Posts Categorized: MSK

This patient has an ACL tear, along with what other injuries?

This 55-year-old male has right knee pain after a fall down an embankment. He has an ACL tear, but what other injuries are present in this complex case? What is indicated by the arrows? You are shown these five static images, plus a GIF rotating a sagittal series. This patient has an ACL tear (pink… Read more »

What is the unusual anatomic variant in this wrist case?

This 29-year-old male presented with a traumatic injury of the left palmar wrist. What anatomic variant seen in this patient must be taken into account? Ulnar-sided pain in this case can be attributed to: ECU tenosynovitis, tendinosis, and longitudinal partial-thickness tearing (images 3 and 4, arrows). ECU subsheath inflammation (horizontal arrow-image 3). Peripheral TFCC attachment… Read more »

What does this foot case have to do with a Bill Murray movie?

This 49-year-old presents with an ulcer, open wound and renal insufficiency. For some reason, this calls to mind Sergeant Hulka’s big toe. Which movie features Sergeant Hulka? What should you call this infection? Sergeant Hulka appears in the movie ‘Stripes,’ with a cast that includes Bill Murray and John Candy. As for this infection, it’s… Read more »

What does a farm animal have to do with this shoulder case?

A 68-year-old man presents with shoulder pain after many years of repetitive motion. His deformity shares a name with a farm animal, but which one is it? This deformity is known as the “goat beard deformity” and it’s indicated by the arrow in the first image. More shoulder case review is available at MRI Online.

What is this nine-year-old’s unusual gymnastics injury?

This 9-year-old presents with an elbow injury from gymnastics. What is the mechanism? What does the solitary arrow indicate? What is the accompanying soft tissue injury? What do the double arrows indicate? The findings are the result of an acute valgus insult. The capitellum (single arrow) is edematous, a sign of this mechanism. The soft… Read more »

What has happened to this man’s finger?

This is a 48-year-old man who fell nine months ago and now has swelling and pain in the right index finger. What do the paired arrows label in image 1? What does the single arrow label in image 1? What does the single vertical arrow label in image 2? What do the sets of three… Read more »

What’s the life-threatening finding in this knee case?

This 57-year-old male presents with a large mass. What is it? But, more importantly, on these axial water-weighted MRI images, what is the potentially life-threatening finding?   The high signal mass is a gastrocnemius semimembranous bursal cyst (one of the many types of Baker’s cysts). The life-threatening finding is the absence of flow phenomena in… Read more »

Is there cause for concern in this 10-year-old with knee pain?

This 10-year-old presents with right knee pain and swelling. There is no known trauma. What’s the most likely diagnosis? What is indicated by the arrows in the back of the knee? Is it concerning?   The diagnosis is Sinding-Larsen-Johansson syndrome or inferior patellar “apophysitis” (yellow arrow). The green arrows indicate lymph nodes, and they are… Read more »

How should you repair this patient’s heel pain?

This 59-year-old presents with heel pain. Diagnosis is obvious on water-weighted sagittal MRI, but how do you repair this?   It’s an obvious plantar fasciitis with a tear. As for how to repair it, that’s a trick question. You put the patient in a boot and manage their pain. The surgical treatment for plantar fasciitis… Read more »

What does the alpha angle suggest in this hip?

You are shown two MRI images. One is a standard orthogonal coronal with a line through it. This shows the angle of acquisition to evaluate the alpha angle. The second image is the axial oblique with the lines used for alpha angle measurement. Questions: What is a normal alpha angle? What does an abnormal alpha… Read more »