MSK Clinical cases TRAUMATOLOGY Radiology course MSK Clinical cases TRAUMATOLOGY Istituto di Radiologia Paolo Felisaz

Acute Trauma to the Knee CASE 1 Patient falls to the ground from heights with twisting injury of the knee. no focal tenderness, no effusion; able to walk.

Case 1 First exam? X-ray CT MRI US

Acute Trauma to the Knee X-ray of the knee AP LL http://radiopaedia.org/articles/knee-radiograph-an-approach

Acute Trauma to the Knee No fracture seen on the X-ray Still pain Second study? MRI w/o contrast MRI w contrast US knee CT w/o contrast

Acute Trauma to the Knee MRI of the knee (w/o contrast) Sagittal view Medial Lateral http://radiopaedia.org/cases/knee-mri-sagittal-pd

Acute Trauma to the Knee Normal aspect of the ACL http://radiopaedia.org/cases/knee-mri-sagittal-pd

Acute Trauma to the Knee Normal aspect of the PCL http://radiopaedia.org/cases/knee-mri-sagittal-pd

Acute Trauma to the Knee https://acsearch.acr.org/docs/69419/Narrative/

Acute Trauma to the Knee CASE 2 Sky accident with twisting injury of the knee focal tenderness Instability to clinical examination First study? X - ray MRI w/o contrast MRI w contrast US knee

Acute Trauma to the Knee

Acute Trauma to the Knee X ray of the knee Normal?? Fracture on the lateral aspect of tibia http://radiopaedia.org/articles/avulsion-fractures-of-the-knee

Acute Trauma to the Knee MRI of the knee (w/o contrast) T2 Fat suppressed PD

Acute Trauma to the Knee MRI of the knee (w/o contrast) T2 Fat suppressed ACL complete tear http://radiopaedia.org/articles/anterior-cruciate-ligament-tear

Acute Trauma to the Knee MRI of the knee Meniscal tear of the lateral meniscus http://radiopaedia.org/cases/medial-and-lateral-meniscal-tears-in-a-complex-knee-injury

Acute Trauma to the Knee MRI of the knee Meniscal tear also of the medial meniscus http://radiopaedia.org/cases/medial-and-lateral-meniscal-tears-in-a-complex-knee-injury

Acute Trauma to the Knee MRI of the knee T2 Fat suppressed Joint effusion http://radiopaedia.org/cases/medial-and-lateral-meniscal-tears-in-a-complex-knee-injury

Acute Trauma to the Knee T2 Fat suppressed Joint effusion http://radiopaedia.org/articles/anterior-cruciate-ligament-tear

Acute Trauma to the Knee https://acsearch.acr.org/docs/69419/Narrative/

Acute hip pain CASE 3 No trauma Elderly patient. Osteoporosis. Not able to walk. First study? X – ray hip X ray pelvis MRI w/o contrast CT

Acute hip pain X ray of the hip Femoral neck fracture http://radiopaedia.org/cases/femoral-neck-fracture-1

Acute hip pain

Acute hip pain CT of the hip Femoral neck fracture http://radiopaedia.org/articles/femoral-neck-fracture

Acute hip pain CT of the hip Femoral neck fracture Coronal Axial http://radiopaedia.org/articles/femoral-neck-fracture

Acute hip pain

CASE 4 Acute hip pain High energy decelerating trauma First study? X – ray CT US MRI w contrast

Acute Trauma to the Knee X ray of the knee Hip dislocation http://radiopaedia.org/articles/hip-dislocation

Acute trauma of the ankle CASE 5 Football game, ankle twisting. Suspect ankle sprain or fracture. First exam: X ray MRI w/o contrast CT US

Acute trauma of the ankle Normal??

