Gordon Andrews

Proximal tibiofibular joint: an often-forgotten cause of lateral knee pain.

OBJECTIVE This article presents the imaging findings of proximal tibiofibular joint disorders that can cause lateral knee pain. CONCLUSION The proximal tibiofibular joint is often neglected in the evaluation of lateral knee pain. The images presented in this article highlight the diverse disorders of this area. Because this joint is usually in the field of view in radiography, CT, and MRI of the knee, evaluation of it should be a part of all knee imaging assessments.

Get a kick out of this: the spectrum of knee extensor mechanism injuries

At the end of this article, the reader should be able to (1) recognise normal anatomy and anatomical variants of the extensor mechanism of the knee on various imaging modalities, including plain film, ultrasound and MRI; (2) diagnose a broad spectrum of EM injuries in adult and paediatric patients including patellar and quadriceps tendinopathy, Osgood–Schlatter disease, Sindig–Larsen–Johansson syndrome, chondromalacia patellae and patellar fractures on various imaging modalities; and (3) appreciate the important role of imaging in the diagnosis of musculoskeletal injuries.

The ABCs of the anterior cruciate ligament: a primer for magnetic resonance imaging assessment of the normal, injured and surgically repaired anterior cruciate ligament

This article reviews the magnetic resonance imaging (MRI) findings of the native and reconstructed anterior cruciate ligament (ACL). MRI is the most accurate non-invasive modality to evaluate the ACL. Tears of the ACL manifest with direct and indirect signs. The reconstructed ACL has several complications including re-tear and anterior arthrofibrosis, which are also accurately assessed using MRI.

Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder

Shoulder disease is common in the athletic population and may arise as a consequence of a single traumatic episode or multiple repeated events. Associated labroligamentous injuries can result in substantial disability. Specific athletic and occupational activities result in predictable injury patterns. Imaging in general and magnetic resonance (MR) imaging, in particular, are vital in establishing the correct diagnosis and excluding common mimicking conditions, to ensure timely and appropriate management. In this review, the utility of MR imaging and MR arthrography will be explored in evaluation of shoulder disease, taking into account normal variants of the labroligamentous complex. Subsequently, broad categories of labral lesions and instability, external and internal impingement, as well as nerve entrapment syndromes, will be discussed, while emphasizing their imaging findings in the clinical context and illustrating key features. More recent concepts of internal impingement and secondary subacromial impingement will also be clarified.

Evaluating bone marrow oedema patterns in musculoskeletal injury

MRI is a common tool in the evaluation of musculoskeletal injury that allows the clinician to pinpoint specific pathologies. The patients history and physical exam play a critical role in the diagnosis of sports injuries, however, complementary imaging can play an important role in determining the nature and extent of injury. With the widespread use of MRI, attention has focused on the signals generated following injury. In particular, bone marrow oedema (BME) patterns can be used to aid in the diagnosis of musculoskeletal injury. In this pictorial essay, the authors will demonstrate common patterns of BME that accompany a wide range of musculoskeletal injuries. It is expected that by the end of this article, the reader will be able to (1) recognise BME is a phenomenon observed on MRI following sports injury; (2) recognise typical patterns of BME; (3) understand the relationship of oedema to the type of injury and (4) in the presence of oedema, understand other co-existing injuries that ultimately may have an impact on management.

Rotator cuff troublemakers: pitfalls of MRI and ultrasound

Rotator cuff pathology is routinely evaluated in many imaging centers with both magnetic resonance imaging (MRI) and ultrasound. Despite good diagnostic accuracy using each of these modalities, certain limitations persist. In this pictorial essay, we describe five potential “troublemakers” of rotator cuff pathology which are recurrent themes in our busy shoulder referral center. The comparison of imaging findings on MRI and ultrasound are discussed. An awareness of these potential pitfalls will help improve radiologists’ diagnostic accuracy of rotator cuff pathology, and allow the clinician to optimize imaging referral and better interpret the subsequent report.

Puck to Pubalgia: Imaging of Groin Pain in Professional Hockey Players

Hockey is one of the fastest and most aggressive team sports, with great potential for injury. Groin injuries are common (5%e7% of all ice hockey injuries), can occur without contact, and account for a game loss of 25 player games per team per year in the National Hockey League (NHL) [1]. Injury data from the NHL revealed that 13e20 per 100 players per year sustained groin injuries [2]. These injuries are also seen in the amateur athlete, although they are often more severe in professional hockey players because of increased stresses and continued play despite injury. The groin is a complex anatomical region where 3 major body areas (abdomen, pelvis, and lower limbs) meet. Groin pain in athletes has multiple etiologies that are not often clinically apparent, some of which are classified under the term ‘‘athletic pubalgia’’ [3]. Athletic pubalgia is a clinical syndrome that may take on numerous forms and variations but primarily includes refractory unilateral or bilateral groin pain exacerbated by activity [4]. Chronic groin pain in athletes may also be of hip joint etiology, particularly secondary to femoral-acetabular impingement seen in this age group. Without proper diagnosis and treatment, these injuries may become chronic and even career threatening. The ability of magnetic resonance imaging (MRI) to depict anatomy and soft-tissue characteristics has proven useful in the evaluation of patients with groin pain [5,6]. It can be helpful in detecting the location of injury as well as delineating among muscular, tendinous, periosteal bony, and chondral injuries. We describe the magnetic resonance (MR)

The Corpus Callosum: Imaging the Middle of the Road

Although the structure of the mammalian brain from species to species is relatively constant, unique to placental mammals is the corpus callosum. From the Latin ‘‘corpus callosum,’’ which means tough body, it is a crescent-shaped mass of white matter at the base of the longitudinal fissure that connects the cerebral hemispheres and is the main passageway for commissural fibers. Its 4 named parts are the rostrum, genu, body, and splenium. Insults to the corpus callosum can be congenital or acquired. The latter can be subdivided into neoplastic, traumatic, vascular, demyelinating, and miscellaneous etiologies. In this pictorial essay, we present pathologies that involve the corpus callosum diagnosed with computed tomography (CT) and magnetic resonance (MR).

Elbow Injury: MRI Pitfalls

The elbow is a complex hinge synovial joint. It is comprised of three bones and three articulations, allowing for flexion, extension, supination, and pronation of the forearm. The elbow is less commonly imaged than many of the other large joints in the musculoskeletal system, usually limited to competitive and recreational athletes, as well as those sustaining chronic repetitive occupational injuries. The combination of complex bony and soft tissue anatomy, as well as inexperience related to the lower frequency of imaging, can render interpretation of elbow magnetic resonance imaging (MRI) particularly vulnerable to mistakes in interpretation. Such pitfalls may result from artifacts from MRI sequences or patient positioning; they may be due to normal anatomy that may mimic pathology; or they may be due to normal variant anatomy that may mimic pathology.

Pearls for Interpreting Computed Tomography of the Cervical Spine in Trauma

The high morbidity and mortality associated with cervical spine injuries makes identification and classification essential. It is important to have a systematic approach to evaluation, especially in the trauma setting with other distracting injuries. Understanding the anatomy and biomechanics enables rapid and accurate interpretation of images. In severe trauma and in patients with rigid spinal disease, the classic patterns of injury may be difficult or impossible to recognize. This article provides an approach to acquiring and interpreting cervical spine images in the setting of acute trauma and reviews the classic patterns of injury.