Coracoid Process-A Hub of Shoulder Ligaments.

Coracoid process is a hook-like structure connected with multiple ligaments. The complexity and its close relations often create confusion. The aim of this study is to identify the ligaments attached to the coracoid process as discrete structures on 3T magnetic resonance imaging (MRI) scans. This is a retrospective observational study. One-hundred twenty MRI shoulder studies performed during November and December 2019 at Dept of Radiology, Deenanath Mangeshkar Hospital, Pune, were evaluated. These were obtained on 3T MRI (Siemens, Pennsylvania, United States) machine. All scans were evaluated by two experienced musculoskeletal radiologists. The ligaments studied were coracohumeral (CHL), coracoclavicular (CCL), coracoacromial (CAL), and coracoglenoid (CGL) ligaments. Mean age of cohort was 56.3 years with 59.2% males and 56.2% right shoulder studies. Pain was the main presenting symptom (49%) followed by instability (35%). Reader 1 identified CHL in 106 out of 120 and reader 2 identified 108 out of 120 on all 3 planes. Substantial interobserver agreement (κ =0.65) was noted for sagittal T1 and proton density fat saturated (PDFS) sequences. Both readers could identify CCL and CAL ligaments in all three sequences with better confidence on nonfat saturated sagittal images. Reader 1 identified CGL in 9 on axial and 12 on sagittal images among 120 cases. Reader 2 identified CGL in 13 on axial and 16 on sagittal images among 120 cases. With a κ = 0.702 for the axial PDFS and κ = 0.72 for sagittal T1 and PDFS sequence, substantial interobserver agreement was noted. Sagittal images were better in the evaluation of CGL. Identifying ligaments attached to coracoid on MRI helps in managing associated pathological states.

Foreign Body Induced Osteomyelitis in the Hand - Commonly Missed Clinical and Radiological Diagnosis.

Introduction: Thorn prick is commonly seen in people that are involved in gardening. In some cases, they are unaware of the precedent thorn prick or present for medical attention quite late and forget about the history of thorn prick. In such cases, it is challenging for the clinicians and the radiologist to rule out the cause of the osteomyelitis caused by an unrecognized foreign body. Case Report: A 14-year-old girl presented with a swelling of the hand and discharging sinuses with a radiographic picture of osteomyelitis of the 5th metacarpal. The CT and MRI showed features consistent with osteomyelitis as well, possibly tuberculous in etiology. Even after the completion of AKT (anti-tubercular treatment), the patient continued to have discharging sinuses out of which a plant thorn spontaneously egressed, and subsequently, the patient was completely relieved of her symptoms. Retrospective evaluation of the MRI showed the presence of a foreign body that was hyperdense on CT and was initially thought to be a sequestrum. Conclusion: Hence, even though a definite history of trauma/thorn prick is not given (although highly unusual in the case of hand), an organic foreign body should be considered in the etiologic differential diagnosis of non-responding chronic osteomyelitis and discharging sinuses.