Teaching Atlas of Musculoskeletal Imaging Teaching Atlas of Musculoskeletal Imaging PPeetteerr LL.. MMuunnkk,, MM..DD..,, CC..MM..,, FF..RR..CC..PP..CC.. Professor Departments of Radiology and Orthopaedics University of British Columbia Head Section of Musculoskeletal Radiology Vancouver General Hospital and Health Science Center Vancouver, British Columbia, Canada AAnntthhoonnyy GG.. RRyyaann,, MM..BB..,, BB..CC..HH..,, BB..AA..OO..,, FF..RR..CC..SS..II..,, MM..SScc.. ((EEnnggiinneeeerriinngg aanndd PPhhyyssiiccaall SScciieenncceess iinn MMeeddiicciinnee)),, DD..II..CC..,, FF..RR..CC..RR..,, FF..FF..RR..RR..CC..SS..II.. Consultant Musculoskeletal and Interventional Radiologist Waterford Regional Teaching Hospital Ardkeen, Waterford City, Republic of Ireland Radiologic Tutor and Clinical Instructor in Radiology The Royal College of Surgeons in Ireland Dublin, Republic of Ireland Thieme New York •Stuttgart Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Editor: Birgitta Brandenburg Assistant Editor: Ivy Ip Vice President, Production and Electronic Publishing: Anne T. Vinnicombe Production Editor: Print Matters, Inc. Vice President, International Marketing: Cornelia Schulze Sales Director: Ross Lumpkin ChiefFinancial Officer: Peter van Woerden President: Brian D. Scanlan Compositor: Compset, Inc. Printer: The Maple-Vail Book Manufacturing Group Library ofCongress Cataloging-in-Publication Data Munk, Peter L. Teaching atlas ofmusculoskeletal imaging / Peter L. Munk, Anthony G. Ryan. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-58890-372-3 (alk. paper) ISBN-10: 1-58890-372-9 (alk. paper) ISBN-13: 978-3-13-141981-1 (alk. paper) ISBN-10: 3-13-141981-4 (alk. paper) 1. Musculoskeletal system—Diseases—Imaging—Atlases. 2. Musculoskeletal system—Diseases—Case studies. I. Ryan, Anthony G. II. Title. [DNLM: 1. Musculoskeletal Diseases—diagnosis—Atlases. 2. Musculoskeletal Diseases—diagnosis—Case Reports. 3. Diagnostic Imaging—Atlases. 4. Diagnostic Imaging—Case Reports. 5. Musculoskeletal System—injuries—Atlases. 6. Musculoskeletal System—injuries—Case Reports. WE 17 M966t 2007] RC925.5.M86 2007 616.7’0754—dc22 2006102651 Copyright ©2008by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher’s consent is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication ofany kind, translating, preparation ofmicrofilms, and electronic data processing and storage. IImmppoorrttaanntt nnoottee::Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors ofthe material herein have consulted sources believed to be reliable in their efforts to provide information that is complete and in accord with the standards accepted at the time ofpublication. 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Some ofthe product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance ofa name without desig- nation as proprietary is not to be construed as a representation by the publisher that it is in the public domain. Printed in the United States 5 4 3 2 1 The Americas ISBN 978-1-58890-372-3 Rest ofWorld ISBN 978-3-13-141981-1 DEDICATIONS To my wife, Alice Maria Chung, who has loved me and stuck by me through difficult and easy times; to my daughters, Charlotte Gisele Munk, Eleanor Ruth Munk, and Sophie Alexis Munk, who have taught me the meaning of true affection; and to our Lord, Jesus Christ. —Peter L. Munk For those to whom I owe the greatest debt of gratitude: my parents, Margaret and Jeremiah Ryan (Ní bheidh a leithéidí ann arís); and for those for whom I am continually grateful—my wife, Caitríona, and son, Michael. —Anthony G. Ryan CONTENTS Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvi Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvii PART I Internal Joint Derangement KNEE CASE 1 Anterior Cruciate Ligament Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Anthony G. Ryan and Peter L. Munk CASE 2 Posterior Cruciate Ligament Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Anthony G. Ryan and Peter L. Munk CASE 3 Meniscal Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Hema N. Choudur, Anthony G. Ryan, and Peter L. Munk CASE 4 Meniscal Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Hema N. Choudur, Anthony G. Ryan, and Peter L. Munk CASE 5 Collateral Ligament Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Anthony G. Ryan and Peter L. Munk CASE 6 Intra-articular Loose Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Anthony G. Ryan and Peter L. Munk CASE 7 Quadriceps Mechanism Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Anthony G. Ryan and Peter L. Munk CASE 8 Popliteal Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Anthony G. Ryan and Peter L. Munk CASE 9 Osgood-Schlatter’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Anthony G. Ryan and Peter L. Munk CASE 10 Jumper’s Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 Anthony G. Ryan and Peter L. Munk CASE 11 Discoid Meniscus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62 Anthony G. Ryan and Peter L. Munk CASE 12 Chondromalacia Patellae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66 Hema N. Choudur, Anthony G. Ryan, Peter L. Munk, and Laurel O. Marchinkow SHOULDER CASE 13 Rotator Cuff Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 Kevin Rowan, Anthony G. Ryan, Peter L. Munk, and Bruce B. Forster CASE 14 Glenoid Labral Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 Kevin Rowan, Anthony G. Ryan, Peter L. Munk, and Bruce B. Forster