifestations
294 Lymphoma of Bone
Tumor-like lesions
295
296
297
298
299
300
Langerhans Cell Histiocytosis
Fibrous Dysplasia
Simple Bone Cyst
Aneurysmal Bone Cyst
Fibroxanthoma
Lower Extremity Variants, Other
301
302
303
304
305
Lipoma, Soft Tissue
Hibernoma
Lipomatosis, Nerve
Parosteal Lipoma
Lipoma Arborescens, Knee
Metastatic tumors
Soft Tissue tumors
Other
Adipocytic tumors
Benign
Intermediate (Locally Aggressive)
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
306 Atypical Lipomatous Tumor
Malignant
307 Liposarcoma, Myxoid
308 Liposarcoma, Pleomorphic
Fibroblastic/Myofibroblastic Tumors
Benign
309 Elastofibroma
Intermediate (Locally Aggressive)
310 Desmoid-Type Fibromatosis
Intermediate (Rarely Metastasizing)
Malignant
So-called Fibrohistiocytic Tumors
Benign
311 Giant Cell Tumor Tendon Sheath
312 Xanthoma
Intermediate (Rarely Metastasizing)
Malignant
313 Pleomorphic MFH/Undifferentiated Pleomorphic Sarcoma
314 Dermatofibrosarcoma Protuberans
Smooth Muscle Tumors
Benign
Malignant
Pericytic (Perivascular) Tumors
315 Glomus Tumor
Skeletal Muscle Tumors
Benign
Malignant
Vascular & lymphatic tumors
Benign
316 Hemangioma, Soft Tissue
317 Klippel-Trenaunay-Weber Syndrome
Intermediate (Locally Aggressive)
Intermediate (Rarely Metastasizing)
Malignant
318 Angiosarcoma of Soft Tissue
Chondro-Osseous Tumors
319 Extraskeletal Osteosarcoma
320 Intraarticular Chondroma
Tumors of Uncertain Differentiation
Benign
321 Intramuscular Myxoma
Intermediate (Rarely Metastasizing)
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Malignant
322 Synovial Sarcoma
Peripheral Nerve Sheath Tumors
Non-neoplastic Lesions
323 Morton Neuroma
324 Traumatic Neuroma
Neurofibroma
325 Neurofibroma
Schwannoma
326 Schwannoma
Nerve Sheath Myxoma
Perineurioma
Granular Cell Tumor
Malignant Peripheral Nerve Sheath Tumor (MPNST)
327 Malignant Peripheral Nerve Sheath Tumor
Skin and Subcutanious Lesions
328 Rheumatoid Nodule
Congenital, Familial, & Developmental Conditions
Generalized
329
330
331
332
Arthrogryposis
Fibrodysplasia Ossificans Progressiva
Neurofibromatosis
Osteogenesis Imperfecta
Upper extremity disorders
333
334
335
336
Madelung Deformity
Glenoid Hypoplasia
Ulnar Variance
Carpal Coalition
Lower extremity disorders
337 Developmental Dysplasia of the Hip
338 Proximal Femoral Focal Deficiency
Foot deformities
Contenital foot deformities
339 Club Foot (Talipes Equinovarus)
340 Congenital Vertical Talus (Rocker Bottom Foot)
341 Pes Planus (Flatfoot)
Acquired
Tarsal coalitions
342 Tarsal Coalition
Other (Nongeneralized Conditions)
Displasias
Skeletal dysplasias
2/5/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Dwarfism
343 Achondroplasia
344 Spondyloepiphyseal Dysplasia
345 Thanatophoric Dwarfism
Non-dwarfing dysplasias
346
347
348
349
Ollier Disease
Cleidocranial Dysplasia
Maffucci Syndrome
Nail Patella Disease (Fong)
Sclersing dysplasias
350
351
352
353
354
355
Melorheostosis
Intramedullary Osteosclerosis
Pycnodysostosis
Osteopoikilosis
Progressive Diaphyseal Dysplasia
Osteopetrosis
Musculolkeletal Complications of Systemic Diseases
Diabetes
356 Diabetes: MSK Complications
357 Dialysis-Related Disease, Metastatic Calcification
HIVAIDS
358 HIV-AIDS
Hemophilia
359 Hemophilia: MSK Complications
Syphilis
Sarcoidosis
360 Sarcoidosis, Bone
Vascular Disease
Other
Polio
Anatomic Variants
Lower Extremity
361
362
363
364
Dorsal Defect Patella
Gastrocnemius Muscle Variant
Talar Ridge
Accessory Muscles, Ankle and Foot
Upper Extremity
365 Buford Complex
366 Sublabral Foramen
2/5/2016