Pearls from Stoller Macau April 2011 - 5. Mid and Forefoot

1. 1st MTP Anatomy p166
2. Skimboarder's Toe - "reverse turf toe" - dorsal plate injury
3. Lisfrance ligament - medial cuneiform to 2nd MT base
• dorsal, interosseus and plantar components - fail from dorsal to plantar
• no interosseus ligament between 1st and 2nd MT bases
4. Baxter's Neuropathy
• Ab. Digiti Mini Atrophy; check nerve entrapment foot
5. Adventitial Bursitis
• no anatomic bursa in foot
• at pts of frictional wear,
• may present as mases
• plantar 1st and 5th, hallux valgus common

Pearls from Stoller Macau April 2011 - 4. Ankle

1. NB: anterior process talus; lateral process calcaneus (snowboarders)
2. Subtalar joint - anterior, middle, posterior facets
3. Lateral gutter -- a 3D space between AITFL/PITFL and ATFL/PTFL
4. Posterior ankle ligaments - Transverse Tib-Fib Lig, PITFL, Tibial Slip, PTFL
5. Anterolateral impingement (soft tissue related to antero-lat gutter) vs Ant. impingement (bony)
6. Soft Tissue Impingement
• Anterolateral (ATFL and  AITFL related to partial or completer tear)
• Syndesmotic
• Posterior (PTFL -- myxoid)
7. Spring (Calcaneonavicular ligament)
• Lateral/Intermediate/Superomedial
• Axial - int. and lat.; slice up - superomedial
• Coronal - next to TP
8. POP Syndrome
• # or displacement of Os peroneum
• Ass. Peroneus Longus Tear
9. Tarsal Tunnel Syndrome
• Post. Tibial N. compression
10. 4 Plantar Muscles -  (Med) Ab. Hallucis, Fl. Dig. Brevis, Quadratus Plantae, Ab. Digiti Minimi
11. Subtalar ligaments
• subtalar interosseus - medial (coronal)
• cervical - lateral and anterior (coronal and sag)
• intermediate root extensor retinaculum - post. to cervical (sag)
12. OLT Stages
13. Tennis Leg - ruptured crura; fascia

Pearls from Stoller Macau April 2011 - 3. Knee

1. Trochlear groove - assess on sag.
2. Meniscofemoral and meniscotibial (coronary) recesses.
3. Horizontal tear - must extend to apex (sag).
4. Flap tear - one type that looks horizontal but extends short of apex creating small inferior leaf.
5. Flap tear -- vertical configuration, but inner 1/3 (sag).
6. Vertical/longitudinal tear - outer 1/3 (sag).
7.  Menisco-capsular separation -- two scenarios
• ACL with tear of periph of post. horn lat. meniscus (fluid betw. capsule and periph. of post. horn).
• MCL tear with meniscotibial lig. tear.
8.  Posterolat. corner -- review on sag and axial.
9. SONK -- almost all cases are probably insufficiency fractures
10. CMP - MRI adaptation of Outerbridge classification; describe rather than classify; ICRS classification.
11. MPFL - slice above proximal origin of MCL, tears at femur
12. Patella tendinosis - best on GRE.

Pearls from Stoller Macau April 2011 - 2.Shoulder

1. Anterior band of IGHL can have high attachment -- 3rd structure on axial (in addition to labrum and MGHL).
2. Sublabral foramen (antero-superior); sublabral sulcus (superior)
3. Hill-Sachs - position - where articular cartilage in NOT; at level of footprint on axial (1st two slices).
4. MGHL - "squiggly" on Sag.
5. Patterns of glenoid sclerosis.
6. Anteroinferior labrum -- assess 1st -- spectrum of injury
• Perthes -  labral tear, minimal displacement, intact periosteum
• ALPSA - labral tear and medial displacement of IGLLC, medially stripped but intact periosteum (NB POLPSA)
• GLAD - labral tear (partial), no detachment, chondral defect, intact periosteum
• Bankart - avulsion of IGLLC (anterior and medial), disruption of scapula perisoteum
7.  SGHL/CHL -- "Biceps pulley" -- look on Sag
8. HAGL -- anterior band IGHL tear (+BHAGL) aot RHAGL or PHAGL -- post. band
9. GAGL
10. "Wave Sign" -- massive RC tear  - repairable acute tear without scarring

Pearls from Stoller Macau April 2011 - 1.Technique

1. Zoom in to see detail.
2. Every series should contain a plain T1.
3. GRE/T2* -- for shoulders and knee at least -- useful for chondrocalcinosis, PVNS, blood
4. Hip -- should include sag
5. Hip - one large FOV series
6. Ankle -- NB ant. process of calcaneus and lateral process of talus