Muscle Imaging

Evaluation and characterization of skeletal muscle pathology is a frequently encountered indication for musculoskeletal imaging. Causes of muscle pathology are diverse and include traumatic, autoimmune, infectious, inflammatory, neurologic, and neoplastic. Each etiology while dramatically different in the pathophysiology may present with similar imaging features. An understanding of the subtle differences in imaging features between the pathologic conditions may serve to guide diagnosis and treatment in these often complex cases. In this section, we will discuss the various skeletal muscle pathologies and the imaging features associated with each.

Imaging of the Hip

Imaging evaluation of the hip joint requires expert knowledge about the detailed anatomy and specific injuries. This chapter will include various osseous pathologies that can affect the hip joint such as stress fractures, osteonecrosis, or subchondral insufficiency fractures. Several types of mechanical impingement between the osseous components of the hip joint will be discussed such as femoroacetabular impingement, abnormal antetorsion, and subspine impingement. Detailed evaluation of damage to the labrum, articular cartilage, and other intra-articular structures is described.

Adult Tumors of Soft Tissue, Bone, and Bone Marrow: What the Clinician Wants to Know

The perceived value of the radiologist to the healthcare team hinges on the accuracy of image interpretation and the quality, clarity, and consistency of the associated report. A thorough understanding of what clinicians want to know from imaging of soft tissue, bone, and bone marrow tumors allows the radiologist to better analyze and communicate the relevant findings using a common multidisciplinary language. Inclusion in the report of a detailed patient history relative to the tumor is also important in that it indicates to the clinician and the patient a clear engagement in the patient’s care and an insight into the desired imaging objectives. With these tenets in mind, this review highlights what clinicians want to know from imaging for soft tissue, bone, and bone marrow tumors.

Spine Degeneration and Inflammation

Conventional radiographs and CT are primary investigations in spinal trauma. However MRI is the primary technique in the assessment of degenerative and inflammatory disorders. There are occasions when conventional radiographs, CT and bone scintigraphy assist in the diagnosis of degenerative and inflammatory disorders.A detailed understanding of anatomy and spine dynamic function is essential in the interpretation of imaging.Degenerative disorders including disc disease sometimes result in neural compression, facet joint and costovertebral arthropathy which is also potentially associated with spinal stenosis and neural compression. Scheuermann described a disorder with template irregularity that mimics degenerative disorders but is a genetic condition. Pars interarticularis stress fractures were once thought to be congenital in origin but are now regarded as stress injuries occurring in adolescence potentially leading to lifelong spondylolisthesis.Inflammatory joint disease is not just ankylosing spondylitis. There are a range of disorders, and the reporting practitioner must understand and appreciate the symptoms and signs on images. The early diagnosis of inflammatory arthropathy especially ankylosing spondylitis is essential in the effective management of the disease. Imaging is a major component of an accurate and effective diagnosis.

Pelvis and Groin

The groin and pelvis represent a large anatomical region with disorders affecting a diverse array of osteoarticular, musculotendinous, gastrointestinal, and genitourinary structures. Although it can be difficult to pinpoint a pain generator clinically, patients often present with non-specific orthopedic complaints at the anterior, lateral, inferior, or posterior aspect of the pelvis. The purpose of this practical review is to highlight the most important anatomy, injury patterns, and diagnostic imaging findings at each of these four sites.

Wrist and Hand

The wrist and hand have complex anatomy with small bones and supporting soft tissue structures, which limits the diagnostic yield for radiologic assessment. Knowledge of anatomy and different clinical entities is key to the radiologic diagnosis. Some of the essential anatomic and clinical topics in radiologic interpretation include knowledge of the topographic tendon anatomy of wrist and hand, the intrinsic and extrinsic carpal ligaments, the thumb ligaments, thumb carpometacarpal ligaments, the triangular fibrocartilage complex, the extensor mechanism, and the flexor tendons and pulleys. In this chapter, common traumatic injuries affecting the wrist and hand are reviewed.

Rotator Cuff

Shoulder pain accounts for 16% of the musculoskeletal complaints and represents an important cause of absenteeism of work. Abnormalities of the rotator cuff, including tears, are frequently seen on imaging studies. Unfortunately, asymptomatic tears are frequent, up to 60% in patients older than 60 years old; therefore clinical correlation is essential.New anatomical concepts and new surgical techniques have evolved within the entire spectrum of lesions. It is essential to be aware of the information that is important for the decision-making as this information should stand out in our reports.In this course we will therefore review the different rotator cuff tears and its differential diagnosis.

Knee

Imaging has a crucial role in detecting internal derangements of the knee, and knowledge of pathologic conditions has increased. Imaging aspects of meniscal, ligament, tendinous, and chondral lesions will be discussed in this chapter.

Correction to: Rotator Cuff

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Arthritis

Imaging plays an important role in the diagnosis and management of joint disease. However, to accurately diagnose the underlying cause of a patient’s arthritis, consideration must be given to the clinical information available as well as to the imaging features of the disease. The pattern of joint involvement in each case is particularly important, with consideration of the number of joints involved, whether or not the joints are affected symmetrically on both sides of the body, and which specific joints are affected. In cases of peripheral arthritis involving the small joints of the hands and feet, the distribution of joint disease detected on the radiograph is often as important in making the correct diagnosis as the radiographic features of the disease.While cross-sectional imaging modalities have an important role to play, the conventional radiograph remains fundamental to the diagnosis of joint disease and is commonly the first imaging investigation undertaken.