Faculty Bibliography

We report a case of a 47-year-old man who presented with progressive loss of motion and pain in the right shoulder. Radiographs of the shoulder demonstrated dense ossification in the glenoid and humeral head with extension into the periarticular soft tissues. CT and MRI scans confirmed the radiographic findings and also revealed ossification of the glenoid labrum. A radiographic diagnosis of melorheostosis, an uncommon benign sclerosing bone dysplasia, was made. Because of the patient's severe symptomatology, he underwent total shoulder arthroplasty. Histological analysis of the resected masses was consistent with melorheostosis with a few areas covered by a cartilage cap. This case illustrates several uncommon but important features of melorheostosis, including mechanical obstruction of joint motion requiring joint replacement, ossification of the glenoid labrum, and cartilage-covering portions of the intra-articular masses, not to be confused with cartilage-producing tumors

OBJECTIVE: Entrapment of the first branch of the lateral plantar nerve is a well-recognized but diagnostically elusive cause of heel pain. The MR finding of selective atrophy of the abductor digiti quinti (ADQ) muscle has been reported as a marker of such entrapment. We performed a prospective study of consecutive patients undergoing foot and ankle MRI to determine the prevalence of ADQ atrophy and to examine the clinical symptoms of patients found to have ADQ atrophy. SUBJECTS AND METHODS: A prospective study of all patients referred for ankle and foot MRI examinations was performed. Six hundred two patients were included in the study: 387 females and 215 males. All images were evaluated for the presence of selective fatty atrophy of the ADQ muscle. The clinical notes on all patients with findings of ADQ atrophy were analyzed for descriptions of symptoms leading to the MR examination, the presence of symptoms that might be related to nerve entrapment, and the influence on clinical management related to the MR finding of ADQ atrophy. RESULTS: Thirty-eight of the 602 patients had selective fatty atrophy of the ADQ, 29 females and nine males. Only one patient had a clinical diagnosis of possible nerve entrapment before MR examination. MRI findings of ADQ atrophy altered clinical management in only one patient. CONCLUSION: Selective fatty atrophy of the ADQ is not a rare finding on MR examination of the foot and ankle, being seen in 6.3% of all studies and in 7.5% of all studies in females. The clinical relevance of selective ADQ atrophy seen on MRI is uncertain

PURPOSE: To describe the magnetic resonance imaging (MRI) appearances of tears of the deltoid muscle and tendon in patients with rotator cuff tears and without a prior history of shoulder surgery. MATERIALS AND METHODS: Deltoid tears diagnosed on MR examinations were prospectively recorded between February 2003 through June 2004. The images of these patients were then retrospectively reviewed to determine the location of the deltoid tear, the presence of rotator cuff tears, tendon retraction, muscle atrophy, degree of humeral head subluxation, bony erosive changes involving the undersurface of the acromion, and the presence of edema or fluid-like signal intensity in the deltoid muscle and overlying subcutaneous tissues. RESULTS: There were 24 (0.3%) patients with deltoid tears; nine men and 15 women. The age range was 54 to 87 (average 73) years. The right side was involved in 20 cases, and the left in four cases. Fifteen patients had full thickness and nine had partial thickness tears of the deltoid. Shoulder pain was the most common presenting symptom. The physical examination revealed a defect in the region of the deltoid in two patients. Nineteen patients had tears in the muscle belly near the musculotendinous junction, and five had avulsion of the tendon from the acromial origin. Full thickness rotator cuff tears were present in all of the patients, and 22 patients had associated muscle atrophy. Subcutaneous edema and fluid-like signal was present in 15 patients. CONCLUSION: Tears of the deltoid muscle or tendon is an unusual finding, but they can be seen in patients with chronic massive rotator cuff tears. Partial thickness tears tend to involve the undersurface of the deltoid muscle and tendon. Associated findings such as intramuscular cyst or ganglion in the deltoid muscle belly and subcutaneous edema or fluid-like signal overlying the deltoid in a patient with a rotator cuff tear should raise the suspicion of a deltoid tear

This article prospectively determines through magnetic resonance imaging (MRI) the incidence of isolated teres minor atrophy and its gender and age distribution, and documents associated findings related to the rotator cuff, labroligamentous complex, and quadrilateral space. Two hundred seventeen consecutive shoulder MRI examinations performed over a 3-month period were prospectively reviewed and evaluated for isolated teres minor atrophy. Twelve (5.5%) patients had non-compressive isolated teres minor atrophy. Ninety-two percent (n=11) of these patients had rotator cuff or labroligamentous complex tears. No patients had an associated mass within the quadrilateral space. The average patient age was 60 years and 11 of the 12 patients were male. Isolated teres minor atrophy on MRI is most commonly seen in older patients who do not fit the expected clinical presentation of quadrilateral space syndrome. The anatomical relationship of the teres minor nerve to the joint capsule and the frequency of associated shoulder injuries in these patients raises the possibility of an association between humeral decentering and teres minor atrophy. Quadrilateral space syndrome would appear to be a very rare cause of isolated teres minor atrophy

The MRI appearance of 'Little Leaguer's shoulder' has not been previously reported in the radiology literature. Purported etiologies include proximal humeral epiphyseolysis, osteochondrosis of the proximal humeral epiphysis, stress fracture of the proximal humeral epiphyseal plate, and rotational stress fracture of the proximal humeral epiphyseal plate. We describe magnetic resonance imaging findings in four patients and review the literature

Femoral stress fractures represent an uncommon but important lower-extremity injury in athletes and soldiers. Careful assessment of the involved and contralateral lower extremity and the spine is required to make the diagnosis. Based on a review of the literature, specific treatment is based on individual patient assessment. In most cases, nonoperative management results in an excellent outcome. Certain fractures will require operative intervention to prevent displacement or to reduce a displaced fracture and return stability to the lower extremity. Complications in athletes with femoral stress fractures are rare. Most athletes can expect to return to their preinjury level of competition, if they are compliant with the treatment plan

OBJECTIVE: The purpose of this article is to review the current understanding of the MRI appearance of articular cartilage and its relationship to the microscopic and macroscopic structure of articular cartilage, the optimal pulse sequences to be used in imaging, the appearance of both degenerative and traumatic chondral lesions, the appearance of the most common cartilage repair procedures, and future directions and developments in cartilage imaging. CONCLUSION: Articular cartilage plays an essential role in the function of the diarthrodial joints of the body but is frequently the target of degeneration or traumatic injury. The recent development of several surgical procedures that hold the promise of forming repair tissue that is hyaline or hyalinelike cartilage has increased the need for accurate, noninvasive assessment of both native articular cartilage and postoperative repair tissue. MRI is the optimal noninvasive method for assessment of articular cartilage

The surgical management of knee injuries has increased in recent years. Postoperative magnetic resonance (MR) imaging of the knee following surgical intervention serves an important role in the diagnostic evaluation of patients with recurrent or residual symptoms following surgical intervention. MR imaging additionally assists in the noninvasive documentation of temporal changes at the surgical site potentially reflective of procedural success, or failure. Background understanding of the common surgical procedures performed, their normal postoperative MR imaging appearance, and imaging features of potential procedural complications are essential in the accurate evaluation of patients following prior knee surgery. The focus of the following article is to review the clinical and MR imaging features of the postoperative knee following prior surgical treatment of ligamentous, meniscal, and articular cartilage injuries of the joint