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

2. 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.

3. Case 1
First exam?
X-ray CT
MRI US

4. Acute Trauma to the Knee
X-ray of the knee AP LL

5. 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

6. Acute Trauma to the Knee
MRI of the knee (w/o contrast)
Sagittal view
Medial
Lateral

7. Acute Trauma to the Knee
Normal aspect of the ACL

8. Acute Trauma to the Knee
Normal aspect of the PCL

9. Acute Trauma to the Knee

10. 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

11. Acute Trauma to the Knee

12. Acute Trauma to the Knee
X ray of the knee
Normal??
Fracture on the lateral aspect of tibia

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

14. Acute Trauma to the Knee
MRI of the knee (w/o contrast)
T2 Fat suppressed
ACL complete tear

15. Acute Trauma to the Knee
MRI of the knee
Meniscal tear of the lateral meniscus

16. Acute Trauma to the Knee
MRI of the knee
Meniscal tear also of the medial meniscus

17. Acute Trauma to the Knee
MRI of the knee
T2 Fat suppressed
Joint effusion

18. Acute Trauma to the Knee
T2 Fat suppressed
Joint effusion

19. Acute Trauma to the Knee

20. 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

21. Acute hip pain X ray of the hip Femoral neck fracture

22. Acute hip pain

23. Acute hip pain CT of the hip Femoral neck fracture

24. Acute hip pain CT of the hip Femoral neck fracture Coronal Axial

25. Acute hip pain

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

27. Acute Trauma to the Knee
X ray of the knee
Hip dislocation

28. 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

29. Acute trauma of the ankle
Normal??

30. Acute trauma of the ankle
Comminuted peroneal fracture
Tibial fracture
Talus fracture
Calcaneal fracture

31. Acute trauma of the ankle

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

33. 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

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

35. Acute foot pain

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

37. Acute shoulder pain Clavicle fracture X ray of the shoulder

38. Acute shoulder pain

39. 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

40. Acute shoulder pain Clavicular fracture Shoulder dislocation
X ray of the shoulder
Clavicular fracture
Shoulder dislocation
Humerus fracture
ACJ dislocation

41. Acute shoulder pain

42. 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

43. Normal MRI of the shoulder
Acute shoulder pain
Normal MRI of the shoulder
Coronal

44. Acute shoulder pain Sagittal MRI of the shoulder

45. Acute shoulder pain Axial MRI of the shoulder

46. Acute shoulder pain MRI of the shoulder Elevation of the humera head
Rotator cuff tear (sovraspinatus)
Tendon retracted
Joint effusion

47. Acute shoulder pain Rotator cuff tear
MRI of the shoulder
Biceps tendon
Bicipital groove
biceps tendon (long head) dislocated medially

48. Acute shoulder pain

49. 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

50. Acute shoulder pain US of the shoulder Normal anatomy

51. Acute shoulder pain Rotator cuff tear US of the shoulder

52. Acute shoulder pain Rotator cuff tear US of the shoulder

53. Acute shoulder pain
You suspect rotator cuff tear

54. hand/wrist
CASE 11
Snowboard…
First time…

55. Hand/Wrist

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

57.
Hand/Wrist
Colles FX

58. Hand/Wrist

59. hand/wrist CASE 12 Chronic pain after injury at the wrist X ray MRI USCT

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

61. 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.

62. Hand/Wrist

63. 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

64. Elbow
Ultrasound

65. Elbow
Humerus
Radial condyle

66. Thank you