Friction Syndromes of the Knee: The Iliotibial Band and Anterior Fat Pads.

As participation in sporting activities increases among the general population, the incidence of overuse injuries continues to rise. Friction syndromes of the knee are common and are often clinically diagnosed without the need for imaging. However, clinical symptoms may overlap with other joint abnormalities, and physical examination may be limited in individuals with excessive pain. Magnetic resonance imaging has remained the modality of choice for the evaluation of internal derangements of the joints and is a useful aid in the diagnosis of friction syndrome of the knee. This case report provides clinicians with an understanding of the most common friction syndromes of the knee joint as well as their imaging findings. (Journal of Surgical Orthopaedic Advances 27(1):77-80, 2018).

Two Patients and Two Knee Cysts.

Differential diagnosis of a cystic lesion adjacent to menisci can be a challenge even when the case presents as seemingly straightforward. To "tell the story" as accurately as possible, the radiologist must be familiar with the natural history of these lesions as well as distinctive imaging features and must take all relevant factors into consideration, such as patient's age, activity level, and surgical history. This article presents two cases to illustrate how imaging features affect the report and management plan. (Journal of Surgical Orthopaedic Advances.

Scapulothoracic Joint Dysfunction.

Scapulothoracic derangements are often overlooked and hidden within the clinical fog created by complex back, shoulder, and rib symptoms. This study reviewed 200 magnetic resonance imaging and computed tomography studies dedicated for scapular imaging between January 2010 and May 2016. This article discusses scapulothoracic pathologies and imaging findings.

Milwaukee Shoulder Syndrome.

Milwaukee shoulder syndrome (MSS) is a rare, rapidly destructive arthropathy associated with calcium hydroxyapatite crystal deposition. This condition is a combination of rotator cuff tear, osteoarthritic changes, noninflammatory joint effusion containing crystals, synovial hyperplasia, cartilage and subchondral bone destruction, and multiple osteochondral loose bodies. This article discusses pathophysiology, clinical presentation, differential considerations, and magnetic resonance imaging findings of MSS.

Plantar Fibromatosis and Other Fibroblastic and Fibrohistiocytic Soft Tissue Tumors of the Foot.

Plantar fibromatosis, also known as Ledderhose's disease, is a benign fibroblastic disorder of plantar aponeurosis, more specifically the medial side of the foot arch. Magnetic resonance imaging (MRI) has an important role in the diagnosis, staging, and determining the deep extension found in advanced, aggressive forms of plantar fibromatosis, thereby guiding appropriate clinical and surgical management. This case report aims to provide radiologists and clinicians with simple guidelines for the differential diagnosis of the fibroblastic and fibrohistiocytic soft tissue tumors of the foot with the emphasis on the MRI findings. (Journal of Surgical Orthopaedic Advances 26(4):266-270, 2017).

Cutting Corners or a New Standard?: Increasing Scarcity of T1 Data Sets.

The technological innovation of magnetic resonance imaging (MRI) is ongoing and necessitates recurring reevaluation of appropriateness standards. As evidenced by current standards, T1 data sets provide an essential role to musculoskeletal imaging. According to a recent survey, T1 data sets are increasingly underutilized. This article discusses common and less commonly recognized T1 data set utility. It is suggested that a single non-fat-suppressed T1 data set (in any plane) continues to be standard in routine MRI musculoskeletal imaging.

Complex Regional Pain Syndrome.

Complex regional pain syndrome (CRPS) is a neurological disorder producing peripheral neurogenic inflammatory process in hands and feet distal to injury, which may lead to severe disability. Symptoms are often out of proportion to the initiating event and not limited to a single peripheral nerve. There is no gold standard in diagnosis of this entity, and a multidisciplinary approach is necessary for proper diagnosis. Magnetic resonance imaging (MRI) is one of the most useful diagnostic modalities in early stages of CRPS (when clinical diagnosis is most difficult), the most desirable time to diagnose this disorder to expedite treatment and improve function. This article discusses MRI findings of CRPS, particularly in the early phase, and differential considerations.

Spectrum of Injury to Posterior Glenoid Labral Complex With Emphasis on Diffuse Labral Tears.

The posterior glenoid labrum has numerous surrounding structures and any of them can undergo derangement. It is prudent to consider the posterior glenoid labrum complex (PGLC) as a whole rather than simply the labral tissue in isolation when evaluating magnetic resonance imaging (MRI) of the shoulder. The PGLC contains the posterior capsulolabral junction, posterior capsule (posteroinferiorly , the posterior band of the inferior glenohumeral ligament), posterior chondro-osseous junction, posterior chondrolabral junction, posterior glenoid bone, posterior glenoid subchondral bone, posterior glenoid cartilage, posterior labrum, synovial fold (variably seen), and posterior glenoid periosteum (or periosteal sleeve). Noninvasive MRI techniques are the mainstay in evaluating PGLC injury with or without the use of intra-articular gadolinium contrast agents. When using the PGLC model, a spectrum of pathology can be stratified.

Cam and Pincer Type of Femoroacetabular Impingement.

