Justin Q. Ly

The Transverse Humeral Ligament A Separate Anatomical Structure or a Continuation of the Osseous Attachment of the Rotator Cuff

Background No study to date has isolated the anatomical nature of the transverse humeral ligament and its relationship to the biceps tendon and the anterosuperior portion of the rotator cuff. Hypothesis There is no separate identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed by fibers from the subscapularis and supraspinatus tendons. Study Design Descriptive laboratory study. Methods A total of 14 shoulder examinations were performed on 7 matched pairs of fresh-frozen cadaveric shoulders. Magnetic resonance imaging scans were performed, followed by gross and microscopic anatomical dissection. Results In the location of the transverse humeral ligament, magnetic resonance imaging and gross dissection revealed the continuation of superficial fibers of the subscapularis tendon from the tendon body across the intertubercular groove to attach to the greater tuberosity, whereas deeper fibers of the subscapularis tendon inserted on the lesser tuberosity. Longitudinal fibers of the supraspinatus tendon and the coracohumeral ligament were also noted to travel the length of the groove, deep to the other interdigitating fibers but superficial to the biceps tendon. Histologic studies confirmed these gross dissection patterns of fiber attachment and also revealed the absence of elastin fibers, which are more commonly seen in ligamentous structures and are typically absent from tendinous structures. Conclusion There is no identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed mainly by the fibers of the subscapularis tendon, with contributions from the supraspinatus tendon and the coracohumeral ligament. Clinical Relevance According to our findings, dislocations of the long head of the biceps must disrupt at least the deep fibers of the annular sling created mainly by the subscapularis tendon insertion. This finding provides anatomical support for the findings of a positive biceps tendon subluxation or dislocation and subscapularis tear during glenohumeral arthroscopy with a normal-appearing subscapularis during open surgery or subacromial arthroscopy.

Radiologic demonstration of temporal development of bizarre parosteal osteochondromatous proliferation

We report a case of bizarre parosteal osteochondromatous proliferation (BPOP) in which radiologic examinations showed temporal development of BPOP following a traumatic event. This evidence supports the theory that BPOP is caused by trauma.

Bare area of the glenoid: magnetic resonance appearance with arthroscopic correlation.

Objective: To review the radiologic findings of a rarely reported focal area of acquired cartilage thinning located at the center of the glenoid fossa. Methods: We retrospectively reviewed the medical records of 3 patients, each possessing a bare area of the glenoid detected on magnetic resonance (MR) imaging. A literature search was performed to obtain the most current information regarding this uncommon entity. Results: Magnetic resonance imaging of the glenoid demonstrated a smoothly marginated subcentimeter area of thinning of the central articular cartilage containing hyperintense joint fluid or contrast in the case with MR arthrography. Arthroscopic correlation was obtained in a single case. Conclusions: The bare area of the glenoid is an acquired cartilage defect located at the center of the glenoid articular surface. Characteristic findings can be seen on MR imaging. Care should be taken not to mistake this acquired condition for posttraumatic defects of the glenoid articular cartilage.

Neural fibrolipoma of the foot.

Neural fibrolipoma is a benign tumor comprised of hypertrophied fibrofatty tissue with intermixed nerve tissue. We present the case of a neural fibrolipoma of the foot that underwent above-ankle amputation and review the characteristic features of this unique form of localized gigantism.

Mri diagnosis of occult ganglion compression of the posterior interosseous nerve and associated supinator muscle pathology

Occult interosseous ganglions in the proximal forearm can result in pain and decreased supination. We will describe the magnetic resonance imaging (MRI) diagnosis of an interesting case of supinator atrophy secondary to compression of the posterior interosseous branch of the radial nerve. A brief review of this entity follows.

Primary leptomeningeal lymphoma of the lumbar spine.

This report describes primary leptomeningeal lymphoma (PLML) of the spine in a 58-year-old female. LML is rare, especially in the immunocompetent, and it is almost always secondary in origin. To our knowledge, there have been very few cases of PLML of the lumbar spine reported in the literature and even fewer reports using recent MR imaging (MRI) technology to aid with diagnosis. MRI is useful in differentiating CNS lesions and may be helpful in the diagnosis of this extremely rare primary lymphoma. PLML is briefly reviewed.

Anatomic and structural evaluation of the hip: a cross-sectional imaging technique combining anatomic and biomechanical evaluations.

To describe a technique of cross-sectional imaging of the adult hip designed to evaluate for anatomic anomalies that may predispose to internal derangement in addition to the routine anatomic assessment. Magnetic resonance (MR) imaging, MR arthrography, and multidetector computed tomography (MDCT) scanning protocols utilize high-resolution imaging, and the surrounding anatomy is also assessed using these scanning techniques. Various measurements may be obtained to assess the overarching anatomic configuration including the caput caput collum diaphysis angle, the femoral angle of torsion, the acetabular angle of torsion, the center edge angle, and the femur length.

Magnetic Resonance Imaging Findings of Golf-Related Injuries

Injuries related to participation in golf are becoming more common given the increasing popularity of the sport itself. Golf is considered to be an activity associated with a moderate risk for sports injuries. Golf injuries are usually attributable to overuse or traumatic mechanisms and primarily occur at the elbow, wrist, shoulder, and lumbar spine. None of these injuries are unique to golf, but each of these injuries represent the most common injuries associated with golfing. This article reviews a wide range of injuries that are encountered in golfers and describes the magnetic resonance imaging findings of each of these injuries.

Intervertebral disk cyst: a case report.

This case describes a patient who presented with chronic low back pain which developed over the course of 1 year. Imaging revealed a 1.1-cm cystic lesion at the L4-L5 vertebral level posterior to the intervertebral disk. Following both magnetic resonance and computed tomography imaging, diagnosis of intervertebral disk cyst was confirmed by both imaging modalities. A computed tomography-guided aspiration of the lesion was performed, and the patient was given a course of steroid injections with complete resolution of the lesion.

Extraskeletal mesenchymal chondrosarcoma: Case report

This is a case report of an extraskeletal mesenchymal chondrosarcoma (ESMC) that originally occurred in the retroperitoneum of a 24-year-old female and later metastasized to the left proximal humerus. Mesenchymal chondrosarcomas are very rare in comparison to conventional chondrosarcomas and even more so when arising from an extraskeletal location. In this report, we discuss the major characteristics of ESMC and offer a review of the current knowledge regarding this rare disease entity.