59 y/o male with ulnar sided wrist pain

1. 59 y/o male with ulnar sided wrist pain

2. 59 y/o male with ulnar sided wrist pain

3. 59 y/o male with ulnar sided wrist pain

4. 59 y/o male with ulnar sided wrist pain

5. 59 y/o male with ulnar sided wrist pain

6. 59 y/o male with ulnar sided wrist pain

7. 59 y/o male with ulnar sided wrist pain

8. TFC Tear • Palmer classification for triangular fibrocartilage complex abnormalities Class 1: Traumatic • A - Central perforation • B - Ulnar avulsion • C - Distal avulsion • D - Radial avulsion with or without sigmoid notch fracture Class 2: Degenerative (ulnocarpal abutment syndrome) stage • A - TFCC wear • B - TFCC wear with lunate and/or ulnar chondromalacia • C - TFCC perforation with lunate and/or ulnar chondromalacia • D - TFCC perforation with lunate and/or ulnar chondromalacia and LT ligament perforation • E - TFCC perforation with lunate and/or ulnar chondromalacia, LT ligament perforation, and ulnocarpal arthritis

9. 30 y/o female with clinical hx of left-sided trunk/thigh hypertrophy?

10. 30 y/o female with clinical hx of left-sided trunk/thigh hypertrophy?

11. 30 y/o female with clinical hx of left-sided trunk/thigh hypertrophy?

12. 30 y/o female with clinical hx of left-sided trunk/thigh hypertrophy?

13. 30 y/o female with clinical hx of left-sided trunk/thigh hypertrophy?

14. 30 y/o female with clinical hx of left-sided trunk/thigh hypertrophy?

15. Absent vs. Atrophic Piriformis muscle? • Piriformis muscle might be absent and there might be variations in origin and insertion sites of some muscles and their relation with regional nerves of this region. • Bannister L, Berry M, Collins P, Dyson M, Dussek J : Muscles of the thigh and gluteal region. In. Williams P (ed): GrayÕs Anatomy. 38 th ed. London: Churchill Livingstone, 1995 : 875-878 • 2) Lee CS, Tsai TL : The relation of the sciatic nerve to the piriformis muscle. Taiwan I Hsueh Hui Tsa Chih 1974; 73 : 75-80.

16. 27 y/o male with twisting ankle injury while hiking

17. 27 y/o male with twisting ankle injury while hiking

18. 27 y/o male with twisting ankle injury while hiking

19. Achilles Avulsion • Greek mythology relates that the legendary warrior Achilles was made invincible by his mother Thetis, who dipped him in the River Styx while holding him by his heel. Because his heel was never immersed, it remained his one area of vulnerability. After the fall of Troy, Achilles met his demise when he was shot in the heel by Paris, whose arrow was guided by the Greek god Apollo. This is the derivation of the term "Achilles tendon."

20. Achilles Avulsion • However, Achilles avulsion is considered rare, usually occuring at the calc. tubercle. • Possible causes: • Traumatic dorsiflexion in maximally plantar flexed foot • Contraction of triceps surae during knee extention in a sprint • Direct blow The heel of achilles: calcaneal avulsion fracture from a gunshot wound.Cooper DE, Heckman JD Foot Ankle. 1989 Feb;9(4):204-6

21. 34 y/o MLB pitcher with shoulder pain

22. 34 y/o MLB pitcher with shoulder pain

23. 34 y/o MLB pitcher with shoulder pain

24. 34 y/o MLB pitcher with shoulder pain

25. Thrower’s Shoulder

26. Elbow pain 55 yr old man pre post

27. Elbow pain 55 yr old man BicipitoradialBursa

28. Cubital Bursae • bicipitoradial bursa • interosseous bursa Bicipitoradial Bursitis: MR Imaging Findings in Eight Patients and Anatomic Data from Contrast Material Opacification of Bursae Followed by Routine Radiography and MR Imaging in Cadavers1 Abdalla Y. Skaf, MD, Robert D. Boutin, MD, Robert Weiber M. Dantas, MD, Andrew W. Hooper, MD, Claus Muhle, MD, David S. Chou, MD, Nittaya Lektrakul, MD, Debra J. Trudell, RA, Parviz Haghighi, MD and Donald L. Resnick, MD 1 From the Departments of Radiology (A.Y.S., R.D.B., R.W.M.D., A.W.H., C.M., D.S.C., N.L., D.J.T., D.L.R.) and Pathology (P.H.), Veterans Affairs Medical Center and University of California San Diego, 3350 La Jolla Village Dr, San Diego, CA 92161.

29. Bicipitoradial Bursa • reduces friction between the biceps tendon and the radial tuberosity • Bursitis • Repetitive mechanical trauma • Infection • Inflammatory arthropathy • Chemical synovitis • Bone proliferation

30. Elbow Pain Torn Biceps Tendon Cubital Bursitis

31. Supinator muscle edema

32. Mass effect in the cubital tunnel may compress the branches of the radial nerve

33. Posterior Interosseous Nerve Syndrome • Compression of the deep branch of the radial nerve • innervates multiple extensor muscles • extensor indicis proprius, extensor digiti quinti, extensor carpi ulnaris, abductor pollicis longus, extensor pollicis brevis, and extensor digitorum communis muscles

35. 34 yo Hockey player

36. SLAP tear with possible extension into the SGHL and MGHL

37. 33 yo woman

38. 33 yo woman • osteopenia, cartilage loss, and erosions, subluxation Rheumatoid Arthritis

39. Same patient

40. OA pattern • Superolateral joint space narrowing • Marginal osteophytes • Eburnation and subchondral cystic change

41. Why the early OA? Femoral Acetabular Impingment? Crystal deposition disorders?

42. 19 yr old Marine with new onset difficulty performing pull-ups

43. 19 yr old Marine with new onset difficulty performing pull-ups

44. Suprascapular Nerve Entrapment • At suprascapular notch, will involve both the supra- and infraspinatus muscles • At the spinoglenoid notch, involves only the infraspinatus • Most common cause is a ganglion cyst from a superior labral tear

45. 36 year old man with arm and hand numbness for one day

46. 36 year old man with arm and hand numbness for one day • Patchy scattered foci and muscular edema • Considerations • Parsonage Turner syndrome • Quadrilateral space syndrome

47. Post op day 1 from ventral hernia repair • Other considerations • Positioning neuropathy

49. T2 T1-PRE POST

50. T2 T1 PRE T1 POST