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.

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.

27 year old gentleman with shin pain.

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.

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.