vii viii CONTENTS CASE 15 Bilateral Shoulder Dislocations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Kevin Rowan, Anthony G. Ryan, Peter L. Munk, and Bruce B. Forster CASE 16 Long Head of Biceps Tendon Dislocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 Kevin Rowan, Anthony G. Ryan, Peter L. Munk, and Bruce B. Forster TEMPOROMANDIBULARJOINT CASE 17 Temporomandibular Joint Disk Dislocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86 Peter L. Munk, Anthony G. Ryan, and Laurel O. Marchinkow HIP CASE 18 Acetabular Labral Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90 Anthony G. Ryan and Peter L. Munk ELBOW CASE 19 Epicondylitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97 Anthony G. Ryan and Peter L. Munk CASE 20 Distal Biceps Tendon Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104 Anthony G. Ryan, Peter L. Munk, and Laurel O. Marchinkow ANKLE CASE 21 Achilles Tendon Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112 Anthony G. Ryan and Peter L. Munk CASE 22 Posterior Tibialis Tendon Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121 Anthony G. Ryan and Peter L. Munk CASE 23 Peroneal Tendon Dislocation/Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129 Anthony G. Ryan and Peter L. Munk WRIST CASE 24 Intrinsic Ligament Tear (Scapholunate Ligament Tear) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137 Anthony G. Ryan and Peter L. Munk CASE 25 Triangular Fibrocartilage Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142 Peter L. Munk and Anthony G. Ryan PART II Congenital and Pediatric Conditions CASE 26 Legg-Calvé-Perthes Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147 Anthony G. Ryan, Peter L. Munk, and Laurel O. Marchinkow CASE 27 Congenital Dislocated Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152 Anthony G. Ryan and Peter L. Munk CASE 28 Achondroplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156 Brian Edward Reeves, Anthony G. Ryan, Peter L. Munk, and Thomas Pope CASE 29 Osteogenesis Imperfecta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160 Anthony G. Ryan and Peter L. Munk CASE 30 Osteopetrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167 Peter L. Munk and Anthony G. Ryan CASE 31 Osteopoikilosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171 Brian Edward Reeves, Anthony G. Ryan, Peter L. Munk, and Thomas Pope CASE 32 Melorheostosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174 Anthony G. Ryan and Peter L. Munk CASE 33 Fong’s Disease/Nail Patella Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179 Hema N. Choudur, Anthony G. Ryan, and Peter L. Munk CASE 34 Tarsal Coalition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183 Anthony G. Ryan and Peter L. Munk CONTENTS ix CASE 35 Mastocytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189 Brian Edward Reeves, Anthony G. Ryan, Peter L. Munk, and Thomas Pope CASE 36 Hurler’s Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193 Brian Edward Reeves, Anthony G. Ryan, Peter L. Munk, and Thomas Pope CASE 37 Diaphyseal Aclasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197 George Nomikos, Brian Edward Reeves, Anthony G. Ryan, Peter L. Munk, Thomas Pope, and Mark Murphey CASE 38 Macrodystrophia Lipomatosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205 Anthony G. Ryan and Peter L. Munk CASE 39 Dermatomyositis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209 Anthony G. Ryan and Peter L. Munk CASE 40 Pyknodysostosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215 Peter L. Munk and Anthony G. Ryan PART III Tumors MALIGNANT CASE 41 Osteosarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey CASE 42 Chondrosarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .224 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey CASE 43 Ewing’s Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .228 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey CASE 44 Malignant Fibrous Histiocytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .232 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey CASE 45 Liposarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .236 Anthony G. Ryan and Peter L. Munk CASE 46 Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .251 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey CASE 47 Multiple Myeloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey CASE 48 Synovial Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .262 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey CASE 49 Adamantinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .265 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey CASE 50 Primary Lymphoma of Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .269 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey BENIGN CASE 51 Enchondroma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .273 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey CASE 52 Chondromyxoid Fibroma of Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .281 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey CASE 53 Intraosseus Lipoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .285 George Nomikos, Mark Murphey, Anthony G. Ryan, and Peter L. Munk CASE 54 Nonossifying Fibroma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey CASE 55 Unicameral Bone Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .294 George Nomikos, Anthony G. Ryan, Peter L. Munk, and Mark Murphey