Femoroacetabular impingement (FAI) has gained considerable attention for the past 20 years and has been accepted as a predisposing factor for early osteoarthritis in young patients, particularly in the population participating in sports. Patients with FAI typically present with deep, intermittent groin discomfort during or after activities involving repetitive or persistent hip flexion. Symptomatic improvement can be achieved from arthroscopic debridement of unstable cartilage flaps, shaving of cartilage irregularities, and surgical correction of deformity of the femoral head\endash neck junction. Early and correct diagnosis of FAI has paramount importance for appropriate and timely management of the disorder before the development of osteoarthritis. Magnetic resonance (MR) imaging offers a noninvasive means of assessing the degree of damage to cartilage and adjacent labrum and bone and also evaluating the effectiveness of treatment. This article describes the morphologic types of FAI with emphasis on MR findings.

Achilles Tendinitis.

Achilles tendinitis is a common etiology of heel pain, which is a common patient complaint. Achilles tendinitis can be classified into noninsertional tendinosis and insertional tendinitis on the basis of clinical features, radiologic signs, and pathologic findings. Magnetic resonance imaging (MRI) allows classification and reveals associated findings, including retrocalcaneal bursitis, paratendinitis, and paratenonitis. Furthermore, MRI may not only confirm findings of Achilles tendinitis but also diagnose other etiologies of heel pain. This article reviews the MRI findings and terminology of Achilles tendinitis often found in radiology reports.

Scapholunate advanced collapse.

This case study reviews the pathophysiology of scapholunate advanced collapse (SLAC), which is the most common etiology of degenerative arthritis in the wrist. The scapholunate ligament serves a critical role in stability of the carpus. Disruption of the scapholunate ligament, its sequela, and the magnetic resonance imaging evaluation are discussed, with review of the defining features of this disease and its progression.

Imaging of the Lisfranc injury.

Lisfranc ligament and joint injuries are relatively uncommon but can result from a variety of low- and high-impact trauma. Up to 20% of Lisfranc fracture-dislocations are misdiagnosed or missed during the initial evaluation. Timely and accurate diagnosis of the injury and early anatomical reduction and stabilization of the Lisfranc joint are crucial to avoid long-term sequelae and functional impairment. Magnetic resonance imaging (MRI) is a sensitive and specific imaging modality and should be considered in injuries with equivocal physical and radiographic findings. In this article, the mechanism and the classification of the Lisfranc joint and ligament injuries are outlined, and imaging findings of different modalities are discussed with the emphasis on MRI.

Palmer Classification and Magnetic Resonance Imaging Findings of Ulnocarpal Impingement.

Ulnocarpal impaction (UCI) syndrome is a well-recognized and relatively frequent cause of ulnar-sided wrist pain and limitation of motion. In the setting of negative or questionable negative radiographs and a strong clinical suspicion for UCI, magnetic resonance imaging (MRI) is helpful in detecting occult disease. Current MRI technology is capable of providing high-spatial-resolution images on multiple planes while manipulating contrast to highlight different tissue types. However, imaging of the triangular fibrocartilage complex has been challenging because of the small and complex components of this structure. In this article, the stages of UCI are discussed with illustrations of the spectrum of MRI findings using Palmer classification as a guideline.

New tools in detecting early cartilage breakdown before morphologic changes.

Recent advances in magnetic resonance imaging (MRI) allow detection of changes in molecular matrix of cartilage and thus allow the earliest detection of its breakdown. These MRI techniques are collectively referred to as "cartilage mapping," which attempts to designate a qualitative assessment of cartilage at each given location on the cartilage surface. These qualitative abnormalities can occur even in the setting of normal cartilage thickness and morphology. This article introduces the molecular biology behind this new technique, discusses some potential clinical applications, and discusses value added over traditional MRI cartilage evaluation.

Adhesive capsulitis.

Adhesive capsulitis of the shoulder, commonly known as "frozen shoulder" or "frozen shoulder syndrome," is a self-limited painful condition that is quite common. In 1984, the prevalence of frozen shoulder was demonstrated at slightly greater than 2% in the general population. In the authors' practice, consisting primarily of orthopedic magnetic resonance imaging, this diagnosis is frequently seen in patients referred for evaluation of rotator cuff tear because the presenting symptoms are similar.

Normal anatomic variants of the acetabular labrum.

Within the past two decades, magnetic resonance imaging (MRI) has evolved into an integral part of noninvasive diagnostic testing for evaluation of musculoskeletal disorders. With the advancements in imaging and coil technology, assessment of small and spatially complex structures, such as the acetabular labrum, became possible. Labral tears are being diagnosed with increasing frequency with MRI. However, the medical literature reveals erratic sensitivity and specificity values of MRI, including MR arthrography, in identifying labral tears. This finding could be partly attributable to false-positive results caused by normal anatomic variants of the acetabular labrum. Additional challenges are introduced by the lack of consensus on the existence and the distributions of the normal anatomic variants of the labrum in MRI and orthopedic literature. In this article, the spectrum and incidence of these variations are discussed with emphasis on MRI features of the variant anatomy and the labral tears.