Hydroxyapatite Deposition Disease (HADD) - MSK Radiology Imaging Findings: • Ovoid hypointense structures along the bursal surface of the superior cuff footprint attachment consistent with Calcium Hydroxyapatite deposits. • Fluid-like signal seen within the deltoid muscle fibers and soft-tissues adjacent to the Calcium Hydroxyapatite deposits consistent with myositis. • T2-hyperintense fluid-signal is seen within the subacromial/subdeltoid bursa consistent with bursitis. Case description: • Hydroxyapatite Deposition Disease is a broad spectrum of musculoskeletal pathology due to crystal deposition. • This is generally monoarticular with inhomogeneous calcifications which are generally round/ovoid and faint on radiograph. • MRI shows globular low-signal on all sequences with surrounding hyperintense signal of the soft-tissues. - Deposits may show blooming on gradient-echo imaging with abnormal signal in the adjacent cuff. - Limits evaluation of cuff pathology (i.e. lower specificity of tear diagnosis) • Milwaukee shoulder: - Generally elderly women with severe destructive arthropathy of the shoulder with hydroxyapatite deposition in the synovial fluid. • Treatment for HADD: generally conservative. They may be needled, lavaged, and aspirated with variable results. Differential diagnosis: • Dystrophic calcifications from other systemic disorders: Progressive systemic sclerosis, hyperparathyroidism, etc. • Tendinopathy or tenosynovitis: Differentiate low-signal normal tendon from globular low-signal Hydroxyapatite deposits. Dr. Donald von Borstel @DrvonBorstel #HADD #Hydroxyapatite #Deposition #Disease #clinical #mri #clinical #Radiology #diagnosis #msk

Illustrations showing elements of a shoulder assessment. Also included on a shoulder assessment would be determination of acromioclavicular joint tenderness, supraspinatus/greater tuberosity tenderness, biceps tendon tenderness (using Speed's test), atrophy and crepitus. (In Speed's test, the arm is fully extended anteriorly, palm facing up. The examiner pushes down on the hand as the patient resists. Pain in the anterior shoulder is a positive test for biceps tendinitis.) #Diagnosis #PhysicalExam #RotatorCuff #Shoulder #Examination #Tendinopathy #Impingement

Posterior Ankle Impingement (Os Trigonum) Syndrome - MSK Radiology Imaging Findings: • Os trigonum which has marrow signal alteration with T2-hyperintense and T1-hypointense signal; consistent with marrow edema/contusion. • Arrows showing posterolateral capsular thickening and fluid-signal consistent with synovitis. • "Edema-like" marrow signal of the posterolateral talus and calcaneus adjacent to the os trigonum. Case description: • Usually presents with localized severe pain at the back of the ankle, worse upon plantar flexion. • Ballet dancer or other athletes with plantar flexion. • MRI: Posterolateral capsular thickening/synovitis; Predisposing factors such as Stieda process, os trigonum, abnormal morphology calcaneal tuberosity; Tenosynovitis flexor hallucis longus Differential diagnosis for similar location of pain: • Posterior syndesmotic ligament tear: no impingement findings and torn ligament on MRI. • Achilles tendinopathy: thickening and abnormal signal of the achilles tendon. • Posterior talar dome osteochondral lesion: pain limits plantar flexion but no symptoms of impingement. Dr. Donald von Borstel @DrvonBorstel #Posterior #Ankle #Impingement #Os #Trigonum #OsTrigonum #Syndrome #clinical #mri #clinical #Radiology #diagnosis #msk

Ottawa Ankle Rule #Diagnosis #Management #EM #Ortho #Sports #Ottawa #Ankle #Foot #Rule

Ankle XRays - Ankle Fractures, Things to Consider by Dr. Sarah Edwards @drsarahedwards #Ankle #XRays #Interpretation #Guide #Tutorial #Fractures #Radiology

Pediatric Elbow Injuries - Elbow Xrays Check the fat pads on the lateral projection: 1. A displaced anterior fat pad (sail sign) is abnormal 2. A visible posterior fat pad is always abnormal 3. Not all joint effusions are associated with fractures. 4. An effusion often suggests that a significant injury has occurred. This is irrespective of if a fracture can be seen or not. Check the anterior humeral line on the lateral projection: 1. A line traced along the anterior cortex of the humerus should have at least one third of the capitellum anterior to it. 2. If less than one third of the capitellum lies anterior to this line, there is a strong probability of a supracondylar fracture with the distal fragment (including the capitellum) displaced posteriorly. Check the radiocapitellar line on the lateral projection: 1. A line drawn along the longitudinal axis of the radial head and neck should pass through the capitellum. If it does not through the capitellum pass through the capitellum: a radial head dislocation is likely. 2. The normal radius frequently shows a bend or slight angulation in the region of its tuberosity. Draw the RC line along the long axis of the proximal 2-3 cm of the radius. Not along the long central axis of the shaft of the radius. Dr. Sarah Edwards @drsarahedwards #Elbow #Injuries #Xrays #Radiology #peds #Pediatrics #clinical