Acute trauma of the ankle Comminuted peroneal fracture Tibial fracture Talus fracture Calcaneal fracture http://radiopaedia.org/cases/ankle-fracture-weber-b2-1

Acute trauma of the ankle

Acute foot pain CASE 6 Runner. 6 days / week First study? X – ray MRI w/o contrast MRI w contrast CT

Acute foot pain X-RAY: Stress fracture of 3° metatarsal bone This type of injury is seen in runners of all levels, ballet dancers, gymnasts, patients with rheumatoid arthritis (RA), those with metabolic bone disease, and neuropathic conditions. Metatarsal stress fracture also is seen with increasing frequency in patients who engage in aerobics

X-RAY: Stress fracture of tibia in another patient. Periosteal callus along anterior-lateral aspect of bone shaft

Acute foot pain

Acute shoulder pain CASE 7 50 years old. Bicicle fall. Pain. First study? X – ray MRI w/o contrast MRI w contrast US CT

Acute shoulder pain Clavicle fracture X ray of the shoulder http://radiopaedia.org/articles/shoulder-radiograph-an-approach

Acute shoulder pain https://acsearch.acr.org/docs/69433/Narrative/

Acute shoulder pain CASE 8 30 years old. Accident in motorbike. Focal tenderness, not able to move the arm. First study? X – ray MRI w/o contrast MRI w contrast US CT

Acute shoulder pain Clavicular fracture Shoulder dislocation X ray of the shoulder Clavicular fracture Shoulder dislocation Humerus fracture ACJ dislocation http://radiopaedia.org/articles/shoulder-radiograph-an-approach

Acute shoulder pain https://acsearch.acr.org/docs/69433/Narrative/

Acute shoulder pain CASE 9 Radiographs noncontributory. Persistent significant pain. Physical examination and history nonspecific. Next study. MRI w/o contrast MRI w contrast US CT

Normal MRI of the shoulder Acute shoulder pain Normal MRI of the shoulder Coronal http://www.radiologyassistant.nl/en/p4f49ef79818c2/shoulder-mr-anatomy.html

Acute shoulder pain Sagittal MRI of the shoulder http://www.radiologyassistant.nl/en/p4f49ef79818c2/shoulder-mr-anatomy.html

Acute shoulder pain Axial MRI of the shoulder http://www.radiologyassistant.nl/en/p4f49ef79818c2/shoulder-mr-anatomy.html

Acute shoulder pain MRI of the shoulder Elevation of the humera head Rotator cuff tear (sovraspinatus) Tendon retracted Joint effusion http://radiopaedia.org/articles/rotator-cuff-tear

Acute shoulder pain Rotator cuff tear MRI of the shoulder Biceps tendon Bicipital groove biceps tendon (long head) dislocated medially http://radiopaedia.org/articles/rotator-cuff-tear

Acute shoulder pain

Acute shoulder pain CASE 10 Patient with acute pain after weigh bearing. Limitation to movement. X ray MRI w/o contrast MRI w contrast US

Acute shoulder pain US of the shoulder Normal anatomy http://radiopaedia.org/cases/shoulder-anatomy-on-ultrasound-1

Acute shoulder pain Rotator cuff tear US of the shoulder http://radiopaedia.org/cases/rotator-cuff-tear-2

Acute shoulder pain Rotator cuff tear US of the shoulder http://radiopaedia.org/cases/rotator-cuff-tear-2

Acute shoulder pain You suspect rotator cuff tear

hand/wrist CASE 11 Snowboard… First time…

Hand/Wrist !@%(!*&#(&)*@$^)_*@#

Hand/Wrist …there was a terrible snow storm…. …The slope was extremely steep…

http://radiopaedia.org/articles/wrist-radiograph-an-approach Hand/Wrist Colles FX

Hand/Wrist

hand/wrist CASE 12 Chronic pain after injury at the wrist X ray MRI US CT

The injury occurred about 6 months prior to the x-ray.

hand/wrist X-RAY: Same patient, magnified view. There is sclerosis of the proximal segment of this scaphoid. This represents avascular necrosis secondary to interruption of blood supply due to trauma.

Hand/Wrist

Elbow CASE 13 45 years old. Tennis player. Chrinic pain to the laterl aspect of the elbow. X ray MRI w/o contrast US CT

Elbow Ultrasound

Elbow Humerus Radial condyle

Thank you http://www.learningradiology.com/medstudents/22mustsformedstudents_files/v3_document.htm