Introduction to MSK imaging

Dr. Fikadu HM MD RR3

                
Basic bone and joint anatomy
-Anatomy
Every long bone has the same
features, although they are
confusingly called different things.

There are several different methods

to describe the long bones. The
easiest way is to identify the shaft
and the proximal and distal “ends”.
The shaft is the roughly parallel
portion of the bone, before it flares
at either end.
The shaft is easiest to describe by
splitting it into proximal, middle
and distal thirds.
 Anatomy
The most important part of the end of a
long bone is the articular surface.
Femoral condyles
The articular surfaces are covered in
cartilage, which protects the joint.
The adjacent bone can always be
Tibial plateau described as sub-articular.
Examples are labelled to the left.
Fibular head
 Anatomy
The other bones are also a bit more
complex, and have named parts.
In the hands and feet:

The carpals and tarsals are all

uniquely named (for
example, the “lunate”).

The metacarpals / tarsals and

phalanges are small “long
bones”, with a base
(proximal), a shaft, and a
head (distal).
 Anatomy

The flat bones are quite difficult to

assess, because they have many
overlapping parts.
The pelvis can be divided into broad
regions:
• Iliac wing
• Acetabular
• Pubic rami
• Sacrum
 Anatomy

The scapula can be divided into

broad regions:
• Scapula spine
• Supraspinus
• Scapula body / infraspinus
• Glenoid
Not shown: coracoid process and
acromion.
 Anatomy

The neck of femur is a common site

of fracture of the elderly, as injuries
here have poor outcomes without
surgical management.
There are multiple named regions,
but the important distinction in
trauma is whether the fracture is
within the joint capsule. The head
and proximal neck of femur are
intra- capsular. The distal neck and
trochanteric region are not.
The general rule of thumb is that
every study of a limb or joint should
have two orthogonal (at right
angles) views.
This usually means a frontal and
lateral view.
Oblique views reveal anatomy that
is obscured by other structures. For
example, the radial head view lifts
the radius from behind the ulna.
The most common reason to perform
limb imaging is to look for fractures.

Dislocations are less common and

are usually more clinically apparent,
“Important” features:
• Degree of displacement
• Location of fracture
• Comminution / fragmentation
• Open / compound injury
The orientation of a fracture is often
described, but has very little impact on
management.
Like the direction of displacement, they
can imply a mechanism of injury.
Common descriptive terms are:
• Transverse
• Oblique
• Spiral
Fracture's of upper limb
 Fracture Clavicle
♥ Most common bone to be broken.
♥ Common in children
♥ Lat. fragment displaced
downward, forward, and medially.
Fracture Scapula
♥ usually no displacement
♥ Supported by muscles on both
sides.
Treatment :
- arm sling .
Fracture Humerus
♥ Proximal humerus ( Surgical
neck, greater tuberosity
♥ Shaft
♥ Distal humerus :
- supra condylar fr.
- intercondylar fr. [ T or Y fr. ]
- fr. med. or lat. epicondyles .
Intercondylar fractures
♥ T or Y – shaped fr.
♥ Intra-articular
[ affecting the joint
surface ] .
Radial head and
olecranon-
intraarticular fructures
Monteggia
Fracture-Dislocation
♥ FR. upper 1/3 ulna + disloc atiatioonn
of the superior R-U joint.

Treatment :
O.R.I.F. of the ulna.
Galeazzi Fracture-
Dislocation
fracture of the distal
third of the shaft of
the radius and
dislocation of the
distal radioulnar joint

Treatment:
Open Reduction
Internal Fixation of
the radial fracture
plating
Colles’ fracture
♥ Fr. distal 1 inch of the radius,
with or without avulsion of the
ulnar styloid .

