Pearls from Stoller Macau April 2011 - 9. Elbow

1. Anatomical Variants
• pseudo defect of trochlea
• transverse trochlea ridge
• pseudo defect of capitellum (post on coronal)
2. Valgus injury (throwing) - tension medial side, compression lateral side
3. "T sign" - partial tear anterior bundle MCL distally
4. Medial Anatomy - PT, FCR, FDS
5. Lateral Anatomy - ECRB (most common tendon involved), EDC, ECU
6. Lateral - 3 ligaments - LCL, LUCL (attaches to supinator crest of ulna distally), annular ligament
7. Biceps tear - if partial need to state wether under or over 50%
8. Lacertus fibrosis - medial to biceps on axial; prevents proximal "slingshot" of torn biceps 
9. Anconeus epitochlearis

Pearls from Stoller Macau April 2011 - 8. Wrist

1. Coronal plain most NB
2. GRE for TFCC
3. Extrinsic ligaments ["volar extrinsic ligaments"]- rarely torn (RSC, RLT, RSL)
4. SL Ligament complex - 3 components - dorsal (strongest), middle (weakest), volar
5. LT Ligament complex - 3 components - d, m , v(strongest)

Pearls from Stoller Macau April 2011 - 7. Muscle

1. Direct Injury - contusion, laceration, haematoma
2. Indirect injury- strain or tear
3. Myositis Ossificans - peripheral calcification - do a CT
4. DOMS

Pearls from Stoller Macau April 2011 - 6. Hip

1. Normal sulcus - Posteroinferior sublabral sulucs, Transverse Ligament Labral Sulcus, Perilabral Sulcus
2. Stellate Lesion - supra-acetabular fossa; more prom. in teens; normal thinning
3. GRE for chondrocalcinosis
4. AVN Grading - Ficat and Arlet
5. TOH -- actually all stress # (subchondral) or insufficiency; repeat MRI in 3 months to exclude AVN (<10%) and document resolution of oedema
6. Labral Tears - most are chondrolabral or longitudinal
7. Iliofemoral ligament - thickening = inflammatory response secondary to degeneration
8. Lig. teres hypertrophy = DDH
9. Labral hypertrophy = DDH

Grading of Disc Related Nerve Root Compression (Pfirrmann et al)

• Grade 0 (normal) - No compromise of the nerve root is seen. There is no evident contact of disk material with the nerve root, and the epidural fat layer between the nerve root and the disk material is preserved.
• Grade 1 (contact) - There is visible contact of disk material with the nerve root, and the normal epidural fat layer between the two is not evident. The nerve root has a normal position, and there is no dorsal deviation.
• Grade 2 (deviation) - The nerve root is displaced dorsally by disk material.
• Grade 3 (compression) - The nerve root is compressed between disk material and the wall of the spinal canal; it may appear flattened or be indistinguishable from disk material.

 February 2004 Radiology, 230, 583-588.

http://radiology.rsna.org/content/230/2/583.full

 

Pearls from Stoller Macau April 2011 - 5. Mid and Forefoot

1. 1st MTP Anatomy p166
2. Skimboarder's Toe - "reverse turf toe" - dorsal plate injury
3. Lisfrance ligament - medial cuneiform to 2nd MT base
• dorsal, interosseus and plantar components - fail from dorsal to plantar
• no interosseus ligament between 1st and 2nd MT bases
4. Baxter's Neuropathy
• Ab. Digiti Mini Atrophy; check nerve entrapment foot
5. Adventitial Bursitis
• no anatomic bursa in foot
• at pts of frictional wear,
• may present as mases
• plantar 1st and 5th, hallux valgus common

Pearls from Stoller Macau April 2011 - 4. Ankle

1. NB: anterior process talus; lateral process calcaneus (snowboarders)
2. Subtalar joint - anterior, middle, posterior facets
3. Lateral gutter -- a 3D space between AITFL/PITFL and ATFL/PTFL
4. Posterior ankle ligaments - Transverse Tib-Fib Lig, PITFL, Tibial Slip, PTFL
5. Anterolateral impingement (soft tissue related to antero-lat gutter) vs Ant. impingement (bony)
6. Soft Tissue Impingement
• Anterolateral (ATFL and  AITFL related to partial or completer tear)
• Syndesmotic
• Posterior (PTFL -- myxoid)
7. Spring (Calcaneonavicular ligament)
• Lateral/Intermediate/Superomedial
• Axial - int. and lat.; slice up - superomedial
• Coronal - next to TP
8. POP Syndrome
• # or displacement of Os peroneum
• Ass. Peroneus Longus Tear
9. Tarsal Tunnel Syndrome
• Post. Tibial N. compression
10. 4 Plantar Muscles -  (Med) Ab. Hallucis, Fl. Dig. Brevis, Quadratus Plantae, Ab. Digiti Minimi
11. Subtalar ligaments
• subtalar interosseus - medial (coronal)
• cervical - lateral and anterior (coronal and sag)
• intermediate root extensor retinaculum - post. to cervical (sag)
12. OLT Stages
13. Tennis Leg - ruptured crura; fascia