 Fluid around the posterior tibial nerve. This axial fat saturated image of the ankle reveals fluid around the posterior tibial nerve. In the right clinical context, this gives rise to pain mimicking plantar fasciitis- due to tarsal tunnel syndrome. The nerve divides into the lateral and medial plantar branches, supplying the sensation and muscles of the foot. Add Comment  This is a reverse Hill-Sachs lesion. As the name implies, this is due to posterior dislocation of the humerus relative to the glenoid. This is associated with a tear of the posterior labrum. It is less common than anterior labral tears, and is classically due to electrocution or epilepsy. In this case, it was due to a traumatic fall off a bicycle. 1. The tumor is considered to be aggressive and requires surgery if one of the following criteria is present: cortical destruction, Moth-eaten or permeative osteolysis, spontaneous pathologic fracture, periosteal reaction, edema surrounding the tumor on MR images, and soft tissue mass. Tumor biopsy followed by complete intralesional treatment is indicated. 2. The tumor is classified as active if two of the following active criteria are present: pain related to the tumor, endosteal scalloping superior to two-thirds of the cortical thickness, extent of endosteal scalloping superior to two-thirds of the lesion length, cortical thickening and enlargement of the medullary cavity. Tumor biopsy or excision is indicated. 3. The tumor is classified as possibly active if one of the previous active criteria is present. In such cases, bone scintigraphy and dynamic-enhanced MR imaging should be obtained. Radionuclide uptake superior to the anterior iliac crest at bone scintigraphy and early and exponential enhancement at dynamic-enhanced MR are considered as two additional active criteria. After these two examinations, if only one criterion is still present, the lesion can be regarded as possibly quiescent, and the following monitoring is suggested: first follow-up at three to six months and then once a year. Otherwise, if two or more active criteria are present, biopsy is recommended. 4. The tumor is considered quiescent and does not require surgery if no active or aggressive criterion is present. A radiological follow-up can be proposed. Taken from: Eur J Radiol. 2011 Jan;77(1):6-12. When should we biopsy a solitary central cartilaginous tumor of long bones? Literature review and management proposal.Parlier-Cuau C, Bousson V, Ogilvie CM, Lackman RD, Laredo JD. Pain medial ankle.   There's oedema in the deep deltoid ligament fibres, associated with mild thickening of the anterior talofibular ligament. Nodular thickening on the articular surface of the ATFL is suggestive of a meniscoid lesion. The appearance is typical for a lot of ankle inversion injuries. The patient "rolls" his ankle. The medial aspect of the talus abuts the distal tibia, and the lateral side is stretched. This results in anterior talofibular ligament tear, and fluid in the anterolateral gutter. Nice review article in the Singapore Medical Journal (link here). I've made a mind map of it as well. 
 OK- messing up the images with colour overlays. There is a thickened and oedematous Lisfranc ligament (1st intermetarsal space) consistent with Lisfranc ligament sprain/partial tear. Note mild widening of the Lisfranc joint. The Lisfranc joint injury spans a spectrum from strain to frank dislocation. We've talked about it here before. The Lisfranc ligament is also called the first intermetatarsal ligament and bridges the medial cuneiform with the base of the 2nd metatarsal. The other metatarsals are connected by intermetatarsal ligaments which are transverse in orientation. The 1st intermetarsal joint has no transverse ligament. This effectively jams the base of the 2nd metatarsal into the cuneiform on weight-bearing (a keystone effect). Lisfranc injuries manifest as a step off at the base of the 2nd metatarsal relative to the cuneiforms. Patients also cannot tip-toe due to pain. Chronic ankle pain. Sagittal PD fat sat and coronal PD.   Nice example of osteochondral injury involving the cartilage tidemark. There are multiple subchondral cysts, and bone oedema. This is quite classic of inversion injuries, with impaction injury between the talus and distal tibia. The important thing, of course, is to make sure that there is no detached osteochondral fragment. For that, follow the cartilage lining from end to end, and the overlying cortex. Make sure there are no cortical disruptions.  MR images demonstrating a fracture of the scaphoid waist. The important thing is as Dr Hollis Potter says, "You can't move protons in it on the PD sequence- it means it's dead bone". There's also widening of the scapholunate joint. So, from first consult to confirmation of diagnosis there can be a delay as initial scaphoid fractures can be radiographically occult. There is institutional variation in practice: some places use nuclear bone scan, and some use repeat radiography, and some use MRI. I prefer to image gently with MRI. What about you? Andy Groves at Cambridge has a very nice paper demonstrating this variation in pratice in the UK. Paper available here. | About Us
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