♥ Common in old age due

to osteoporosis.
:Displacement of the distal fragment
♥ Backwards, upwards,
and laterally.
( displacement and tilt )

♥ Clinically :
- pain, tenderness…….
- dinner-fork deformity.
Fracture scaphoid
♥ may be impacted,not evident early in x-ray.
♥ Clinically : max.tenderness in snuff-box

-
 :Bennet’s fracture
♥ Fr. Base 1st. metacarpal, extending into
the 1st carpo-metacarpal joint.
Lower limb fractures
Lower limb fractures
 Femur

 Tibia and Fibula

 Patella

 Ankle

 Calcaneal

 Metatarsals
FEMORAL FRACTURES
• Proximal end
• Shaft
• Distal end
Intertrochanteric fracture
Subtrochanteric fracture
Pathological femoral shaft fracture
Transverse fracture with rotational displacement and shortening
Supracondylar fracture
Fracture medial condyle
Bipartite patella
Patellar fracture- haemarthrosis
 Tibial plateau fracture

 Stress fractures

 Toddlers fracture
Lateral tibial plateau fracture
The fracture fragment is displaced and depressed from its normal
position
Tibial and fibular fracture
Tibial stress fracture
 ANKLE FRACTURES

Lateral malleolar fractures

 Lateral malleolar fractures are categorized according to their
position in relation to the distal tibiofibular syndesmosis at
the level of the ankle joint.
 Weber fracture classification
 Weber A = Distal to ankle joint

 Weber B = At level of ankle joint

 Weber C = Proximal to ankle joint

Lateral malleolus fracture(Weber A)
Findings & Weber…?

Bimalleolar fracture (Weber B)

Trimalleolar fracture
Arthritis -Definition

• Disease that affects bones on both sides of

the joint space and
• Narrows the space in between them
Osteoarthritis/ Degenerative Arthritis
•Intrinsic degeneration of articular cartilage
•Cartilage becomes thinned,
•A single traumatic event or repetitive events,
•Allows bone cortex to rub against cortex, causing bone
to proliferate →osteophyte reaction.
X-ray Findings

• Radiologic Hallmarks:
• Narrowing of joint space
• Subchondral sclerosis: new bone
• Marginal osteophyte formation
• displacement & bone destruction.
1º DJD of knees affects medial, 1º DJD of hips affects superior,
weight-bearing surface weight-bearing surface
 Small joints

Hand:
- mostcommon small joint :
PIP & DIP, 1st CMC joints
 R3

2º DJD of right ankle following #

Infectious Arthritis
• Infection of a joint
• Should always be considered when there is mono-articular
inflammatory arthritis
Infectious Arthritis
Causes
• Usually staph – characterized by “early”
destruction of articular cortex
• Rapid course (unlike most arthritides)
• ‘knee & hip are ‘most commonly involved infants &
children.
• ‘knee -in adults.
• TB spreads via bloodstream from lung
• More protracted course
• In children, spine most common; in adults, knee
• Healing with ankylosis common in both
SEPTIC ARTHRITIS OF TOE
Rheumatoid arthritis (RA)

• MC inflammatory arthritis (1-2%)

• marked by inflammatory,
hyperplastic synovitis (pannus)
• F>M, 1:2-7; usually 20-50 yoa
• >60 years, F=M
• elevated ESR
• 70 to 80% +RA factor (5% in
general pop)
• +ESR, +ANA
 R3

RA Hands
Advanced RA
• Boutonniere (top)
• Swan neck

• Labs:
• +RF in 80%: IgM against Fc of IgG
• Elevated ESR
• Anemia of chronic disease
Gout
Gout
Findings

• Juxta-articular erosions
• Sharply marginated with sclerotic rims
• Overhanging edges (rat-bites)
• No joint space narrowing until later
• Little or no osteoporosis
• Soft tissue swelling
• Tophi not calcified
 R3

Gout
Olecranon
bursitis with
erosions due to
gout
Hemophilia
Findings

• Overgrowth of epiphyses
• Resorption of secondary trabeculae
• Longitudinal striations
• Widening of intercondylar notch of knee
• Joint effusion
• Hemosiderin deposit around joint
 R3

HEMOPHILIAC ARTHROPATHY
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