Professional Documents
Culture Documents
Extremity Workshop 166097 284 6602 v1
Extremity Workshop 166097 284 6602 v1
Extremities
Andrew Haims
Case #1
• This is a 35 year old
male who fell off a
roof and is now
complaining of knee
pain
PCL
ACL
Let’s take a look at some more ligaments, can you
point out the normal lateral and medial collateral
ligaments on these coronal sequences? How about
the medial and lateral menisci? Click for arrows
Lateral Meniscus Medial Meniscus
LCL
MCL
Let’s now take a look at the anterior and posterior
cruciate ligaments in our trauma patient on these
consecutive sagittal images. Click for another look
at the normals.
These are both torn off their femoral attachments
PCL
ACL
stump
stump
Take a look at our patient’s medial and lateral collateral
ligaments. Do you think they look normal? Click for
normals
The LCL is torn off the fibula and the MCL is torn
proximally, click for arrows.
MCL
disrupted
fibers
LCL
stump
Case 2
biceps
AC
Now take a look at the rotator cuff tendons, which one
do we see on the posterior image and which one do we
see on the mostContrast
anterior 2 images?
above the cuff tendons
Infraspinatus tendon Supraspinatus tendon
These are the most common rotator cuff tendons to tear. There is no
tear in this patient. Where would you expect to see contrast if there
contrast
was a tear? Click to see a tear
tear
What are the other 2 rotator cuff tendons (we already
discussed the supraspinatus and infraspinatus tendons?
Teres minor and subscapularis tendons, Can you
Teres Minor
find them on the provided axial images?
Subscapularis
Subscap=internal rotation
By the attachment of these muscles to
Teres minor=external rotation
the humerus can you determine their
function Can you identify the anterior and posterior labrum
ANTERIOR
Anterior Posterior
labrum POSTERIOR labrum
Now for the diagnosis: on this is a coronal fat-
suppressed T2 weighted image do you see an
abnormality?
There is extensive
edema in the greater
tuberosity of the
humerus consistent
with a nondisplaced
fracture.
Try and think why this
would cause supra and
infraspinatus symptoms
without a rotator cuff tear
The supra and infraspinatus
tendons attach to the greater
tuberosity
Case 3
This is a 27 year old
man who fell and
has wrist pain.
Do you seen an
abnormality?
DORSAL
Radius
Ulna
VOLAR
A common cause of post-traumatic wrist pain is a tear of
the TFCC (triangular fibrocartilage complex). Can you
identify the normal TFCC in this patient on this coronal
image and anatomic drawing.
Now for the diagnosis in this case. This is a coronal fat
suppressed T2 weighted sequence. Do you see an
abnormality?
Hint, look for marrow edema
in one of the carpal bones.
This a nondisplaced
fracture of the scaphoid